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Please cite this article as an ‘Accepted Article’, doi:10.2188/jea.JE20190083
Received May 9, 2019; accepted September 24, 2019; released online October 12, 2019

Gender difference in the association between subjective socioeconomic mobility across life
course and mortality at older ages: Results from the JAGES longitudinal study

Yuiko Nagamine MD, MSc1,2,3, Takeo Fujiwara MD, PhD2, Yukako Tani PhD3, Hiroshi Murayama,n

PhD, MPH, RN, PHN`4, Takahiro Tabuchi MD, PhD5, Katsunori Kondo MD, PhD1,6,7, IchirosioKawachi MD, PhD8

Center for Preventive Medical Science, Chiba University, Chiba, Japan2

Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan3

Department of Family Medicine, Tokyo Medical and Dental University, Tokyo, Japan

4

Institute of Gerontology, The University of Tokyo, Tokyo, Japan

5

Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan

6

Department of Gerontological Evaluation, Center for Gerontology and Social Science, Aichi, Japan

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Center for Well-being and Society, Nihon Fukushi University, Aichi, Japan

8

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston,ce

Massachusetts

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Corresponding author:

Takeo Fujiwara MD, PhD
Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima,
Bunkyo-ku, Tokyo 113-8519, Japan
Tel: +81-3-5803-5187
fujiwara.hlth@tmd.ac.jp

Number of Figures : 0 Number of Tables : 3 Number of appendices : 4

Copyright © 2019 Yuiko Nagamine et al. This is an open access article distributed under the terms of Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ABSTRACT2

Background: Socioeconomic mobility affects health throughout the life course. However, it is not3

known whether there are gender differences in the association between life-course subjective

4socioeconomic status (SSS) mobility and mortality at older ages.

5

Methods: Participants were 16,690 community-dwelling adults aged 65–100 years in the Japan

6

Gerontological Evaluation Study (JAGES). Baseline information including demographic

7

characteristics, depression and lifestyle factors were collected in 2010. Participants’ vital status was

8

confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility

9

into the following categories: ‘persistently high’, ‘downward mobility’, ‘upward mobility’ and10‘persistently low’. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-11

cause mortality.

12

Results: Mortality HRs for the ‘downward’ group were 1.37 (95% confidence interval [CI] 1.08–

131.74) among men and 1.27 (95% CI 0.94–1.71) among women in comparison with the ‘persistently

14high’ group. Compared to the ‘persistently low’ group, the HRs for the ‘upward’ group were 0.54

15(95% CI 0.35–0.83) among women and 0.91 (95CI 0.73–1.24) among men. Associations were not16changed after adjusting for objective socioeconomic status, but attenuated by depression.

17

Conclusions: ‘Downward’ mobility was associated with mortality among men, but not among

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women. Depression appeared to mediate the association. A protective effect of upward mobility was

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observed among women but not among men.

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Keywords: Subjective socioeconomic status; trajectory; all-cause mortality; gender roles; Japan

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Running title: Gender roles associated with SSS mobility and mortality

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INTRODUCTION

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Subjective socioeconomic status (SSS), defined as “a person’s belief about his location in a status

26

order” 1, has been shown to be correlated with health and illness independently from objective

27

socioeconomic status (SES, including educational attainment, income and occupation) 2. Singh-

28

Manoux A et al. concluded that SSS can capture a perceived average of objective SES 3. More recently,

29

the biological pathways linking SSS to health have begun to be documented. People’s perceptions of30

their social status predict health behaviors, such as smoking 4 and sedentarism 2, as well as some31

biomarkers, such as heart rate, sleep latency, cortisol habituation to stress, body fat distribution 5 and32high waist circumference 6. Additionally, SSS has been shown to be inversely related to metabolic

33

syndrome 6, insulin resistance 7, coronary artery diseases, hypertension, diabetes and dyslipidemia 8.

34

As for older people, Instrumental Activities of Daily Living difficulties are also inversely related to35

SSS 2. Presumably, through these pathways, low SSS is associated with excess risk of mortality 9.

36

The statistically significant associations between SSS and all outcomes above—except coronary

37

artery disease, hypertension and diabetes—were observed even after adjusting for objective

38

socioeconomic status.

