Non-standard family histories and wellbeing at older ages.

The life course approach emphasizes that health and wellbeing at older ages are influenced by experiences occurred in the previous stages of life. We contribute to the literature by focusing on the role of the non-standardness of family histories and argue that individuals who experienced non-standard trajectories have been exposed to social sanctions throughout their life course with negative long-term consequences on wellbeing. In our study, non-standardness of family histories is the extent an individual's family history differs from those of the others within reference groups, defined combining birth cohort, gender and country of residence. Family histories between age of 15 and 49 are analyzed using Sequence Analysis, thus accounting for events related to fertility and union formation (marriage and cohabitation) and dissolution, and their timing. Dissimilarities between family sequences are measured using optimal matching and are standardized within the reference groups. We use retrospective data from the seventh wave of the Survey of Health Ageing and Retirement in Europe (SHARE) and estimate linear regression models to assess the association between non-standardness of family histories and older people's life satisfaction. Quality of life and depressive symptoms are examined in additional analyses. A negative association is found between non-standardness of family histories and wellbeing, which is stronger for lower educated individuals and in Southern European countries. Results are consistent with the idea that uncommon family behaviors may have a long-term negative effect on wellbeing. Individual resources and a more tolerant societal context can reduce or eliminate the negative consequences of engaging in non-standard family behaviors.

(Healthy) Aging Patterns in Europe: A Multistate Health Transition Approach.

We explore patterns and determinants of health transition probabilities by combining outcomes of morbidity and mortality to examine different aging patterns across Europe, and to ascertain how individual socio-demographic characteristics modify these patterns. We use panel data from the Survey of Health, Ageing and Retirement in Europe (2004- 2017) for 76,536 individuals aged 50 + in 20 European countries who participated in at least two waves. All transition probabilities were calculated applying a multistate analytical approach. Our findings show significant gender, education, and cohort differences in health transition probabilities and marked cross-country group differences. Central and Northern European countries present lower probabilities of health deterioration than Southern and, especially, Eastern European countries. Having a high level of education, living in Central Europe, and being younger are associated with lower probabilities of health deterioration and, if any, a higher probability of being restored to good health. We found less evidence of differences when transitions end in death. Our study contributes to this line of research by implementing a multistate approach using European harmonized panel dataset, to examine the effects of birth cohort, educational attainment and gender differences on health transitions. Our findings point to the need to consider the specific influence of individual factors in the aging process in different transitions according to the context and with reference to specific vulnerable groups. In the context of aging societies, such a consideration is both essential and policy relevant. Supplementary Information: The online version contains supplementary material available at 10.1007/s12062-022-09403-4.

What influences individual perception of health? Using machine learning to disentangle self-perceived health.

Self-perceived health is a subjective health outcome that summarizes all the health conditions and is widely used in population health studies. Yet, despite its well-known relationship with survival, it is still unclear as to which health conditions are actually taken into account when making an individual assessment of one's own health. The aim of this paper is to assess the influence of four objective health conditions - IADLs, ADLs, chronic diseases, and depression - in predicting self-perceived health among Europeans by age group (50-64 and 65-79) and by sex. Classification trees (J48 algorithm), which pertains to the emerging Machine Learning techniques, were applied to predict self-perceived health according to the four abovementioned objective health conditions of European individuals in the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 55,611). The four variables present different degrees of relevance in establishing predictions of self-perceived health values by age and by sex. Before the age of 65, chronic diseases have the greatest importance, while IADL limitations are more important in the 65-79 age group. Likewise, ADL limitations are more important for women free of chronic diseases in the 50-64 age group; however, these differences disappear among women in the older group. There is an evident degree of interplay between the objective health indicators of chronic diseases, ADLs, IADLs, and depression when predicting self-perceived health with a high level of accuracy. This interplay implies that self-perceived health summarizes different health conditions depending on age. Gender differences are only evident for the younger age group, whereas construction of self-perceived is the same for women and men among the older group. Therefore, none of these four indicators on its own is able to totally substitute self-perceived health.

