Affiliation:
1. Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
2. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Abstract
Abstract
Background
Despite increasing life expectancy (LE), cross-sectional data show widening inequalities in disability-free LE (DFLE) by socioeconomic status (SES) in many countries. We use longitudinal data to better understand trends in DFLE and years independent (IndLE) by SES, and how underlying transitions contribute.
Methods
The Cognitive Function and Ageing Studies (CFAS I and II) are large population-based studies of those aged ≥65 years in three English centres (Newcastle, Nottingham, Cambridgeshire), with baseline around 1991 (CFAS I, n = 7635) and 2011 (CFAS II, n = 7762) and 2-year follow-up. We defined disability as difficulty in activities of daily living (ADL), dependency by combining ADLs and cognition reflecting care required, and SES by area-level deprivation. Transitions between disability or dependency states and death were estimated from multistate models.
Results
Between 1991 and 2011, gains in DFLE at age 65 were greatest for the most advantaged men and women [men: 4.7 years, 95% confidence interval (95% CI) 3.3–6.2; women: 2.8 years, 95% CI 1.3–4.3]. Gains were due to the most advantaged women having a reduced risk of incident disability [relative risk ratio (RRR):0.7, 95% CI 0.5–0.8], whereas the most advantaged men had a greater likelihood of recovery (RRR: 1.8, 95% CI 1.0–3.2) and reduced disability-free mortality risk (RRR: 0.4, 95% CI 0.3–0.6]. Risk of death from disability decreased for least advantaged men (RRR: 0.7, 95% CI 0.6–0.9); least advantaged women showed little improvement in transitions. IndLE patterns across time were similar.
Conclusions
Prevention should target the most disadvantaged areas, to narrow inequalities, with clear indication from the most advantaged that reduction in poor transitions is achievable.
Funder
Dunhill Medical Trust and the National Institute for Health Research (NIHR) Policy Research Programme
NIHR Older People and Frailty Policy Research Unit
NIHR or the Department of Health and Social Care
UK Medical Research Council
Alzheimer’s Society
UK National Institute for Health Research (NIHR) comprehensive clinical research networks in West Anglia and Trent
Dementias and Neurodegenerative Disease Research Network in Newcastle. MRC CFAS
MRC and the UK National Health Service
Dunhill Medical Trust
Newcastle University Research Fellowship
UK NIHR collaboration for leadership in applied health research and care for Cambridgeshire and Peterborough and the Cambridge Biomedical Research Centre infrastructures
Nottingham city and Nottinghamshire county NHS primary care trusts
UK NIHR Policy Research Programme
Publisher
Oxford University Press (OUP)
Subject
General Medicine,Epidemiology
Cited by
27 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献