Socio-economic position and its relationship to physical capacity among elderly people living in Jyväskylä, Finland: five- and ten-year follow-up studies
Introduction
Many studies have shown an inverse relationship between socio-economic factors and different indicators of health status (Cairney & Arnold, 1996; Dahl & Birkelund, 1997; Thorslund & Lundberg, 1994) and mortality in elderly people (Martelin, 1994; Martelin, Koskinen, & Valkonen, 1998). Recent studies have also pointed out that socio-economic factors at baseline are important predictors of functioning in the future in older people (Deeg et al., 1992; Grundy & Glaser, 2000; Guralnik & Kaplan, 1989; Guralnik et al., 1993; Harris, Kovar, Suzman, Kleinman, & Feldman, 1989; Ho, Woo, Yuen, Sham, & Chan, 1997; Palmore, Nowlin, & Wang, 1985; Rogers, Rogers, & Belanger, 1992; Seeman et al., 1994).
In these studies both socio-economic position and functional capacity have been approached and conceptualised in different ways. According to Grundy and Holt (2001) the most useful pair of socio-economic variables in studies of health inequalities in older people are educational qualification or social class paired with a deprivation indicator. Functional capacity is on the other hand, a very broad concept and may comprise, for example physical, cognitive and social functioning as well as performance of activities of daily living. Often functioning is measured by a composite, multidimensional outcome variable or it is approached from the point of view of disability. It is usually assessed with self-reported measures (Grundy & Glaser, 2000; Guralnik & Kaplan, 1989; Guralnik et al., 1993; Harris et al., 1989; Rogers et al., 1992) and less frequently with performance-based measurements (Seeman et al., 1994).
In general persons with a high socio-economic position at baseline maintain better functional capacity during follow-up than persons with a low position (Deeg et al., 1992; Grundy & Glaser, 2000; Guralnik & Kaplan, 1989; Guralnik et al., 1993; Harris et al., 1989; Ho et al., 1997; Palmore et al., 1985; Rogers et al., 1992; Seeman et al., 1994). However, gender differences may exist and control for other factors such as onset of diseases and life style factors has not been conducted in many studies and might lead to different findings. For example, Strawbridge, Camacho, Cohen, and Kaplan (1993) reported that family income and education had stronger associations with 6-year change in functioning among older men than women.
Furthermore, the rate of change in functional capacity may differ between socio-economic groups. For example, the rate of change in cognitive functioning during a ten-year follow-up was predicted by the occupation of longest duration in a study of Japanese men aged 69–71 at baseline. Men who had worked in blue collar occupations showed more decline in cognitive functioning than men in white collar occupations. In addition, a high level of education was associated with good maintenance of physical functioning among women (Deeg et al., 1992). Hemingway, Stafford, Stansfeld, Shipley, and Marmot (1997) reported similar results in middle-aged persons; persons in the lower employment grades showed a greater decline in almost all scales of health functioning than persons with higher employment status during an average 36 month's follow-up. Seeman et al. (1994) found that a higher level of education was associated with a somewhat larger decline in physical performance during a three-year follow-up, but the most educated still had better physical performance.
Physical capacity is an essential domain of functional capacity from the point of view of the autonomy and quality of life of elderly people. Examination of longitudinal changes in physical capacity in elderly people is useful in predicting the need for health and social care. Performance-based measures are important, because they provide information not available in self-report items (Guralnik et al., 1994). For example, these measures have identified a nondisabled group at high risk of progressing to disability (Guralnik, Ferrucci, Simonsick, Salive, & Wallace, 1995), nursing home admission and mortality (Guralnik et al., 1994). Therefore, the effect of socio-economic position on specific areas of performance-based indicators of physical capacity may be informative in understanding patterns of functional decline in elderly people.
Section snippets
General description of survey area and target population
The city of Jyväskylä, which is an educational and industrial centre is located in Central Finland. In 1989 the city had about 66,000 inhabitants, of which 12.4% were aged 65 or over (Heikkinen, 1997). In 1989 the percentages of Finns aged 65 years or older with their basic level of education equivalent to graduation from senior secondary school, vocational school or university were 4.4, 14.3 and 2.3, respectively (Central Statistical Office of Finland, 1991). Percentages were similar for
Results
At the baseline, 91.6% (119 men, 231 women) of those eligible participated in the interview and 77.2% (104 men and 191 women) also took part in the examinations at the study centre. At the five-year and ten-year follow-ups, 87.3% and 79.9%, respectively, of those eligible took part in the interviews, and 71.3% and 59.2% took part in the examinations. Fig. 1 shows participation in interviews and examinations during the study together with deaths and other attrition. Smoking was much more common
Discussion
High levels of education and income were separately related to better maximal walking speed and vital capacity at the baseline and both follow-ups. In addition, persons whose income was high had better maximal hand grip strength in the five- and ten-year follow-ups than those with low income. However, these differences were not very great. When education and income were included in the same model, only income in general was related to physical capacity. Higher income was related to better
Acknowledgements
The authors wish to thank Timo Törmäkangas for his valuable statistical advice and comments during the preparation of this manuscript. The Evergreen project has been supported by the Academy of Finland, the Ministry of Social Affairs and Health, the Ministry of Education, the Social Insurance Institution, the Scandinavian Red Feather project, the Association of Finnish Lions Clubs and the City of Jyväskylä. The present study was financially supported by the University of Jyväskylä and the
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