Socio-economic inequalities in life expectancy of older adults with and without multimorbidity: A record linkage study of 1.1 million people in England
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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.
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CPRD has been employed previously to investigate socio-economic and demographic factors in variation in care of physical and mental health conditions.
“CPRD has been employed previously to investigate socio-economic and demographic factors in variation in care of physical and mental health conditions [27,28].”
From The Impact of demographic, socio-economic and geographic factors on mortality risk among people living with dementia in England (2002–2016) (2021) · cites this paper as [27]
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- Authors
- Chan, M. S., van den Hout, A., Pujades-Rodriguez, M., Jones, M. M., Matthews, F. E., Jagger, C., Raine, R., & Bajekal, M.
- Affiliations
- University of Oxford (GB)
- Department of Statistical Science, University College London, London, UK
- Health Science Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- University College London (GB)
- Newcastle University (GB)
- Corresponding author
- Bajekal, Madhavi
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-04-03
- Volume
- 48
- Issue
- 4
- Pages
- 1340-1351
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC6693817
- OpenAlex
- W2919188527
- Cited by
- 57
- References
- 24
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 8 · 2023: 10 · 2022: 10 · 2021: 10 · 2020: 7 · 2017: 1
- FWCI
- 5.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Epidemiology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc)
- Funders
- Legal & General Assurance Society Ltd
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Keywords
- multimorbidity, life expectancy, socioeconomic disparities, older adults, small-area deprivation, smoking, healthy life expectancy, survival, sex differences, chronic disease, health disparities
- MeSH terms
- Multimorbidity, Aged, Aged, 80 and over, Chronic Disease, England, Female, Health Status, Humans, Life Expectancy, Male, Middle Aged, Poverty Areas, Risk Factors, Smoking, Socioeconomic Factors, Cohort Studies
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