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

17. november 2015 oppdatert av: Harry Hemingway, University College, London

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?

Studieoversikt

Status

Ukjent

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

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.

Studietype

Observasjonsmessig

Registrering (Forventet)

1300000

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Storbritannia
      • London, Storbritannia, WC1 E7H
        • University College London

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

45 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Ja

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

Patients included in the CALIBER dataset.

Beskrivelse

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.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Kohorter og intervensjoner

Gruppe / Kohort
Intervensjon / Behandling
Healthy
Patients without any of the pre-specified chronic diseases
Annen: 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
Annen: This is not an intervention study
This study is based on the retrospective analysis of linked electronic health records.

Hva måler studien?

Primære resultatmål

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

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Yearly non-accidental mortality rates
Tidsramme: 10 years
As outcome 3 but excluding accidental deaths from the numerator
10 years

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

University College, London

Samarbeidspartnere

University of Leeds

Etterforskere

  • Studieleder: Madhavi Bajekal, PhD, University College, London

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. januar 2015

Primær fullføring (Faktiske)

1. september 2015

Studiet fullført (Forventet)

1. januar 2017

Datoer for studieregistrering

Først innsendt

17. november 2015

Først innsendt som oppfylte QC-kriteriene

17. november 2015

Først lagt ut (Anslag)

20. november 2015

Oppdateringer av studieposter

Sist oppdatering lagt ut (Anslag)

20. november 2015

Siste oppdatering sendt inn som oppfylte QC-kriteriene

17. november 2015

Sist bekreftet

1. november 2015

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Andre studie-ID-numre

  • 14_179

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