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Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals

Jane Lyons, Ashley Akbari Orcid Logo, Keith R. Abrams, Amaya Azcoaga Lorenzo, Thamer Ba Dhafari, James Chess, Spiros Denaxas, Rich Fry Orcid Logo, Chris P. Gale, John Gallacher, Lucy Griffiths Orcid Logo, Bruce Guthrie Orcid Logo, Marlous Hall, Farideh Jalali-najafabadi, Ann John Orcid Logo, Clare MacRae, Colin McCowan, Niels Peek, Dermot O’Reilly, Jim Rafferty Orcid Logo, Ronan Lyons Orcid Logo, Rhiannon Owen Orcid Logo

The Lancet Regional Health - Europe, Volume: 32, Start page: 100687

Swansea University Authors: Jane Lyons, Ashley Akbari Orcid Logo, Rich Fry Orcid Logo, Lucy Griffiths Orcid Logo, Ann John Orcid Logo, Jim Rafferty Orcid Logo, Ronan Lyons Orcid Logo, Rhiannon Owen Orcid Logo

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DOI (Published version): 10.1016/j.lanepe.2023.100687

Abstract

Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to in...

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Published in: The Lancet Regional Health - Europe
ISSN: 2666-7762
Published: Elsevier BV 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa63905
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The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK.Methods: Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups.Findings: In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)).Interpretation: This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks.</abstract><type>Journal Article</type><journal>The Lancet Regional Health - Europe</journal><volume>32</volume><journalNumber/><paginationStart>100687</paginationStart><paginationEnd/><publisher>Elsevier BV</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>2666-7762</issnElectronic><keywords>Chronic Disease, Mortality, Disease Trajectories, Population, Health Equity</keywords><publishedDay>30</publishedDay><publishedMonth>9</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-09-30</publishedDate><doi>10.1016/j.lanepe.2023.100687</doi><url>http://dx.doi.org/10.1016/j.lanepe.2023.100687</url><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm>External research funder(s) paid the OA fee (includes OA grants disbursed by the Library)</apcterm><funders>UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales (MRS02770/1).</funders><projectreference/><lastEdited>2023-08-23T10:17:38.4164411</lastEdited><Created>2023-07-18T08:25:05.6423476</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Jane</firstname><surname>Lyons</surname><orcid/><order>1</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>2</order></author><author><firstname>Keith R.</firstname><surname>Abrams</surname><order>3</order></author><author><firstname>Amaya Azcoaga</firstname><surname>Lorenzo</surname><order>4</order></author><author><firstname>Thamer Ba</firstname><surname>Dhafari</surname><order>5</order></author><author><firstname>James</firstname><surname>Chess</surname><order>6</order></author><author><firstname>Spiros</firstname><surname>Denaxas</surname><order>7</order></author><author><firstname>Rich</firstname><surname>Fry</surname><orcid>0000-0002-7968-6679</orcid><order>8</order></author><author><firstname>Chris P.</firstname><surname>Gale</surname><order>9</order></author><author><firstname>John</firstname><surname>Gallacher</surname><order>10</order></author><author><firstname>Lucy</firstname><surname>Griffiths</surname><orcid>0000-0001-9230-624X</orcid><order>11</order></author><author><firstname>Bruce</firstname><surname>Guthrie</surname><orcid>0000-0003-4191-4880</orcid><order>12</order></author><author><firstname>Marlous</firstname><surname>Hall</surname><order>13</order></author><author><firstname>Farideh</firstname><surname>Jalali-najafabadi</surname><order>14</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>15</order></author><author><firstname>Clare</firstname><surname>MacRae</surname><order>16</order></author><author><firstname>Colin</firstname><surname>McCowan</surname><order>17</order></author><author><firstname>Niels</firstname><surname>Peek</surname><order>18</order></author><author><firstname>Dermot</firstname><surname>O’Reilly</surname><order>19</order></author><author><firstname>Jim</firstname><surname>Rafferty</surname><orcid>0000-0002-1667-7265</orcid><order>20</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>21</order></author><author><firstname>Rhiannon</firstname><surname>Owen</surname><orcid>0000-0001-5977-376X</orcid><order>22</order></author></authors><documents><document><filename>63905__28281__040d381ebbf14f619bc17e21fe331335.pdf</filename><originalFilename>APCK13VOR.pdf</originalFilename><uploaded>2023-08-09T11:20:03.1962421</uploaded><type>Output</type><contentLength>1103507</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Distributed