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Comparing the education gradient in health deterioration among the elderly in six OECD countries


  • Côté-Sergent, Aurelie
  • Fonseca, Raquel
  • Strumpf, Erin


Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems.

Suggested Citation

  • Côté-Sergent, Aurelie & Fonseca, Raquel & Strumpf, Erin, 2020. "Comparing the education gradient in health deterioration among the elderly in six OECD countries," Health Policy, Elsevier, vol. 124(3), pages 326-335.
  • Handle: RePEc:eee:hepoli:v:124:y:2020:i:3:p:326-335
    DOI: 10.1016/j.healthpol.2019.12.015

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    References listed on IDEAS

    1. Anne Case & Angus S. Deaton, 2005. "Broken Down by Work and Sex: How Our Health Declines," NBER Chapters, in: Analyses in the Economics of Aging, pages 185-212, National Bureau of Economic Research, Inc.
    2. Aïda Solé-Auró & Pierre-Carl Michaud & Michael Hurd & Eileen Crimmins, 2015. "Disease Incidence and Mortality Among Older Americans and Europeans," Demography, Springer;Population Association of America (PAA), vol. 52(2), pages 593-611, April.
    3. Henrik Brønnum-Hansen & Otto Andersen & Mette Kjøller & Niels Rasmussen, 2004. "Social gradient in life expectancy and health expectancy in Denmark," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 49(1), pages 36-41, January.
    4. Michaud, Pierre-Carl & Goldman, Dana & Lakdawalla, Darius & Gailey, Adam & Zheng, Yuhui, 2011. "Differences in health between Americans and Western Europeans: Effects on longevity and public finance," Social Science & Medicine, Elsevier, vol. 73(2), pages 254-263, July.
    5. James Banks & Alastair Muriel & James Smith, 2010. "Disease prevalence, disease incidence, and mortality in the United States and in England," Demography, Springer;Population Association of America (PAA), vol. 47(1), pages 211-231, March.
    6. McGrail, K.M. & Van Doorslaer, E. & Ross, N.A. & Sanmartin, C., 2009. "Income-related health inequalities in Canada and the United States: A decomposition analysis," American Journal of Public Health, American Public Health Association, vol. 99(10), pages 1856-1863.
    7. repec:dau:papers:123456789/10510 is not listed on IDEAS
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    More about this item


    Health deterioration; Older ages; Education;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I2 - Health, Education, and Welfare - - Education


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