The contribution of multiple long-term conditions to widening inequalities in disability-free life expectancy over two decades: Longitudinal analysis of two cohorts using the Cognitive Function and Ageing Studies.

BACKGROUND

: Disability-free life expectancy (DFLE) inequalities by socioeconomic deprivation are widening, alongside rising prevalence of multiple long-term conditions (MLTCs). We use longitudinal data to assess whether MLTCs contribute to the widening DFLE inequalities by socioeconomic deprivation.

METHODS

: The Cognitive Function and Ageing Studies (CFAS I and II) are large population-based studies of those ≥65 years, conducted in three areas in England. Baseline occurred in 1991 (CFAS I,

FINDINGS

: For people with MLTCs, inequalities in DFLE at age 65 between the most and least affluent widened to around 2.5 years (men:2.4 years, 95% confidence interval (95%CI) 0.4-4.4; women:2.6 years, 95%CI 0.7-4.5) by 2011. Incident disability reduced for the most affluent women (Relative Risk Ratio (RRR):0.6, 95%CI 0.4-0.9), and mortality with disability reduced for least affluent men (RRR:0.6, 95%CI 0.5-0.8). MLTCs prevalence increased only for least affluent men (1991: 58.8%, 2011: 66.9%) and women (1991: 60.9%, 2011: 69.1%). However, DFLE inequalities were as large in people without MLTCs (men:2.4 years, 95%CI 0.3-4.5; women:3.1 years, 95% CI 0.8-5.4).

INTERPRETATION

: Widening DFLE inequalities were not solely due to MLTCs. Reduced disability incidence with MLTCs is possible but was only achieved in the most affluent.

Informations de copyright

© 2021 The Author(s).

Déclaration de conflit d'intérêts

Dr. Bennett reports grants from Dunhill Medical Trust, grants from Medical Research Council, grants from Alzheimer's Society, grants from National Institute of Health Research, during the conduct of the study; Dr. Kingston reports grants from Dunhill Medical Trust, grants from Legal & General, from UKRI Innovate UK, from NIHR School for Primary Care Research, during the conduct of the study; .Dr. Kingston reports grants from Dunhill Medical Trust, grants from Legal & General, grants from UKRI Innovate UK, grants from NIHR School for Primary Care Research, during the conduct of the study;Dr. Lourida reports grants from Dunhill Medical Trust, grants from Medical Research Council, grants from National Institute of Health Research, grants from Alzheimer's Society, during the conduct of the study; Dr. Robinson reports grants from Dunhill Medical Trust, grants from Medical Research Council, grants from Alzheimer's Society, grants from National Institute of Health Research, during the conduct of the study; Dr. Corner reports grants from Dunhill Medical Trust, grants from Medical Research Council, grants from Alzheimer's Society, grants from National Institute of Health Research, during the conduct of the study; Dr. Brayne reports grants from Dunhill Medical Trust, grants from Medical Research Council, grants from Alzheimer's Society, grants from National Institute of Health Research, during the conduct of the study; Dr. Matthews reports grants from Dunhill Trust, NIHR, Medical Research Council, and the Alzheimer's Society UK, during the conduct of the study; Dr. Jagger reports grants from Dunhill Medical Trust, grants from Medical Research Council, grants from Alzheimer's Society, grants from National Institute of Health Research, during the conduct of the study.