IJE Advance Access originally published online on January 19, 2005
International Journal of Epidemiology 2005 34(2):276-283; doi:10.1093/ije/dyh328
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Area deprivation, social class, and quality of life among people aged 75 years and over in Britain
1 Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2 University Department of Geriatric Medicine, Llandough Hospital, Penlan Road, Cardiff, Wales, CF64 2XX UK
3 Section of Care of the Elderly, Faculty of Medicine, Imperial College, Hammersmith Campus, Du Cane Road, London W12 0NN, UK
4 Public Health and Epidemiology Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
* Corresponding author. Dr E Breeze, Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: elizabeth.breeze{at}lshtm.ac.uk
Background There is a shortage of research studies that assess how selected characteristics of neighbourhood and personal social circumstances contribute towards health-related quality of life (QoL) among older people.
Methods Analysis of baseline data for 5581 people aged >75 years and over from the Trial of Assessment and Management of Older People in the Community. The scores for four dimensions from the UK version of the Sickness Impact Profile and for the Philadelphia Geriatric Morale Scale were analysed in relation to individual social class and the Carstairs score of socioeconomic deprivation for the enumeration district of residence.
Results In age and sex adjusted analyses, the proportion of participants of social class IV/V living in the most deprived areas who were in the quintile with worst QoL scores was more than double that among those from social class I/II living in the least deprived areas. Individual social class and area deprivation score contributed roughly equally to this doubling for home management, self-care and social interaction, whereas social class appeared a stronger determinant for mobility. Adjustment for living circumstances, health symptoms, and health behaviours substantially reduced the excess risk associated with social class and area deprivation. Being in a rural area was associated with lower risk of poor morale.
Conclusion Poor socioeconomic characteristics of both the area and the individual are associated with worse functioning (QoL) of older people in the community. This is not fully explained by health status. Policy should consider community-level interventions as well as those directed at individuals.
Keywords Quality of life, socioeconomic factors, older people, urban (rural), morale, deprivation, Sickness Impact Profile
Accepted 5 August 2004
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