The Rich Are Less Likely to Become Unhealthy, and Survive Better Afterwards. Which Advantage is Bigger?

Ruben Castro, University of Pennsylvania

Why a better socioeconomic (SES) position is associated with higher life expectancy is a longstanding question among social researchers. This article adds to the literature by decomposing the socioeconomic gradient (measured by education) in mortality into three parts: the gradient in the transition rate from healthy to unhealthy, the gradient in mortality rates before the transition, and the gradient in mortality after the transition. Follow up data is used to compute those rates, and their SES gradients are estimated with Cox regressions.. Results show that even though the SES gradient in each of the three rates is not substantially different, the gradient in survivorship after reaching poor health is by far the most important component; both the high death rates among the unhealthy and the high prevalence of unhealthiness explain this result. These findings call attention on the double impact of choosing a particular definition of unhealthiness.