Socioeconomic gradient in mortality of working age and older adults with multiple long-term conditions in England and Ontario, Canada.

Autor: Alarilla A; The Health Foundation, 8 Salisbury Square, London, UK. anne.alarilla@health.org.uk., Mondor L; ICES, Toronto, ON, M4N 3M5, Canada.; Health System Performance Network, Toronto, ON, Canada., Knight H; The Health Foundation, 8 Salisbury Square, London, UK., Hughes J; The Health Foundation, 8 Salisbury Square, London, UK., Koné AP; Health System Performance Network, Toronto, ON, Canada.; Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada., Wodchis WP; ICES, Toronto, ON, M4N 3M5, Canada.; Health System Performance Network, Toronto, ON, Canada.; Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada.; Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada., Stafford M; The Health Foundation, 8 Salisbury Square, London, UK.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2023 Mar 11; Vol. 23 (1), pp. 472. Date of Electronic Publication: 2023 Mar 11.
DOI: 10.1186/s12889-023-15370-y
Abstrakt: Background: There is currently mixed evidence on the influence of long-term conditions and deprivation on mortality. We aimed to explore whether number of long-term conditions contribute to socioeconomic inequalities in mortality, whether the influence of number of conditions on mortality is consistent across socioeconomic groups and whether these associations vary by working age (18-64 years) and older adults (65 + years). We provide a cross-jurisdiction comparison between England and Ontario, by replicating the analysis using comparable representative datasets.
Methods: Participants were randomly selected from Clinical Practice Research Datalink in England and health administrative data in Ontario. They were followed from 1 January 2015 to 31 December 2019 or death or deregistration. Number of conditions was counted at baseline. Deprivation was measured according to the participant's area of residence. Cox regression models were used to estimate hazards of mortality by number of conditions, deprivation and their interaction, with adjustment for age and sex and stratified between working age and older adults in England (N = 599,487) and Ontario (N = 594,546).
Findings: There is a deprivation gradient in mortality between those living in the most deprived areas compared to the least deprived areas in England and Ontario. Number of conditions at baseline was associated with increasing mortality. The association was stronger in working age compared with older adults respectively in England (HR = 1.60, 95% CI 1.56,1.64 and HR = 1.26, 95% CI 1.25,1.27) and Ontario (HR = 1.69, 95% CI 1.66,1.72 and HR = 1.39, 95% CI 1.38,1.40). Number of conditions moderated the socioeconomic gradient in mortality: a shallower gradient was seen for persons with more long-term conditions.
Conclusions: Number of conditions contributes to higher mortality rate and socioeconomic inequalities in mortality in England and Ontario. Current health care systems are fragmented and do not compensate for socioeconomic disadvantages, contributing to poor outcomes particularly for those managing multiple long-term conditions. Further work should identify how health systems can better support patients and clinicians who are working to prevent the development and improve the management of multiple long-term conditions, especially for individuals living in socioeconomically deprived areas.
(© 2023. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje