摘要：Objectives. We examined associations between material resources and late-life declines in health. Methods . We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15 441). Results . Disadvantages in health care (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95% CI = 1.29, 2.22), and housing (OR = 1.20; 95% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95% CI = 1.29, 1.58) and food (OR = 1.64; 95% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage. Conclusions . Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone. The past century has witnessed tremendous advances in medical care and technology, along with gains in life expectancy. Yet, these gains in life expectancy have been unequally distributed and have come to a halt for some disadvantaged groups of Americans. 1 Throughout the life course, poor persons fare worse than higher-income individuals on key health indicators. The poor have lower self-rated health, a higher prevalence of chronic conditions, and higher mortality. 2 , 3 Health disparities by race/ethnicity appear similarly entrenched. 3 , 4 The association between socioeconomic status (SES) and health continues into old age and is evident across the income gradient. 5 , 6 Higher SES, measured in terms of education, income, or occupational prestige, is associated with decreased mortality among persons aged 65 years and older, 7 whereas lower levels of education, income, and occupation contribute to higher levels of morbidity and mortality in older individuals. 5 , 7 , 8 The life-course model posits that accumulated disadvantage can contribute to health status in old age. 5 , 9 The socioeconomic gradient in health persists in old age despite participation in Medicare, which provides nearly universal health insurance coverage. 5 , 10 Further improvements in population health will require attention to factors in addition to health care that drive health disparities. 11 , 12 Researchers have called for better measurement of characteristics associated with SES other than income, 13 , 14 including direct measurement of material resources. 15 Material resources, the goods and services that income leverages, have been proposed as critical factors in determining population health, and unequal distribution of these resources may contribute to health disparities. 16 , 17 Unmet needs related to health care, food, and housing are interrelated indicators of material hardship, 15 but only a few cross-sectional studies have simultaneously considered how multiple forms of material hardship may relate to health. 15 , 18 – 20 Instead, previous research has considered the health effects of individual forms of material disadvantage. Inadequate health insurance is related both to lower use of appropriate health services and to poorer health outcomes. 21 – 23 Food insecurity is related to higher rates of functional impairment among persons aged 60 years and older 24 and to poorer health. 25 , 26 Home ownership and other shared household amenities and assets are related to better self-rated health through multiple pathways, including housing conditions and neighborhood environments. 27 – 30 In the present study, we examined simultaneously the population distribution of these 3 basic human needs—health care, food, and housing—and the later-life health consequences of material disadvantage in these domains. We anticipated that each of these material resources would contribute independently to declines in self-rated health and walking ability, even after we controlled for the effects of standard socioeconomic indicators such as education and poverty.
