News release

From: PLOS

Poorer people suffer greater declines in physical function as they age

Older individuals in England and Canada showed persistent wealth gaps in abilities as they aged

In England and Canada, socioeconomic inequalities are associated with differences as people age, with less wealthy people showing reduced mobility and function compared to their wealthier peers, according to a study published August 13^th in the open access journal PLOS Medicine by Stephanie Schrempft from Geneva University Hospitals, Switzerland, and colleagues.

Physical function decreases with age, but there is significant variation in the rate of decline across populations. Wealth is known to have an influence on health and disability, but there are few studies comparing different countries, which would help to identify the policies and structures that contribute to inequalities in health and aging. To address this gap, the authors of this study compared data from two long-term aging studies, analyzing 8,511 people in the English Longitudinal Study of Aging and 22,605 in the Canadian Longitudinal Study on Aging, all between the ages of 50 and 85. The researchers examined the association between wealth and different physical functions, including walking speed, grip strength, lung function, hearing, self-reported trouble with daily activities, such as dressing, bathing, and eating, and more.

The authors found that people with less wealth tended to have lower levels of function and suffered larger declines in mobility and ability to perform daily activities as they aged. The wealth inequalities were more evident in England than in Canada and persisted even after the authors adjusted for chronic conditions, weight status and behaviors like smoking. The differences were as large as a 15-year difference in apparent aging, with the poorest 60-year-old in England having the walking speed of the wealthiest 75-year-old. Women with the least wealth also had more difficulties with mobility and daily activities than men in the same socioeconomic group, but had better lung function. While the results are correlational and could not take into account childhood factors or access to private healthcare, the authors note that policies for healthy aging should focus on people with less wealth, and that broad structural changes are needed to reduce these inequalities.

Silvia Stringhini (senior author) notes, “What struck us most was how much larger the wealth gaps were in England than in Canada. For something as basic as walking speed, the least wealthy were functionally older by roughly 15 years in England versus 9 in Canada. Our study cannot tell us exactly why two countries with universal healthcare and similar income inequality diverge so much, but it tells us the difference is real and substantial. We are now undertaking further cross-country comparative work to better understand which structural factors are driving these gaps.”

“We were surprised by how much larger the wealth gaps in functional ageing were in England than in Canada, and the structural reasons behind that difference are exactly what our ongoing comparative research aims to uncover.”

Stephanie Schrempft (first author) adds, “Wealth gradients in health are nothing new, but almost no one has tracked how functional ageing actually unfolds over time across countries. By following older adults in England and Canada side by side, we could see that being less wealthy does not just mean worse health on average, it means losing physical independence faster as you age.”

“One of the things I found most interesting was that the disadvantage of low wealth was not the same for women and men. The least wealthy women struggled more with mobility and daily activities yet had better lung function than the least wealthy men. That kind of nuance gets lost when you treat the disadvantaged as a single group, which is why we took an intersectional approach that is still rare in ageing research.”