Are partner's features important to understand health at older ages? The Spanish case / ¿Son importantes las características de la pareja para entender la salud en edades avanzadas? El caso español

Objective: To analyse health differences among partnered individuals in Spain aged 65-81 considering their combined (education of both partners and age gap) and household (economic capacity of the household) characteristics. Method: A cross-sectional study of the 2015 Spanish sample of the European Union Statistics on Income and Living Conditions survey (EU-SILC) on partnered individuals aged 65-81 years (N=1787). Using logistic regression models separately for women and men we obtained odds and predicted probabilities of having less than good health (95% confidence intervals) according to combined information from both partners on education and age, the household's economic capacity and partner's health status. Results: Probabilities of not having good health are significantly less among lower educated women whose partners are more highly educated (compared to both partners being lower educated) and among women whose partner is younger or has good health status. The latter also applies to men. Living in a household without economic difficulties also favours health (both sexes). Conclusions: For both sexes a partner's health status is the variable that shows the largest effect on elderly partnered Spanish people's health but women's health appears to be more sensitive to their partner's educational attainment and the household's economic situation. (AU)

Objetivo: Analizar las diferencias de salud entre la población española de 65 a 81 años de edad que vive en pareja, considerando características individuales, combinadas de ambos miembros y generales de la pareja. Método: Estudio transversal de la muestra española del año 2015 de la Encuesta Europea de Condiciones de Vida de personas mayores (edades 65-81 años) que conviven en pareja (N=1787). Mediante modelos de regresión logística independientes para mujeres y hombres se obtuvo la estimación de las probabilidades de no tener buena salud autopercibida (intervalos de confianza del 95%) según la combinación del nivel de estudios y la edad de ambos miembros de la pareja, así como la capacidad económica del hogar y el estado de salud del cónyuge. Resultados: Las probabilidades de no tener buena salud son significativamente menores entre las mujeres con menor nivel de educación cuyas parejas son más educadas (en comparación con las que tienen menos educación) y entre las mujeres cuya pareja es más joven o tiene un buen estado de salud. Esto último también se aplica a los hombres. Vivir en un hogar sin dificultades económicas también favorece la salud en ambos sexos. Conclusiones: Para ambos sexos, el estado de salud de la pareja es la variable que muestra el mayor efecto sobre la salud de la población mayor española que vive en pareja, aunque la salud de las mujeres parece ser más sensible al nivel educativo de su pareja y a la situación económica general del hogar. (AU)

Are partner's features important to understand health at older ages? The Spanish case.

OBJECTIVE: To analyse health differences among partnered individuals in Spain aged 65-81 considering their combined (education of both partners and age gap) and household (economic capacity of the household) characteristics. METHOD: A cross-sectional study of the 2015 Spanish sample of the European Union Statistics on Income and Living Conditions survey (EU-SILC) on partnered individuals aged 65-81 years (N=1787). Using logistic regression models separately for women and men we obtained odds and predicted probabilities of having less than good health (95% confidence intervals) according to combined information from both partners on education and age, the household's economic capacity and partner's health status. RESULTS: Probabilities of not having good health are significantly less among lower educated women whose partners are more highly educated (compared to both partners being lower educated) and among women whose partner is younger or has good health status. The latter also applies to men. Living in a household without economic difficulties also favours health (both sexes). CONCLUSIONS: For both sexes a partner's health status is the variable that shows the largest effect on elderly partnered Spanish people's health but women's health appears to be more sensitive to their partner's educational attainment and the household's economic situation.

Life goes on: The influence of the perceived quality of social relations on older women's mental health after the loss of a partner in Europe.