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Recent studies have begun to focus on the trajectories of SSS across the life course. For

40

example, Burazeri et al. 10 found that downward mobility in SSS (i.e. high SSS in childhood/low SSS

41

during mid-life) was associated with increased risk of acute coronary syndrome (ACS) for both men

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and women at around 60 years of age. In this study, financial loss appeared to mediate downward
mobility and ACS. Depressive symptoms were not considered in the study, although depression might44

be a robust mediator of the association between SSS and ACS. Another study of Latino and Asian45

immigrants in the United States (US) found that downward subjective social mobility was associated46

with elevated risk of major depression 11,12. However, to the best of our knowledge, no studies have47

examined the association between mobility in SSS and mortality among older people prospectively,

48

independent from objective SES, and the mediating effect of depression in this association.

49

It is also not known whether there are gender differences in the association between mobility3

in SSS and health outcomes. Previous studies on “objective” social class mobility have found gender51

differences. For example, Cambois et al. examined occupational class mobility and standardized52

mortality rates (SMR) stratified by sex in a French population aged 30–84 years old. In this study,

53

occupational class was classified into six groups: ‘upper classes’, ‘craft, trade, etc.’, ‘farmers’,54‘clerks’, ‘manual workers’ and ‘inactive’. Among both men and women, individuals who were55

downwardly mobile had statistically significant higher mortality compared to ‘non-movers’. At the56same time, men who moved upwards from ‘inactive’ to a higher occupational position also

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experienced higher mortality risk compared to non-movers. By contrast, among women, moving up

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from the ‘inactive’ group showed a protective effect on mortality risk 13. A study in Poland reported

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that upward intergenerational educational mobility (comparing individuals to their fathers) was

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protectively associated with cardiovascular risk—as measured by the Framingham risk score (FRS)—

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only among men 14. No study has investigated whether there are gender differences in the association

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between “subjective” social class mobility and mortality.

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Gender roles closely mirror the cultural context. For example, in Japan’s traditional patriarchal

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culture, women can be college-educated, but still end up as home-makers and therefore do not benefit

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from upward educational mobility to the same extent as men 15. We derive two theoretical predictions

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for the gender difference we should expect to observe in the association between mobility in SSS and

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mortality. In a rigidly traditional society (men are expected to be bread-winners and women are

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expected to stay at home), (i) upward social mobility may not be beneficial to women; and (ii) in thesame society, downward mobility could be more “toxic” for men because the male is the breadwinner70

and the household’s fortunes are more closely linked to the male’s SES trajectory. In this present study,

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these hypotheses were examined.

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The Japan Gerontological Evaluation Study (JAGES) is a large-scale, population-based cohort

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study established in 2010 that collected data on both childhood and current SSS among healthy older

74(65 years or older) community residents in Japan. Vital status was ascertained in the cohort via linkage

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to death registry data. Previously, using prospective JAGES data from 2003, we reported that lower4

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objective SES (educational attainment and household income) was associated with higher mortality

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in older Japanese adults. In the present study, our objectives were to examine whether trajectories of

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SSS across the life course, that is, subjective social status mobility from childhood to old age, are80

associated with the risk of mortality and whether there is a gender-related difference in the association.

n. However, the impact of differential trajectories of SSS on mortality risk has not been investigated

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METHODS

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Study participants

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Data from an ongoing prospective longitudinal cohort study, the Japan Gerontological Evaluation

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Study (JAGES), was analyzed. The cohort was established with the aim of elucidating the determinants

86of healthy ageing among community-dwelling seniors. The baseline survey was administered between

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August 2010 and January 2012, when survey questionnaires were mailed to 131,468 community-

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dwelling individuals aged ≥ 65 years who were physically and cognitively independent. People from89

24 municipalities throughout Japan were invited to participate. Participants were randomly selected

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from the official residence registries in 13 large municipalities; and in the remaining 11 smaller

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municipalities, census data of all eligible residents was sought. A total of 86,063 subjects returned the92questionnaire (response rate: 65.5%).