under the terms of a Creative Commons Attribution CC-BY 4.0 Licence</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling v2 63905 2023-07-18 Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals 1b74fa5125a88451c52c45bcf20e0b47 Jane Lyons Jane Lyons true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false d499b898d447b62c81b2c122598870e0 0000-0002-7968-6679 Rich Fry Rich Fry true false e35ea6ea4b429e812ef204b048131d93 0000-0001-9230-624X Lucy Griffiths Lucy Griffiths true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 52effe759a718bd36eb12cdd10fe1a09 0000-0002-1667-7265 Jim Rafferty Jim Rafferty true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false 0d30aa00eef6528f763a1e1589f703ec 0000-0001-5977-376X Rhiannon Owen Rhiannon Owen true false 2023-07-18 HDAT Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK.Methods: Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups.Findings: In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)).Interpretation: This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks. Journal Article The Lancet Regional Health - Europe 32 100687 Elsevier BV 2666-7762 Chronic Disease, Mortality, Disease Trajectories, Population, Health Equity 30 9 2023 2023-09-30 10.1016/j.lanepe.2023.100687 http://dx.doi.org/10.1016/j.lanepe.2023.100687 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University External research funder(s) paid the OA fee (includes OA grants disbursed by the Library) UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales (MRS02770/1). 2023-08-23T10:17:38.4164411 2023-07-18T08:25:05.6423476 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Jane Lyons 1 Ashley Akbari 0000-0003-0814-0801 2 Keith R. Abrams 3 Amaya Azcoaga Lorenzo 4 Thamer Ba Dhafari 5 James Chess 6 Spiros Denaxas 7 Rich Fry 0000-0002-7968-6679 8 Chris P. Gale 9 John Gallacher 10 Lucy Griffiths 0000-0001-9230-624X 11 Bruce Guthrie 0000-0003-4191-4880 12 Marlous Hall 13 Farideh Jalali-najafabadi 14 Ann John 0000-0002-5657-6995 15 Clare MacRae 16 Colin McCowan 17 Niels Peek 18 Dermot O’Reilly 19 Jim Rafferty 0000-0002-1667-7265 20 Ronan Lyons 0000-0001-5225-000X 21 Rhiannon Owen 0000-0001-5977-376X 22 63905__28281__040d381ebbf14f619bc17e21fe331335.pdf APCK13VOR.pdf 2023-08-09T11:20:03.1962421 Output 1103507 application/pdf Version of Record true Distributed under the terms of a Creative Commons Attribution CC-BY 4.0 Licence true eng http://creativecommons.org/licenses/by/4.0/
title Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
spellingShingle Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
Jane Lyons
Ashley Akbari
Rich Fry
Lucy Griffiths
Ann John
Jim Rafferty
Ronan Lyons
Rhiannon Owen
title_short Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
title_full Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
title_fullStr Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
title_full_unstemmed Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
title_sort Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals
author_id_str_mv 1b74fa5125a88451c52c45bcf20e0b47
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author_id_fullname_str_mv 1b74fa5125a88451c52c45bcf20e0b47_***_Jane Lyons
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
d499b898d447b62c81b2c122598870e0_***_Rich Fry
e35ea6ea4b429e812ef204b048131d93_***_Lucy Griffiths
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
52effe759a718bd36eb12cdd10fe1a09_***_Jim Rafferty
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
0d30aa00eef6528f763a1e1589f703ec_***_Rhiannon Owen
author Jane Lyons
Ashley Akbari
Rich Fry
Lucy Griffiths
Ann John
Jim Rafferty
Ronan Lyons
Rhiannon Owen
author2 Jane Lyons
Ashley Akbari
Keith R. Abrams
Amaya Azcoaga Lorenzo
Thamer Ba Dhafari
James Chess
Spiros Denaxas
Rich Fry
Chris P. Gale
John Gallacher
Lucy Griffiths
Bruce Guthrie
Marlous Hall
Farideh Jalali-najafabadi
Ann John
Clare MacRae
Colin McCowan
Niels Peek
Dermot O’Reilly
Jim Rafferty
Ronan Lyons
Rhiannon Owen
format Journal article
container_title The Lancet Regional Health - Europe
container_volume 32
container_start_page 100687
publishDate 2023
institution Swansea University
issn 2666-7762
doi_str_mv 10.1016/j.lanepe.2023.100687
publisher Elsevier BV
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
url http://dx.doi.org/10.1016/j.lanepe.2023.100687
document_store_str 1
active_str 0
description Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK.Methods: Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups.Findings: In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)).Interpretation: This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks.
published_date 2023-09-30T10:17:39Z
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