Socioeconomic differences in healthy and disease-free life expectancy between ages 50 and 75: a multi-cohort study.

Jenny Head,Marie Zins,Jussi Vahtera,Paula Salo,Marcel Goldberg,Paola Zaninotto,Hugo Westerlund,Holendro Singh Chungkham,Martin Hyde,Sari Stenholm,Mika Kivimäki,Kristina Alexanderson

doi:10.1093/eurpub/cky215

Abstract

BackgroundThere are striking socioeconomic differences in life expectancy, but less is known about inequalities in healthy life expectancy and disease-free life expectancy. We estimated socioeconomic differences in health expectancies in four studies in England, Finland, France and Sweden.MethodsWe estimated socioeconomic differences in health expectancies using data drawn from repeated waves of the four cohorts for two indicators: (i) self-rated health and (ii) chronic diseases (cardiovascular, cancer, respiratory and diabetes). Socioeconomic position was measured by occupational position. Multistate life table models were used to estimate healthy and chronic disease-free life expectancy from ages 50 to 75.ResultsIn all cohorts, we found inequalities in healthy life expectancy according to socioeconomic position. In England, both women and men in the higher positions could expect 82–83% of their life between ages 50 and 75 to be in good health compared to 68% for those in lower positions. The figures were 75% compared to 47–50% for Finland; 85–87% compared to 77–79% for France and 80–83% compared to 72–75% for Sweden. Those in higher occupational positions could expect more years in good health (2.1–6.8 years) and without chronic diseases (0.5–2.3 years) from ages 50 to 75.ConclusionThere are inequalities in healthy life expectancy between ages 50 and 75 according to occupational position. These results suggest that reducing socioeconomic inequalities would make an important contribution to extending healthy life expectancy and disease-free life expectancy.

Highlights

At the first observation point when participants were included in the analysis, the prevalence of poor self-rated health ranged from 20% in France to 36% in Finland
The risk of mortality or poor self-reported health from a state of good self-reported health was higher for people in the lowest occupational group
Poor health state showed a similar gradient by occupational position

Summary

Introduction

The few studies that have examined socioeconomic inequalities in health expectancies found that those in lower socioeconomic groups are doubly disadvantaged by shorter life expectancy and more years spent in ill health.[6,7] Results showed that people with higher education live longer but spend more years in better health than those with a lower education.[8,9,10,11,12] Even fewer studies have investigated occupational socioeconomic position, a more proximal measure which may better reflect adulthood circumstances,[13] and these suggest that there are socioeconomic differences in health expectancies.[14,15] Given that many governments expect people to extend their working lives and that good health is associated with extended working, it is important to study socioeconomic inequalities in health expectancies. These results suggest that reducing socioeconomic inequalities would make an important contribution to extending healthy life expectancy and disease-free life expectancy

Methods

Results

Discussion

Conclusion