Multimorbid life expectancy across race, socio-economic status, and sex in South Africa.

Multimorbidity is increasing globally as populations age. However, it is unclear how long individuals live with multimorbidity and how it varies by social and economic factors. We investigate this in South Africa, whose apartheid history further complicates race, socio-economic, and sex inequalities. We introduce the term 'multimorbid life expectancy' (MMLE) to describe the years lived with multimorbidity. Using data from the South African National Income Dynamics Study (2008-17) and incidence-based multistate Markov modelling, we find that females experience higher MMLE than males (17.3 vs 9.8 years), and this disparity is consistent across all race and education groups. MMLE is highest among Asian/Indian people and the post-secondary educated relative to other groups and lowest among African people. These findings suggest there are associations between structural inequalities and MMLE, highlighting the need for health-system and educational policies to be implemented in a way proportional to each group's level of need.

On the Timing of Marriage and Childbearing: Family Formation Pathways Among Immigrants in Switzerland.

This paper examines childbearing in and outside of marriage as a manifestation of the Second Demographic Transition among immigrant populations in Switzerland. Based on full-population register data, we simultaneously analyse fertility and partnership changes at different stages of the migration process. Results from a multistate event history model show that most of the differences in family formation patterns between migrant groups and natives are in the sequencing of marriage and first birth among childless unmarried women. Out of wedlock family trajectories prove to be a common experience for European migrants, but a sustainable family pathway only among natives, as well as among immigrants from France, and Sub-Saharan Africa. Among married women, it is the risk of a third birth that marks the differences between groups; first and second birth rates are relatively similar across migrant groups. Distinguishing between the transition patterns of newly arrived immigrants and settled immigrants (characterised by various residence durations) support the disruption hypothesis among EU migrants and the interrelated life events hypothesis among non-EU groups. Family size and the partnership context of fertility highlight which family regime prevails in different population subgroups and the role that immigrants play in the Second Demographic Transition and family transformation in Europe.

Inequalities in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States.

OBJECTIVES: To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States. We also assess MMLE inequalities by sex and education. METHODS: Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-2009), the Mexican Health and Aging Study (2012-2018), and the Health and Retirement Study (2004-2018). We apply an incidence-based multistate Markov approach to estimate disability-free and disabling MMLE and stratify models by sex and education to study within-country heterogeneity. Multimorbidity is defined as a count of two or more chronic diseases. Disability is defined using limitations in activities of daily living. RESULTS: Costa Ricans have the lowest MMLE, followed by Mexicans, then individuals from the US. Individuals from the US spend about twice as long with disability-free multimorbidity compared with individuals from Costa Rica or Mexico. Females generally have longer MMLE than males, with particularly stark differences in disabling MMLE. In the US, higher education was associated with longer disability-free MMLE and shorter disabling MMLE. We identified evidence for cumulative disadvantage in Mexico and the US, where sex differences in MMLE were larger among the lower educated. DISCUSSION: Substantial sex and educational inequalities in MMLE exist within and between these countries. Estimating disability-free and disabling MMLE reveals another layer of health inequality not captured when examining disability and multimorbidity separately. MMLE is a flexible population health measure that can be used to better understand the aging process across contexts.

Partnership Status, Health, and Mortality: Selection or Protection?

Married individuals have better health and lower mortality than nonmarried people. Studies show that when cohabitants are distinguished from other nonmarried groups, health differences between partnered and nonpartnered individuals become even more pronounced. Some researchers have argued that partnered individuals have better health and lower mortality because a partnership offers protective effects (protection); others have posited that partnered people have better health and lower mortality because healthy persons are more likely to form a union and less likely to dissolve it (selection). This study contributes to this debate by investigating health and mortality by partnership status in England and Wales and analyzing the causes of mortality differences. We use combined data from the British Household Panel Survey and the UK Household Longitudinal Study and apply a simultaneous-equations hazard model to control for observed and unobserved selection into partnerships. We develop a novel approach to identify frailty based on self-rated health. Our analysis shows that partnered individuals have significantly lower mortality than nonpartnered people. We observe some selection into and out of unions on unobserved health characteristics, but the mortality differences by partnership status persist. The study offers strong support for the marital protection hypothesis and extends it to nonmarital partnerships.

Cognitive impairment and partnership status in the United States, 1998-2016, by sex, race/ethnicity, and education.

