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Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage
  1. Richard Tawiah1,2,
  2. Carol Jagger3,
  3. Kaarin J Anstey1,2,
  4. Kim M Kiely1,2
  1. 1 School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
  3. 3 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  1. Correspondence to Dr Kim M Kiely, University of New South Wales, Sydney, NSW 2052, Australia; k.kiely{at}unsw.edu.au

Abstract

Background The aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends.

Methods Data were drawn from the nationally representative Household Income and Labour Dynamics in Australia survey. Two cohorts (baseline age 50+ years) were followed up for 7 years, from 2001 to 2007 and from 2011 to 2017, respectively. Social disadvantage was indicated by the Socio-Economic Indexes for Areas (SEIFA). Two DFLEs based on a Global Activity Limitation Indicator (GALI) and difficulties with activities of daily living (ADLs) measured by the 36-Item Short Form Survey physical function subscale were estimated by cohort, sex and SEIFA tertile using multistate models.

Results Persons residing in the low-advantage tertile had more years lived with GALI and ADL disability than those in high-advantage tertiles. Across the two cohorts, dynamic equilibrium for GALI disability was observed among men in mid-advantage and high-advantage tertiles, but expansion of GALI disability occurred in the low-advantage tertile. There was expansion of GALI disability for all women irrespective of their SEIFA tertile. Compression of ADL disability was observed for all men and for women in the high-advantage tertile. Compared to the 2001 cohort, disability incidence was lower for the 2011 cohort of men within mid-advantage and high-advantage tertiles, whereas recovery and disability-related mortality were lower for the 2011 cohort of women within the mid-advantage tertile.

Conclusion Overall, compression of morbidity was more common in high-advantage areas, whereas expansion of morbidity was characteristic of low-advantage areas. Trends also varied by sex and disability severity.

  • ageing
  • health expectancy
  • social inequalities

Data availability statement

Data may be obtained from a third party and are not publicly available. Household Income and Labour Dynamics in Australia data are not publicly available but can be requested from the Australian Department of Social Services National Centre for Longitudinal Data (https://dataverse.ada.edu.au/dataverse/hilda). Data coding and analysis scripts are available online (https://osf.io/tkhyn/).

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Data availability statement

Data may be obtained from a third party and are not publicly available. Household Income and Labour Dynamics in Australia data are not publicly available but can be requested from the Australian Department of Social Services National Centre for Longitudinal Data (https://dataverse.ada.edu.au/dataverse/hilda). Data coding and analysis scripts are available online (https://osf.io/tkhyn/).

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Footnotes

  • Contributors RT conducted the analysis, interpreted the results and contributed to the drafting of the manuscript. KJA obtained project funding, interpreted the results and provided critical revisions of the manuscript. CJ obtained project funding, interpreted the results and provided critical revisions of the manuscript. KMK conceived the study design, obtained project funding, and contributed to the analysis and drafting of the manuscript.

  • Funding This work was supported by Australian Research Council (ARC) grant #DP190100459. KJA is funded by National Health and Medical Research Council Fellowship #1102694.

  • Disclaimer The funders had no role in the conduct of this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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