Socioeconomic Determinants of Health in Late Life: Wealth, Education, and Mortality Among US Medicare Beneficiaries (2024)

Undergraduate: Allison Musty

Faculty Advisor: Claire Yang
Department: Sociology

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Socioeconomic status (SES) is associated with health outcomes in older adult populations in the US. Low SES has associations with negative health consequences in this population, including increased risk of disability and mortality. Wealth and education are both used to measure SES. Education exerts a force on late-life health as a fundamental cause, but it may not reflect current SES in older adults. Wealth may capture fluctuations in financial resources and the cumulative effects of advantages/disadvantages throughout the life course. Using Rounds 1-9 (2011-2019) of the National Health and Aging Trends Study, this thesis examined trends in all-cause mortality differentiated by wealth vs education in a sample of 4,639 Medicare beneficiaries. Descriptive associations of wealth and education with mortality were assessed using Kaplan-Meier curves. Cox proportional hazards models assessed risk of mortality associated with each measure of SES, adjusted for covariates (age, racial/ethnic group, gender, marital status, history of smoking, and presence of anxious or depressive symptoms) and the opposing measure. Then, interaction of these models with age was estimated. Wealthier and more educated individuals were more likely to survive for nine years. In models based on wealth, education did not modify changes in risk of mortality. However, wealth mediated the effects of education on mortality risk. For both measures, associations were stronger at ages 65-79. Wealth measures SES in a manner that considers progression of the life course and should be utilized in study of this population. Interventions should focus on addressing modifiable pathways between economic status and health.