Surprising SES gradients in mortality, health, and biomarkers in a Latin American population of adults

Abstract

Vast evidence from demographic and health surveys has shown that poorer health and higher mortality in children are clearly associated with lower socioeconomic status (SES) of parents everywhere in low- and high-income countries. In contrast, the evidence of an SES gradient in the health of adults in developing countries is scarce and conflicting. Particularly puzzling is the fact that subjective general health status measures have been found in some studies to have much larger SES gradients than more objectively measured health indicators. Crimmins (2005) discussed some hypotheses that could help explain these patterns, but there has been little analysis regarding which hypotheses are consistent with observed data. This article further investigates this paradox using data from an ongoing longitudinal study of health and survival among elderly Costa Ricans (the Costa Rican Study on Longevity and Healthy Aging [CRELES]). CRELES has a rich array of health indicators, including subjective health, functional disability, mental health, frailty, and an array of objectively measured health conditions from blood and urine samples, as well as mortality data. In addition, CRELES collected data on various pathways through which these SES effects might be mediated as they influence different types of health indicators. In this article, we both document varying SES gradients across a wide range of well-defined health indicators and also estimate SES gradients in mediating behavior variables in order to elucidate what hypotheses may be most promising for further research.