What is the Impact of Socioeconomic Inequalities in the Rates of Transition Between Health, Multimorbidity and Death Amongst Older People in England?
试验速览
- 阶段
- 不适用
- 入组人数
- 1,300,000
- 试验地点
- 1
- 主要终点
- Overall life expectancy
研究概览
简要总结
Life expectancy at age 65 in the most deprived fifth of the English population was about 4 years shorter than of the most affluent fifth in 2010. The inverse gradient between mortality and social position is well established. But how disease patterns and multimorbidity (having two or more long term conditions at the same time) impact on differential mortality rates is inconclusive: is it because disadvantaged groups acquire more or more lethal combinations of, diseases over their life course; or, simply, become ill at ages younger than more affluent groups?
详细描述
The association between social inequality and cause-specific mortality and single disease morbidity has been studied extensively. However, it remains unclear whether having two or more chronic diseases concurrently (or 'multimorbidity') plays a role in contributing to the inequalities gap in survival. This is particularly relevant given an ageing population and the trend of a widening in the life expectancy gap across several European countries.
Multimorbidity incidence increases rapidly with age. Estimates of the prevalence of multimorbidity in older people range from 55% to 98%, mainly due to the selection of diseases included, population coverage (hospital, community) and data source (self-reported surveys or clinical records). However, across all studies there is a clear and consistent pattern of higher prevalence rates at older ages, with multimorbidity.
Many aspects of the patient health trajectory remain under-explored. Patient case-mixes are likely to vary across socioeconomic groups, alongside a host of prognostic factors, including the clustering of multiple risk factors, age of onset, and disease presentation, progression and management in the presence of multiple health conditions.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 45 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Registered with a participating practice that has agreed to data linkage
- •Registered with an 'up to standard' participating general practice for at least 1 year
- •Aged 45 and over on Jan 1st 2001 or who turn 45 between 1st Jan 2001 and 25th March 2010, irrespective of initial health status.
排除标准
- •Patients with a record unlinked to deprivation due to missing or incomplete postcode of residence.
结局指标
主要结局
Overall life expectancy
时间窗: 10 years
Incident rates of transitions between no disease, 1 disease, 2+ diseases, and death.
Yearly multimorbidity incidence rate
时间窗: 10 years
Numerator: Of patients with either 0 or 1 chronic diseases as on 1st Jan of the year, all those who become multimorbid by 31st Dec of the year. Denominator: patient years at risk of patients with either 0 or 1 chronic diseases as on 1st Jan of the year
Yearly multimorbidity prevalence
时间窗: 10 years
Numerator: all those with 2 or more listed diseases on 1st July of the year. Denominator: All eligible patients on 1st July of the year, irrespective of disease status on that date.
Health state-specific life expectancies
时间窗: 10 years
Incident rates of transitions between four health states - no disease, 1 disease, 2+ diseases, and death.
Yearly all-cause mortality rates
时间窗: 10 years
Numerator: number of deaths until 31st Dec of the year amongst the patients included in the denominator. Denominator: Person years at risk of patients with 0,1,2 or more diseases on 1st Jan of the year.
次要结局
- Yearly non-accidental mortality rates(10 years)
研究者
Harry Hemingway
Professor of Epidemiology and Public Health
University College, London