Socioeconomic status and the expectation of disability in old age: estimates for England

Objectives-The longer life expectancy in old age of more privileged socioec onomic groups is well established, but less clear is whether the net effect of additional years of life is a lengthened, stable or reduced duration of disability. Estimates of healthy and disabled life expectancy (using defin itions including dependency in activities of daily living and cognitive imp airment) were made, contrasting occupational classes I and II (professional and managerial) with the rest. Design-Disability prevalence was estimated from the Medical Research Counci l Cognitive Function and Ageing study. Sullivan's method was used to calcul ate health expectancy. Subjects-10 377 people aged 65 years or over in Cambridgeshire, Newcastle, Nottingham and Oxford. Subjects were classified as disabled if they had evi dence of dementia (using the Automated Geriatric Examination Computer Assis ted Taxonomy) or scored 11 or more on the modified Townsend Disability scal e, at baseline screen. Results-The prevalence of disability overall and need for "constant care" w as lower in both men and women in social classes I and II compared with the rest. Men aged 65 to 69 in classes I and II can expect nearly 14 years of life free of disability compared with 11.5 years for those in classes III t o V: for women the equivalent expectations are 15.5 and 13.8 years. Men age d 65 to 69 in classes I and II can also expect a shorter duration of disabi lity: 1 year compared with 1.6 years for classes III to V. In women expecta tion of disability is higher overall, but shows little difference by occupa tional class. Conclusions-Relatively privileged socioeconomic groups in England, especial ly men, can expect fewer years of disability despite longer overall life ex pectancy. These findings lend weight to optimistic scenarios for the future numbers of older people with disability.