Matthews Ruth J, Jagger Carol, Hancock Ruth M
University of Leicester, Leicester, UK.
Soc Sci Med. 2006 May;62(10):2489-99. doi: 10.1016/j.socscimed.2005.11.019. Epub 2005 Dec 20.
The effect of socio-economic disadvantage on mortality is well documented and differences exist even at older ages. However, whether this translates into differences in the quality of life lived at older ages is less well studied, and in particular in the proportion of remaining life spent without ill health (healthy life expectancy), a key UK Government target. Although there have been studies exploring socio-economic differences in disability-free life expectancy (DFLE) worldwide, these have tended to focus on a single measure of socio-economic advantage, for example, education, race, social class or income, with the majority based on cross-sectional data from younger populations. In this prospective study we examine differences in DFLE and total life expectancy (TLE) at older ages using a range of measures of socio-economic advantage. We use a longitudinal study of 1480 participants aged 75 years or over in 1988 registered with a UK primary care practice, who were followed up until 2003 with measurements at up to seven time points. Disability was defined as difficulty with any one of five activities of daily living. The largest differences in DFLE for both men and women were found for housing tenure. Women aged 75 years living in owned or mortgaged property could expect to live 1 year extra without disability compared with those living in rented accommodation, while for men the difference was almost 1.5 years. The effect of socio-economic advantage on disability-free and total life expectancies appeared to be larger for men than women. In women, socio-economic advantage had more effect on DFLE than total life expectancy for all indicators considered, thus the socio-economically advantaged experienced a compression of disability.
社会经济劣势对死亡率的影响已有充分记录,甚至在老年阶段也存在差异。然而,这种差异是否会转化为老年生活质量的差异,尤其是在无健康问题的剩余寿命比例(健康预期寿命,这是英国政府的一个关键目标)方面,研究较少。尽管全球已有研究探讨无残疾预期寿命(DFLE)方面的社会经济差异,但这些研究往往只关注单一的社会经济优势衡量指标,例如教育程度、种族、社会阶层或收入,且大多数基于年轻人群的横断面数据。在这项前瞻性研究中,我们使用一系列社会经济优势衡量指标,考察老年阶段的DFLE和总预期寿命(TLE)差异。我们对1988年在英国一家初级医疗诊所登记的1480名75岁及以上参与者进行了纵向研究,随访至2003年,最多进行了7次测量。残疾被定义为在五项日常生活活动中的任何一项存在困难。在住房保有情况方面,男性和女性的DFLE差异最大。75岁的女性中,拥有自有房产或抵押房产的人比租房者预期无残疾生存时间多1年,而男性的这一差异近1.5年。社会经济优势对男性无残疾预期寿命和总预期寿命的影响似乎大于女性。在女性中,对于所有考虑的指标,社会经济优势对DFLE的影响比对总预期寿命的影响更大,因此社会经济状况较好的女性残疾期有所缩短。