International Differences in Mortality at Older Ages: Dimensions and Sources by National Research Council of the National Academies

Author:National Research Council of the National Academies
Language: eng
Format: epub
Tags: Behavioral and Social Sciences : Aging
Publisher: NATIONAL ACADEMIES PRESS
Published: 2011-01-27T00:00:00+00:00

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Do Cross-Country Variations in Social Integration and Social Interactions Explain Differences in Life Expectancy in Industrialized Countries?

James Banks, Lisa Berkman, and James P. Smith with Mauricio Avendano and Maria Glymour

INTRODUCTION

Variations in life expectancy among industrialized countries have been attributed to differences in patterns of health behavior, health care, socioeconomic conditions, and variations in social and economic policies. In this chapter, we explore whether variations in morbidity, mortality, and life expectancy are related to variations in the extent to which countries have different levels of social integration or social support. Extensive research suggests that aspects of social networks and social integration may be associated with mortality in a number of countries (Berkman and Syme, 1979; Berkman et al., 2004; Blazer, 1982; Fuhrer and Stansfeld, 2002; Fuhrer et al., 1999; House, Robbins, and Metzner, 1982; Kaplan et al., 1988; Khang and Kim, 2005; Orth-Gomer and Johnson, 1987; Orth-Gomer, Rosengren, and Wilhelmsen, 1993; Orth-Gomer, Unden, and Edwards, 1988; Orth-Gomer et al., 1998; Penninx et al., 1998; Sugisawa, Liang, and Liu, 1994; Welin et al., 1985). But in no studies have we been able to compare either risks or distributions of comparably defined social networks across countries, nor have we been able to understand if variations in social networks and social participation might explain cross-country variations in population health.

We explore these issues from several perspectives. Ideally, we want to assess the variability in distributions of social networks and support in many countries. We would also like to identify whether risks associated with social isolation and various health outcomes are the same in each country. For social networks and support to “explain” cross-country differences in life expectancy, at least one of two conditions must be met. First, a different fraction of the population needs to be exposed to risk factors across countries. Second, the health risk—“toxicity”—associated with risk factors might differ between countries. For common risk factors, even small differences in toxicity may have large population health effects. Differences in toxicity could occur if population differences in exacerbating or compensatory factors influence the risk of disease. For example, if countries had public policies protecting citizens against deleterious health effects of extreme poverty, we might not see health effects manifest themselves there, even though poverty was present. Third, we would hope to assess in a single model whether social integration and support can account for cross-country differences in life expectancy. In this chapter we examine the first two but do not have adequate data to test the third in a compelling way, except for a comparison of England and the United States.

The lack of truly harmonized individual-level data across countries on relevant exposures and health outcomes over time limits our ability to examine this question. To overcome this limitation, we start by comparing associations between social integration and social support in the United States and England, using data from the Health and Retirement Survey (HRS) and the English Longitudinal Study of Ageing (ELSA). Although not identical, these surveys have very comparable measurements of social networks and social support, as well as comparable data on health conditions and associated risks.

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