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Baseline Health, Socioeconomic Status, and 10-Year Mortality Among Older Middle-Aged Americans: Findings From the Health and Retirement Study, 1992–2002

¹ Northwestern University Feinberg School of Medicine, Chicago, Illinois.
² Case Western University, Cleveland, Ohio.

Address correspondence to Joe Feinglass, PhD, Division of General Internal Medicine, Northwestern Feinberg School of Medicine, 676 St. Clair No. 200, Chicago, IL 60611. E-mail: j-feinglass{at}northwestern.edu

Objectives. This study analyzed whether socioeconomic status in older middle age continues to be associated with 10-year survival after data are controlled for baseline health status.

Methods. We confirmed deaths through 2002 for 9,759 participants in the Health and Retirement Study, aged 51 to 61 in 1992. We used discrete time survival models to examine hazard ratios over 10 years of follow-up. We examined associations of demographic characteristics and socioeconomic status measures before and after adjustment by health status and behavioral risk factors.

Results. The 10-year mortality rate was 10.9%, ranging from 4.7% for respondents reporting excellent health to 35.8% for those reporting poor health at baseline. Lower levels of education, income, and wealth were strongly associated with higher mortality risk after we controlled for just demographic characteristics. After further adjustment for health status and behavioral risk factors, only household income remained significant.

Discussion. Baseline health by age 50 is an important pathway in the association between midlife socioeconomic status and mortality risk to age 70. The continuing effect of low household income on mortality risk was concentrated among respondents reporting excellent to good health at baseline. Socioeconomic disparities in middle-age health continue to limit disability-free life expectancy at older ages.

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