The loss of a spouse/partner is a major stressor, undermining one's mental health, especially in mid-life and old age. Social ties are key moderators of the impact of bereavement, serving to enhance psychological resilience and facilitating social engagement and access to resources. Our aim was to explore the association between depression levels and the interaction between the composition of, and level of satisfaction with, social networks among women who have lost their husband. The study was undertaken from a cross-national perspective, examining women throughout Europe. We used data from the SHARE Survey (sixth wave; N = 6,820). Using linear regression models, we find negative evaluations of social relations influenced the mental health of European widows, mostly when relatives exclusively composed their social network. The perceived quality of that network had more impact on the mental health of older widows in Northern and Western European countries than in their Southern and Eastern counterparts.

Until Death Do Us Part. The Influence of Own and Partner's Socioeconomic Status on the Health of Spanish Middle-Aged Population.

OBJECTIVES: To explore whether the influence of a partner's socioeconomic status (SES) on health has an additive or a combined effect with the ego's SES. METHODS: With data on 4533 middle-aged (30-59) different-sex couples from the 2012 Spanish sample of the European Union Statistics on Income and Living Conditions (EU-SILC) survey, we apply separate sex-specific logistic regression models to calculate predicted probabilities of having less than good self-perceived health according to individual and partner's characteristics separately and combined. RESULTS: Both approaches led to similar results: Having a partner with better SES reduces the probabilities of not having good health. However, the combined approach is more precise in disentangling SES effects. For instance, having a higher educated partner only benefits health among Spanish low-educated men, while men's health is worse if they have a working spouse. Conversely, women's health is positively influenced if at least one couple member is economically active. CONCLUSIONS: There are significant health differences between individuals according to their own and their partner's SES in an apparently advantageous population group (i.e., individuals living with a partner). The combinative approach permits obtaining more precise couple-specific SES profiles.

Examining social determinants of health: the role of education, household arrangements and country groups by gender.

BACKGROUND: The majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities. We go beyond this by exploring how the combination of education (micro level) and household arrangements (mezzo level) is associated with self-perceived health. METHODS: Our data source is the 2014 cross-sectional data from the European Survey of Living Conditions (EU-SILC). We calculate the predicted probabilities of poor self-perceived health for the middle-aged European population (30-59 years) as a function of the combination of the two SDHs. This is done separately for five European country groups (dual-earner; liberal; general family support; familistic; and post-socialist transition) and gender. RESULTS: We observe a double health gradient in all the country groups: first, there is a common health gradient by education (the higher the education, the lower the probability of poor health); second, household arrangements define a health gradient within each educational level according to whether or not the individual lives with a partner (living with a partner is associated with a lower probability of poor health). We observe some specificity in this general pattern. Familistic and post-socialist transition countries display large differences in the predicted probabilities according to education and household arrangements when compared with the other three country groups. Familistic and post-socialist transition countries also show the largest gender differences. CONCLUSIONS: Health differences in European populations seem to be defined, first, by education and, second, by living or not living with a partner. Additionally, different social contexts (gender inequalities, educational profile, etc.) in European countries change the influences on health of both the SDHs for both women and men.

Determinantes sociales de la salud de distintos niveles por género: educación y hogar en España / Social determinants of health at distinct levels by gender: education and household in Spain

Objetivo: Explorar desde una perspectiva de género la asociación con la salud subjetiva de la interacción del nivel educativo y la tipología de hogar en el marco de los determinantes sociales de la salud (DSS) en los niveles micro y mezzo. Método: Los datos utilizados proceden de la muestra española de la Encuesta Europea de Condiciones de Vida para el año 2014. La asociación entre la interacción de ambos DSS con la salud autopercibida se ha analizado mediante modelos de regresión logística separados para mujeres y hombres. El modelo con la interacción se ha contrastado con el modelo aditivo para evaluar las posibles ventajas. Resultados: El modelo para la interacción muestra una reducción o incluso la desaparición de los efectos negativos sobre la salud de aquellas tipologías de hogar asociadas con una peor salud cuanto mayor es el nivel educativo, mostrando especificidades propias para cada sexo. Conclusiones: Los perfiles de mala salud de mujeres y hombres se dibujan de manera más precisa al combinar ambos DSS. Entre las mujeres se confirma el papel destacado que ambos DSS tienen para entender sus desigualdades en salud. Entre los hombres, sobre todo aquellos con menor nivel educativo, la interacción destapa una mayor importancia del hogar como DSS. De este modo se podrán diseñar políticas públicas más efectivas para disminuir las desigualdades tanto de género como de salud

