Life course socio-economic position and healthy ageing: A systematic review of longitudinal studies

Ye, Y., Long, C., Chua, K.-C., Moreno-Agostino, D., Prina, M.

Institute of Psychiatry, Psychology & Neuroscience, King\'s College LondonInstitute of Psychiatry, Psychology & Neuroscience, King\'s College London · medrxiv

Paper

Abstract

Abstract: Background: Increasing health inequalities among older adults globally illustrate the urgent need for effective interventions. Socio-economic position (SEP) may affect healthy ageing through various life course mechanisms. However, longitudinal associations between life course SEP and healthy ageing as a multidimensional construct remain unclear. Methods: We conducted a comprehensive systematic review of longitudinal studies investigating the associations between life course SEP indicators and multidimensional healthy ageing outcomes. A systematic literature search was conducted across four databases (MEDLINE, Embase, PsycINFO, and Web of Science) from inception to April 2025. Due to the heterogeneity in the operationalisation of SEP and healthy ageing, a narrative synthesis was performed (Prospero CRD42023418728). Results: 47 articles were included in the review. Across multiple SEP indicators and life stages, higher educational levels (39/43 studies, 90.7%) and higher income or wealth (31/36 studies, 86.1%) were positively associated with better healthy ageing. Occupation showed inconsistent evidence. Life-course evidence showed childhood SEP disadvantage predicted poorer later-life outcomes (13/17 studies), with cumulative multi-stage disadvantage showing additive effects (5 studies) and upward mobility conferring benefits (3 studies). These patterns manifested in three age-related inequality trajectories: widening (18/23 studies), convergence, and persistence, with education-cognitive disparities showing strongest widening effects. Cross-national evidence revealed regional specificities, including economic indicator preferences and context-specific stratification factors. Studies also identified gender moderation effects (5 studies) and examined mediating pathways (6 studies). Conclusion: Education showed the most consistent protective effects, while income/wealth effects were positive but complex. Health inequalities widened with age, highlighting lasting childhood impacts. Targeted interventions addressing early educational investment and life stage-specific strategies are needed for reducing healthy ageing inequalities.

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Research summary

Higher educational levels and income are positively associated with better healthy ageing outcomes. The paper addresses socio-economic factors that influence healthy ageing, which is a critical aspect of longevity research.

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