Retirement and perceived social inferiority strongly link with health inequalities in older age: decomposition of a concentration index of poor health based on Polish cross-sectional data

BACKGROUND Identifying mechanisms that generate and sustain health inequalities is a prerequisite for developing effective policy response, but little is known about factors contributing to health inequalities in older populations in post-transitional European countries such as Poland. Demographic aging of all populations requires new and deeper insights. METHODS Data came from the Polish edition of the cross-sectional European Social Survey, Wave 6 (2012). Logistic regression was applied to identify socioeconomic factors relevant to self-assessed health in a population aged 45 or over. Decomposition of a concentration index provided information about the distribution of health-relevant demographics and social characteristics along a socioeconomic continuum, and their contributions to observed health inequalities. RESULTS Overall, 17.4 % of respondents aged 45 or over assessed their health as poor or very poor. Predictors of poor health included income insufficiency, disability or retirement, retirement, low social activity, and social position. A steep socioeconomic gradient in self-assessed health in Polish population was found. The primary contributor to the observed health inequality (as summarized by concentration index) was income, followed by labor market situation, particularly retirement. Self-assessed place in society contributed to overall inequality, scoring similarly to social activity. Contributions from age and education were moderate but non-significant, gender was negligible, and chronological aging explained neither poor health nor socioeconomic health inequalities. CONCLUSIONS Although elderly people represent a particularly vulnerable group, their disadvantages are associated with social rather than natural causes. Policies addressing health inequalities in aging populations must provide systemic opportunities for maintaining good health. Transitioning to retirement is a critical entry point for policy action that stimulates social engagement and maintains self-esteem of older people.