Income Health Inequalities
Among Older Persons
The Mediating Role of Multiple
Gary W. Evans, PhD
Elaine Wethington, PhD
Meredith Coleman, BA
Margo Worms, BA
Edward A. Frongillo, PhD
We examine whether the pervasive income gradient in health
among senior citizens can be explained in part by multiple risk exposure.
A representative sample of 457 older persons (
living independently at home were assessed in a longitudinal study. Health was
assessed with a standard self-report index. Risks included loss of a loved one,
caregiver burden, low housing quality, and low social integration.
The prospective link between income and subsequent health 2 years later is
largely explained by exposure to a confluence of multiple risk factors during
the 2-year period. These findings incorporate controls for negative affectivity.
Low-income, older persons are significantly more likely to have
lost a loved one or close friend, be burdened by extensive caregiving demands
for someone else, be more socially isolated, and live in lower quality housing.
These risk exposures, in turn, largely account for the prospective link between
income and health.
income; multiple risk; health disparities
ncome-related health inequalities are both substantial and ubiquitous.
This has led to numerous attempts to account for health inequalities, with
varying success. To date, no single mechanism has been uncovered that pro-
vides a satisfactory accounting of health inequalities. An essential reason
for this is that health inequalities likely have a complex, multivariate foun-
dation that includes, at a minimum, biological inheritance, health behaviors
(e.g., smoking, diet), psychological characteristics (e.g., depression, hostility),
Journal of Aging and Health
Volume 20 Number 1
© 2008 Sage Publications
at CORNELL UNIV on February 24, 2010