Inequalities in subjective health among older Europeans: a systematic literature review

Sanna L. Read, London School of Hygiene and Tropical Medicine (LSHTM)
Emily Grundy, University of Cambridge
Catriona Towriss, London School of Hygiene and Tropical Medicine (LSHTM)

Systematic reviews aim to provide a complete summary of scientific literature relevant to a particular research question and are now a nearly universal first stage of empirical research in many disciplines such as epidemiology and public health but not yet widely used in demography. We conducted a systematic literature review on inequalities in subjective health in older age in Europe. The dimensions of subjective health considered were self-rated health, quality of life, life satisfaction,and loneliness. The review focused on educational, socioeconomic and gender differences in these outcomes. We considered evidence on possible interactions between the various social indicators and other factors that may contribute to or mediate associations, such as health related behavior and social support, as well as age and gender differences in associations. Journal articles published between 1995 and 2011 were identified using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and IBSS. A total of 43 studies on self-rated health, 20 studies on quality of life, nine studies on life satisfaction and five studies on loneliness were identified. In general lower education and poorer socio-economic position were associated with poorer subjective health. Indicators of current circumstances such as income and home ownership showed a stronger association with outcomes than past circumstances such as occupational status or education. Associations tended to be weaker in the oldest age groups. Adjusting for intermediate factors, such as social support and health related behaviours, reduced the association between subjective health and socioeconomic position. Gender differences were not consistent and tended to diminish after adjusting for health and life circumstances.