Social inequalities in musculoskeletal ageing among community dwelling older men and women in the United Kingdom

Abstract

The population of the United Kingdom (UK) is ageing; the already substantial burden of musculoskeletal disorders on health and social care systems will increase over time as the population ages. Social inequalities in health are well documented for the UK in general but little is known about social inequalities in musculoskeletal ageing. Using data from the 3,225 ‘young-old’ (age 59 to 73 years) community dwelling men and women who participated in the Hertfordshire Cohort Study, this thesis has explored social inequalities in musculoskeletal ageing: specifically, loss of muscle strength and physical function (PF); falls; Fried frailty; and osteoporosis. Socioeconomic position was characterised by age left full-time education, parental social class at birth and own social class in adulthood, and current material deprivation by housing tenure and car availability. Not owning one’s home was associated with lower grip strength and increased frailty prevalence among men and women and with poorer self-reported short-form 36 (SF-36) PF among men. Reduced car availability was associated with lower grip strength and poorer SF-36 PF among men and women and with increased falls and frailty prevalence among men. There was no convincing evidence for social inequalities in fracture, dual-energy x-ray absorptiometry (DXA) total femoral bone mineral density (BMD) and bone loss rate, or peripheral quantitative computed tomography (pQCT) strength strain indices for the radius or tibia. This thesis has argued that social variations in height, fat mass, diet and physical activity are likely to have mediated these results. Moreover, evidence for a social gradient in grip strength but not BMD is consistent with ageing skeletal muscle remaining highly responsive to physical activity in later life in a way that ageing bone does not; the impact of lifecourse customary and occupational physical activity on social inequalities in musculoskeletal ageing merits further research. The results presented in this thesis suggest that any clinical interventions designed to reduce the loss of muscle mass and function with age should be targeted proportionately across the social gradient; strategies to reduce fracture and osteoporosis should continue to have a universal population focus. Finally, this thesis suggests that there exists a subgroup of older men and women in the UK who face the multiple jeopardy of increased levels of material deprivation combined with greater loss of muscle strength and physical function; these men and women urgently need the government to commit to reform of the funding system for adult care and support.

More information

Identifiers

ORCID for H.E. Syddall: orcid.org/0000-0003-0171-0306

ORCID for Maria Evandrou: orcid.org/0000-0002-2115-9358

Catalogue record

Export record