Inequalities in health at older ages: a longitudinal investigation of the onset of illness and survival effects in England.
BACKGROUND
previous studies have suggested a decline in the relationship between socioeconomic circumstances and health or functioning in later life, but this may be due to survival effects.


OBJECTIVE
to examine whether wealth gradients in the incidence of illness decline with age, and, if so, whether this decline is explained by differential mortality.


METHODS
the study included participants in the first two waves of the English Longitudinal Study of Ageing (ELSA), a large national longitudinal study of the population aged 50+ in England, who reported good health, no functional impairment, or no heart disease at baseline. Wealth inequalities in onset of illness over 2 years were examined across age groups, with and without the inclusion of mortality. Outcome measures were functional impairment, heart disease, self-reported health, and all-cause mortality (in conjunction with self-reported health and disability) or circulatory-related mortality (in relation to heart disease).


RESULTS
wealth predicted onset of functional impairment equally across age groups. For self-reported health and heart disease, wealth gradients in the onset of illness declined with age. Selective mortality contributed to this decline in the oldest age groups.


CONCLUSIONS
socioeconomic inequality in developing new health problems persist into old age for certain illnesses, particularly functional impairment, but not for heart disease. Selective mortality explains only some of the decline in health inequalities with age.
McMunn
Anne
A
Department of Epidemiology & Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. a.mcmunn@ucl.ac.uk
Nazroo
James
J
Breeze
Elizabeth
E
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D012959:Socioeconomic Factors