Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English Longitudinal Study of Ageing

Summary: Background: Age discrimination (or ageism) is pervasive in society. Other forms of discrimination (such as racism) have been linked with adverse health outcomes, but age discrimination has not been well studied in public health. We aimed to examine associations between perceived age discrimination and health and wellbeing in England. Methods: We did a longitudinal observational population study with data from the English Longitudinal Study of Ageing, a nationally representative sample of older men and women. Participants were aged 50 years or older and reported experiences of age discrimination via a face-to-face computer-assisted personal interview and a self-completed questionnaire between July, 2010, and June, 2011. Self-rated health, chronic health conditions, and depressive symptoms were assessed between July, 2010, and June, 2011, and between May, 2016, and June, 2017. We used logistic regression to test cross-sectional associations between perceived age discrimination and baseline health status and prospective associations between perceived age discrimination and incident ill health over 6 years. Analyses were adjusted for age, sex, and wealth. Findings: Our sample for cross-sectional analyses of 2010–11 data comprised 7731 people who took part in the face-to-face interview, returned the self-completion questionnaire, and had available data for age discrimination. Perceived age discrimination was reported by 1943 (25·1%) participants. Patients who perceived age discrimination were more likely to self-report fair or poor health (odds ratio [OR] 1·32 [95% CI 1·17–1·48]) and to have coronary heart disease (1·33 [1·14–1·54]), chronic lung disease (1·37 [1·11–1·69]), arthritis (1·27 [1·14–1·41]), limiting long-standing illness (1·35 [1·21–1·51]), and depressive symptoms (1·81 [1·57–2·08]) than those who did not perceive age discrimination. Follow-up data collected 6 years after the baseline assessment were available for 5595 participants. Longitudinally, perceived age discrimination was associated with the deterioration of self-rated health (OR 1·32 [95% CI 1·10–1·58]) and incident coronary heart disease (1·66 [1·18–2·35]), stroke (1·48 [1·08–2·10]), diabetes (1·33 [1·01–1·75]), chronic lung disease (1·50 [1·10–2·04]), limiting long-standing illness (1·32 [1·10–1·57]), and depressive symptoms (1·47 [1·16–1·86]) over 6 years. Interpretation: Among older adults living in England, perceived age discrimination was associated with increased odds of poor self-rated health and risk of incident serious health problems over a 6-year period. These findings underscore the need for effective interventions at the population level to combat age stigma and discrimination. Funding: UK Economic and Social Research Council