Gender and life course occupational social class differences in trajectories of functional limitations in midlife: findings from the 1946 British birth cohort.

摘要

BACKGROUND: Older women and those of lower socioeconomic position (SEP) consistently constitute a larger portion of the disabled population than older men or those of higher SEP, yet no studies have examined when in the life course these differences emerge. METHODS: Prevalence of self-reported limitations in the upper body (gripping or reaching) and lower body (walking or stair climbing) at 43 and 53 years were utilized from 1,530 men and 1,518 women from the British 1946 birth cohort. Generalized linear models with a binomial distribution were used to examine the effects of gender, childhood and adult SEP, and the differences in the SEP effects by gender on the prevalence of limitations at age 43 years and changes in prevalence from 43 to 53 years. RESULTS: For both genders, the prevalence of upper and lower body limitations were reported at 3%-5% at age 43 years. However, by age 53 years, women's upper body limitations had increased to 28% and lower body limitations to 21%, whereas men's limitations had only increased to 12% and 11%, respectively. Men and women whose father's occupation was manual or whose adult head of household occupation was manual had higher prevalence of both limitations compared with those with non-manual backgrounds. These differences widened with age, especially in women. The effect of adult SEP on the prevalence of limitations was stronger than that of childhood SEP and was partly mediated by educational attainment. CONCLUSION: Our findings provide the first evidence that prevention of disability in old age should begin early in midlife, especially for women from manual occupation households.