title: Social inequalities and disability in older men: prospective findings from the British regional heart study.
abstract: The independent association of socio-economic position with self-reported disability was assessed. The effect of home and car ownership as additional indices of socio-economic position within occupational social classes was explored. Data from a prospective study of a cohort of 7735 men aged 40-59 years at recruitment and representative of the occupational social class distribution of middle-aged men in Great Britain were used. Men were selected from one general practice in each of 24 towns in England, Wales and Scotland in 1978-1980. The present study concerns 5773 (88.4% of those able to take part) men aged 52-73 years at follow up in 1992 who completed the disability section of a postal questionnaire. A quarter (1453) of men reported disability. Socio-economic position measured as both occupational class (social class I vs. V: age-adjusted OR 5.0, 95% CI 3.4-7.5) and ownership of home and car (both vs. neither: age-adjusted OR 2.8, 95% CI 2.3-3.4) showed a graded relationship with likelihood of reporting disability in 1992. Within all social class groups, those owning both home and car had a lower risk of disability than those who owned neither, even after adjustment for a wide range of risk factors. Men from manual occupations were more likely than those in non-manual occupations to report disability on developing chronic diseases. The relationship between socio-economic position and severe, but not milder, disability appeared to be independent of disease status. Socio-economic position is a strong predictor of disability in later life independent of a wide range of lifestyle factors and presence of diagnosed disease. The likelihood of reporting disability between and within social class groups is influenced by material wealth.
authors.affiliation: MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. shah.ebrahim@bristol.ac.uk
authors.forename: Shah
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Olia
authors.initials: O
authors.lastname: Papacosta
authors.forename: Goya
authors.initials: G
authors.lastname: Wannamethee
authors.forename: Joy
authors.initials: J
authors.lastname: Adamson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology*; D002908:Chronic Disease; D006233:Persons with Disabilities / Q000145:classification* / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D018434:Sickness Impact Profile; D012923:Social Class; D012959:Socioeconomic Factors; D012962:Sociology, Medical; D006113:United Kingdom / Q000453:epidemiology