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Dawn E. Alley, PhD, Beth J. Soldo, PhD, José A. Pagán, PhD, John McCabe, BA, Madeleine deBlois, MSEd, Samuel H. Field, PhD, David A. Asch, MD, MBA and Carolyn Cannuscio, ScD

Dawn E. Alley is with the Department of Epidemiology and Preventive Medicine, Division of Gerontology, University of Maryland School of Medicine, Baltimore. Beth J. Soldo and John McCabe are with the Population Aging Research Center, University of Pennsylvania, Philadelphia. José A. Pagán is with the Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, and the University of Texas-Pan American, Edinburg. Madeleine deBlois is with the Department of Society, Human Development, and Health at the Harvard School of Public Health, Boston, MA. Samuel H. Field is with the Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill. David A. Asch is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center and the Department of Health Care Management and Economics, University of Pennsylvania, Philadelphia. Carolyn Cannuscio is with the Department of Family Medicine and Community Health and the Leonard Davis Institute for Health Economics and the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia.

Correspondence: Correspondence should be sent to Dawn E. Alley, PhD, 660 West Redwood Street #221B, Baltimore, MD 21201 (e-mail: dalley{at}epi.umaryland.edu). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We examined associations between material resources and late-life declines in health.

Methods. We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15 441).

Results. Disadvantages in health care (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95% CI = 1.29, 2.22), and housing (OR = 1.20; 95% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95% CI = 1.29, 1.58) and food (OR = 1.64; 95% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.

Conclusions. Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.