Impact of Socioeconomic Inequalities in Transition Between Health, Multimorbidity and Death Amongst Older People

Multimorbidity Clinical Trial

Official title:

What is the Impact of Socioeconomic Inequalities in the Rates of Transition Between Health, Multimorbidity and Death Amongst Older People in England?

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT02609516
• Other study ID #: 14_179
• Status: Active, not recruiting
• Phase: N/A
• First received: November 17, 2015
• Last updated: November 17, 2015
• Start date: January 2015
• Est. completion date: January 2017

Study information

• Verified date: November 2015
• Source: University College, London
• Contact: n/a
• Is FDA regulated: No
• Health authority: United Kingdom: Medicines and Healthcare Products Regulatory Agency
• Study type: Observational

Clinical Trial 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?

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.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 1300000
• Est. completion date: January 2017
• Est. primary completion date: September 2015
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: 45 Years and older

Eligibility

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.

Study Design

Observational Model: Cohort, Time Perspective: Retrospective

Related Conditions & MeSH terms

• Multimorbidity

Intervention

Other:
• This is not an intervention study
This study is based on the retrospective analysis of linked electronic health records.

Locations

Country	Name	City	State
United Kingdom	University College London	London

Sponsors (2)

Lead Sponsor	Collaborator
University College, London	University of Leeds

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Yearly multimorbidity incidence rate	Numerator: Of patients with either 0 or 1 chronic diseases as on 1st Jan of the year, all those who become multimorbid by 31st Dec of the year.; Denominator: patient years at risk of patients with either 0 or 1 chronic diseases as on 1st Jan of the year	10 years	No
Primary	Yearly multimorbidity prevalence	Numerator: all those with 2 or more listed diseases on 1st July of the year. Denominator: All eligible patients on 1st July of the year, irrespective of disease status on that date.	10 years	No
Primary	Yearly all-cause mortality rates	Numerator: number of deaths until 31st Dec of the year amongst the patients included in the denominator.; Denominator: Person years at risk of patients with 0,1,2 or more diseases on 1st Jan of the year.	10 years	No
Primary	Overall life expectancy	Incident rates of transitions between no disease, 1 disease, 2+ diseases, and death.	10 years	No
Primary	Health state-specific life expectancies	Incident rates of transitions between four health states - no disease, 1 disease, 2+ diseases, and death.	10 years	No
Secondary	Yearly non-accidental mortality rates	As outcome 3 but excluding accidental deaths from the numerator	10 years	No