Disability free life expectancy: a simulation study of scenarios to extend healthy years and reduce inequalities.
Level 3 - non-randomized controlled study
Simulation modeling based on longitudinal cohort study data
PubMed 42168976 · doi:10.1186/s12916-026-04934-5
What was done
Multistate simulation modeling was applied to pooled longitudinal data from 16,899 individuals aged 50 and older across three English cohort studies: the English Longitudinal Study of Ageing, the Cognitive Function and Ageing Study II, and the Newcastle 85+ Study. The authors simulated hypothetical interventions addressing: (1) excess disability risk and lower recovery rates in the 20% most deprived areas, (2) age-related increases in disability risk and declines in recovery, and (3) combined age- and deprivation-targeted interventions.
What was found
Interventions targeting solely the most deprived quintile yielded modest Disability-Free Life Expectancy gains of up to 2.8 years for women and 2.3 years for men (in deprived areas only). Interventions reducing age-related disability risk alone by 40% increased Disability-Free Life Expectancy by 6.3 to 8.7 years, but widened the gap between most and least deprived populations. Combining a 30% reduction in age-based disability probability, corresponding increases in recovery, and removal of deprivation-associated inequalities increased Disability-Free Life Expectancy by 4.8 to 8.6 years for individuals aged 50, with women in deprived areas gaining the most.
Why it matters
This modeling shows that population-wide, age-targeted interventions can paradoxically widen health inequalities unless coupled with measures specifically addressing socioeconomic deprivation.
Limits
The findings derive from mathematical simulation scenarios rather than real-world implemented trials, assuming hypothetical percentages of risk reduction and recovery. Generalizability is limited to older adults (aged 50+) in England.
Cited by
- context Due to the gap between lifespan and healthy life expectancy, people in England spend up to 23 years at the end of life in poor health or managing chronic conditions.