Impact of Socioeconomic Inequalities in Transition Between Health, Multimorbidity and Death Amongst Older People

What is the Impact of Socioeconomic Inequalities in the Rates of Transition Between Health, Multimorbidity and Death Amongst Older People in England?

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?

Study Overview

• Status: Unknown
• Conditions: Multimorbidity
• Intervention / Treatment: Other: This is not an intervention study

Detailed Description

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.

• Study Type: Observational
• Enrollment (Anticipated): 1300000

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, WC1 E7H
    • University College London

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 45 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients included in the CALIBER dataset.

Description

Inclusion Criteria:

• 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.

Exclusion Criteria:

• Patients with a record unlinked to deprivation due to missing or incomplete postcode of residence.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Healthy; Patients without any of the pre-specified chronic diseases	Other: This is not an intervention study; This study is based on the retrospective analysis of linked electronic health records.
Multimorbid; Patients having any two or more of the pre-specified chronic diseases	Other: This is not an intervention study; This study is based on the retrospective analysis of linked electronic health records.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Yearly multimorbidity incidence rate	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	10 years
Yearly multimorbidity prevalence	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.	10 years
Yearly all-cause mortality rates	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.	10 years
Overall life expectancy	Incident rates of transitions between no disease, 1 disease, 2+ diseases, and death.	10 years
Health state-specific life expectancies	Incident rates of transitions between four health states - no disease, 1 disease, 2+ diseases, and death.	10 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Yearly non-accidental mortality rates	As outcome 3 but excluding accidental deaths from the numerator	10 years

Collaborators and Investigators

• Sponsor: University College, London
• Collaborators: University of Leeds
• Investigators: Study Director: Madhavi Bajekal, PhD, University College, London

Study record dates

Study Major Dates

• Study Start: January 1, 2015
• Primary Completion (Actual): September 1, 2015
• Study Completion (Anticipated): January 1, 2017

Study Registration Dates

• First Submitted: November 17, 2015
• First Submitted That Met QC Criteria: November 17, 2015
• First Posted (Estimate): November 20, 2015

Study Record Updates

• Last Update Posted (Estimate): November 20, 2015
• Last Update Submitted That Met QC Criteria: November 17, 2015
• Last Verified: November 1, 2015

More Information

Terms related to this study

• Keywords: Ageing; Mortality; Multimorbidity; Health inequalities
• Other Study ID Numbers: 14_179