Socioeconomic status and transitions in status in old age in relation to limiting long-term illness measured at the 1991 Census - Results from the UK Longitudinal Study

Background: In the light of increasing interest in health inequalities, this paper aims to assess i) whether material deprivation in late middle age and early old age is associated with greater risk of limiting long-term illness 20 years later and ii) whether deterioration in socioeconomic status during the first 10 years carries a higher risk than remaining in a higher status. Methods: The Longitudinal Study comprised a 1% sample of people registered on the 1971 Census in England and Wales; data from successive censuses are linked with vital events such as deaths. The subjects were 23,320 people aged 55-74 years in 1971 and living in the community in 1971, 1981 and 1991. Logistic regression was used to perform the analyses. Results: The relative risk of having a limiting long-term illness 20 years later for people in rented accommodation without a car at age 55-64 years was 1.2 compared to those in owner-occupied accommodation with a car. For those aged 65-74 years in 1971 the excess risk was 9%, Moving out of owner occupation between 1971 and 1981 and losing access to a car were associated with excess risk similar to that for people already disadvantaged in 1971. Thus, socioeconomic circumstances in late middle and early old age and deterioration in such circumstances after age 55 years, are associated with limiting long-term illness among people who have survived in the community until at least age 75 years. Conclusion: Although health selection cannot be ruled out, it appears that health inequalities do not completely disappear in very old age.