Education and age trajectories of chronic conditions: Are tests of the cumulative advantage and disadvantage hypothesis biased by underreporting?

• Published in: Social science & medicine (1982) Vol. 334; p. 116134
• Main Authors: Leopold, Liliya, van Valkengoed, Irene G.M., Engelhardt, Henriette
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.10.2023
• Subjects: Cumulative advantage/disadvantage; Diabetes; Health inequality; Hypertension; Life course perspective; Hypertension; Life course perspective; Diabetes; Health inequality; Cumulative advantage/disadvantage
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2023.116134

This study examined the impact of underreporting on tests of the cumulative advantage and disadvantage hypothesis (CAD), which predicts age-related increases in health disparities between individuals with higher and lower education. Using the English Longitudinal Study of Ageing (ELSA), we identified underreporting by comparing self-reported hypertension and diabetes with biomedically measured hypertension (systolic blood pressure≥140 mm Hg and/or diastolic blood pressure≥90 mm Hg) and diabetes (fasting glucose level≥7 mmol/l and/or HbA1c≥6.5%). In a sample of 11,859 respondents aged 50 to 85 (54% women, 97% White), we assessed the associations between underreporting and the main analytic constructs in tests of the CAD (education, age, sex, and cohort). The results showed that self-reported measures underestimated the prevalence of hypertension and diabetes. Underreporting showed weak to moderate associations with the main constructs in tests of the CAD, being more pronounced in individuals with lower education, in older age, in more recent cohorts, and among men. When correcting for underreporting using biomedical measures, the overall prevalence of hypertension and diabetes increased substantially, but education differences in age trajectories of both conditions remained similar. Underreporting affected conclusions about the prevalence of hypertension and diabetes, but it did not affect conclusions about the CAD hypothesis for either condition. •Educational differences in the prevalence of hypertension remain stable with age.•Educational differences in the prevalence of diabetes increase substantially with age.•Underreporting affects conclusions about the prevalence of hypertension and diabetes.•Underreporting does not affect conclusions about change in educational differences with age for either condition.