White C, Edgar G. Inequalities in disability-free life expectancy by social class and area type: England, 2001–03 . Health Statistics Quarterly 2010; 45 (Spring): 57-80.

Background: Disability-free life expectancy (DFLE) is an important indicator which combines longevity with functional health status. This article examines inequalities in DFLE by socio-economic position in England, and between Local Authorities (LAs) in the deprived ‘Spearhead group’ and other LAs.

Methods: Census and vital event data available from the ONS Longitudinal Study were used to calculate estimates of DFLE based on limiting long-term illness or disability status for each Registrar General’s Social Class (RGSC) in 2001–03, in England as a whole and within the ‘Spearhead group’ and non-Spearhead LAs.

Results: A predominantly linear relationship was present with DFLE increasing with rising social class. The differences observed in DFLE at birth and at age 65 between people assigned to the professional and unskilled manual social classes were statistically significant and substantial, demonstrating a clear social inequality in the amount of life, the functional health status during those years lived, their absolute number, and thus the relative proportion of life spent free from a limiting long-term illness or disability.

Among professional men, no statistically significant differences in DFLE at birth were found between the ‘Spearhead group’ and the non-Spearhead LAs. However, men assigned to the other social classes in the ‘Spearhead group’ were disadvantaged in terms of lower DFLE than their counterparts in the non-Spearhead LAs. Manual women living in non-spearhead LAs had comparable DFLE to women assigned to the managerial and technical and skilled non-manual social classes living in the ‘Spearhead group’.

The magnitude of inequality in DFLE at birth between professionals and the unskilled manual class in the proportion of life spent free of a limiting long-term illness or disability also varied between the ‘Spearhead group’ and non-Spearhead LAs: among men, a difference of 7.7 per cent was present in non-Spearhead LAs, compared with 13.1 per cent in the ‘Spearhead group’; among women, the equivalent differences were 5.2 per cent and 9.4 per cent.

Conclusions: These results confirm that the assumptions made with regard to sex differences in DFLE need to be set in the context of socio-economic position, and assumptions made regarding sex and social differences need to set in the context of geography. The scale of the inequalities shown is important for policy responses and understanding of differences in service needs.