Healthy Life

Quantifying health inequalities in England

In Figure 3, we show the contribution of each condition to health disparities by age group. Absolute levels of inequality are very small for younger people, but this analysis shows that there is a clear transition of inequality across the life cycle. Children in more deprived areas are much more likely to be living with asthma, epilepsy and to experience alcohol problems and are less likely to be diagnosed with anxiety or depression. From the age of 20 we see greater differences in chronic pain, alcohol problems and anxiety and depression. From the age of 30 we begin to see health inequalities manifesting in different kinds of health conditions. Disparities in diabetes, COPD and cardiovascular disease rates grow and overtake anxiety and depression, although we still observe growing inequalities in chronic pain and alcohol problems. Among people aged 50 and older, inequality in morbidity is dominated by chronic pain, COPD, diabetes and dementia. Contrary to other diseases, we see a higher prevalence of diagnosed cancer in the least deprived areas among older patients.

These findings suggest that health inequalities start at an early age and accumulate over time. Chronic stress and adverse conditions have been shown to contribute directly and indirectly to poorer health outcomes through their cumulative impact. This phenomenon, known as allostatic load, is linked to earlier death and is greater for those from poorer backgrounds. The stages of inequality in ill health shown here strengthens the case for a life course approach to public health policy.

The disparity in diagnosed ill health then reduces for people aged 80 or older. People living to this age have time to develop long-term illness even if they live in the least deprived areas. This is a study of people living with diagnosed illness and so does not reflect the stark inequalities in mortality rates. It is therefore worth thinking about the amount of time spent in ill health in the context of life expectancy.

Life expectancy and living with illness

Differences in the prevalence of diagnosed long-term conditions can be explained by inequalities in the wider determinants of health. Here, we explore the age at which we see disparities in health starting to develop.

We have produced alternate estimates of life expectancy to national statistics using our primary care data linked to mortality records, along with an additional measure of disease-free life expectancy (see Table 1). Disease-free life expectancy provides an estimate of the average number of years a person would live without being diagnosed with any of the illnesses included in the CMS.

Back To Top