Surprising SES Gradients in mortality, health, and biomarkers in a Latin American population of adults.

BACKGROUND: To determine socioeconomic status (SES) gradients in the different dimensions of health among elderly Costa Ricans.

HYPOTHESIS: SES disparities in adult health are minimal in Costa Rican society.

METHODS: Data from the Costa Rican Study on Longevity and Healthy Aging study: 8,000 elderly Costa Ricans to determine mortality in the period 2000-2007 and a subsample of 3,000 to determine prevalence of several health conditions and biomarkers from anthropometry and blood and urine specimens.

RESULTS: The ultimate health indicator, mortality, as well as the metabolic syndrome, reveals that better educated and wealthier individuals are worse off. In contrast, quality of life-related measures such as functional and cognitive disabilities, physical frailty, and depression all clearly worsen with lower SES. Overall self-reported health (SRH) also shows a strong positive SES gradient. Traditional cardiovascular risk factors such as diabetes and cholesterol are not significantly related to SES, but hypertension and obesity are worse among high-SES individuals. Reflecting mixed SES gradients in behaviors, smoking and lack of exercise are more common among low SES, but high calorie diets are more common among high SES.

CONCLUSIONS: Negative modern behaviors among high-SES groups may be reversing cardiovascular risks across SES groups, hence reversing mortality risks. But negative SES gradients in healthy years of life persist.