Objective: To explore from a gender perspective the association with subjective health of the interaction between education and household arrangements within the framework of social determinants of health placed at the micro and mezzo levels. Methods: The data comes from the Spanish sample of the European Union Statistics on Income and Living Conditions for 2014. Independent logistic regression models for men and women were run to analyze the association with subjective health of the interaction between education and household arrangements. An additive model was run to assess possible advantages over the interaction approach. Results: The interaction models show a lower or even no significant effect on health of household arrangements usually negatively associated with health among individuals with high education, displaying specific patterns according to sex. Conclusions: Health profiles of women and men are more precisely drawn if both social determinants of health are combined. Among the women, the important role was confirmed of both social determinants of health in understanding their health inequalities. Among the men, mainly those with low educational achievement, the interaction revealed that the household was a more meaningful social determinant of health. This could enable the definition of more efficient public policies to reduce health and gender inequalities

[Social determinants of health at distinct levels by gender: education and household in Spain]. / Determinantes sociales de la salud de distintos niveles por género: educación y hogar en España.

OBJECTIVE: To explore from a gender perspective the association with subjective health of the interaction between education and household arrangements within the framework of social determinants of health placed at the micro and mezzo levels. METHODS: The data comes from the Spanish sample of the European Union Statistics on Income and Living Conditions for 2014. Independent logistic regression models for men and women were run to analyze the association with subjective health of the interaction between education and household arrangements. An additive model was run to assess possible advantages over the interaction approach. RESULTS: The interaction models show a lower or even no significant effect on health of household arrangements usually negatively associated with health among individuals with high education, displaying specific patterns according to sex. CONCLUSIONS: Health profiles of women and men are more precisely drawn if both social determinants of health are combined. Among the women, the important role was confirmed of both social determinants of health in understanding their health inequalities. Among the men, mainly those with low educational achievement, the interaction revealed that the household was a more meaningful social determinant of health. This could enable the definition of more efficient public policies to reduce health and gender inequalities.

El efecto de la crisis económica sobre la salud en España según el nivel educativo y la relación con la actividad: ¿importa también la duración de la crisis? / The effect of the economic crisis on health in Spain according to educational level and employment status: Does the duration of the crisis also matter?

RESUMEN El objetivo del trabajo es explorar el posible efecto que la crisis económica ha tenido sobre la salud de la población nacida en España en edad adulta previa a la jubilación (entre 30 y 59 años). Específicamente, a partir de los datos de la European Union Statistics on Income and Living Conditions (EU-SILC) para los años 2006, 2010 y 2014 analizamos diferencias en la salud autopercibida según su perfil socioeconómico y la posición que ocupan en el hogar. Nuestros resultados muestran que la salud de los hombres y las mujeres tienen niveles de asociación similares con ciertos factores (por ejemplo, nivel educativo) y diferenciados con otros (la salud de la mujer es ligeramente más sensible al nivel de los ingresos del hogar, mientras la salud de los hombres a su propio estado de empleo). Finalmente, mientras que en el primer periodo se observan mejoras sustanciales en la salud autopercibida en casi todos los grupos socioeconómicos, en el segundo periodo no hay casi ningún cambio e incluso, para algunos hombres con un perfil más desfavorecido (inactivos con educación baja), la salud empeoró.

