Physical Functioning Declines More Rapidly Among the Poor, Underinsured

Wealthier Americans and those with private health insurance fare better than others on physical functioning. A recent study showed this health gap widens as they age.

Researchers found that, when the study began, middle-aged and older Americans with more income and assets reported having less trouble with five activities of daily living: walking across a room, bathing, eating, dressing and getting in and out of bed.

Over time, though, “The rich stay healthier, while the poor see steeper declines in their health as they age,” Richardson said in a press release. The disadvantage for the poor accumulates over time, Richardson, professor of social work at Ohio State University said.

This study, published in a recent issue of Health and Social Care in the Community, is one of the few that have linked socioeconomic status — which includes income and assets — and health insurance on people’s physical functioning over an extended period of time, according to study co-author Virginia Richardson.

Those with private health insurance also reported less trouble with these activities than did those without such insurance. That gap also increased over time.

The researchers used data from the Health and Retirement Study, copnducted by the University of Michigan, which followed Americans over 50 years of age, from 1994 to 2006. Richardson and colleagues used data on 6,519 participants.

In 1994, when data was first collected, the researchers found that those with higher income and assets had better functioning. The key finding was how this gap grew over time, Richardson said.

“The more income and assets you have, the slower your health decline will be,” she said. This was true for both men and women.

Those who had private health insurance at the beginning of the study also reported fewer problems with physical functioning than those who did not..

Education made a difference among older black adults; those with more education tended to have better functioning than those with lower levels.

The results complement other studies that suggest that economically disadvantaged people may not be able to afford needed medications, or may take steps to make their prescriptions last longer, like cutting pills in half.

They may also avoid diagnostic tests that could help identify disease earlier. This may be especially true for those who lack private health insurance that can help pay for expensive testing.

Richardson said the findings suggest that public health care policies need to consider how people’s economic resources will change their physical functioning as they age.

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