Socioeconomic determinants of functional dependence in later life: Evidence from a concentration index decomposition
1
Department of Public Health, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
2
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States
Popul. Med. 2026;8(Supplement Supplement 1):A126
ABSTRACT
INTRODUCTION:
Functional dependence in activities of daily living (ADL) is a key indicator of health and wellbeing in older populations and reflects cumulative disadvantages across the life course. Identifying the socioeconomic determinants of ADL depence is critical for developing equitable healty ageing policies.
METHODS:
This study used data from the Türkiye Older Persons Profile Survey 2023, conducted by the Turkish Statistical Institute(TURKSTAT). The analysis included 29785 individuals aged 50 years and older, with sampling weights applied to ensure national representativeness. ADL dependence was defined using Katz ADL index (score<6). Socieconomic inequalities was assessed using the standart concentration index(CI), ranked by equivalized household income. A regression-based decomposition analysis was conducted to quantify the contributions of demographic, socioeconomic, health-related factors to overall inequality.
RESULTS:
Clear socioeconomic inequalities were observed in ADL dependence, with a disproportionate concentration among lower-income older adults. Older age groups were more prevalent in lower-income strata (CI=-0.036 for ages 60-69; CI=-0.135 for ages 70-79). Poor self-rated health was more prevalent among lower-income groups (CI=-0.214), and chronic diease prevalence showed a similar pattern (CI=-0.046), indicating a socioeconomic gradient in health status. Higher educational level and employment status showed pro-rich distrubitions. Both university education and employment was strongly concentrated among higher-income groups (Respectively; CI=0.592; CI=0.202). Decomposition analysis showed that health-related factors were the dominant contributors to inequality (34.0%), followed by age-related factors (25.4%). Education and work status each explained approximately 10.5% of the observed inequality while income-related factors explained 9.4%. Marital status, household structure, and insurance coverage contributed smaller but non-negligible shares to inequalities.
CONCLUSIONS:
Socioeconomic inequalities in ADL dependence among older adults in Türkiye is driven primarily by health and age-related disparities, followed by educational and employment status. A life-course approach addressing social determinants of health from early life may reduce socioeconomic inequalities and support functional independence in older age.
Functional dependence in activities of daily living (ADL) is a key indicator of health and wellbeing in older populations and reflects cumulative disadvantages across the life course. Identifying the socioeconomic determinants of ADL depence is critical for developing equitable healty ageing policies.
METHODS:
This study used data from the Türkiye Older Persons Profile Survey 2023, conducted by the Turkish Statistical Institute(TURKSTAT). The analysis included 29785 individuals aged 50 years and older, with sampling weights applied to ensure national representativeness. ADL dependence was defined using Katz ADL index (score<6). Socieconomic inequalities was assessed using the standart concentration index(CI), ranked by equivalized household income. A regression-based decomposition analysis was conducted to quantify the contributions of demographic, socioeconomic, health-related factors to overall inequality.
RESULTS:
Clear socioeconomic inequalities were observed in ADL dependence, with a disproportionate concentration among lower-income older adults. Older age groups were more prevalent in lower-income strata (CI=-0.036 for ages 60-69; CI=-0.135 for ages 70-79). Poor self-rated health was more prevalent among lower-income groups (CI=-0.214), and chronic diease prevalence showed a similar pattern (CI=-0.046), indicating a socioeconomic gradient in health status. Higher educational level and employment status showed pro-rich distrubitions. Both university education and employment was strongly concentrated among higher-income groups (Respectively; CI=0.592; CI=0.202). Decomposition analysis showed that health-related factors were the dominant contributors to inequality (34.0%), followed by age-related factors (25.4%). Education and work status each explained approximately 10.5% of the observed inequality while income-related factors explained 9.4%. Marital status, household structure, and insurance coverage contributed smaller but non-negligible shares to inequalities.
CONCLUSIONS:
Socioeconomic inequalities in ADL dependence among older adults in Türkiye is driven primarily by health and age-related disparities, followed by educational and employment status. A life-course approach addressing social determinants of health from early life may reduce socioeconomic inequalities and support functional independence in older age.
| eISSN: | 2654-1459 |
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