Does Socioeconomic Health Inequality Change as the Population Ages? Evidence from Swedish Panel Data PDF Download

Author: Kamrul Islam
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Languages : en
Pages : 0

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Book Description
Rationale: In many countries, the potential health impact of the increasing trend in the absolute and relative proportion of elderly people in the population is one central issue of demographic transition. This increased number of aged individuals can have several influences on a society. These influences have attracted considerable attention in recent years; they include a higher demand for health care, reduced tax revenues, and a reduced labor supply. Changes in demographic composition may also impact social health inequality; however, although this issue may have important implications for social health inequality measures, it has received less attention in the literature. Aim: Attempts to explain the channels through population aging might affect socioeconomic health inequality. The empirical aspects of this study involved examining the impact of aging on measures of inequalities of health-related quality of life in a fixed population followed over a 17-year period. Methods: We used three panel waves (1980/81, 1988/89, 1996/97) of around two decades covering 3,310 Swedish individuals. Health-related quality of life (HRQoL) score or health state score as a measure of health were used to estimate the observed trend in health inequality, taking concentration index (CI) as a measure of health inequality. The decomposition procedure with the panel data fixed-effects model was used in an attempt to clarify the channels by which population aging affected health inequality over time. Results: Our results demonstrate that conventional unstandardized and age-gender-standardized CIs for health were positive in all three waves and increased as the cohorts became progressively older. Decomposition analyses indicated that health declined differently in different cohorts and also differently across income groups. A key finding is that through age-related income mobility, the relative income rankings reduction for the older cohort implies that the elderly people in lower health states tended to select to the poor group, which then drove the measured CIs upward. This may appear counterintuitive, since the main reason for changes in health over time is natural aging. This observation led us to carry out additional analyses of the observed health inequality, in which instead of current income we used the mean income (lifetime income) over time as the ranking variable and found that unstandardized CIs still increased, although not by as much as previously, and that the age-gender-standardized CIs were quite stable over time. Conclusion: It may appear that health system-relevant "avoidable inequalities" in health are rather constant in Sweden. The main reason for the observed increase in inequality based on current income ranking might be due to the fact that income is redistributed over the life cycle, and that old people in poor health are therefore selected into the poorer income groups. These results may also have implications for international comparisons of inequalities in health across countries, since countries with a system where old people's incomes are more heavily reduced after retirement may tend to have higher measured inequalities based on current income compared with countries with more moderate retirement income effects.