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Approximately one-fifth of the total sample (N=19,528) was randomly selected to receive a

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supplementary survey module inquiring about their childhood and current SSS. After excluding those
who had missing SSS responses (N=2,832) as well as individuals who could not be linked to mortality

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register data (n=6), our analytical sample consisted of 16,690 subjects (7,944 men and 8,746 women).

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The JAGES protocol was approved by the Ethics Committee in Research of Human Subjects at Nihon

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Fukushi University (No. 10-05) and the Ethics Committee of Chiba University, Faculty of Medicine

99(No. 1777).

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Ascertainment of death5Participants were matched to death records from the public long-term care insurance system, which103

is maintained by local municipal authorities throughout Japan. All deaths were reported and submitted

104by physicians to municipalities. In the analysis sample from 2013, 780 deaths were found, which was

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4.7% of total participants at baseline. Of these deaths, 524 were men (6.6% of 7,944 male participants),

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and 256 were women (2.9% of 8,746 female participants).

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Childhood and current SSS

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Childhood SSS was asked using the following question: “How would you rate your social status when110

you were aged 15 years compared to others in society at that time?” 17. Possible responses were111

arranged on a 5-point Likert scale: ‘high’, ‘middle-high’, ‘middle’, ‘middle-low’, or ‘low’.

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Current SSS was assessed by the question: “How would you rate your current social status in113

comparison with others in society?”, with the same 5-point Likert scale of responses.

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Since a previous study showed that even subtle downward/upward mobility can be

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associated with health outcomes 13, we subtracted the 5-point Likert scale response for childhood SSS

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from the same 5-point Likert scale response for adult SSS, and categorized the resulting numbers into

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‘downward SSS trajectory’ if the calculated result was -4 to -1, ‘no change’ if 0 and ‘upward SSS

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trajectory’ if +1 to +4. Subsequently, ‘no change’ was dichotomized into two groups and the119

individual was defined as ‘persistently high’ if both childhood and current SSS were ‘high’, ‘middle-

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high’ or ‘middle’, and ‘persistently low’ if both SSS were ‘middle-low’ or ‘low’.

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Covariates

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Self-reported adult height, current income, education and marital status were included as potential

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confounding factors. Additionally, depression and lifestyle factors were included as potential

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mediators of the association between SSS mobility and mortality. Adult height was used as a proxy126

of childhood adversity such as childhood nutrition and disease status 18,19. Adult height was127

categorized into five groups in 5cm intervals specific to each gender: for men: <155, 155–159.9, 160–6

164.9, 165–169.9, and ≥170cm; and for women: <145, 145–149.9, 150–154.9, 155–159.9, and129≥160cm 17. Education was assessed as years of schooling (0–9, 10–12, or ≥13 years) and annual

130household income was equalized by dividing the gross income by the square root of the number of131household members (< 2.00, 2.00–3.99, or ≥ 4·00 million yen). We decided not to include

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occupational class as a covariate after performing the sensitivity analysis. Marital status was133

categorized as married, widowed, divorced, unmarried or others. The 15-item short form of the134

Geriatric Depression Scale (GDS) (Japanese version) was used to assess depression and categorized135

as no depression (0–4), moderate depression (5–9), and depression (10+) 20,21. Lifestyle factors

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included smoking status (current smoker/ex-smoker or non-smoker), alcohol intake (current

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drinker/ex-drinker or non-drinker), walking time per day (<30min, 30≤) and body mass index (BMI)

138(underweight (<18.5), normal (18.5–24.9), overweight (25.0-29.9) or obesity (30.0≤)) 22.

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Statistical analysis

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Data was analyzed by gender because self-rated health 23 and depressive symptoms 24,25 differed142

between men and women in our sample 26,27. Cox proportional hazards models were used to estimate

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hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality during the 3-year follow-

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up period. The following sequential multivariable-adjusted models were constructed: model 1 was

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adjusted for age, model 2 was additionally adjusted for adult height, adult objective SES (educational

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and income level) and marital status, model 3 was additionally adjusted for depression, and model 4
was additionally adjusted for lifestyle factors. Analysis was performed using Stata/SE version 13.1
(Stata Corp, College Station, TX 77845, USA).

