The association between socioeconomic status and changes in health in Europe

Numerous studies have found disparities in health between socioeconomic groups in modern societies (van Doorslaer, Wagstaff et al., 1997; Huisman, Kunst et al., 2004; Dalstra, Kunst et al., 2005). Many international studies targeted at measuring disparities in morbidity use self-perceived health as outcome, which is a broad, generic measure of health. Although many studies found that self-perceived health is a good predictor of mortality (Idler and Benyamini 1997), differences in reporting and expectations may influence this outcome. A more specific measure of morbidity is self-reported chronic diseases. Several country-specific longitudinal studies have examined socioeconomic disparities in chronic diseases such as heart disease and stroke (Mackenbach, Cavelaars et al., 2000; Avendano, Kunst et al., 2005). However, there are few European overviews of disparities in chronic disease incidence, as existing studies are based on cross-sectional data (Cavelaars, Kunst et al., 1998; Dalstra, Kunst et al., 2005) or mortality as an outcome (Mackenbach, Bos et al., 2003; Huisman, Kunst et al., 2004; Avendano, Kunst et al., 2005). Based on data from two waves of the SHARE study, this paper examines disparities between socioeconomic groups in incident chronic diseases, death, poor self-perceived health and disability. It is generally known that risk factors are not spread evenly over socioeconomic groups (Cavelaars, Kunst et al., 1998). Therefore, we also examined the association between socioeconomic status and incident health outcomes adjusting for modifiable risk factors.