Making the extra years count:

Inequalities in disability and dependency with

increasing longevity

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 Welcome from chair
Dr Brian Beach, Senior Research Fellow, ILC

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What is ILC?
ILC is the UK’s specialist think tank on the impact of longevity on society and
what happens next. We:
• Are independent and politically neutral
• Use evidence-based research for policy
• Work collaboratively to pioneer solutions for the future
Our work focuses on three strategic priorities:
• Maximising the benefits of longevity
• Ensuring longer lives are good for everyone
• Future-proofing policy and practice

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Partners Programme
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 Presentation of findings
Prof Carol Jagger, Newcastle University

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Making the extra years count - Inequalities
in disability and dependency with
increasing longevity

From Newcastle. For the world.

Making the extra years count

Project team Advisory Group

• Professor Carol Jagger • Professor Tom Scharf (Chair)
• Dr Andrew Kingston – Newcastle University
• Dr Holly Q Bennett • Professor Clare Bambra
• Professor Fiona Matthews – Newcastle University
• Professor Lynne Corner • Professor Julia Newton
• Dame Louise Robinson – Academic Health Sciences Network, NE and N
• Dr Ilianna Lourida Cumbria
• Professor Les Mayhew
– CASS Business School and ILC-UK
• Older People and Frailty Policy Research Unit
• Dr Gemma Spiers

7
From Newcastle. For the world.
Making the extra years count – aims

Project aims
Are changes in years with disability and Definitions
dependency at age 65 over the last 20 years • Disability
• Due to (a) increased incidence of – Difficulties or help required with basic or
disability/dependency, (b) reduced ability to instrumental activities of daily living (ADL and
return to independence, or (c) longer survival IADL)
with disability/dependency?
• Due to individual long-term conditions becoming • Dependency
more prevalent, or more disabling, or because – Help required with ADL or IADL or severe
multiple conditions (multi-morbidity) have cognitive impairment
increased? – Reflects lapsed time requiring help
• Being experienced similarly by all social groups?

8
From Newcastle. For the world.
Background

Longitudinal data
Baseline 2-yr follow-up

No disability No disability

Disability Disability

Dead

• Life expectancy increases have slowed and have reversed since Covid (Aburto et al., JECH 2021)
• National trends usually based on X-sectional data - limited ability to understand drivers
• Unique longitudinal data for 2 generations of people aged 65+ in 1991 and 2011 from the Cognitive Function
and Ageing Studies

9
From Newcastle. For the world.
Making the extra years count – key messages

Four key messages from the project

Between 1991 and 2011
• Inequalities increased substantially because the
“richest” experienced delayed disability – the
“poorest” longer life with disability

• Women with some health conditions experienced a

reduction in disability

• The “poorest” saw a much greater increase in the

prevalence of multiple long-term conditions
(MLTCs) - but this didn’t explain the inequalities

• It IS possible to delay disability even in the

presence of MLTCs

10
From Newcastle. For the world.
 Making the extra years count – DFLE at age 65 by deprivation

DFLE gap 1.0 year 2.7 years 0.7 years 3.1 years
Disability gap 0.1 year 0.8 years 0.8 years 0.7 years

From Newcastle. For the world.

 Making the extra years count – new statistic DFLE50%

1991 Most advantaged men

25
• DFLE (along with LE and DLE) usually reported
at a single age – i.e. age 65
20
1991 DFLE50%: 79
• If these quantities are illustrated across the age
15 range there is a point where the DFLE line crosses
Years

the DLE line – a turning point

10
• This turning point (DFLE50%) is the age at which
5 50% of remaining life is spent free of disability and
50% with disability
0
65 70 75 80 85 90 95
• From this age the majority of remaining life will be
Age
spent with disability
1991 Life expectancy
1991 Disability-free life expectancy
1991 Life expectancy with disability
12
From Newcastle. For the world.
DFLE50% by deprivation – change from 1991 to 2011 - MEN

Most advantaged Least advantaged

25 25
1991 DFLE50%: 79 1991 DFLE50%: 77
20 20

15 15
2011 DFLE50%: 85 2011 DFLE50%: 79
Years

Years
10 10

5 5

0 0
65 70 75 80 85 90 95 65 70 75 80 85 90 95
Age Age

1991 Life expectancy 2011 Life expectancy

1991 Disability-free life expectancy 2011 Disability-free life expectancy
1991 Life expectancy with disability 2011 Life expectancy with disability

From Newcastle. For the world.