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RESULTS151

The overall and gender-stratified characteristics of the study subjects are described in Table 1. Among152

all participants, 25.7% of men and 31.5% of women reported both a high childhood SSS and high153

current SSS, while 18.7% of men and 14.3% of women reported low current SSS and childhood SSS.
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Twenty percent of men and 30.0% of women were categorized as ‘downward mobility’ while 35.6%

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of men and 24.2% of women were categorized as ‘upward mobility’ (Table 1).
Among men, after adjustment for age, the HR from the ‘downward mobility’ group was 1.37

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(95% CI: 1.08–1.74) compared to those in the ‘persistently high’ group (Model 1, Table 2). Even after158

adjustment for adult height, adult objective SES and marital status, the HR of ‘downward mobility’159

was significantly higher compared to ‘persistently high’ (HR 1.35; 95% CI 1.05–1.72, Model 2).

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Additional adjustment for depression attenuated the association between ‘downward mobility’ and161

mortality, which became non-significant (HR 1.22; 95% CI 0.95–1.56, Model 3). Additional

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adjustment for lifestyle factors showed a non-significant association (HR 1.22; 95% CI 0.95–1.56,

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Model 4). On the other hand, compared to the ‘persistently low’ group, no significant association was

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found between ‘upward mobility’ and mortality among men.

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Interestingly, the trend was opposite in women (Table 3). Women from the downward

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mobility group showed no significant excess mortality risk compared to the ‘persistently high’ group167

either before (HR 1.27; 95% CI 0.94–1.71, Model 1) or after adjustment for age, adult height,

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objective SES and other covariates (HR 1.08; 95%CI 0.79–1.47, Model 4). Although the result was169

not statistically significant, the point estimate of the HR showed that adjustment for depression

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considerably attenuated the effect of downward mobility among women also. We additionally171

conducted a check for the interaction between gender by mobility in the SSS and mortality. The result

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confirmed that downward mobility was harmful only among men. However, compared to‘persistently low’, the age-adjusted HR of the ‘upward mobility’ group was 0.54 (95% CI: 0.35–0.83,

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Model 5). After adjustment for adult height, adult objective SES and marital status, the HR for

175‘upward mobility’ was slightly attenuated to 0.58 (95% CI: 0.38–0.90, Model 6). In the final model,

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after additional adjustment for depression and other covariates, the HR for ‘upward mobility’ was177

attenuated to statistical non-significance (HR 0.68; 95% CI: 0.44–1.07, Model 8).

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DISCUSSION8In this analysis of life-course trajectories of SSS among Japanese older adults, we found four notable

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patterns: (a) ‘downward mobility’ increased the risk of mortality compared to the ‘persistently high’182

group only among men; (b) ‘upward mobility’ decreased the risk of mortality only among women,

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with no effect seen among men; (c) depression appeared to mediate the association between mobility

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in SSS and mortality, and finally, (d) objective SES in later life did not fully explain the relationship

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between mobility in SSS and mortality.

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Our finding of excess mortality among downwardly mobile groups is consistent with187

previous studies in other populations and other age groups 10-12. However, it was observed only among

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men in the older Japanese population. Downward mobility increases the risk of poor health for men

189because of a subjective sense of deprivation in adult life relative to their childhood status. This might190

be less salient for women in Japanese society because their economic fortunes are more tightly linked

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to their spouse’s status. As shown in Table 1, over 90% of women in the sample were married or192

previously married (now widowed). Also, as mentioned above, the gender difference here is probably

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real because the formal test of interaction was statistically significant only among men. In addition to194

that, depression is probably mediating the association between downward mobility and mortality.

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Depression had the strongest attenuation effect among covariates in Model 3 both among men and196

women.

