How to narrow the gap in disability-free life expectancy with a focus on long-term conditions: an evidence synthesis review

This review will identify and examine published evidence of effective interventions that prevent or postpone the development of disability, relating to long-term conditions.

Background

We will only consider evidence that includes a measure of socio-economic status to allow us to comment on the relative impact among different groups.

We will focus on a small number of conditions that are a major source of morbidity and mortality, and look only at interventions that are recommended in National Institute for Health and Care Excellence (NICE) guidance. Information on outcomes by socioeconomic status will be identified and summarised.

Where there are no data in the evidence used by NICE, we will conduct a targeted search for other evidence using standard systematic review methodology. Our initial plan is to focus on osteoarthritis, depression, and Type II diabetes.

Aims and objectives

Aims:

To produce estimates of the size of effects needed to narrow the gap in Disability Free Life Expectancy between richest and poorest in the UK, and estimate the intervention size required and time frame to make an impact.

Objectives:

1. To estimate the effect size to reduce inequalities in DFLE, under a range of different scenarios
2. To undertake methodological development work to investigate the impact of COVID-19 on life expectancy and DFLE
3. To understand the impact of inequalities on long-term conditions after adjustment for COVID-19

Methods

• Work package 1: The interaction between long-term conditions and socio-economic status in DFLE
• Work package 2: Scenario modelling to evaluate the magnitude of effect size that interventions will need to deliver to meaningfully reduce life expectancy and DFLE.
• Work package 3: Exploring how COVID-19 will impact life expectancy and DFLE

Policy relevance

This work will provide evidence as to the size and length of term for interventions/policies to demonstrate the most effective narrowing of the gap between the experience of good health of the richest and poorest, focused on the main conditions that are associated with inequalities in DFLE in England. Increasing DFLE in disadvantaged areas will make a major contribution to reducing inequalities in DFLE across the population.

Delivery dates

Stage one: March 2023

Further work: December 2023

Associated resources and publications

• How to narrow the gap in disability with a focus on long-term conditions: an evidence synthesis review protocol (PDF)
• How to narrow the gap in disability free life expectancy between rich and poor, with a focus on long-term conditions: a rapid evidence synthesis – Executive Summary, Full Report (PDF)
• Kunonga et al. (2023) – Health interventions and the unseen impact on equality (The Lancet Healthy Longevity) DOI: 10.1016/S2666-7568(22)00268-9