b'AGING IN THE 21ST CENTURYInvestigating the Source of Understanding Healthrisk past age 65. A potential explanation for this US Disadvantage Disparity in the US lessening of the impact of all three indicators of While socioeconomic health inequalities areWhat does it mean to be poor in the US? WhatSES is selective survival. That is, those with lower present in all countries, they are more pro- impact does it have on health? HRS is well-de- SES tend to die at younger ages than those with nounced in the US. Many of the studies in thissigned to address these important questions.higher SES, making the survivors a much healthi-chapter examine the association between SESNumerous studies using HRS data documenter group at older ages.and health and seek to explain the generallythe SES health gradient and try to disentangle sharper gradient in the US. Overall, mostthe ways in which disadvantage can lead to poorHealth at middle age is a very studies confirm greater SES disparities in healthhealth outcomes. Other studies consider the conditions in the US compared to other coun- impact of neighborhood environment on health.important predictor of eventual tries. Even though the gradient is also presentAnother line of research finds that the rootsdeath. The 10-year mortality for mortality, the difference between countriesof health disparities at older ages may beginrate is 4.7% for those reporting is smaller. There are clear differences acrossin childhood. excellent health, and 35.8% for countries in behavioral health risks like smoking and obesity, but they do not explain the USDisease and Disadvantage those reporting poor health in health disadvantage and also do not explain theIncome and education are commonly used indi- middle age.fact that health disparities are greater in the UScators of SES. Personal wealth may be an equally compared to other countries. The answers mayimportant resource for older people. Income, lie elsewhere in the broader social and economiceducation and wealth are all independent riskAttempting to elucidate the path through context of each nation. Several lines of researchfactors for stroke in men and women aged which SES affects mortality over the life course, using HRS data seek to understand more about50 to 64 (Avendano and Glymour 2008). TheseFeinglass et al. (2007) use HRS data from 1992 to socioeconomic differentials in health in the US. results account for the negative effects of other2002 linked to the National Death Index to deter-known risk factors such as smoking, physicalmine all-cause mortality over the 10-year span. inactivity, higher BMI, hypertension, dia- Health at middle age is a very important betes and heart disease. Conversely,predictor of eventual death. The wealth, income and education10-year mortality rate is 4.7% are not associated with strokefor those reporting excel-lent health, and 35.8% for those reporting poor health in middle age. After accounting for baseline health and There are clear differences across countries in behavioral health risks like smoking and obesity, but they do not explain the US health disadvantage and also do not explain the fact that health disparities are greater in the US compared to other countries.76'