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.

Results

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.

Conclusion

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

Full publication

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

(The Lancet Healthy Longevity)

Date

March 2025

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