Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study
Summary: Background: Social inequalities in mortality persist in high-income countries with universal health care, and the mechanisms by which these inequalities are generated remain unclear. We aimed to examine whether social inequalities were present before or after the onset of adverse health co...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-01-01
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| Series: | The Lancet Public Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468266719302269 |
| _version_ | 1818510587880013824 |
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| author | Aline Dugravot, MSc Aurore Fayosse, MSc Julien Dumurgier, PhD Kim Bouillon, PhD Tesnim Ben Rayana, MSc Alexis Schnitzler, PhD Mika Kivimaki, ProfFMedSci Séverine Sabia, PhD Archana Singh-Manoux, ProfPhD |
| author_facet | Aline Dugravot, MSc Aurore Fayosse, MSc Julien Dumurgier, PhD Kim Bouillon, PhD Tesnim Ben Rayana, MSc Alexis Schnitzler, PhD Mika Kivimaki, ProfFMedSci Séverine Sabia, PhD Archana Singh-Manoux, ProfPhD |
| author_sort | Aline Dugravot, MSc |
| collection | DOAJ |
| description | Summary: Background: Social inequalities in mortality persist in high-income countries with universal health care, and the mechanisms by which these inequalities are generated remain unclear. We aimed to examine whether social inequalities were present before or after the onset of adverse health conditions (multimorbidity, frailty, and disability). Methods: Our analysis was based on data from the ongoing Whitehall II cohort study, which enrolled British civil servants aged 35–55 years in 1985–88. Participants were assessed for three indicators of socioeconomic status (education, occupational position, and literacy) at age 50 years. Participants underwent clinical examinations (in 2002–04, 2007–09, 2012–13, and 2015–16) for assessment of frailty (two or more of low physical activity, slow walking speed, poor grip strength, weight loss, and exhaustion) and disability (two or more difficulties in bathing, dressing, going to the toilet, transferring, feeding, and walking). In addition, electronic health records were used to assess the incidence of multimorbidity (two or more of diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, arthritis, cancer, dementia, and Parkinson's disease) and mortality. In analyses adjusted for sociodemographic factors, we used multistate models to examine social inequalities in transitions from healthy state to adverse health conditions and subsequently to mortality. Findings: Of 10 308 individuals in the Whitehall II study cohort, 6425 had relevant data available at 50 years and to the end of follow-up on Aug 31, 2017, and were included in our analysis. Participants were followed up for a median of 23·6 years (IQR 19·6–28·9). 1694 (26·4%) of 6425 participants developed multimorbidity, 1733 (27·0%) became frail, 692 (10·8%) had a disability, and 611 (9·5%) died. Multimorbidity (hazard ratio [HR] 4·12 [95% CI 3·41–4·98]), frailty (HR 2·38 [95% CI 1·93–2·93]), and disability (HR 1·73 [95% CI 1·34–2·22]) were associated with increased risk of mortality; these associations were not modified by socioeconomic status. In multistate models, occupation was the socioeconomic status indicator that was most strongly associated with inequalities in the transition from healthy state to multimorbidity (HR 1·54 [95% CI 1·37–1·73]), to frailty (HR 2·08 [95% CI 1·85–2·33]), and to disability (HR 1·44 [95% CI 1·18–1·74]). Socioeconomic status indicators did not affect transitions to mortality in those with multimorbidity, frailty, or disability. Interpretation: Socioeconomic status affects the risk of multimorbidity, frailty, and disability, but does not affect the risk of mortality after the onset of these adverse health conditions. Therefore, primary prevention is key to reducing social inequalities in mortality. Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health. Funding: UK Medical Research Council; National Institute on Aging, National Institutes of Health; British Heart Foundation. |
| first_indexed | 2024-12-10T23:21:57Z |
| format | Article |
| id | doaj.art-52df9b04818947dfbd845a5620526680 |
| institution | Directory Open Access Journal |
| issn | 2468-2667 |
| language | English |
| last_indexed | 2024-12-10T23:21:57Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Public Health |
