Gesundheitswesen 2017; 79(08/09): 656-804
DOI: 10.1055/s-0037-1605645
Vorträge
Georg Thieme Verlag KG Stuttgart · New York

The effect of income and wealth on the onset of health deficit accumulation in older adults in Europe – results from the SHARE study

AJ Stephan
1   Ludwig-Maximilians-Universität München, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, München
,
R Strobl
1   Ludwig-Maximilians-Universität München, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, München
2   Klinikum der Universität München, Deutsches Schwindel- und Gleichgewichtszentrum, München
,
E Grill
1   Ludwig-Maximilians-Universität München, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, München
2   Klinikum der Universität München, Deutsches Schwindel- und Gleichgewichtszentrum, München
3   Ludwig-Maximilians-Universität München, Münchner Zentrum für Gesundheitswissenschaften, München
› Author Affiliations
Further Information

Publication History

Publication Date:
01 September 2017 (online)

Also available ateRef
 

Introduction:

Although aging typically results in an accumulation of health deficits, individuals differ regarding the timing of the onset of this process. Our objective was to assess the effect of income („stream of resources“) and wealth („stock of resources“) on age at deficit accumulation (DA) onset.

Methods:

Data originates from the SHARE (Survey of Health, Aging and Retirement in Europe) study and includes a population sample of adults aged 50 years and older from ten European countries who participated in at least three out of the 2004/05, 2006/07, 2010/11 and 2012/13 waves. A Deficit Accumulation Index (DAI, range 0 – 1) was constructed from 50 health deficits. DA onset was defined as having DAI values > 0.08 in at least two consecutive measurements following an initial value ≤0.08. Gross total annual household income was defined as the sum of all household members' self-reported incomes in euro, divided by the square root of the household size and dichotomized according to the country-specific poverty threshold. Wealth was measured in tertiles of net worth (sum of all financial and real assets minus debts) in euro adjusted for purchasing power parity exchange rates. The adjustment set was identified using directed acyclic graphs. We applied a random effect model for time-to-event data with country as group variable.

Results:

Out of 6,765 participants (Ø 61 years, 48% women) who were initially at risk of DA onset, 1,659 (25%) subsequently experienced a DA onset. Median age at onset was 81 years, ranging from 75 years (Germany) to 85 years (Switzerland, Netherlands, Denmark). Individuals in the lowest wealth tertile had a significantly increased risk for earlier DA onset (HR: 1.38, 95% CI [1.14; 1.67]). Income below the poverty threshold showed no significant effect (HR: 1.17, 95% CI [0.27; 5.19]).

Conclusions:

European populations differ regarding their median age at DA onset. Individual wealth resources rather than income seemed to predict earlier DA onset.