Chan, MS; van den Hout, A; Pujades-Rodriguez, M; Jones, MM; Matthews, FE; 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.
Int J Epidemiol, 48 (4).
pp. 1340-1351.
ISSN 1464-3685
https://doi.org/10.1093/ije/dyz052
SGUL Authors: Jones, Melvyn Mark
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.
Item Type: |
Article
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Additional Information: |
© The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
Keywords: |
Multimorbidity, health expectancy, inequalities, mortality, multi-state modelling, Aged, Aged, 80 and over, Chronic Disease, Cohort Studies, England, Female, Health Status, Humans, Life Expectancy, Male, Middle Aged, Multimorbidity, Poverty Areas, Risk Factors, Smoking, Socioeconomic Factors, Humans, Chronic Disease, Life Expectancy, Risk Factors, Cohort Studies, Smoking, Health Status, Socioeconomic Factors, Poverty Areas, Aged, Aged, 80 and over, Middle Aged, England, Female, Male, Multimorbidity, Multimorbidity, inequalities, mortality, health expectancy, multi-state modelling, Epidemiology, 0104 Statistics, 1117 Public Health and Health Services |
SGUL Research Institute / Research Centre: |
Academic Structure > Institute of Medical & Biomedical Education (IMBE) |
Journal or Publication Title: |
Int J Epidemiol |
ISSN: |
1464-3685 |
Language: |
eng |
Dates: |
Date | Event |
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1 August 2019 | Published | 3 April 2019 | Published Online | 13 March 2019 | Accepted |
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Publisher License: |
Creative Commons: Attribution-Noncommercial 4.0 |
Projects: |
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PubMed ID: |
30945728 |
Web of Science ID: |
WOS:000484383300039 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/112675 |
Publisher's version: |
https://doi.org/10.1093/ije/dyz052 |
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