Gondek, Dawid; (2020) We are living longer, but not healthier: evidence from the British birth cohorts and the Uppsala Birth Cohort Multigenerational Study. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Life expectancy has increased in the last decades of the 20th century and at the beginning of the 21st century, for instance, in the United Kingdom from 66.3 years in 1946 to 82.0 in 2015. However, the evidence on trends in other key health indicators, such as non-communicable conditions or disability, has been inconsistent. The systematic review of 53 studies found no evidence for improvement in the age-standardised or age-specific prevalence of any of the studied major chronic conditions over the last few decades, apart from Alzheimer’s disease. The evidence on trends in disability, expressed as prevalence or health expectancy was inconclusive. In the secondary analyses of the 1958 and 1970 British birth cohorts, with the total sample of n=16,834, I found that the prevalence of multimorbidity was higher in the younger cohort: 24.3% vs 17.8% at age 42-48. Across both cohorts, early-life parental social class, birthweight, cognitive ability and body mass index at age 10/11, internalising and externalising problems at 16 were associated with multimorbidity at age 42-48. A higher prevalence of morbidity in younger birth cohorts was not limited to physical health. In the comparison across the 1946, 1958 and 1970 British birth cohorts (n=28,362), progressively younger birth cohorts had higher levels of mental health symptoms across adulthood. Worsening health across progressively younger birth cohorts has also been observed in Sweden, in the analysis of the Uppsala Birth Cohort Multigenerational Study. Successively younger birth cohorts (1915-1972) had a higher prevalence of hospitalisation at overlapping ages, with inter-cohort differences emerging from early- 4 adulthood and increasing with age in absolute terms. Those with medium and low parental socioeconomic position (vs high) had respectively 13% and 20% higher odds of experiencing hospitalisation during the observation period (1989-2008)—when age, year-of-birth and gender were accounted for. Hence, rising life expectancy has not translated into improving health and reduced hospitalisation, associated with non-communicable conditions, both in Great Britain and Sweden. This is likely to translate in greater demands on healthcare and public services.

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