Enlighten: ThesesAn examination of the relationship between life course socioeconomic position and quality of life among Europeans in early old age and the influence of the welfare regimeClaireNiedzwiedzauthorBackground: Low socioeconomic position throughout the life course is associated with a number of adverse health outcomes in older people. However, whether life course socioeconomic position influences subjective outcomes in early old age, such as quality of life, is not well known. There is a lack of life course research that considers the wider structural determinants of health. In particular, it is not well understood if the association between life course socioeconomic position and quality of life is the same across European societies that have differing welfare state arrangements. This thesis addressed two key aims: (1) Investigate whether, and how, life course socioeconomic position influences the quality of life of Europeans in early old age. (2) Examine differences in this relationship by welfare regime. Methods: Two methodological approaches were taken to address the research objectives: (1) A systematic review of quantitative studies examining the influence of life course socioeconomic position on quality of life was conducted, with a narrative synthesis. (2) An empirical analysis was carried out examining the influence of life course socioeconomic position on the quality of life of individuals in early old age, as measured by CASP-12 and life satisfaction. This used secondary data from 13 European countries (representing Southern, Scandinavian, Post-communist, and Bismarckian welfare regimes) that were part of Wave 2 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) and SHARELIFE, which collected retrospective life histories of respondents. Two statistical techniques were used to analyse the data: multilevel modelling and path analysis. Slope indices of inequality were calculated to enable measures of socioeconomic position to be compared. Results: The systematic review identified 12 relevant studies, which varied in terms of the outcomes examined, study quality, and populations. No studies were identified from Bismarckian or Post-communist welfare regimes, with most containing populations from the Scandinavian or Liberal regime types. Some supportive evidence was found for a latent effect of low childhood socioeconomic position on quality of life among women. Social mobility models were generally not supported. High quality studies addressing inter-generational mobility were lacking and few studies examined cumulative and pathway effects. Results from the analysis using SHARE suggested that the most proximal measures of socioeconomic position were the strongest predictors of quality of life. In most welfare regimes, inequalities in quality of life were largest by current wealth, but among women in the Southern and Post-communist regimes inequalities by education level were particularly large. In the Scandinavian regime there were very small differences in quality of life between the least and most educated. Generally, there was little difference in the magnitude of socioeconomic inequalities in quality of life between Scandinavian and Bismarckian regimes. Support for a latent effect on quality of life was lacking, using most measures of childhood socioeconomic position. The findings from both the multilevel models and path analysis supported the pathway theory whereby childhood socioeconomic position chiefly influenced quality of life through later socioeconomic experiences. However, the number of books in childhood exhibited a weak association with quality of life even when taking into account current measures of socioeconomic position, suggesting a small latent effect for this measure. When stratifying by welfare regime, the potential direct effect from the number of books in childhood was specific to particular welfare regimes and genders. A greater number of socioeconomically advantaged positions over the life course was associated with higher quality of life in early old age, but the results suggested this was mainly due to the influence of socioeconomic advantage during adulthood. The association between life course socioeconomic position (as measured by a cumulative socioeconomic advantage score) and quality of life was weaker in the Scandinavian regime and stronger in Southern and Post-communist regimes. Including a measure of current financial distress greatly attenuated these associations. There was generally a lack of supportive evidence for an effect of social mobility on quality of life. Conclusions: Socioeconomic inequalities in quality of life were apparent in all welfare regimes and were largest by more proximal measures of socioeconomic position. Overall, Scandinavian and Bismarckian welfare regimes exhibited both higher quality of life and narrower inequalities in quality of life, compared to Southern and Post-communist regimes. Interventions to reduce socioeconomic inequalities across the life course are needed, but those which buffer the effect of financial distress in early old age may be particularly beneficial for improving quality of life and producing a more equitable distribution.H Social Sciences (General)RA0421 Public health. Hygiene. Preventive Medicine2014-08University of GlasgowThesis

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