Asymmetric behavioral responses to changes in subjective survival expectations: Implications for health investment in...

Subjective survival probability (SSP) is a key predictor of economic and health decisions in later life, yet existing research assumes that gains and losses in survival expectations have symmetric behavioral effects. This study examines how within-person changes in SSP are associated with health-promoting behaviors among middle-aged and older adults in South Korea.

Using ten waves of the Korean Longitudinal Study of Ageing (2006-2024), we estimate individual fixed-effects models on an analytic sample of 65,069 person-wave observations from 10,878 individuals aged 45 and older. We extend the standard symmetric model by adopting an asymmetric fixed-effects framework, which decomposes cumulative SSP increases and decreases into separate parameters.

The symmetric model shows that a one-unit increase in SSP (on a 0-10 scale) is associated with a 0.69 percentage-point increase in regular exercise, after controlling for self-rated health, chronic diseases, functional limitations, and socioeconomic characteristics. The asymmetric decomposition reveals two distinct patterns: exercise responds exclusively to SSP losses (loss-only), while paid health checkups respond only to SSP gains (gain-only). Formal symmetry tests reject equal absolute effects for both outcomes (p < .05).

These findings provide evidence that associations between changing survival expectations and health behaviors may be asymmetric. The domain-specific nature of these asymmetries-loss-only disengagement in exercise and gain-only investment in preventive care-suggests that interventions targeting middle-aged and older adults may benefit from considering potentially different mechanisms linking survival expectations to behavior across outcome domains.