Socioeconomic inequalities in functional ageing trajectories in England and Canada: A comparative longitudinal cohort study

Socioeconomic disparities in the progression of functional ageing were investigated through a longitudinal comparison of England and Canada. Drawing from the English Longitudinal Study of Ageing (ELSA, 2012–2023, comprising 8,511 participants, 55% of whom were women, aged 50–85 years at baseline) and the Canadian Longitudinal Study on Aging (CLSA, 2012–2021, involving 22,605 participants, 49% of whom were women, aged 50–85 years at baseline), the study aimed to examine the link between wealth and physical functioning.

This included aspects such as gait speed, grip strength, chair stands, lung function, self-rated hearing, self-rated eyesight, mobility difficulties, and difficulties performing daily activities.

Findings revealed that lower wealth was linked with poorer performance across these physical functions and a more rapid decline in mobility and ability to carry out daily activities with advancing age. In the English cohort, wealthier participants displayed a more pronounced decrease in gait speed over time, although their overall level of functioning remained superior throughout the study period.

Conversely, in the Canadian cohort, wealthier individuals exhibited a steeper decline in chair rise performance and self-rated eyesight compared to their less affluent counterparts.

The scale of wealth disparities in functional health status was notably larger in England than in Canada, particularly in terms of gait speed (15 years of functioning lost at age 60 in England, as opposed to 9 years in Canada) and difficulties with basic daily activities (20 years in England, compared to 9 years in Canada). Additionally, certain interactions between wealth and sex emerged, indicating that women with the lowest wealth faced greater challenges in mobility, daily activities, and hearing compared to men with the lowest wealth, although they demonstrated better lung function.

Despite adjusting for variables such as chronic conditions, weight status, health behaviors, and social connections, the association between wealth and functional outcomes remained significant. Limitations of the study encompass its focus on adult socioeconomic conditions and the inability to explore the influence of other crucial factors on the observed associations, like access to private healthcare.

The study concludes that socioeconomic inequalities in functional ageing are evident in both England and Canada, with a greater magnitude in England. These disparities cannot be fully explained by common risk factors, underscoring the need for comprehensive strategies that integrate individual interventions with structural measures to tackle socioeconomic inequalities and cross-country differences in functional ageing.

The study also highlights the importance of considering sex-specific differences in the design of such interventions.