Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in context
Summary: Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | The Lancet Regional Health. Europe |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776223001060 |
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| author | Jane Lyons Ashley Akbari Keith R. Abrams Amaya Azcoaga Lorenzo Thamer Ba Dhafari James Chess Spiros Denaxas Richard Fry Chris P. Gale John Gallacher Lucy J. Griffiths Bruce Guthrie Marlous Hall Farideh Jalali-najafabadi Ann John Clare MacRae Colin McCowan Niels Peek Dermot O’Reilly James Rafferty Ronan A. Lyons Rhiannon K. Owen |
| author_facet | Jane Lyons Ashley Akbari Keith R. Abrams Amaya Azcoaga Lorenzo Thamer Ba Dhafari James Chess Spiros Denaxas Richard Fry Chris P. Gale John Gallacher Lucy J. Griffiths Bruce Guthrie Marlous Hall Farideh Jalali-najafabadi Ann John Clare MacRae Colin McCowan Niels Peek Dermot O’Reilly James Rafferty Ronan A. Lyons Rhiannon K. Owen |
| author_sort | Jane Lyons |
| collection | DOAJ |
| description | Summary: Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK. Methods: Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000–2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups. Findings: In total, 965,905 individuals aged 5–104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (−0.45 years (99% CI: −0.45, −0.44)) and in 70 year old males dying after developing multimorbidity (−1.98 years (99% CI: −2.01, −1.95)). Interpretation: This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks. Funding: UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales. |
| first_indexed | 2024-03-12T23:05:16Z |
| format | Article |
| id | doaj.art-fa7c73ea5ef841fe8910fd7055841c8f |
| institution | Directory Open Access Journal |
| issn | 2666-7762 |
| language | English |
| last_indexed | 2024-03-12T23:05:16Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj.art-fa7c73ea5ef841fe8910fd7055841c8f2023-07-19T04:23:58ZengElsevierThe Lancet Regional Health. Europe2666-77622023-09-0132100687Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in contextJane Lyons0Ashley Akbari1Keith R. Abrams2Amaya Azcoaga Lorenzo3Thamer Ba Dhafari4James Chess5Spiros Denaxas6Richard Fry7Chris P. Gale8John Gallacher9Lucy J. Griffiths10Bruce Guthrie11Marlous Hall12Farideh Jalali-najafabadi13Ann John14Clare MacRae15Colin McCowan16Niels Peek17Dermot O’Reilly18James Rafferty19Ronan A. Lyons20Rhiannon K. Owen21Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK; Corresponding author. Swansea University Medical School, Data Science Building, Singleton Park, Swansea, Wales SA2 8PP, UK.Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UKDepartment of Statistics, University of Warwick, Coventry, UK; Centre for Health Economics, University of York, York, UKInstituto Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain; School of Medicine, University of St Andrews, St Andrews, UKDivision of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UKSwansea Bay Health Board, Morriston Hospital, Swansea, Wales, UKInstitute of Health Informatics, University College London, London, UKPopulation Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UKSchool of Medicine, University of Leeds, Leeds, UKDementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UKPopulation Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UKAdvanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UKLeeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UKCentre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UKPopulation Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UKAdvanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UKSchool of Medicine, University of St Andrews, St Andrews, UKDivision of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UKSchool of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UKSwansea Trials Unit, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UKPopulation Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UKPopulation Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UKSummary: Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK. Methods: Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000–2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups. Findings: In total, 965,905 individuals aged 5–104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (−0.45 years (99% CI: −0.45, −0.44)) and in 70 year old males dying after developing multimorbidity (−1.98 years (99% CI: −2.01, −1.95)). Interpretation: This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks. Funding: UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales.http://www.sciencedirect.com/science/article/pii/S2666776223001060Chronic diseaseMortalityDisease trajectoriesPopulation-wideHealth equity |
| spellingShingle | Jane Lyons Ashley Akbari Keith R. Abrams Amaya Azcoaga Lorenzo Thamer Ba Dhafari James Chess Spiros Denaxas Richard Fry Chris P. Gale John Gallacher Lucy J. Griffiths Bruce Guthrie Marlous Hall Farideh Jalali-najafabadi Ann John Clare MacRae Colin McCowan Niels Peek Dermot O’Reilly James Rafferty Ronan A. Lyons Rhiannon K. Owen Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in context The Lancet Regional Health. Europe Chronic disease Mortality Disease trajectories Population-wide Health equity |
| title | Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in context |
| title_full | Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in context |
| title_fullStr | Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in context |
| title_full_unstemmed | Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in context |
| title_short | Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individualsResearch in context |
| title_sort | trajectories in chronic disease accrual and mortality across the lifespan in wales uk 2005 2019 by area deprivation profile linked electronic health records cohort study on 965 905 individualsresearch in context |
| topic | Chronic disease Mortality Disease trajectories Population-wide Health equity |
| url | http://www.sciencedirect.com/science/article/pii/S2666776223001060 |
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