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Education-related inequalities in disability during the last years of life: a full population register-based study
  1. Erwin Stolz1,
  2. Moritz Oberndorfer2,3,
  3. Wolfgang Freidl1
  1. 1Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
  2. 2Helsinki Institute for Demography and Population Health, University of Helsinki Faculty of Social Sciences, Helsinki, Uusimaa, Finland
  3. 3Center for Social Inequalities in Population Health, University of Helsinki, Helsinki, Uusimaa, Finland
  1. Correspondence to Dr Erwin Stolz; erwin.stolz{at}medunigraz.at

Abstract

Background Little is known about education-related inequalities in late-life disability. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) to assess education-related inequalities in the duration of late-life disability.

Methods In this retrospective mortality follow-back study, we analyse receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living, during the last 5 years of life among all decedents aged 65 years and over from 2020 in Austria (n=76 772).

Results The higher the level of education, the shorter the period for which ALTCA was received. Over the last 5 years of life, those with the primary/lower secondary education received ALTCA for 47% or 10 months (men), respectively, 38% or 12 months (women) longer than those with tertiary education. Education-related inequalities decreased with time to death and age at death.

Conclusion We found education-related inequalities in the duration of late-life disability, that is, higher education was associated with a prolonged ability to live independently during the last years of life. Inequalities in disability decreased with time to death and age at death, pointing to a gradual levelling due to mortality-related declines as well as selective mortality.

  • EDUCATION
  • DEATH
  • DISABLED PERSONS
  • Health inequalities

https://doi.org/10.1136/jech-2024-222669

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    Footnotes

    • X @MOOberndorfer

    • Contributors ES is the corresponding author, he planned the study, performed all statistical analysis and wrote the article. ES is also the guarantor. MO and WF critically reviewed the manuscript.

    • Funding The work of ES and WF was supported by no specific institution but only the Medical University of Graz. MO was supported by the European Research Council under the European Union's Horizon 2020 research and innovation programme (grant agreement No 101019329) and by an MSCA Postdoctoral European Fellowship (grant agreement No 101150833), and grants to the Max Planck – University of Helsinki Center from the Jane and Aatos Erkko Foundation, the Max Planck Society, University of Helsinki and Cities of Helsinki, Vantaa and Espoo. The study does not necessarily reflect the Commission's views and in no way anticipates the Commission's future policy in this area.

    • Competing interests None declared.

    • 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.