Cognitively impaired adults without a partner are highly disadvantaged, as partners constitute an important source of caregiving and emotional support. With the application of innovative multistate models to the Health and Retirement Study, this paper is the first to estimate joint expectancies of cognitive and partnership status at age 50 by sex, race/ethnicity, and education in the United States. We find that women live a decade longer unpartnered than men. Women are also disadvantaged as they experience three more years as both cognitively impaired and unpartnered than men. Black women live over twice as long as cognitively impaired and unpartnered compared with White women. Lower-educated men and women live around three and five years longer, respectively, as cognitively impaired and unpartnered than more highly educated men and women. This study addresses a novel facet of partnership and cognitive status dynamics and examines their variations by key socio-demographic factors.

Long-term exposure to air pollution and mortality in Scotland: A register-based individual-level longitudinal study.

BACKGROUND: Air pollution is associated with several adverse health outcomes. However, heterogeneity in the size of effect estimates between cohort studies for long-term exposures exist and pollutants like SO2 and mental/behavioural health outcomes are little studied. This study examines the association between long-term exposure to multiple ambient air pollutants and all-cause and cause-specific mortality from both physical and mental illnesses. METHODS: We used individual-level administrative data from the Scottish-Longitudinal-Study (SLS) on 202,237 individuals aged 17 and older, followed between 2002 and 2017. The SLS dataset was linked to annual concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution at 1 km2 spatial resolution using the individuals' residential postcode. We applied survival analysis to assess the association between air pollution and all-cause, cardiovascular, respiratory, cancer, mental/behavioural disorders/suicides, and other-causes mortality. RESULTS: Higher all-cause mortality was associated with increasing concentrations of PM2.5, PM10, NO2, and SO2 pollutants. NO2, PM10, and PM2.5 were also associated with cardiovascular, respiratory, cancer and other-causes mortality. For example, the mortality hazard from respiratory diseases was 1.062 (95%CI = 1.028-1.096), 1.025 (95%CI = 1.005-1.045), and 1.013 (95%CI = 1.007-1.020) per 1 µg/m3 increase in PM2.5, PM10 and NO2 pollutants, respectively. In contrast, mortality from mental and behavioural disorders was associated with 1 µg/m3 higher exposure to SO2 pollutant (HR = 1.042; 95%CI = 1.015-1.069). CONCLUSION: This study revealed an association between long-term (16-years) exposure to ambient air pollution and all-cause and cause-specific mortality. The results suggest that policies and interventions to enhance air quality would reduce the mortality hazard from cardio-respiratory, cancer, and mental/behavioural disorders in the long-term.

Spatial patterns of COVID-19 and non-COVID-19 mortality across waves of infection in England, Wales, and Scotland.

Recent studies have established the key individual-level risk factors of COVID-19 mortality such as age, gender, ethnicity, and socio-economic status. However, the spread of infectious diseases is a spatial and temporal process implying that COVID-19 mortality and its determinants may vary sub-nationally and over time. We investigate the spatial patterns of age-standardised death rates due to COVID-19 and their correlates across local authority districts in England, Wales, and Scotland across three waves of infection. Using a Spatial Durbin model, we explore within- and between-country variation and account for spatial dependency. Areas with a higher share of ethnic minorities and higher levels of deprivation had higher rates of COVID-19 mortality. However, the share of ethnic minorities and population density in an area were more important predictors of COVID-19 mortality in earlier waves of the pandemic than in later waves, whereas area-level deprivation has become a more important predictor over time. Second, during the first wave of the pandemic, population density had a significant spillover effect on COVID-19 mortality, indicating that the pandemic spread from big cities to neighbouring areas. Third, after accounting for differences in ethnic composition, deprivation, and population density, initial cross-country differences in COVID-19 mortality almost disappeared. COVID-19 mortality remained higher in Scotland than in England and Wales in the third wave when COVID-19 mortality was relatively low in all three countries. Interpreting these results in the context of higher overall (long-term) non-COVID-19 mortality in Scotland suggests that Scotland may have performed better than expected during the first two waves. Our study highlights that accounting for both spatial and temporal factors is essential for understanding social and demographic risk factors of mortality during pandemics.

Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016.

Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.

The spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnic groups in the United Kingdom: a multilevel longitudinal analysis.