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Generally, upward SES mobility has a protective effect on health compared to persistently

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low SES 28. In our study, ‘upward’ SSS mobility attenuated mortality risks among women, but notamong men. This pattern is contrary to our original hypothesis that upward mobility would not affect200

women’s risk, because even if women graduated from college, this would not be reflected by higher

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earnings/income. Many Japanese women of the generation in our sample became housewives

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irrespective of their years and quality of education 15. For men, we did not find either a harmful or203

protective effect of ‘upward’ mobility in this study. We can cite two possibilities why upward mobility

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is sometimes harmful. Firstly, status incongruity refers to when upward mobility creates stress205

because the individual feels like an outsider in her new status/position. Striving for upward mobility
9and success can also induce stress, also known as the John Henryism phenomenon 29. Secondly, the207“long arm” of low childhood SES may continue to exert an influence on health even if the individual

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manages to escape from lower status, i.e. poor childhood SES persists even if someone achieves high209

SES in later life 30. For women in this study, there was a protective effect of ‘upward’ mobility. In

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theory, upward mobility for Japanese women could be even more stressful than in the west, because

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it was so non-normative and consequently women in positions of authority and power could become212very isolated. However, in the age-group represented by our cohort, we may assume that the majority

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of ‘upward’ mobility more closely reflected their father’s or spouse’s social class rather than their214

own 31 so that it may not be indicative of exposure to status incongruity.

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Our results are also notable for finding that mobility in SSS had a similar impact on mortality

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even after adjusting for objective SES. The contribution of SSS to mental and physical health—over217

and above the contribution of objective SES—has been previously discussed 5,32,33. Singh-Manoux et218

al. investigated the determinants of SSS in a cohort of middle-aged British civil servants 3. They219

concluded that classic objective SES such as occupational grade, income and education were highly

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correlated to SSS, but none of them fully explained the impact of SSS on health. Two possible

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explanations for the residual effect of SSS have been proposed 25: (a) SSS may reflect an individual’s

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SES more comprehensively than objective SES by capturing, for example, feelings of financial

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security, stocks of wealth, the respect of peers, satisfaction with standard of living, and so on; and (b)

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SSS may capture not only the objective social grade, but also people’s sense of their relative position
in society and its impact on health.

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On the other hand, the possibility of reverse causation between SSS and health, especially227

mental health, has also been raised as an alternative explanation 25,34. That is, depressed individuals

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are more likely to make pessimistic evaluations of their past and present circumstances. However, a229

strength of our study is that the outcome was objective (mortality), and not self-assessed (such as

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depression), thereby avoiding the threat of common method bias.

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Limitations of this study should be mentioned. First, childhood SSS was assessed via
10subjective recall. Previous research, however, supports the reliability of retrospective assessments of233

childhood SSS using siblings’ recall of childhood SSS 35. Second, our analysis was limited to all-234

cause mortality, and cause-specific mortality was not considered. Future studies should examine

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cause-specific mortality, such as coronary heart disease, stroke, or cancer, to clarify the effect of236

mobility in SSS among older Japanese adults, who are ranked as having the longest life expectancy

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in the world 36. Third, our findings may have been biased by selective survival due to the fact that all238

the participants were aged 65-100 years at baseline, i.e. more vulnerable population may have already239

died before the start of follow-up. Lastly, the duration of follow-up (three years) was comparatively

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short.

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In conclusion, our study found a possible harmful effect of downward SSS mobility on

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mortality among Japanese older men and protective effect of upward SSS mobility among women.

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The adverse downward effect was mediated by depression. Additionally, mobility in SSS in later life244

may have higher predictive value on mortality related to depression than objective SES. Mobility in

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SSS from childhood to older age may be important to be considered when assessing the mortality risk

246of older people.

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Conflict of Interest: The authors declare that they have no conflicts of interest.

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Funding: This study used data from JAGES (the Japan Gerontological Evaluation Study), which was
supported by the MEXT (Ministry of Education, Culture, Sports, Science and Technology, Japan)

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Supported Program for the Strategic Research Foundation at Private Universities (2009-2013), JSPS

253

(Japan Society for the Promotion of Science) KAKENHI (grant numbers JP18390200, JP22330172,

254

JP22390400, JP23243070, JP23590786, JP23790710, JP24390469, JP24530698, JP24683018,

255

JP25253052, JP25870573, JP25870881, JP26285138, JP26882010,JP15H01972), Health Labour

256

Sciences Research Grants (grant numbers H22-Choju-Shitei-008, H24-Junkanki [Seishu]- Ippan-007,

257

H24-Chikyukibo-Ippan-009, H24-Choju-Wakate-009, H25-Kenki-Wakate-015,H25-Choju-Ippan11

