Health gap between social groups widens in later life

The health divide between the most affluent and the worst off in society increases in later life, finds a study published on bmj.com.

This has important implications for government policies to tackle health inequalities.

Researchers looked at over 10,000 British civil servants aged between 35 and 55, who were taking part in the Whitehall II study. The employees worked in 20 different departments and were from all occupational grades. They were surveyed five times between 1985 and 2004 on their physical, psychological and social functioning.

Occupational grade was measured each time and participants were asked to classify their employment status (employed or retired).

The results show that physical health declines with age in all groups, while mental health tends to improve with age.

However, physical health declined more rapidly with age in the lower occupational grades, resulting in a widening of health inequalities with age. For example, the average physical health of a 70 year old high grade man or woman was similar to the physical health of a low grade person around 8 years younger. In mid-life, this gap was only 4.5 years.

Although mental health improved with age for all occupational groups, the rate of improvement was slower for low occupational grades, resulting in widening health inequalities in early old age. This gap was explained by better mental health attained by the high occupational grades after retirement. However, retirement was not associated with a similar improvement in mental health for the low grades.

This study shows that inequalities in self-reported health increase from mid-life to early old age, say the authors. These results appear to contradict other studies, which show converging relative health inequalities in later life.

Occupational class continues to affect the health and functioning of older people well into their retirement. Helping people from disadvantaged social classes to achieve the good health that is attained by more advantaged groups would help to reduce need and prevent the growing crisis in health care inequalities among the elderly as the population ages, they conclude.