Socio-economic inequalities in life expectancy of older adults with and without multimorbidity: a record linkage study of 1.1 million people in England
Socio-economic inequalities in life expectancy of older adults with and without multimorbidity: a record linkage study of 1.1 million people in England
复制标题
DOI：
10.1093/ije/dyz052
复制
发表时间：
2019-08-01
影响因子：
7.7
通讯作者：
Bajekal, Madhavi
中科院分区：
文献类型：
--
作者：
Chan, Mei Sum;van den Hout, Ardo;Bajekal, Madhavi
背景：多病的发病年龄及其患病率有很好的文献记载。然而，它对预期寿命不平等的影响还有待量化。方法2001年至2010年对110万名年龄在45岁及以上的英国人进行随访。多病被定义为患有30种主要慢性疾病中的2种或2种以上。多状态模型用于估计健康和多发病率的年数，按性别、吸烟状况和小区域贫困的五分位数分层。结果：不同比例的多病发病和随后的生存导致65岁时最少（Q1）的预期寿命比最多（Q5）的预期寿命更高：男性的健康预期寿命差距为2年[Q1: 7.7年（95%可信区间：6.4-8.5）vs Q5: 5.4(4.4-6.0)]，女性的健康预期寿命差距为3年[Q1: 8.6 (7.5-9.4) vs Q5: 5.9 (4.8-6.4)]；男性的多重疾病预期寿命差距为1年[Q1: 10.4 (9.9-11.2) vs Q5: 9.1(8.7-9.6)]，但女性没有[Q1: 11.6 (11.1-12.4) vs Q5: 11.5(11.1-12.2)]。不平等现象有所减少，但不能完全归因于吸烟率的社会经济差异：从不吸烟者的多病发病时间较晚，从不吸烟者和曾经吸烟者的多病存活时间较长。结论社会劣势与多重发病的关系是复杂的。通过量化社会人口统计学和吸烟相关因素对多病发病和随后生存的影响，我们为更公平地分配预防和保健资源以满足当地需求提供了证据。
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: 7.7years (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.