003, H26-Irryo-Shitei-003 [Fukkou], H26-Choju-Ippan-006, H27-Ninchisyou-Ippan-001), the259

Research and Development 37 Grants for Longevity Science from AMED (Japan Agency for Medical

260

Research and Development), the Personal Health Record (PHR) Utilization Project from AMED, the261

Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology

262(grant numbers 24-17, 24-23, 29-42) , World Health Organization Centre for Health Development

263(WHO Kobe Centre) (WHO APW 2017/713981). The views and opinions expressed in this article

264

are those of the authors and do not necessarily reflect the official policy or position of the respective

265

funding organizations.

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Acknowledgements: This study used data from the Japan Gerontological Evaluation Study (JAGES),

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conducted by the Center for Well-being and Society, Nihon Fukushi University. We thank other

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JAGES group members for their assistance. We also thank Emma Barber for editing our paper.

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13

Men (n=7,944)

Women (n=8,746)

N (%)

N (%)

65–69

2731 (34.4%)2844 (32.5%)

70–742332 (29.4%)

75–79

1656 (20.8%)

80 ≤1225 (15.4%)

sioTable 1 Characteristics of participants

2042 (25.7%)2756 (31.5%)

1588 (20.0%)2622 (30.0%)2531 (28.9%)
1800 (20.6%)
1571 (18.0%)

Ver

Mobility of SSS*
Persistently highed

Downward mobility
Upward mobilitynAge (years)

2829 (35.6%)2114 (24.2%)

1485 (18.7%)1254 (14.3%)

580 (7.3%)

1071 (12.2%)

Middle-short

1331 (16.8%)

2442 (27.9%)

Middle2498 (31.4%)2884 (33.0%)

Middle-tall

2066 (26.0%)

1461 (16.7%)

Tall1092 (13.7%)

389 (4.4%)

Missing

377 (4.7%)

499 (5.7%)

High (≥ 4.00)

851 (10.7%)782 (8.9%)

Middle (2.00 - 3.99)

2846 (35.8%)2569 (29.4%)

Low (< 2.00)

3201 (40.3%)3506 (40.1%)

Missing

1046 (13.2%)

1889 (21.6%)

Persistently low

ptHeighta

Ac

ce

Short

Equivalised income (million yen)

14

Education (years)
1654 (20.8%)971 (11.1%)

Middle (10 - 12)2528 (31.8%)2930 (33.5%)

Low (- 9)3465 (43.6%)4538 (51.9%)

Other/Missing

297 (3.7%)

307 (3.5%)nHigh (≥ 13)6748 (84.9%)

Widowed611 (7.7%)

Divorced

181 (2.3%)5056 (57.8%)2846 (32.5%)
321 (3.7%)

Ver

MarriedsioMarital status

Unmarried
Others/Missing

Non-smoker

190 (2.2%)

302 (3.8%)333 (3.8%)

ed

Smoking status

102 (1.3%)

1873 (23.6%)

7066 (80.8%)5516 (69.4%)

674 (7.7%)555 (7.0%)1006 (11.5%)

Current drinker/Ex-drinker

4778 (60.1%)

1332 (15.2%)

Non-drinker

2698 (34.0%)6923 (79.2%)

468 (5.9%)

491 (5.6%)< 30 min/day

2354 (29.6%)

2869 (32.8%)≥ 30 min/day

5156 (64.9%)

5279 (60.4%)

Missing

434 (5.5%)

598 (6.8%)

Underweight (< 18.5)

424 (5.3%)

699 (8.0%)

Normal (18.5–24.9)

5397 (67.9%)5749 (65.7%)

MissingAc

ce

Alcohol intake

pt

Smoker/ex-smoker

Missing

Walking time

Body weight status (BMI, kg/m2)

15

Overweight (25.0–29.9)

1612 (20.3%)1550 (17.7%)

Obesity (≥ 30.0)

128 (1.6%)

228 (2.6%)

Missing

383 (4.8%)520 (5.9%)

No depression (GDS** < 5)4970 (62.6%)5130 (58.7%)