ABSTRACT The objective of this study is to explore the possible impact of the economic crisis on the health of the Spanish-born population not of retirement age (between 30 and 59 years). Specifically, using data from the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2006, 2010 and 2014, we analyze differences in self-perceived health by socioeconomic profile and position occupied in the household. According to our results, the health of men and women show similar levels of association with certain factors (such as education) and different levels with others (women's health is more sensitive to household income level while men's is more sensitive to employment status). Finally, while substantial improvements in self-perceived health were observed during the first period in almost all socioeconomic groups, during the second period there was almost no change, and for the most disadvantaged men (inactive in the labor market and with low educational levels), health worsened.

Early-life conditions and health at older ages: The mediating role of educational attainment, family and employment trajectories.

OBJECTIVES: We examine to what extent the effect of early-life conditions (health and socioeconomic status) on health in later life is mediated by educational attainment and life-course trajectories (fertility, partnership, employment). METHODS: Using data from the Survey of Health, Ageing and Retirement in Europe (N = 12,034), we apply, separately by gender, multichannel sequence analysis and cluster analysis to obtain groups of similar family and employment histories. The KHB method is used to disentangle direct and indirect effects of early-life conditions on health. RESULTS: Early-life-conditions indirectly impact on health in later life as result of their influence on education and family and employment trajectories. For example, between 22% and 42% of the effect of low parental socio-economic status at childhood on the three considered health outcomes at older age is explained by educational attainment for women. Even higher percentages are found for men (35% - 57%). On the contrary, the positive effect of poor health at childhood on poor health at older ages is not significantly mediated by education and life-course trajectories. Education captures most of the mediating effect of parental socio-economic status. More specifically, between 66% and 75% of the indirect effect of low parental socio-economic status at childhood on the three considered health outcomes at older age is explained by educational attainment for women. Again, higher percentages are found for men (86% - 93%). Early-life conditions, especially socioeconomic status, influence family and employment trajectories indirectly through their impact on education. We also find a persistent direct impact of early-life conditions on health at older ages. CONCLUSIONS: Our findings demonstrate that early-life experiences influence education and life-course trajectories and health in later life, suggesting that public investments in children are expected to produce long lasting effects on people's lives throughout the different phases of their life-course.

The effect of the economic crisis on health in Spain according to educational level and employment status: Does the duration of the crisis also matter? / El efecto de la crisis económica sobre la salud en España según el nivel educativo y la relación con la actividad: ¿importa también la duración de la crisis?

The objective of this study is to explore the possible impact of the economic crisis on the health of the Spanish-born population not of retirement age (between 30 and 59 years). Specifically, using data from the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2006, 2010 and 2014, we analyze differences in self-perceived health by socioeconomic profile and position occupied in the household. According to our results, the health of men and women show similar levels of association with certain factors (such as education) and different levels with others (women's health is more sensitive to household income level while men's is more sensitive to employment status). Finally, while substantial improvements in self-perceived health were observed during the first period in almost all socioeconomic groups, during the second period there was almost no change, and for the most disadvantaged men (inactive in the labor market and with low educational levels), health worsened.

El objetivo del trabajo es explorar el posible efecto que la crisis económica ha tenido sobre la salud de la población nacida en España en edad adulta previa a la jubilación (entre 30 y 59 años). Específicamente, a partir de los datos de la European Union Statistics on Income and Living Conditions (EU-SILC) para los años 2006, 2010 y 2014 analizamos diferencias en la salud autopercibida según su perfil socioeconómico y la posición que ocupan en el hogar. Nuestros resultados muestran que la salud de los hombres y las mujeres tienen niveles de asociación similares con ciertos factores (por ejemplo, nivel educativo) y diferenciados con otros (la salud de la mujer es ligeramente más sensible al nivel de los ingresos del hogar, mientras la salud de los hombres a su propio estado de empleo). Finalmente, mientras que en el primer periodo se observan mejoras sustanciales en la salud autopercibida en casi todos los grupos socioeconómicos, en el segundo periodo no hay casi ningún cambio e incluso, para algunos hombres con un perfil más desfavorecido (inactivos con educación baja), la salud empeoró.

