Wealth adds 8-9 healthy years to life expectancy

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The wealthiest men and women can expect to live an additional eight to nine years free from disability compared to people in the poorest groups, according to University College London (UCL)-led research. The study analysed data from 10,754 and 14,803 adults aged 50 and over from the English Longitudinal Study of Ageing (ELSA) and the US Health and Retirement Study (HRS), respectively.

The researchers set out to examine how long people in England and the US can expect to live free from disabilities such as being unable to get in and out of bed or unable to cook for themselves, and to what extent socioeconomic factors play a part. Data was collected from study participants in 2002 and they were followed for a period of 10 years until 2013.

The researchers found that socioeconomic inequalities in disability-free life expectancy were similar across all ages in England and the US but the biggest socioeconomic advantage in both countries and across all age groups was wealth. Dr Paola Zaninotto (UCL Epidemiology and Health Care), lead author, said: “While life expectancy is a useful indicator of health, the quality of life as we get older is also crucial. By measuring healthy life expectancy, we can get an estimate of the number of years of life spent in favourable states of health or without disability.

“Our study makes a unique contribution to understanding the levels of inequalities in health expectancies between England and the US where healthcare systems are very different.” In both countries, people in the study were divided into three groups ( each containing 33% of the sample) based on total household wealth (the sum of net financial wealth and net housing wealth minus all debts) and comparisons were made between the richest and least wealthy groups.

The paper shows that at age 50 the wealthiest men in England and the US lived around an additional 31 ‘healthy’ years compared to around 22-23 years for those in the poorest wealth groups. Women from the wealthiest groups from the US and England lived around an additional 33 ‘healthy’ compared to 24.6 and 24 years from the poorest wealth groups in England the US respectively.

Zaninotto added: “We know that improving both the quality and the quantity of years that individuals are expected to live has implications for public expenditure on health, income, long-term care of older people and work participation and our results suggest that policy makers in both England and the US must make greater efforts into reducing health inequalities.”

The authors comprised of an international team of researchers from UCL, University of Turku and the National Institute for Health and Welfare in Finland, Harvard University, Swansea University, Inserm and Stockholm University.

The English Longitudinal Study of Ageing is supported by the National Institute on Aging and a consortium of the UK government departments coordinated by the National Institute for Health Research (NIHR). The Health and Retirement Study is supported by the National Institute on Aging.

Abstract
Background: We examined socioeconomic inequalities in disability-free life expectancy in older men and women from England and the United States and explored whether people in England can expect to live longer and healthier lives than those in the United States.
Methods: We used harmonized data from the Gateway to Global Aging Data on 14,803 individuals aged 50+ from the U.S. Health and Retirement Study (HRS) and 10,754 from the English Longitudinal Study of Ageing (ELSA). Disability was measured in terms of impaired activities and instrumental activities of daily living. We used discrete-time multistate life table models to estimate total life expectancy and life expectancy free of disability.
Results: Socioeconomic inequalities in disability-free life expectancy were of a similar magnitude (in absolute terms) in England and the United States. The socioeconomic disadvantage in disability-free life expectancy was largest for wealth, in both countries: people in the poorest group could expect to live seven to nine fewer years without disability than those in the richest group at the age of 50.:
Conclusions: Inequalities in healthy life expectancy exist in both countries and are of similar magnitude. In both countries, efforts in reducing health inequalities should target people from disadvantaged socioeconomic groups.

Authors
Paola Zaninotto, George David Batty, Sari Stenholm, Ichiro Kawachi, Martin Hyde, Marcel Goldberg, Hugo Westerlund, Jussi Vahtera, Jenny Head

University College London

Journal of Gerontology abstract

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