SES Disparities in Obesity, Diabetes, and Hypertension among Older Adults in Low and Middle Income Countries

Low and middle income countries experienced rapid demographic changes and increased life expectancy during the 1930s-1960s, mainly because of public health interventions and medical innovations. Increasingly larger groups of survivors of poor early life conditions continued to live in poor socioeconomic conditions which continued to produce a stunted population. Older adults from these cohorts may now exhibit sharper SES health inequalities due to being less socially mobile as a result of early life conditions. Drawing from a subset of the harmonized cross national RELATE data (n=160,661), we examined the degree to which this conjecture has merit by comparing SES health disparities according to adult height for measured obesity, selfreported diabetes, and measured hypertension in older adults from low and middle income countries born in the 1930s through the mid-1940s and living in urban areas. We benchmarked results using data from the US and England. A positive education gradient appeared for obesity in taller individuals but there was no significant gradient for shorter individuals; sharper positive gradients appeared for diabetes for shorter individuals; and no significant association appeared for hypertension for individuals of any height. In contrast, the US and England showed significant negative gradients for education across all health outcomes. The results show the overall importance of early life conditions in adult health, particularly for obesity, across all developing countries, in contrast with US and England. However, the results do not produce convincing evidence of the conjecture regarding sharper SES inequalities in the cohorts born during the 1930s-1940s. Nevertheless, because obesity is a strong predictor of diabetes and hypertension, the results may forecast what is to come for the health of cohorts born in the later period of the 1930s-1960s. SES Disparities in Obesity, Diabetes, and Hypertension Among Older Adults in Low and Middle Income Countries 3