The relationship between health and partnership history in adulthood: insights through retrospective information from Europeans aged 50 and over.

The association between health and partnership status is a growing concern within the social sciences. Some partnership situations exhibit positive effects on health, while partnership breakdowns display negative impacts. However, case studies show that these associations may change with age, due to potential sources of heterogeneity within a population. The current analysis explored this association over the adult life course (ages 30-64) of Europeans aged 50 years and older based on retrospective information on health and partnership from SHARELIFE (N = 23,535 after data screening). The data allowed us to control for socio-demographic covariates as well as for individual infirmity, measured by childhood health. We also considered contextual survival selection effects by comparing 13 European countries for which pre-adult mortality levels largely differed among the cohorts involved (1907-1958). Discrete-time hazard analyses examined the risk of suffering from a major episode of poor health (self-reported) in adulthood as a function of partnership history, using two approaches: a pooled model and country-specific models. The results revealed no differences between those who lived with a partner (first union) and single individuals in terms of the retrospective hazards of poor health. We hypothesize that this result stems from the cumulative effect of survival selection on individuals in advanced ages according to partnership status. The results also partially point to the plausibility of a contextual survival selection, which should be confirmed by further research based on additional health indicators.

El Impacto de la Política en la Salud

América Latina: La Acumulación de Capital, la Salud y el Papel de las Instituciones Internacionales. Antonio Ugalde, Núria Homedes / Política Fiscal y Política Sanitaria: Tensiones Evidentes a partir de los Criterios de Reparto de la Masa Coparticipable y los Métodos de Determinación de Transferencia / Nelly Catalina Barbieri / Sobre Progreso Social y Sostenibilidad: ¿Existirá Buenos Aires cuando los Jóvenes de Hoy sean Viejos? José A. Tapia Granados. RESEÑA HISTÓRICA: Un Médico Higienista Buscando Ordenar el Mundo Urbano Argentino de Comienzos del Siglo XX. Diego Armus. CONFERENCIA: Las Ciencias y la Política. Carlos Matus

El impacto de la política en la salud / The impact of policy on health

El objetivo de este artículo es presentar los resultados principales del estudio que analizó el impacto que tiene el poder político sobre la mortalidad infantil y la esperanza de vida en la mayoría de países de la Organización para la Cooperación y el Desarrollo Económico desde 1950 hasta 1998. Los países se agruparon según la tradición política que los había gobernado durante más tiempo a lo largo de los años 1950-1998. La mortalidad infantil y la esperanza de vida al nacer fueron las variables dependientes. Las variables independientes se agruparon en variables de poder político, mercado de trabajo, estado del bienestar y desigualdades de renta. Se presenta un análisis descriptivo de todas las variables según tradición política y también coeficientes de correlación de Pearson entre las variables para distintos períodos.La principal conclusión del estudio es que la duración de los gobiernos de partidos proredistributivos desempeña un papel importante en la reducción de las desigualdades derenta y en la disminución de la mortalidad infantil...

The importance of the political and the social in explaining mortality differentials among the countries of the OECD, 1950-1998.

This article analyzes (within the conceptual frame defined in the previous article) the impact of political variables such as time of government by political parties (social democratic, Christian democratic or conservative, liberal, and ex-dictatorial that have governed the OECD countries during the 1950-1998 period) and their electoral support on (1) redistributional policies in the labor market and in the welfare state; (2) the income inequalities measured by Theil and Gini indexes; and (3) health indicators, such as infant mortality and life expectancy. This analysis is carried out statistically by a bivariate and a multivariate analysis (a pooled cross-sectional study). Both analyses show that political variables play an important role in defining how public and social policies determine the levels of inequalities and affect the level of infant mortality. In general, political parties more committed to redistributional policies, such as social democratic parties, are the most successful in reducing inequalities and improving infant mortality. Less evidence exists, however, on effects on life expectancy. The article also quantifies statistically the relationship between the political and the policy variables and between these variables and the dependent variables--that is, the health indicators.