Is 'Wealth' still important for health & how to measure it among older Australians?

“There is a remarkably close link between where you are on the socioeconomic ladder and your health – the higher the rank, the better the health. I call this the social gradient in health.” Professor Sir Michael Marmot Socio-economic position (SEP) is an accepted strong predictor of health and wellbeing, and thus, is considered an important confounder in epidemiological and social research. The most common assessments of SEP are income, education and occupation. However, SEP can be captured in multiple ways and determining the most appropriate measure can be complicated. Selecting the most appropriate measure of SEP is important as unsuitable measures can manufacture misleading or conflicting findings. In older adults specifically, there are known issues with capturing SEP. For example, while education opportunities were available for both men and women, the cultural context in the mid 1900s persuaded more men than women to continue education at all levels. Similarly to education, paid employment has socio-normative issues as women were, and remain, the primary caregiver to children and aging parents. The measure of occupation may be useful in mid adult hood, but as people detach from the workforce they may work less, undertake an occupation which is driven by enjoyment rather income, or be categorised as retired. Also, a measure of income in older adults that is dependent upon a pension or retirement fund may not reflect their lifestyle depending on other assets (e.g. house ownership). A measure based on postcode may be useful in childhood and mid adulthood, however, as adults enter older age they may downsize or relocate, particularly after retirement. Also, the health outcomes of older adults may be affected by SEP across the life span, including childhood (socialisation years), adult hood (the working years), and older adult hood (present time). This is particularly important to consider for postcode as older persons may stay in a neighbourhood that is changing around them but not necessarily reflect their lifetime SEP. Furthermore, it is difficult to compare aspects, such as income, across birth cohorts or at different time periods because of inflation. Reducing the inequalities in health is a longstanding aim of government strategies. SEP is one example of inequality and hence, it is important to ensure we have a robust means of measuring SEP and disadvantage. In addition, SEP is an accepted strong predictor of health and wellbeing, and thus, is considered an important confounder in epidemiological and social research. Selecting the most appropriate measure of SEP is important as unsuitable measures can manufacture misleading or conflicting findings. In older adults specifically, there are known issues with capturing SEP. This project aims to explore the most appropriate measure of SEP for older adults, specifically in terms of older Australians. For small projects, one of the aims can be completed. AIM 1: A Systematic Literature Review Aim: to examine the academic literature to capture how SEP has been measured and assessed in prior cohort studies examining health outcomes. Methodology: Key words will be defined. A systematic search of the literature will be utilised to capture cohorts examining health outcomes. If the number is onerous, cohorts will be restricted to Australia, UK and USA. We will search the following sources from the earliest record to date: Medline through Pubmed, CINAHL, google scholar and EMBASE. Publications will be grouped according to the cohort (if multiple papers) and the SEP measure. AIM 2: Data Analysis Candidates must possess the desire to undertake extensive data analysis. Aim: to examine the most appropriate measure SEP (singular or composite) for ASPREE participants Methodology: The project will utilise pre-existing, de-identified data from Australia’s largest active clinical trial in healthy ageing, the ASPREE (ASPirin in Reducing Events in the Elderly) study. ASPREE is a 5-year randomised double-blind placebo-controlled trial of low-dose aspirin compared to placebo in 16,703 community-dwelling Australian adults aged ≥70 years. Additionally, this project will use the sub-study ALSOP (ASPREE Longitudinal Survey of Older Persons). Through which 14,909 Australians were recruitmed. Baseline data will be assessed through cross-sectional summary scores and statistical analysis (linear and logistic regression).