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

Overview

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?

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.

Conditions

Interventions