BMC public health · 2026
Socioeconomic inequalities in disability among older adults in urban and rural Indonesia: a population-based study.
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Witriani Witriani, Puspitasari Mardiana Dwi, Rahardja Mugia Bayu
Аннотация
BACKGROUND: Disability may restrict older adults' ability to exercise their rights to health and well-being. The living environment has a significant impact on reducing the risk of disability. Unfortunately, financial insecurity may limit Indonesian older adults' access to age-friendly services in their environment. This study aims to monitor socioeconomic inequalities in disability, considering both urban and rural contexts.
METHODS: The unit of analysis included 129,234 older adults aged 60 and over residing in 514 districts. Data were drawn from the combined datasets of the 2023 National Socioeconomic Survey (SUSENAS) and the 2021 Village Data Census (PODES). Disability status, measured using the Washington Group Six Short questions (WG-SS), was the outcome variable. Socioeconomic Status (SES) was assessed by household expenditure and educational attainment. The Intraclass Correlation Coefficient (ICC) was used to analyze the association between districts and socioeconomic inequalities in disability status. The Relative Index of Inequality (RII) was estimated using log-binomial regression models, adjusting for age, sex, marital status, Self-Rated Health Status (SRHS), and access to primary care facilities and open public space within the district.
RESULTS: Indonesia's urban and rural areas had ICC values of 22.8%, 20.3%, and 18.9%, respectively. The RII revealed statistically significant differences in disability status. The disparity between the lowest and highest education levels was greater in urban areas (RII = 1.311) than in rural areas (RII = 1.154). Similarly, for household expenditure, the disparity was greater in urban (RII = 1.186) than rural areas (RII = 1.150). As disability is an adverse health outcome, an RII value of more than 1 implies a higher risk of disability among lower SES groups; thus, the risk of disability increases with decreasing SES.
CONCLUSIONS: While area development is necessary to minimize the risk of disability, disparities in disability status among older adults with the highest and lowest SES are more pronounced in urban than in rural areas. Addressing issues of person-environment fit is essential to eliminate socioeconomic inequalities in disability status.
METHODS: The unit of analysis included 129,234 older adults aged 60 and over residing in 514 districts. Data were drawn from the combined datasets of the 2023 National Socioeconomic Survey (SUSENAS) and the 2021 Village Data Census (PODES). Disability status, measured using the Washington Group Six Short questions (WG-SS), was the outcome variable. Socioeconomic Status (SES) was assessed by household expenditure and educational attainment. The Intraclass Correlation Coefficient (ICC) was used to analyze the association between districts and socioeconomic inequalities in disability status. The Relative Index of Inequality (RII) was estimated using log-binomial regression models, adjusting for age, sex, marital status, Self-Rated Health Status (SRHS), and access to primary care facilities and open public space within the district.
RESULTS: Indonesia's urban and rural areas had ICC values of 22.8%, 20.3%, and 18.9%, respectively. The RII revealed statistically significant differences in disability status. The disparity between the lowest and highest education levels was greater in urban areas (RII = 1.311) than in rural areas (RII = 1.154). Similarly, for household expenditure, the disparity was greater in urban (RII = 1.186) than rural areas (RII = 1.150). As disability is an adverse health outcome, an RII value of more than 1 implies a higher risk of disability among lower SES groups; thus, the risk of disability increases with decreasing SES.
CONCLUSIONS: While area development is necessary to minimize the risk of disability, disparities in disability status among older adults with the highest and lowest SES are more pronounced in urban than in rural areas. Addressing issues of person-environment fit is essential to eliminate socioeconomic inequalities in disability status.