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. 2024 Aug 1;34(4):696-703.
doi: 10.1093/eurpub/ckae062.

Younger but sicker? Cohort trends in disease accumulation among middle-aged and older adults in Scotland using health-linked data from the Scottish Longitudinal Study

Eloi Ribe  1 , Genevieve Isabelle Cezard  2   3 , Alan Marshall  4 , Katherine Keenan  5
Affiliations

Younger but sicker? Cohort trends in disease accumulation among middle-aged and older adults in Scotland using health-linked data from the Scottish Longitudinal Study

Eloi Ribe et al. Eur J Public Health. .

Abstract

Background: In the United Kingdom, rising prevalence of multimorbidity-the co-occurrence of two or more chronic conditions- is coinciding with stagnation in life expectancy. We investigate patterns of disease accumulation and how they vary by birth cohort, social and environmental inequalities in Scotland, a country which has long suffered from excess mortality and poorer health outcomes relative to its neighbours.

Methods: Using a dataset which links census data from 1991, 2001 and 2011 to disease registers and hospitalization data, we follow cohorts of adults aged 30-69 years for 18 years. We model physical and mental disease accumulation using linear mixed-effects models.

Results: Recent cohorts experience higher levels of chronic disease accumulation compared to their predecessors at the same ages. Moreover, in more recently born cohorts we observe socioeconomic status disparities emerging earlier in the life course, which widen over time and with every successive cohort. Patterns of chronic conditions are also changing, and the most common diseases suffered by later born cohorts are cancer, hypertension, asthma, drug and alcohol problems and depression.

Conclusion: We recommend policies which target prevention of chronic disease in working age adults, considering how and why certain conditions are becoming more prevalent across time and space.

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Figures

Figure 1
Figure 1
Predicted multimorbidity scores by cohort and age (based on model 1 estimates in Supplementary table S3). Source: Scottish Longitudinal Study.
Figure 2
Figure 2
Predicted multimorbidity scores by age, cohort and SIMD quintile. Source: Scottish Longitudinal Study.
Figure 3
Figure 3
Differences in estimated multimorbidity scores of multimorbidity (A) Least- vs. Most-deprived SIMD quintiles; (B) Social vs. Owned housing tenure; (C) No education vs High) by cohort and age. Source: Scottish Longitudinal Study.
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