BACKGROUND: Air pollution is associated with poor health; though it is unclear whether this association is stronger for ethnic minorities compared to the rest of the population. This study uses longitudinal data to investigate the spatial-temporal effect of air pollution on individuals' reported health and its variation by ethnicity in the United-Kingdom (UK). METHODS: Longitudinal individual-level data from Understanding Society: the UK Household Longitudinal Study including 67,982 adult individuals with 404,264 repeated responses over 11 years (2009-2019) were utilized and were linked to yearly concentrations of NO2, SO2, and particulate-matter (PM10, PM2.5) pollution once at the local authority and once at the census Lower Super Output Area (LSOA) of residence for each individual. This allows for analysis at two geographical scales over time. The association between air pollution and individuals' health (Likert scale: 1-5, Excellent to poor) and its variation by ethnicity was assessed using three-level mixed-effects ordered logistic models. Analysis distinguished between spatial (between areas) and temporal (across time within each area) effects of air pollution on health. RESULTS: Higher concentrations of NO2, SO2, PM10, and PM2.5 pollution were associated with poorer health. Decomposing air pollution into between (spatial: across local authorities or LSOAs) and within (temporal: across years within each local authority or LSOA) effects showed a significant between effect for NO2 and SO2 pollutants at both geographical scales, while a significant between effect for PM10 and PM2.5 was shown only at the LSOAs level. No significant within effects were detected at an either geographical level. Indian, Pakistani/Bangladeshi, Black/African/Caribbean and other ethnic groups and non-UK-born individuals reported poorer health with increasing concentrations of NO2, SO2, PM10, and PM2.5 pollutants in comparison to the British-white and UK-born individuals. CONCLUSION: Using longitudinal data on individuals' health linked with air pollution data at two geographical scales (local authorities and LSOAs), this study supports the presence of a spatial-temporal association between air pollution and poor self-reported health, which is stronger for ethnic minorities and foreign-born individuals in the UK, partly explained by location-specific differences. Air pollution mitigation is necessary to improve individuals' health, especially for ethnic minorities who are affected the most.

Interaction between childbearing and partnership trajectories among immigrants and their descendants in France: An application of multichannel sequence analysis.

While there is a large literature investigating migrant marriage or fertility, little research has examined how childbearing and partnerships are interrelated. In this paper, we investigate how childbearing and partnership trajectories evolve and interact over the life course for immigrants and their descendants and how the relationship varies by migrant origin. We apply multichannel sequence analysis to rich longitudinal survey data from France and find significant differences in family-related behaviour between immigrants, their descendants, and the native French. Immigrants' family behaviour is characterized by stronger association between marriage and childbearing than in the native population. However, there are significant differences across migrant groups. Turkish immigrants exhibit the most conservative family pathways. By contrast, the family behaviour of European immigrants is similar to that of the native population. The study also demonstrates that the family behaviour of some descendant groups has gradually become indistinguishable from that of the native French, whereas for other groups significant differences in family behaviour persist.Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2022.2049856.

Partnership and fertility trajectories of immigrants and descendants in the United Kingdom: A multilevel multistate event history approach.

We study the interrelationships between partnership and fertility trajectories of immigrant women and female descendants of immigrants using the UK Household Longitudinal Study. We propose a novel multistate event history approach to analyse the outcomes of unpartnered, cohabiting, and married women. We find that the partnership and fertility behaviours of immigrants and descendants from European and Western countries are similar to those of native women: many cohabit first and then have children and/or marry. Those from countries with conservative family behaviours (e.g. South Asian countries) marry first and then have children. Women from the Caribbean show the weakest link between partnership changes and fertility: some have births outside unions; some form a union and have children thereafter. Family patterns have remained relatively stable across migrant generations and birth cohorts, although marriage is being postponed in all groups. Our findings on immigrants support the socialization hypothesis, whereas those on descendants are in line with the minority subculture hypothesis.

A Longitudinal Analysis of the Association Between Long-Term Exposure to Air Pollution and Cognitive Function Among Adults Aged 45 and Older in China.