| spelling | doaj.art-52df9b04818947dfbd845a56205266802022-12-22T01:29:42ZengElsevierThe Lancet Public Health2468-26672020-01-0151e42e50Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort studyAline Dugravot, MSc0Aurore Fayosse, MSc1Julien Dumurgier, PhD2Kim Bouillon, PhD3Tesnim Ben Rayana, MSc4Alexis Schnitzler, PhD5Mika Kivimaki, ProfFMedSci6Séverine Sabia, PhD7Archana Singh-Manoux, ProfPhD8Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, FranceInserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, FranceInserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France; Cognitive Neurology Center, Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal, Assistance Hôpitaux Publique de Paris, Université de Paris, Paris, FranceDépartement d'Information Médicale, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, FranceInserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, FranceInserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, FranceDepartment of Epidemiology and Public Health, University College London, London, UKInserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France; Department of Epidemiology and Public Health, University College London, London, UKInserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France; Department of Epidemiology and Public Health, University College London, London, UK; Correspondence to: Prof Archana Singh-Manoux, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris 75010, FranceSummary: Background: Social inequalities in mortality persist in high-income countries with universal health care, and the mechanisms by which these inequalities are generated remain unclear. We aimed to examine whether social inequalities were present before or after the onset of adverse health conditions (multimorbidity, frailty, and disability). Methods: Our analysis was based on data from the ongoing Whitehall II cohort study, which enrolled British civil servants aged 35–55 years in 1985–88. Participants were assessed for three indicators of socioeconomic status (education, occupational position, and literacy) at age 50 years. Participants underwent clinical examinations (in 2002–04, 2007–09, 2012–13, and 2015–16) for assessment of frailty (two or more of low physical activity, slow walking speed, poor grip strength, weight loss, and exhaustion) and disability (two or more difficulties in bathing, dressing, going to the toilet, transferring, feeding, and walking). In addition, electronic health records were used to assess the incidence of multimorbidity (two or more of diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, arthritis, cancer, dementia, and Parkinson's disease) and mortality. In analyses adjusted for sociodemographic factors, we used multistate models to examine social inequalities in transitions from healthy state to adverse health conditions and subsequently to mortality. Findings: Of 10 308 individuals in the Whitehall II study cohort, 6425 had relevant data available at 50 years and to the end of follow-up on Aug 31, 2017, and were included in our analysis. Participants were followed up for a median of 23·6 years (IQR 19·6–28·9). 1694 (26·4%) of 6425 participants developed multimorbidity, 1733 (27·0%) became frail, 692 (10·8%) had a disability, and 611 (9·5%) died. Multimorbidity (hazard ratio [HR] 4·12 [95% CI 3·41–4·98]), frailty (HR 2·38 [95% CI 1·93–2·93]), and disability (HR 1·73 [95% CI 1·34–2·22]) were associated with increased risk of mortality; these associations were not modified by socioeconomic status. In multistate models, occupation was the socioeconomic status indicator that was most strongly associated with inequalities in the transition from healthy state to multimorbidity (HR 1·54 [95% CI 1·37–1·73]), to frailty (HR 2·08 [95% CI 1·85–2·33]), and to disability (HR 1·44 [95% CI 1·18–1·74]). Socioeconomic status indicators did not affect transitions to mortality in those with multimorbidity, frailty, or disability. Interpretation: Socioeconomic status affects the risk of multimorbidity, frailty, and disability, but does not affect the risk of mortality after the onset of these adverse health conditions. Therefore, primary prevention is key to reducing social inequalities in mortality. Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health. Funding: UK Medical Research Council; National Institute on Aging, National Institutes of Health; British Heart Foundation.http://www.sciencedirect.com/science/article/pii/S2468266719302269 |
| spellingShingle | Aline Dugravot, MSc Aurore Fayosse, MSc Julien Dumurgier, PhD Kim Bouillon, PhD Tesnim Ben Rayana, MSc Alexis Schnitzler, PhD Mika Kivimaki, ProfFMedSci Séverine Sabia, PhD Archana Singh-Manoux, ProfPhD Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study The Lancet Public Health |
| title | Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study |
| title_full | Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study |
| title_fullStr | Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study |
| title_full_unstemmed | Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study |
| title_short | Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study |
| title_sort | social inequalities in multimorbidity frailty disability and transitions to mortality a 24 year follow up of the whitehall ii cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S2468266719302269 |
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