Socio-economic inequalities in life expectancy of older adults with and without multimorbidity: a record linkage study of 1.1 million people in England. (3rd April 2019)

• Record Type: Journal Article
• Authors: Chan, Mei Sum; van den Hout, Ardo; Pujades-Rodriguez, Mar; Jones, Melvyn Mark; Matthews, Fiona E; Jagger, Carol; Raine, Rosalind; Bajekal, Madhavi
• Is Part Of: International journal of epidemiology. Volume 48:Number 4(2019)
• Page Start: 1340
• Page End: 1351
• Publication Date: 2019-04-03
• Subjects: Multimorbidity -- inequalities -- mortality -- health expectancy -- multi-state modelling; Epidemiology -- Periodicals; 614.4
• DOI: 10.1093/ije/dyz052
• Languages: English
• ISSNs: 0300-5771

Abstract

Abstract: Background: Age of onset of multimorbidity and its prevalence are well documented. However, its contribution to inequalities in life expectancy has yet to be quantified. Methods: A cohort of 1.1 million English people aged 45 and older were followed up from 2001 to 2010. Multimorbidity was defined as having 2 or more of 30 major chronic diseases. Multi-state models were used to estimate years spent healthy and with multimorbidity, stratified by sex, smoking status and quintiles of small-area deprivation. Results: Unequal rates of multimorbidity onset and subsequent survival contributed to higher life expectancy at age 65 for the least (Q1) compared with most (Q5) deprived: there was a 2-year gap in healthy life expectancy for men [Q1: 7.7 years (95% confidence interval: 6.4–8.5) vs Q5: 5.4 (4.4–6.0)] and a 3-year gap for women [Q1: 8.6 (7.5–9.4) vs Q5: 5.9 (4.8–6.4)]; a 1-year gap in life expectancy with multimorbidity for men [Q1: 10.4 (9.9–11.2) vs Q5: 9.1 (8.7–9.6)] but none for women [Q1: 11.6 (11.1–12.4) vs Q5: 11.5 (11.1–12.2)]. Inequalities were attenuated but not fully attributable to socio-economic differences in smoking prevalence: multimorbidity onset was latest for never smokers and subsequent survival was longer for never and ex smokers. Conclusions: The association between social disadvantage and multimorbidity is complex. By quantifying socio-demographic and smoking-related contributions to multimorbidity onset and subsequent survival, we provide evidence for more equitable allocation of prevention and health-care resources to meet local needs.