OBJECTIVES: Evidence suggests long-term exposure to fine particulate matter air pollution (PM2.5) is associated with a higher risk of cognitive impairment, especially among older adults. This study examines the relationship between PM2.5 exposure and cognitive function in China's aging population. METHODS: We used longitudinal data from the China Health and Retirement Longitudinal Study (2011-2015) linked with historical PM2.5 concentrations (2000-2015) from remotely sensed satellite data. Growth curve models were applied to estimate associations between PM2.5 exposure (measured in intensity, duration, and a joint variable of intensity with duration for cumulative exposure) and cognitive function. RESULTS: Relative to the lowest exposure group, exposure in the second group of PM2.5 intensity (35-50 µg/m3) is associated with poorer cognitive function, but higher levels of PM2.5 appear to be associated with better cognitive function, indicating a U-shaped association. Similar patterns are seen for fully adjusted models of PM2.5 duration: the second group (13-60 months) is associated with worse cognitive function than the first group (0-12 months), but coefficients are nonsignificant in longer duration groups. Joint analysis of PM2.5 intensity with duration suggests that duration may play a more detrimental role in cognitive function than intensity. However, we do not find a statistically significant association between PM2.5 exposure and the rate of cognitive decline. DISCUSSION: Our findings are mixed and suggest that some categories of higher and longer exposure to PM2.5 are associated with poorer cognitive function, while that exposures do not hasten cognitive decline. However, more work is necessary to disentangle PM2.5 exposure from individuals' background characteristics, particularly those jointly associated with cognitive function and urban living.

Air pollution and individuals' mental well-being in the adult population in United Kingdom: A spatial-temporal longitudinal study and the moderating effect of ethnicity.

BACKGROUND: Recent studies suggest an association between ambient air pollution and mental well-being, though evidence is mostly fragmented and inconclusive. Research also suffers from methodological limitations related to study design and moderating effect of key demographics (e.g., ethnicity). This study examines the effect of air pollution on reported mental well-being in United Kingdom (UK) using spatial-temporal (between-within) longitudinal design and assesses the moderating effect of ethnicity. METHODS: Data for 60,146 adult individuals (age:16+) with 349,748 repeated responses across 10-data collection waves (2009-2019) from "Understanding-Society: The-UK-Household-Longitudinal-Study" were linked to annual concentrations of NO2, SO2, PM10, and PM2.5 pollutants using the individuals' place of residence, given at the local-authority and at the finer Lower-Super-Output-Areas (LSOAs) levels; allowing for analysis at two geographical scales across time. The association between air pollution and mental well-being (assessed through general-health-questionnaire-GHQ12) and its modification by ethnicity and being non-UK born was assessed using multilevel mixed-effect logit models. RESULTS: Higher odds of poor mental well-being was observed with every 10µg/m3 increase in NO2, SO2, PM10 and PM2.5 pollutants at both LSOAs and local-authority levels. Decomposing air pollution into spatial-temporal (between-within) effects showed significant between, but not within effects; thus, residing in more polluted local-authorities/LSOAs have higher impact on poor mental well-being than the air pollution variation across time within each geographical area. Analysis by ethnicity revealed higher odds of poor mental well-being with increasing concentrations of SO2, PM10, and PM2.5 only for Pakistani/Bangladeshi, other-ethnicities and non-UK born individuals compared to British-white and natives, but not for other ethnic groups. CONCLUSION: Using longitudinal individual-level and contextual-linked data, this study highlights the negative effect of air pollution on individuals' mental well-being. Environmental policies to reduce air pollution emissions can eventually improve the mental well-being of people in UK. However, there is inconclusive evidence on the moderating effect of ethnicity.

A longitudinal analysis of PM2.5 exposure and multimorbidity clusters and accumulation among adults aged 45-85 in China.

While previous studies have emphasised the role of individual factors in understanding multimorbidity disparities, few have investigated contextual factors such as air pollution (AP). We first use cross-sectional latent class analysis (LCA) to assess the associations between PM2.5 exposure and multimorbidity disease clusters, and then estimate the associations between PM2.5 exposure and the development of multimorbidity longitudinally using growth curve modelling (GCM) among adults aged 45-85 in China. The results of LCA modelling suggest four latent classes representing three multimorbidity patterns (respiratory, musculoskeletal, cardio-metabolic) and one healthy pattern. The analysis shows that a 1 µg/m3 increase in cumulative exposure to PM2.5 is associated with a higher likelihood of belonging to respiratory, musculoskeletal or cardio-metabolic clusters: 2.4% (95% CI: 1.02, 1.03), 1.5% (95% CI: 1.01, 1.02) and 3.3% (95% CI: 1.03, 1.04), respectively. The GCM models show that there is a u-shaped association between PM2.5 exposure and multimorbidity, indicating that both lower and higher PM2.5 exposure is associated with increased multimorbidity levels. Higher multimorbidity in areas of low AP is explained by clustering of musculoskeletal diseases, whereas higher AP is associated with cardio-metabolic disease clusters. The study shows how multimorbidity clusters vary contextually and that PM2.5 exposure is more detrimental to health among older adults.