DFLE50% by deprivation – change from 1991 to 2011 - WOMEN

Most advantaged Least advantaged

25 25

1991 DFLE50%: 68 1991 DFLE50%: 68

20 20

2011 DFLE50%: 73 2011 DFLE50%: 67

15 15
Years

Years
10 10

5 5

0 0
65 70 75 80 85 90 95 65 70 75 80 85 90 95
Age Age

1991 Life expectancy 2011 Life expectancy

1991 Disability-free life expectancy 2011 Disability-free life expectancy
1991 Life expectancy with disability 2011 Life expectancy with disability

Source: Bennett, Kingston, Spiers et al. IJE (2021)

From Newcastle. For the world.
Making the extra years count – why are inequalities widening?

Click icon to add picture

What is driving the widening
Baseline 2-yr follow-up
inequalities?
Men No disability No disability
• Most advantaged
− 30% reduction in incident disability
− 80% increase in recovery
− 60% reduction in death from a disability-free state Disability Disability
• Least advantaged
− 30% reduction in death from disability state – therefore longer life
with disability Dead

Women
• Most advantaged
− 30% reduction in incident disability
• Least advantaged
− No change in any transitions

15
From Newcastle. For the world.
Making the extra years count – the role of single long-term conditions

Change in long-term conditions

between 1991 and 2011? Less in CFAS II More in CFAS II

• Prevalence (odds)
− Diabetes and peripheral vascular disease (PVD) more than
doubled
− Coronary Heart Disease (CHD) and hearing difficulties
increased by 20%
− Cognitive impairment reduced by 40%
• Disabling effect
− In men all conditions resulted in an increase in years with
disability between 1991 and 2011 with smallest increase for
PVD (0.7 years)
− In women there was a reduction in years with disability with
arthritis (0.2 yrs), CHD (1.1 yrs), diabetes (0.2 yrs), hearing
difficulties (0.5 yrs), respiratory disease (0.6 yrs)
− Largest increase for cognitive impairment for men (1.8 yrs) and
women (1.3 yrs)

16
From Newcastle. For the world.
Making the extra years count – the role of multiple long-term conditions

What is the role of multiple long-term conditions (MLTCs)?

Between 1991 and 2011
• Prevalence of MLTCs
− The overall prevalence of MLTCs increased but only in 65-74 years age group
− Prevalence of MLTCs changed little for most advantaged but increased by 10 percentage points in least
advantaged

• For men and women with MLTCs there was hardly any DFLE inequality by deprivation in 1991
– by 2011 DFLE inequality had tripled to around 2.5 years

• Increase in DFLE inequality similar in men and women without MLTCs - so MLTCs not all the
reason for DFLE inequality

• Most advantaged men and women with MLTCs had a reduction in disability incidence
17
From Newcastle. For the world.
Making the extra years count – key messages

Four key messages from the project

Between 1991 and 2011
• Inequalities increased substantially because the
“richest” experienced delayed disability – the
“poorest” longer life with disability

• Women with some health conditions experienced a

reduction in disability

• The “poorest” saw a much greater increase in the

prevalence of multiple long-term conditions
(MLTCs) - but this didn’t explain the inequalities

• It IS possible to delay disability even in the

presence of MLTCs

18
From Newcastle. For the world.
Making the extra years count - acknowledgements

CFAS studies collaboration

19
From Newcastle. For the world.
Making the extra years count – Inequalities
in disability and dependency with increasing
longevity

Thank you

ncl.ac.uk
 Response
Prof Les Mayhew, ILC & Cass Business School

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 Counting the cost of inequalities
Les Mayhew
Professor of statistics, the Business School, City University, London

Head of Global Research

ILC
Research issues arising
• What is the significance of an increasing gap between health and life expectancy
i.e. more years spent with disability or poor health?
• Are these avoidable years i.e. can something be done earlier in life to address
problems later on or do we put our faith in medical research?
• Can we put a value on an increasing gap in terms of pensions, health and welfare
costs and if so how to do that?
• What does it tell us about policies to improve health versus life extensions i.e. the
prevention versus treatment argument?
 An illustrative chart combining life, health and work spans
90
Unhealthy years
80
Inactive healthy years
70
Working lives
Age

60
State Pension Age
50

40

30

20
Where to next?
Ideally…..
• A life course approach based on adults of working age focusing on
health and work and the economics of ageing
• An accounting framework combining demographic, health, economic
variables with fiscal effects
• A ‘what-if’ capability e.g. what is the impact on economic growth and
the fiscal implications of a one-year improvement in health
• Creation of a single overarching measure of inequality combining
these concepts
 Response
Prof Sir Michael Marmot, UCL Institute of
Health Equity

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 Response
Baroness Young of Old Scone

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 Response
Prof Sir Muir Gray, Optimal Ageing Programme

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 Response
Dr Alison Giles, Public Health England

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Q&A discussion

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Closing remarks
Dr Brian Beach, ILC

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Thank you

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