Moderate depression (5 ≤ GDS < 10)1406 (17.7%)1490 (17.0%)

Depression (10 ≤ GDS)

496 (6.2%)

Missing1072 (13.5%)

si
o

a

n

Depressive symptoms

539 (6.2%)

1587 (18.1%)

Ve
r

Height (<155, 155–159.9, 160–164.9, 165–169.9, and ≥170cm for men and <145,

145–149.9, 150–154.9, 155–159.9, and ≥160cm for women).
*SSS = Subjective Socioeconomic Status

Ac

ce

pt

ed

**GDS = Geriatric Depression Scale

16

Model 2

Model 3Model 4

ref

ref

ref

ref

Downward

1.37 (1.08 - 1.74)

1.35 (1.05 - 1.72)

1.22 (0.95 - 1.56)

1.22 (0.95 - 1.56)

Upward0.87 (0.69 - 1.09)

0.85 (0.68 - 1.08)

0.83 (0.66 - 1.04)

0.84 (0.66 - 1.05)

Persistently low

0.95 (0.73 - 1.24)

0.91 (0.69 - 1.20)

0.83 (0.63 - 1.10)

0.78 (0.59 - 1.03)

Model 5Model 6

Model 7

Model 8Persistently high1.05 (0.80 - 1.37)

1.09 (0.83 - 1.44)

1.20 (0.91 - 1.58)

1.28 (0.97 - 1.69)

Downward

1.44 (1.10 - 1.88)

1.47 (1.13 - 1.93)

1.46 (1.12 - 1.91)

1.56 (1.19 - 2.04)

Upward

0.91 (0.71 - 1.18)

0.94 (0.72 - 1.22)

0.99 (0.76 - 1.29)

1.07 (0.82 - 1.39)

ref

ref

ref

ref

Persistently lowedModels 1 and 5 were adjusted for age

VerPersistently highnModel 1sioTable 2. Hazard ratio of SSS* mobility, SES** and other covariates among men (N=7,944)

Models 2 and 6 were additionally adjusted for height, equivalised income, education, marital status

pt

Models 3 and 7 were additionally adjusted for GDS***
Models 4 and 8 were additionally adjusted for smoking status, drinking habits, BMI**** and walking

ce

times

* SSS = Subjective Socioeconomic Status

Ac** SES = Socioeconomic Status*** GDS = Geriatric Depression Scale**** BMI = Body Mass Index

17Model 2

Model 3Model 4

ref

ref

ref

ref

Downward

1.27 (0.94 - 1.71)

1.22 (0.90 - 1.65)

1.10 (0.81 - 1.50)

1.08 (0.79 - 1.47)

Upward

0.71 (0.49 - 1.04)

0.69 (0.48 - 1.02)

0.68 (0.47 - 1.00)

0.69 (0.47 - 1.01)

Persistently low

1.33 (0.91 - 1.94)

1.20 (0.81 - 1.76)

1.07 (0.72 - 1.58)

1.01 (0.68 - 1.50)

Model 5Model 6

Model 7

Model 8Persistently high0.75 (0.52 - 1.10)

0.83 (0.57 - 1.23)

0.94 (0.63 - 1.38)

0.99 (0.67 - 1.47)

Downward

0.95 (0.66 - 1.38)

1.02 (0.70 - 1.48)

1.03 (0.71 - 1.49)

1.06 (0.73 - 1.55)

Upward0.54 (0.35 - 0.83)

0.58 (0.38 - 0.90)

0.64 (0.41 - 0.99)

0.68 (0.44 - 1.07)

ref

ref

ref

ref

ed

Persistently low

Ver

Persistently highnModel 1sioTable 3. Hazard ratios of SSS* mobility, SES** and other covariates among women (N=8,746)

Models 1 and 5 were adjusted for age

ptModels 2 and 6 were additionally adjusted for height, equivalised income, education, marital status
Models 3 and 7 were additionally adjusted for GDS***

times

ce

Models 4 and 8 were additionally adjusted for smoking status, drinking habits, BMI**** and walking

Ac* SSS = Subjective Socioeconomic Status** SES = Socioeconomic Status*** GDS = Geriatric Depression Scale**** BMI = Body Mass Index

18