Make up or break up? Partnership transitions among young adults in England and Wales.

This study investigates partnership transitions of young adults born between 1974 and 1990 in England and Wales. These cohorts were affected by the expansion of higher education, increasing gender equality, and ideational changes, but faced increased economic precarity caused by the economic and housing crisis. Given these changes, it is likely that the partnership experiences of young adults including marriage, cohabitation, separation, and repartnering have also undergone considerable changes. We apply competing risks event history analysis to combined data from the British Household Panel Survey and the UK Household Longitudinal Study to determine how birth cohort, gender, socio-economic background, and educational attainment influence partnership changes. We study the transition into and out of first cohabitation and marriage and repartnering between age 16 and 27. Cohabitation has become a universal form of first union among young adults born in the late 1970s and 1980s regardless of their socio-economic background or educational level, but their first unions do not last long. While cohabiters are equally likely to marry or separate in the oldest cohort (1974-1979), cohabiting unions are very likely to end in separation among the two youngest cohorts (1980-1984 and 1985-1990). Consequently, repartnering has become common; those in the youngest cohort repartner rather quickly suggesting that an increasing number of individuals experience multiple partnerships. Highly educated young adults have higher rates of entry into first cohabitation than their lower educated counterparts across all cohorts. However, we do not find differences in cohabitation outcomes by socio-economic background and educational level indicating that the main changes have taken place across birth cohorts. The results also suggest that there is a convergence in partnership experiences among young men and women. The increased prevalence of sliding into and out of cohabitation could indicate significant changes in the meaning young people attach to first partnerships.

Separation and Elevated Residential Mobility: A Cross-Country Comparison.

This study investigates the magnitude and persistence of elevated post-separation residential mobility (i.e. residential instability) in five countries (Australia, Belgium, Germany, the Netherlands, and the UK) with similar levels of economic development, but different welfare provisions and housing markets. While many studies examine residential changes related to separation in selected individual countries, only very few have compared patterns across countries. Using longitudinal data and applying Poisson regression models, we study the risk of a move of separated men and women compared with cohabiting and married individuals. We use time since separation to distinguish between moves due to separation and moves of separated individuals. Our analysis shows that separated men and women are significantly more likely to move than cohabiting and married individuals. The risk of a residential change is the highest shortly after separation, and it decreases with duration since separation. However, the magnitude of this decline varies by country. In Belgium, mobility rates remain elevated for a long period after separation, whereas in the Netherlands, post-separation residential instability appears brief, with mobility rates declining rapidly. The results suggest that housing markets are likely to shape the residential mobility of separated individuals. In countries, where mortgages are easy to access and affordable rental properties are widespread, separated individuals can rapidly adjust their housing to new family circumstances; in contrast, in countries with limited access to homeownership and small social rental markets, separated individuals experience a prolonged period of residential instability.

Infection rates from Covid-19 in Great Britain by geographical units: A model-based estimation from mortality data.

This study estimates cumulative infection rates from Covid-19 in Great Britain by local authority districts (LADs) and council areas (CAs) and investigates spatial patterns in infection rates. We propose a model-based approach to calculate cumulative infection rates from data on observed and expected deaths from Covid-19. Our analysis of mortality data shows that 7% of people in Great Britain were infected by Covid-19 by the last third of June 2020. It is unlikely that the infection rate was lower than 4% or higher than 15%. Secondly, England had higher infection rates than Scotland and especially Wales, although the differences between countries were not large. Thirdly, we observed a substantial variation in virus infection rates in Great Britain by geographical units. Estimated infection rates were highest in the capital city of London where between 11 and 12% of the population might have been infected and also in other major urban regions, while the lowest were in small towns and rural areas. Finally, spatial regression analysis showed that the virus infection rates increased with the increasing population density of the area and the level of deprivation. The results suggest that people from lower socioeconomic groups in urban areas (including those with minority backgrounds) were most affected by the spread of coronavirus from March to June.

The effect of air-pollution and weather exposure on mortality and hospital admission and implications for further research: A systematic scoping review.

