地区层面的社会经济不平等在日常生活活动中无残疾预期寿命在英格兰：一个模型研究。

IF 13.4 Q1 GERIATRICS & GERONTOLOGY

Lancet Healthy Longevity Pub Date : 2025-04-01 DOI:10.1016/j.lanhl.2025.100700

Laurie E Davies PhD , David R Sinclair PhD , Prof Christopher Todd PhD , Prof Barbara Hanratty MD , Prof Fiona E Matthews PhD , Andrew Kingston PhD

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引用次数: 0

摘要

背景：需要更多关于无残疾预期寿命（DFLE）的社会经济不平等的证据，以帮助制定缩小社会经济最贫困和最贫困人群之间差距的方法。日常生活活动残疾是最严重和最昂贵的残疾阶段。使用联合纵向数据，我们旨在量化英格兰老年男性和女性ADL- dfle和ADL残疾总人年生活的区域层面的社会经济不平等。方法：在这项建模研究中，我们统一了来自英国三个纵向研究的50岁或以上个体的ADL残疾、区域剥夺、年龄和自我报告性别的数据：英国老龄化纵向研究（n= 11337）、认知功能和老龄化研究II （n=7469）和纽卡斯尔85+研究（n=847）。我们使用多状态模型，并按性别和地区社会经济地位（多重剥夺指数的80%）计算有和没有ADL残疾的剩余预期寿命。根据这些数据和英国国家统计局（Office for National Statistics） 2024年的人口数据，我们估计了来自社会经济最贫困地区的65岁以上ADL残障人士的额外年人数。结果：生活在最贫困地区的人与生活在最贫困地区的人相比，生活在最贫困地区的人发生ADL残疾的风险较低(风险比[HR] 0.61 [95% CI 0.55 ~ 0.69]；解读：解决健康方面潜在的社会经济不平等的有针对性的政策可能是长期的最终解决办法。资助：国家卫生和保健研究所健康老龄化政策研究单位。

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Area-level socioeconomic inequalities in activities of daily living disability-free life expectancy in England: a modelling study

Background

More evidence of socioeconomic inequalities in disability-free life expectancy (DFLE) is needed to help develop approaches to narrow the gap between the most and least socioeconomically deprived people. Activities of daily living (ADL) disability represents the most severe and expensive disablement stage. Using combined longitudinal data, we aimed to quantify area-level socioeconomic inequalities in ADL-DFLE and the total person-years lived with ADL disability, in older men and women in England.

Methods

In this modelling study, we harmonised data on ADL disability, area deprivation, age, and self-reported gender for individuals aged 50 years or older from three longitudinal studies in England: the English Longitudinal Study of Ageing (n=11 337), the Cognitive Function and Ageing Study II (n=7469), and the Newcastle 85+ Study (n=847). We used multistate modelling, and calculated the remaining life expectancy with and without ADL disability by gender and area-level socioeconomic status (<20%, 20–80%, and >80% of Index of Multiple Deprivation). From these data and Office for National Statistics population figures for the year 2024, we estimated the extra person-years lived with ADL disability by those aged 65 years from the most socioeconomically deprived areas.

Findings

Those living in the least deprived areas had a reduced risk of ADL disability compared with those in the most deprived areas (hazard ratio [HR] 0·61 [95% CI 0·55–0·69]; p<0·0001), as did those in the middle area-level socioeconomic group (HR 0·76 [0·69–0·84]; p<0·0001). Increasing area-level socioeconomic disadvantage was associated with reduced life expectancy and more time spent with ADL disability, particularly for women. Living in the most disadvantaged areas was associated with people having ADL disability 11·0 years earlier for men and 12·0 years earlier for women, compared with living in the least deprived areas. An extra 59 000 person-years for men and 88 000 person-years for women were lived with ADL disability by those in the most deprived areas, at the population level, compared with the least deprived areas.

Interpretation

Targeted policies to address underlying socioeconomic inequalities in health are likely to be the long-term definitive solution.

Funding

National Institute for Health and Care Research Policy Research Unit in Healthy Ageing.

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来源期刊

Lancet Healthy Longevity GERIATRICS & GERONTOLOGY-

CiteScore

16.30

自引率

2.30%

发文量

192

审稿时长

12 weeks

期刊介绍： The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.