Gender differences in the life course origins of adult functioning and mortality
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A high degree of physical functioning is necessary for independently performing the numerous routine and valued tasks of daily life. Poor functioning not only hinders independent living, it can lower the quality of life, impede full social participation, and elevate the risk of death. However, not all adults are at equal risk of poor functioning: women experience worse functioning and live a greater number of years functionally impaired compared with men. Studies of this gap have focused on inequities in adult circumstances, such as socioeconomic status, but have generally fallen short of fully accounting for it. Recasting this research within a life-course, epidemiological framework points to the potential role of early-life circumstances. Early-life circumstances may impart a biological imprint, and they may also launch long-term trajectories of social circumstances, that could differentially shape functioning for men and women. Thus, this dissertation examines the life course origins of the gender gap in functioning and active life expectancy among older U.S. adults using two nationally-representative datasets: the National Survey of Midlife Development in the United States and the Health and Retirement Study. In sum, the findings reveal that: (a) a host of early-life circumstances, such as parents’ education levels, leave an indelible stamp on functional ability and active life expectancy for women and men, irrespective of adult circumstances, (b) while some early-life adversities, such as extreme poverty, were marginally more consequential for women’s than men’s functioning, they appear to be primarily more consequential for precipitating metabolic conditions such as diabetes and obesity rather than directly impacting functioning, (c) explanations of the gap must incorporate endogenous biological differences between men and women; explanations that focus exclusively on socially-structured inequities are insufficient, and (d) exposures to socioeconomic resources accumulate across the life course to shape functioning differently for men than women; particularly between white men, who enjoy better functioning with higher educational attainment irrespective of early-life socioeconomic exposures, and white women whose functioning gains plateau if they experienced early-life socioeconomic adversities. Overall, the results underscore the importance of a life course perspective in explicating gender disparities in functioning, longevity, and active life expectancy.