BACKGROUND: Air-pollution and weather exposure beyond certain thresholds have serious effects on public health. Yet, there is lack of information on wider aspects including the role of some effect modifiers and the interaction between air-pollution and weather. This article aims at a comprehensive review and narrative summary of literature on the association of air-pollution and weather with mortality and hospital admissions; and to highlight literature gaps that require further research. METHODS: We conducted a scoping literature review. The search on two databases (PubMed and Web-of-Science) from 2012 to 2020 using three conceptual categories of "environmental factors", "health outcomes", and "Geographical region" revealed a total of 951 records. The narrative synthesis included all original studies with time-series, cohort, or case cross-over design; with ambient air-pollution and/or weather exposure; and mortality and/or hospital admission outcomes. RESULTS: The final review included 112 articles from which 70 involved mortality, 30 hospital admission, and 12 studies included both outcomes. Air-pollution was shown to act consistently as risk factor for all-causes, cardiovascular, respiratory, cerebrovascular and cancer mortality and hospital admissions. Hot and cold temperature was a risk factor for wide range of cardiovascular, respiratory, and psychiatric illness; yet, in few studies, the increase in temperature reduced the risk of hospital admissions for pulmonary embolism, angina pectoris, chest, and ischemic heart diseases. The role of effect modification in the included studies was investigated in terms of gender, age, and season but not in terms of ethnicity. CONCLUSION: Air-pollution and weather exposure beyond certain thresholds affect human health negatively. Effect modification of important socio-demographics such as ethnicity and the interaction between air-pollution and weather is often missed in the literature. Our findings highlight the need of further research in the area of health behaviour and mortality in relation to air-pollution and weather, to guide effective environmental health precautionary measures planning.

Intersecting household-level health and socio-economic vulnerabilities and the COVID-19 crisis: An analysis from the UK.

The effects of COVID-19 are likely to be socially stratified. Disease control measures introduced during the COVID-19 pandemic mean that people spend much more time in their immediate households, due to lockdowns, the need to self-isolate, and school and workplace closures. This has elevated the importance of certain household-level characteristics for individuals' current and future wellbeing. The multi-dimensional poverty and health inequalities literature suggests that poor health and socio-economic conditions cluster in the general population, which may exacerbate societal inequalities over time. This study investigates how COVID-19-related health- and socio-economic vulnerabilities co-occur at the household level, and how they are distributed across household types and geographical areas in the United Kingdom. Using a nationally representative cross-sectional study of UK households and individuals and applying principal components analysis, we derived summary measures representing different dimensions of household vulnerabilities critical during the COVID-19 epidemic: health, employment, housing, financial and digital. Our analysis highlights four key findings. First, although COVID-19-related health risks are concentrated in retirement-age households, a substantial proportion of working-age households also face these risks. Second, different types of households exhibit different vulnerabilities, with working-age households more likely to face financial and housing precarities, and retirement-age households health and digital vulnerabilities. Third, there are area-level differences in the distribution of household-level vulnerabilities across England and the constituent countries of the United Kingdom. Fourth, in many households, different dimensions of vulnerabilities intersect; this is especially prevalent among working-age households. The findings imply that the short- and long-term consequences of the COVID-19 crisis are likely to significantly vary by household type. Policy measures that aim to mitigate the health and socio-economic consequences of the COVID-19 pandemic should consider how vulnerabilities cluster and interact with one another both within individuals and different household types, and how these may exacerbate already existing inequalities.

Trends in multimorbidity, complex multimorbidity and multiple functional limitations in the ageing population of England, 2002-2015.

This study aimed to estimate the prevalence of three measures of multimorbidity among people aged 50 years or older in England. Beside the basic measure of two or more diseases within a person, we added a measure of three or more affected body systems (complex multimorbidity) and a measure of 10 or more functional limitations. We found that the three health outcomes became more prevalent between 2002 and 2015. They were more common among females than males and were becoming more common among younger age groups. While in 2002, the prevalence of basic multimorbidity overcame 50% from the 70-74 age group upwards, in 2015 it crossed the same threshold in the 65-69 age group. The distribution of multimorbidity and multiple functional limitations were stratified by the amount of household wealth. Multiple functional limitations reflected the largest differences between the most and the least affluent groups (5.9-fold in 2014/2015), followed by the measure of complex multimorbidity (2.8-fold in 2014/2015) and basic multimorbidity (1.9-fold) in 2014/2015.While age acted as a levelling factor for the wealth differences in basic multimorbidity, it had no such effect on the two other outcomes. Our study observed social polarization among multimorbid ageing population in England where complex multimorbidity and multiple functional limitations increase faster and reflect stronger inequality than basic multimorbidity.