FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 355:695-703 August 17, 2006 Number 7 Next

	Full Text PDF PDA Full Text Supplementary Material Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Although the relationship between extreme poverty and poor health among older adults has long been recognized, less attention has been devoted to investigating whether a gradient in disability exists in the United States among persons with middle-class and upper-class incomes. We attempted to determine whether a gradient in functional limitation exists across the full spectrum of income among persons 55 years of age or older.

Methods We obtained data from the Census 2000 Supplementary Survey, which used the methods and questionnaire of the American Community Survey, a nationally representative survey of 890,698 households with a response rate of 95 percent. Our sample included 149,000 men and 186,675 women who were at least 55 years of age, of whom 32,680 men and 48,111 women reported having a functional limitation (a long-lasting condition that substantially limited one or more basic physical activities, such as climbing stairs or lifting).

Results A social-class gradient was observed for both men and women between the ages of 55 and 84, a gradient that held true even at the upper rungs of the socioeconomic ladder. For example, in comparison to persons between the ages of 55 and 64 who lived at 700 percent of the poverty line or above, persons of the same age but below the poverty line had six times the odds of reporting a functional limitation. With increasing income, the odds ratio declined. A significant gradient was present up to, but not beyond, the age of 85 years.

Conclusions Our findings suggest that functional limitation in Americans between the ages of 55 and 84 years is inversely related to social class across the full spectrum of the socioeconomic gradient.

Source Information

From the School of Public Health, University of California, Berkeley (M.M.); the Faculty of Social Work and the Department of Family and Community Medicine, University of Toronto, Toronto (E.F.-T.); and the Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Md. (J.M.G.).

Address reprint requests to Dr. Minkler at 316 Warren Hall, University of California, Berkeley, CA 94720-7360, or at mink{at}berkeley.edu.

Full Text of this Article

This article has been cited by other articles:

• Choudhry, N. K, Zagorski, B., Avorn, J., Levin, R., Sykora, K., Laupacis, A., Mamdani, M. (2008). Comparison of the Impact of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management Trial on Prescribing Patterns: A Time-Series Analysis. The Annals of Pharmacotherapy 42: 1563-1572 [Abstract] [Full Text]  
• Marrie, R., Horwitz, R, Cutter, G, Tyry, T, Campagnolo, D, Vollmer, T (2008). Comorbidity, socioeconomic status and multiple sclerosis. Mult Scler 14: 1091-1098 [Abstract]  
• Kasper, J. D., Ensminger, M. E., Green, K. M., Fothergill, K. E., Juon, H.-S., Robertson, J., Thorpe, R. J. (2008). Effects of Poverty and Family Stress Over Three Decades on the Functional Status of Older African American Women. J. Gerontol. B Psychol. Sci. Soc. Sci. 63: S201-S210 [Abstract] [Full Text]  
• Murabito, J. M., Pencina, M. J., Zhu, L., Kelly-Hayes, M., Shrader, P., D'Agostino, R. B. Sr (2008). Temporal Trends in Self-Reported Functional Limitations and Physical Disability Among the Community-Dwelling Elderly Population: The Framingham Heart Study. Am. J. Public Health 98: 1256-1262 [Abstract] [Full Text]  
• Groffen, D. A. I., Bosma, H., van den Akker, M., Kempen, G. I. J. M., van Eijk, J. Th. M. (2008). Material deprivation and health-related dysfunction in older Dutch people: findings from the SMILE study. Eur J Public Health 18: 258-263 [Abstract] [Full Text]  
• Fernald, L C H, Adler, N E (2008). Blood pressure and socioeconomic status in low-income women in Mexico: a reverse gradient?. J. Epidemiol. Community Health 62: e8-e8 [Abstract] [Full Text]  
• Stevens, K. N., Lang, I. A., Guralnik, J. M., Melzer, D. (2008). Epidemiology of balance and dizziness in a national population: findings from the English Longitudinal Study of Ageing. Age Ageing 37: 300-305 [Abstract] [Full Text]  
• Tomey, K. M., Sowers, M. R., Crandall, C., Johnston, J., Jannausch, M., Yosef, M. (2008). Dietary Intake Related to Prevalent Functional Limitations in Midlife Women. Am J Epidemiol 167: 935-943 [Abstract] [Full Text]  
• Sowers, M., Tomey, K., Jannausch, M., Eyvazzadeh, A., Nan, B., Randolph, J. Jr (2007). Physical Functioning and Menopause States. Obstet Gynecol 110: 1290-1296 [Abstract] [Full Text]  
• Sutedja, N. A., Veldink, J. H., Fischer, K., Kromhout, H., Wokke, J.H.J., Huisman, M. H.B., Heederik, D. J.J., Van den Berg, L. H. (2007). Lifetime occupation, education, smoking, and risk of ALS. Neurology 69: 1508-1514 [Abstract] [Full Text]  
• Schroeder, S. A. (2007). We Can Do Better -- Improving the Health of the American People. NEJM 357: 1221-1228 [Full Text]  
• Jagger, C., Matthews, R., Melzer, D., Matthews, F., Brayne, C., MRC CFAS, (2007). Educational differences in the dynamics of disability incidence, recovery and mortality: Findings from the MRC Cognitive Function and Ageing Study (MRC CFAS). Int J Epidemiol 36: 358-365 [Abstract] [Full Text]