title: Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.
abstract: OBJECTIVE
  We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment.
  
  
  METHODS
  The English Longitudinal Study of Ageing, a panel study of 12,765 participants aged 50 years and older in four waves from 2004 to 2011, selected using a stratified random sample of households in England. Distribution of illness burden, diagnosis and treatment by wealth was estimated using regression analysis.
  
  
  METHODS
  The main outcome measures were ORs for the illness burden, diagnosis and treatment, respectively, adjusted for age, sex and wealth. We estimated the illness burden for angina with the Rose Angina scale, diabetes with fasting glycosylated haemoglobin, depression with the Centre for Epidemiologic Studies Depression Scale, osteoarthritis with self-reported pain and disability and cataract with self-reported poor vision. Medical diagnoses were self-reported for all conditions. Treatment was defined as β-blocker prescription for angina, surgery for osteoarthritis and cataract, and receipt of predefined effective interventions for diabetes and depression.
  
  
  RESULTS
  Compared with the wealthiest, the least wealthy participant had substantially higher odds for illness burden from any of the five conditions at all four time points, with ORs ranging from 4.2 (95% CI 2.6 to 6.8) for diabetes to 15.1 (11.4 to 20.0) for osteoarthritis. The ORs for diagnosis and treatment were smaller in all five conditions, and ranged from 0.9 (0.5 to 1.4) for diabetes treatment to 4.5 (3.3 to 6.0) for angina diagnosis.
  
  
  CONCLUSIONS
  The substantially higher illness burden in less wealthy participants was not matched by appropriately higher levels of diagnosis and treatment.
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: N
authors.initials: N
authors.lastname: Steel
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Hardcastle
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: M O
authors.initials: MO
authors.lastname: Bachmann
authors.affiliation: University of Exeter Medical School, Exeter, UK.
authors.forename: S H
authors.initials: SH
authors.lastname: Richards
authors.affiliation: University of Exeter Medical School, Exeter, UK.
authors.forename: L T A
authors.initials: LTA
authors.lastname: Mounce
authors.affiliation: Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: A
authors.initials: A
authors.lastname: Clark
authors.affiliation: NIHR CLAHRC South West Peninsula, Exeter, UK.
authors.forename: I
authors.initials: I
authors.lastname: Lang
authors.affiliation: University of Exeter Medical School, Exeter, UK.
authors.forename: D
authors.initials: D
authors.lastname: Melzer
authors.affiliation: University of Exeter Medical School, Exeter, UK.
authors.forename: J
authors.initials: J
authors.lastname: Campbell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002386:Cataract / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D057566:Self Report; D012959:Socioeconomic Factors
keywords: EPIDEMIOLOGY