Socio-economic inequalities in life expectancy of older adults with and without multimorbidity: A record linkage study of 1.1 million people in England

Chan, Mei Sum; Van Den Hout, Ardo; Pujades-Rodriguez, Mar; Jones, Melvyn Mark; Matthews, Fiona E.; Jagger, Carol; Raine, Rosalind; Bajekal, Madhavi

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.

Citation

Chan, M. S., Van Den Hout, A., Pujades-Rodriguez, M., Jones, M. M., Matthews, F. E., Jagger, C., Raine, R., & Bajekal, M. (2019). Socio-economic inequalities in life expectancy of older adults with and without multimorbidity: A record linkage study of 1.1 million people in England. International Journal of Epidemiology, 48(4), 1340-1351. https://doi.org/10.1093/ije/dyz052

• Journal Article Type: Article
• Publication Date: Aug 1, 2019
• Deposit Date: Dec 8, 2023
• Journal: International Journal of Epidemiology
• Print ISSN: 0300-5771
• Electronic ISSN: 1464-3685
• Publisher: Oxford University Press
• Volume: 48
• Issue: 4
• Pages: 1340-1351
• DOI: https://doi.org/10.1093/ije/dyz052
• Public URL: https://hull-repository.worktribe.com/output/4452164