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Lookup NU author(s): Dr Holly Bennett, Dr Andrew KingstonORCiD, Dr Gemma Frances SpiersORCiD, Dr Louise Robinson, Dr Lynne Corner, Professor Clare BambraORCiD, Professor Carol Brayne, Professor Fiona MatthewsORCiD, Emerita Professor Carol Jagger
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Background: Despite increasing life expectancy (LE), cross-sectional data shows 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 ≥65 years in three English centres (Newcastle, Nottingham, Cambridgeshire), with baseline around 1991 (CFAS I, n=7635) and 2011 (CFAS II, n=7762) and two 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), whilst 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. Conclusion: Prevention should target the most disadvantaged areas to narrow inequalities, with clear indication from the most advantaged that reduction in poor transitions is achievable.
Author(s): Bennett HQ, Kingston A, Spiers G, Robinson L, Corner L, Bambra C, Brayne C, Matthews FE, Jagger C
Publication type: Article
Publication status: Published
Journal: International Journal of Epidemiology
Year: 2021
Volume: 50
Issue: 3
Pages: 841-851
Print publication date: 01/06/2021
Online publication date: 09/01/2021
Acceptance date: 10/12/2020
Date deposited: 29/01/2021
ISSN (print): 0300-5771
ISSN (electronic): 1464-3685
Publisher: Oxford University Press
URL: https://doi.org/10.1093/ije/dyaa271
DOI: 10.1093/ije/dyaa271
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