Socioeconomic inequalities in disease prevalence by age and sex for 17 common long-term conditions in England: retrospective, observational study of electronic primary care records from Clinical Practice Research Datalink (CPRD) Aurum

TL;DR

This study shows that socioeconomic status strongly affects the prevalence of long-term diseases in England, with significant differences seen in conditions like COPD and mental illness.

Contribution

The study provides a detailed analysis of socioeconomic inequalities in disease prevalence across age and sex for 17 conditions using a large primary care database.

Findings

16 out of 17 conditions showed higher prevalence in the most deprived fifth of the population.

Chronic obstructive pulmonary disease had the highest prevalence rate ratio (3.29) between the most and least deprived groups.

Equity gaps for most conditions were largest in middle age and decreased with age.

Abstract

Evidence on socioeconomic inequalities in the prevalence of common long-term conditions and their variation across the life course is necessary for equitable service design and resource allocation. We used routinely collected electronic primary care records and a unified data extraction and analysis framework to estimate socioeconomic variations in the prevalence of 17 common long-term conditions by age and sex.

Electronic records for 2.2 m patients registered with 300 randomly selected primary care practices contributing to the Clinical Practice Research Datalink Aurum database were used to estimate observed, age-sex standardised and age-specific rates of disease prevalence on 31 March 2020 by Index of Multiple Deprivation quintile groups. Inequality in disease burden was expressed as the prevalence rate ratio (RR) between the most and least deprived fifths of the population.

Age-sex standardised prevalence rates were higher in the most deprived compared with the least deprived fifth of the population for 16 of 17 conditions. The largest relative differences in disease prevalence were observed for chronic obstructive pulmonary disease (RR: 3.29; 95% CI: 3.19 to 3.38), severe mental illness (RR: 2.72; 95% CI: 2.60 to 2.85) and peripheral arterial disease (RR: 2.58; 95% CI: 2.46 to 2.72). For most conditions, the equity gap was largest in middle age and reduced with age thereafter.

Substantial socioeconomic inequalities in disease prevalence are evident in the English population. A catalogue of disease prevalence by socioeconomic quintile group, age and sex is provided to facilitate further analysis and modelling.

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