Socioeconomic status, well-being and mortality: a comprehensive life course analysis of panel data, Germany, 1984-2016

Abstract

Background: This study seeks to explore potential causal mechanisms involved in the observed associations between several socioeconomic status (SES) indicators, well-being and mortality, by taking a life course perspective focusing on (i) the trajectory of income and domain-specific well-being indicators, (ii) the influence of different SES indicators on well-being and mortality, (iii) the interactions between those trajectories, and (iv) the associations of the income and domain-specific well-being trajectories with all-cause mortality. Methods: Socioeconomic status is operationalised by net household income, education, employment and marital status. Well-being is measured with two indicators: life satisfaction and satisfaction with health. Data from the German Socio-Economic Panel, collected between 1984 and 2016 and comprising more than 55,000 individuals, are analysed by means of longitudinal k-means cluster analysis, simultaneous equation systems and parametric time-to-death regressions. Results: The analyses indicate the presence of large reciprocal effects of the trajectories of income and well-being on each other. However, the results suggest that well-being has a larger influence on income than the opposite, namely, income on well-being. The mortality analysis, on the other hand, revealed that the history of satisfaction with health is a much stronger predictor of longevity than the individual’s income history. Mortality risk was found lower among married individuals and those with tertiary education. In contrast, unemployment was associated with lower income and well-being levels. The findings provide support to the notion that education is a superior SES indicator than income in the investigation of the social determinants of well-being and mortality. Conclusion: The present study provides evidence of large reciprocal effects of income and well-being and emphasises the importance of taking a life course approach in the investigation of the social determinants of health. Several SES indicators and both well-being indicators were found to be highly predictive of all-cause mortality and indicate the presence of cumulative effects related to one’s income and well-being trajectories.