TY - JOUR
T1 - Education and age trajectories of chronic conditions
T2 - Are tests of the cumulative advantage and disadvantage hypothesis biased by underreporting?
AU - Leopold, Liliya
AU - van Valkengoed, Irene G. M.
AU - Engelhardt, Henriette
N1 - Funding Information: This research was funded by the German Research Foundation , Grant Nr. EN 424/12–1. Health Measures and Health Inequality Over the Life Course. Publisher Copyright: © 2023
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Objective: This study examined the impact of underreporting on tests of the cumulative advantage and disadvantage hypothesis (CAD), which predicts age-related increases in health disparities between individuals with higher and lower education. Methods: Using the English Longitudinal Study of Ageing (ELSA), we identified underreporting by comparing self-reported hypertension and diabetes with biomedically measured hypertension (systolic blood pressure≥140 mm Hg and/or diastolic blood pressure≥90 mm Hg) and diabetes (fasting glucose level≥7 mmol/l and/or HbA1c≥6.5%). In a sample of 11,859 respondents aged 50 to 85 (54% women, 97% White), we assessed the associations between underreporting and the main analytic constructs in tests of the CAD (education, age, sex, and cohort). Results: The results showed that self-reported measures underestimated the prevalence of hypertension and diabetes. Underreporting showed weak to moderate associations with the main constructs in tests of the CAD, being more pronounced in individuals with lower education, in older age, in more recent cohorts, and among men. When correcting for underreporting using biomedical measures, the overall prevalence of hypertension and diabetes increased substantially, but education differences in age trajectories of both conditions remained similar. Conclusions: Underreporting affected conclusions about the prevalence of hypertension and diabetes, but it did not affect conclusions about the CAD hypothesis for either condition.
AB - Objective: This study examined the impact of underreporting on tests of the cumulative advantage and disadvantage hypothesis (CAD), which predicts age-related increases in health disparities between individuals with higher and lower education. Methods: Using the English Longitudinal Study of Ageing (ELSA), we identified underreporting by comparing self-reported hypertension and diabetes with biomedically measured hypertension (systolic blood pressure≥140 mm Hg and/or diastolic blood pressure≥90 mm Hg) and diabetes (fasting glucose level≥7 mmol/l and/or HbA1c≥6.5%). In a sample of 11,859 respondents aged 50 to 85 (54% women, 97% White), we assessed the associations between underreporting and the main analytic constructs in tests of the CAD (education, age, sex, and cohort). Results: The results showed that self-reported measures underestimated the prevalence of hypertension and diabetes. Underreporting showed weak to moderate associations with the main constructs in tests of the CAD, being more pronounced in individuals with lower education, in older age, in more recent cohorts, and among men. When correcting for underreporting using biomedical measures, the overall prevalence of hypertension and diabetes increased substantially, but education differences in age trajectories of both conditions remained similar. Conclusions: Underreporting affected conclusions about the prevalence of hypertension and diabetes, but it did not affect conclusions about the CAD hypothesis for either condition.
KW - Cumulative advantage/disadvantage
KW - Diabetes
KW - Health inequality
KW - Hypertension
KW - Life course perspective
UR - http://www.scopus.com/inward/record.url?scp=85170405443&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.socscimed.2023.116134
DO - https://doi.org/10.1016/j.socscimed.2023.116134
M3 - Article
C2 - 37690158
SN - 0277-9536
VL - 334
JO - Social science & medicine (1982)
JF - Social science & medicine (1982)
M1 - 116134
ER -