Poverty and Trajectory of Subjective Health Among Older Koreans: Focusing on Multifaceted Nature of Poverty

Background: Economic vulnerability is increasing as one ages. Although old-age poverty in developed countries has significantly decreased with the advent of pension system, there are still a great number of elders live under poverty. Many studies have demonstrated that older adults under poverty are at risk for poor health, because they face financial barriers to accessing services, safe living environments, and lack of resources to maintain good health. However, there is still limited research investigating multifaceted nature of poverty and trajectory of health among older adults over time.

Purpose: This study aimed to investigate intra- and interpersonal differences in subjective health among older Koreans, and particularly focused on how poverty influences changes in subjective health. Drawing from life course and cumulative disadvantage theory, the associations between poverty and subjective health were examined with observations over eight years of period time. In addition, this study includes various measures of poverty to address various concepts and experiences of poverty.

Methods: We obtained the data from eight waves of Korea Welfare Panel Study, which is a nationally representative survey of South Korea (2006-2013). Our sample was restricted to older adults over 65 years at the baseline who were participated in the survey at least three time points during the entire period of study (N=3,337, Obs.=24,076). Hierarchical linear models were employed to analyze trajectories of self-rated health and their associations with various measures of poverty: incidence, depth (i.e., poverty gap), and duration of poverty, and subjective poverty. Poverty was calculated based on all the incomes from labor, assets, pension, and other social security.

Results: Self-rated health among older Koreas got worse over time, after controlling demographic characteristics, working status, health care utilization, income and functional health. The trajectories of self-rated health varied among different poverty group measured by diverse and dynamic concepts of poverty. First, older adults who were under 150% of poverty line were more likely to report poorer health, and the rate of changes in self-rate health were greater than the better income group. Interestingly, we found that elders under 100-150% poverty line tended to have poorer health than those under the poverty line, and their health got worse faster than health among the non-poor and the poorest. Second, older adults who experienced poverty at least one time during the study period were more likely to have poorer self-rated health than those who never experienced poverty, and there was no significant difference between elders under poverty over all the study period and those who experienced transient poverty. Lastly, trajectories of self-rated health were not significantly influenced by subjective economic status.

Conclusions: Along with aging population, there is a great need for policy makers and service providers to understand poverty dynamics and its effects on health among older adults. With longitudinal observations, this research highlights health disparity among older Koreans in terms of incidence, depth, and duration of poverty. Also, we suggest the importance of formal social support to elders at risk for poverty including near-poor elderly and elderly with transient poverty experiences.