Social Inequality and Visual Impairment in Older People

Jennifer Whillans, James Nazroo

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Objectives: Visual impairment is the leading cause of age-related disability, but the social patterning of loss of vision in older people has received little attention. This study’s objective was to assess the association between social position and
onset of visual impairment, to empirically evidence health inequalities in later life.

Method: Visual impairment was measured in 2 ways: self-reporting fair vision or worse (moderate) and self-reporting poor vision or blindness (severe). Correspondingly, 2 samples were drawn from the English Longitudinal Study on Ageing (ELSA). First, 7,483 respondents who had good vision or better at Wave 1; second, 8,487 respondents who had fair vision or better at Wave 1. Survival techniques were used.

Results: Cox proportional hazards models showed wealth and subjective social status (SSS) were significant risk factors associated with the onset of visual impairment. The risk of onset of moderate visual impairment was significantly higher for the lowest and second lowest wealth quintiles, whereas the risk of onset of severe visual impairment was significantly higher for the lowest, second, and even middle wealth quintiles, compared with the highest wealth quintile. Independently, lower SSS was associated with increased risk of onset of visual impairment (both measures), particularly so for those placing themselves on the lowest rungs of the social ladder.

Discussion: The high costs of visual impairment are disproportionately felt by the worst off elderly. Both low wealth and low SSS significantly increase the risk of onset of visual impairment.
Original languageEnglish
Article numbergbv163
Pages (from-to)532-542
Number of pages11
JournalJournals of Gerontology - Series B Psychological Sciences and Social Sciences
Issue number3
Publication statusPublished - 3 Feb 2016


  • Health inequalities
  • Longitudinal study
  • Social determinants of health
  • Subjective social status
  • Visual impairment
  • Wealth


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