Reducing socioeconomic disparities in health in later life and promoting healthy ageing: the role of potentially modifia

Differences in health between more and less socially advantaged groups persist in older age in the UK. Neighbourhood social factors are likely to be important in older age when people spend more time in the area where they live. However, there is limited research on the importance of neighbourhood factors on health in later life. This research will examine the impact of neighbourhood factors on health in later life (>60 years) in Britain; the role of specific neighbourhood characteristics such as living environment and social support will be studied. Health outcomes to be studied are cardiovascular disease (a leading cause of death in old age) and related outcomes such as diabetes, disability and poor oral health - these health outcomes also influence ‘healthy ageing‘. Another objective is to identify possible ways in which neighbourhood factors influence health in later life such as lifestyle (smoking, physical activity, diet), biological factors, treatment provision and air pollution. Data from two ongoing studies in older British populations will be used for the research. The research aims to not only help prevent disease and improve health in later life, but also reduce social differences in health in older age.

The influence of socioeconomic factors on health persists in older age in the UK; these factors could operate at neighbourhood and individual level. The contributions of neighbourhood socioeconomic factors are likely to be particularly important in later life (>60 years), when individuals are more exposed to their residential context than in middle-age. However, there is little evidence from longitudinal studies on the influence of neighbourhood factors on health in later life. This proposal aims to examine the impact of neighbourhood socioeconomic conditions longitudinally on health in older people in Britain, and to identify pathways underlying these associations. Health outcomes include cardiovascular disease (CVD) and related chronic health outcomes (type 2 diabetes, disability and poor oral health). CVD is a leading cause of morbidity and mortality in older age; examining disability and oral health broadens the scope of studying important health outcomes that determine ‘healthy ageing‘. The objectives are (i) to investigate the influence of specific neighbourhood factors such as economic (income, employment), physical (living environment) and social characteristics (crime, social support) on these chronic health outcomes, and (ii) to determine possible pathways underlying these associations including lifestyle (smoking, physical activity, diet, obesity), novel biological factors (inflammatory markers), treatment provision and air pollution. Whether neighbourhood socioeconomic measures can improve cardiovascular risk prediction in later life will also be examined. The proposed research will be assessed in two longitudinal population-based studies of older British subjects: British Regional Heart Study (BRHS), and the English Longitudinal Study of Ageing (ELSA). These data sources have complementary strengths: BRHS has especially detailed information on health outcomes, lifestyle and biological factors in a cohort of older men followed-up from middle-age; and ELSA includes both older men and women with detailed data on individual socioeconomic factors in later life. Ten-year follow-up data on BRHS subjects aged 60-79 years will be used and 8-10 years follow-up data on ELSA subjects aged 60 years. Data on neighbourhood factors will include the Index for Multiple Deprivation (overall and individual domains) and other characteristics such as living environment from routine national data sources including the Office for National Statistics; multilevel modelling will be used for the analyses. The purpose of the proposed project is - to identify potentially modifiable factors associated with neighbourhoods to improve the scope of preventing CVD and related chronic health outcomes in later life, thereby contributing to healthy ageing; and to reduce social disparities in health in later life.