FACETS OF SOCIOECONOMIC POSITION AND THE ONSET AND PROGRESSION OF FUNCTIONAL LIMITATION IN MEXICO
The association between lower socioeconomic position and poor health has been observed across countries and health outcomes. Socioeconomic position is often measured by education, income, wealth, and occupation which are often treated as interchangeable. Less work has studied how these measures differ in their associations with health. In the United States, lower education is reported to increase the onset of functional limitation while lower income predicts functional deterioration. I apply this framework to a developing country, Mexico, to determine, by birth cohort, how measures of socioeconomic position throughout the life-course affect the onset and progression of functional limitation. Data comes from Waves 1-3 of the Mexican Health & Aging Study (MHAS), a longitudinal household-based sample of Mexican adults (age 50+) and their spouses. Interviews were conducted in 2001, 2003, and 2012 (n=15,186). Socioeconomic variables included education, occupation, income, and wealth. Functional limitation is assessed using Nagi and Activities of Daily Living (ADL) items. Onset and progression between waves is modeled using multinomial probit regression. Lower education was associated with developing functional limitations across sex and birth cohorts but these associations were only present in urban areas. Financial resources including income and wealth did not predict functional limitation onset or progression after accounting for educational. Rather, those with lower educational attainment were more likely to experience functional deterioration although this was restricted to urban areas and was stronger among females than males. Being in a higher decile of wealth was associated with a lower likelihood of worsening functional limitation only among the older old. Among older Mexican adults, the lower educated seem more likely to develop a functional limitation and to deteriorate faster than their higher educated counterparts. Socioeconomic gradients were stronger in urban areas and educational gradients in functional limitation progression were stronger among women. The education-functional limitation onset association is consistent with previous studies in the United States. However, the often lack of an association between financial resources and functional deterioration differs from previous studies in the United States. Compared to developed societies, educational attainment may play a more significant role in disablement in Mexico.
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The University of Texas Medical Branch at Galveston