Health inequalities in old age: the relative contribution of material, behavioral and psychosocial factors in a German sample.

Background: Whereas the association between education and health in later life is well described, investigations about the underlying mechanisms of these health inequalities are scarce. This study examines the relative contribution of material, behavioral and psychosocial factors to health inequalities in older Germans. Methods: Data were drawn from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analytic sample included 3246 participants aged 60-85 years. We examined the independent and indirect contribution of material, behavioral and psychosocial factors to the association between education and self-rated health based on logistic regression models. Results: Material factors were most important as they were additionally working through behavioral and psychosocial factors whereas the independent contribution of behavioral and psychosocial factors was much lower than suggested in the separate analyses of the three explanatory pathways. Conclusions: Policy interventions that focus on the improvement of material living conditions might reduce health inequalities in old age. In studies on the underlying mechanisms of health inequalities, material, behavioral and psychosocial factors should be modeled as inter-related predictors as the separate analysis does not reveal their actual contribution so that the relevance of single explanatory pathways might be overestimated.