Clinical trial NCT02609516: Impact of Socioeconomic Inequalities in Transition Between Health, Multimorbidity and Death Amongst Older People
Official title: What is the Impact of Socioeconomic Inequalities in the Rates of Transition Between Health, Multimorbidity and Death Amongst Older People in England?
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Multimorbidity
Keywords: Multimorbidity
Health inequalities
Ageing
Mortality
Lead sponsor: University College, London
Sponsor class: OTHER
Collaborators: name: University of Leeds
First posted: 2015-11-20
Enrollment: 1300000
Sex: ALL
Minimum age (years): 45
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Patients included in the CALIBER dataset.

Brief summary: Life expectancy at age 65 in the most deprived fifth of the English population was about 4 years shorter than of the most affluent fifth in 2010. The inverse gradient between mortality and social position is well established. But how disease patterns and multimorbidity (having two or more long term conditions at the same time) impact on differential mortality rates is inconclusive: is it because disadvantaged groups acquire more or more lethal combinations of, diseases over their life course; or, simply, become ill at ages younger than more affluent groups?

Detailed description: The association between social inequality and cause-specific mortality and single disease morbidity has been studied extensively. However, it remains unclear whether having two or more chronic diseases concurrently (or 'multimorbidity') plays a role in contributing to the inequalities gap in survival. This is particularly relevant given an ageing population and the trend of a widening in the life expectancy gap across several European countries.

Multimorbidity incidence increases rapidly with age. Estimates of the prevalence of multimorbidity in older people range from 55% to 98%, mainly due to the selection of diseases included, population coverage (hospital, community) and data source (self-reported surveys or clinical records). However, across all studies there is a clear and consistent pattern of higher prevalence rates at older ages, with multimorbidity.

Many aspects of the patient health trajectory remain under-explored. Patient case-mixes are likely to vary across socioeconomic groups, alongside a host of prognostic factors, including the clustering of multiple risk factors, age of onset, and disease presentation, progression and management in the presence of multiple health conditions.

Eligibility criteria: Inclusion Criteria:

* Registered with a participating practice that has agreed to data linkage
* Registered with an 'up to standard' participating general practice for at least 1 year
* Aged 45 and over on Jan 1st 2001 or who turn 45 between 1st Jan 2001 and 25th March 2010, irrespective of initial health status.

Exclusion Criteria:

* Patients with a record unlinked to deprivation due to missing or incomplete postcode of residence.

Primary outcomes:
measure: Yearly multimorbidity incidence rate
timeFrame: 10 years
measure: Yearly multimorbidity prevalence
timeFrame: 10 years
measure: Yearly all-cause mortality rates
timeFrame: 10 years
measure: Overall life expectancy
timeFrame: 10 years
measure: Health state-specific life expectancies
timeFrame: 10 years
Secondary outcomes:
measure: Yearly non-accidental mortality rates
timeFrame: 10 years
Other outcomes:
Locations:
city: London
country: United Kingdom
facility: University College London
Study officials:
affiliation: University College, London
name: Madhavi Bajekal, PhD
role: STUDY_DIRECTOR
References: