Five things the ONS Longitudinal study has taught us about older age

Since the early 1970s,  the ONS Longitudinal Study has shed light on a huge range of social issues: this series of Linking our Lives blogs looks back on the major contributions which have been made to different fields of research using this unique data resource. This blog is the third in the series, and highlights some of the key ways in which this one per cent sample of the population of England and Wales, which contains census and life event data on more than a million people, has contributed to the study of older age. The series aims to highlight the breadth of further research which will become possible when the 2021 Census link to the study is finalised in 2025.

Health inequalities and mortality

From its earliest days, the ONS-LS has been used to shed light on health inequalities: work led by John Fox focused on unemployment and mortality, and was quoted in the important 1982 Black Report. Fox and his colleagues found death rates among men who were unemployed at the time of the 1971 Census were higher than expected over the ensuing decade. They estimated that after other factors such as socio-economic background were taken into account, unemployment was associated with a 20-30 per cent excess death rate. Women married to unemployed men also had higher-than-expected death rates, they found.

Older age and place of residence

The ONS LS has also been used to shed light on factors associated with household changes in later life. In 2003 Emily Grundy and Karen Glaser reported on older widowed and divorced women moving from independent living into either family or institutional care in the 1970s and 1980sand found that owner occupiers were significantly more likely than tenants to move in with relatives  rather than to institutions.

:A further study on the living arrangements of older people with cancer,  led by Emily Grundy in 2004,  found those who lived with others were more likely to be able to die at home than those who lived alone.

With Mark Jitlal, Emily Grundy looked in 2007 at socio-demographic variations in moves to institutional care. Using data from the 1990s, they found those who were in rented accommodation, lived alone, were unmarried, childless or suffered from long-term illness were more likely to make this transition. Women were more likely to do so than men, particularly if they were childless.

This work was extended in a paper published in 2010 by Emily Grundy, which looked at data from the early 2000s. It found older people’s chances of living with relatives rather than alone or in a couple had decreased over time. Those who lived in institutions had higher mortality than others and this excess had grown over time suggesting stronger health related selection.

In 2013, Susan Ramsay and colleagues looked at the effects of caregiving on mortality, and found that while caregivers were more likely to report poor health than others, they were also at significantly lower risk of dying.

Marital and fertility histories and older age

In the early 2000s, Emily Grundy and colleagues carried out a series of studies looking at changes in women’s fertility during the 20^th Century and asked whether these changes might be linked to socio-economic factors. With Cecilia Tomassini, she published a 2005 paper which asked whether the mortality of women born between 1911 and 1940 was linked to the age at which they became mothers, the number of children they had and the intervals between births. The study found those who had been teenage mothers, who had at least five children or who had short birth intervals – including twins – had higher mortality rates. However, this also applied to those who had no children, while those who had children later had lower risks.

In 2006 Emily Grundy and Cecilia Tomassini looked at fatherhood and mortality and found men who had a child before the age of 23 had higher mortality and higher risk of poor health than other fathers, while the reverse was the case for those who had children after the age of 40. Men who had four or more children also had worse health later in life, but contrary to expectations married men with no children did not suffer that disadvantage.

This theme was explored further in a 2010 paper which looked at the health effects of marriage on older people. It found men who were unmarried, widowed, divorced or even remarried had higher mortality rates than those who remained in a long first marriage. Those who remarried were also at greater risk of long-term illness. For unmarried women the picture was different –they had raised mortality rates, but those in the 2001 census cohort actually had lower odds of reporting long-term illness.

These effects were also reported in a study looking at marital history and mortality in England and Finland – long-term marriage had a protective effect, it found. Once social factors were taken into account those who had long first marriages had the lowest mortality, while those never married, divorced or widowed had the highest.

Health inequalities and older age

In the early 2000s, census data from ONS-LS participants in 1971 and 1981 was used to examine socio-economic differences in cancer survival. Previous studies had shown those from poorer backgrounds had worse outcomes, but this research was able to produce a more nuanced picture.

Andrew Sloggett and Emily Grundy used the data to link census responses with records of cancer diagnoses between 1981 and 1997. Outcomes for those who had been diagnosed with a primary malignant cancer at age 45 or older were followed up to the year 2000.

This research was able to produce a measure which showed the relative cancer survival rates of different social groups when compared to the population as a whole. It showed that while the most commonly-used measure, the Carstairs index, was adequate for highlighting differential outcomes, a measure which factored in car access and housing tenure produced a more sensitive measure. Social class in isolation was a relatively weak indicator of survival differentials, it found.

Work on health inequalities has been able to examine social class differences in the amount of time older adults live after stopping work, and how these differences relate to health. Emily Murray and colleagues followed up ONS-LS participants who were aged between 50 and 75 at the time of the 2001 census and who had stopped work by the 2011 census. They found both social class and health were independent predictors of post-work life expectancy, with professional people gaining 2.7 years over those from unskilled backgrounds, and those in good health gaining 2.4 years over those whose health was poor. Lower social class groups were negatively affected by uniform state pension ages, because they were more likely to stop work at younger ages due to health reasons, they found.

Older age and the labour market

Research on extended working lives and the factors driving people’s decisions to leave or remain in work has been able to gain insights from ONS- LS data. In 2016, Emily  Murray and colleagues looked at how local area unemploymentcould be linked to health and to workforce exit. Using information on ONS-LS participants who were aged 40-69 and working in 2001, they asked how their odds of being sick, disabled or retired in 2011 was linked to the level of unemployment in their areas. Again they found that both high area unemployment and poor health were independently linked to people becoming sick, disabled or retired. Those in areas of high unemployment were more likely to identify as being sick or disabled, while improvements in employment rates were less likely to affect the positions of those in poor health than of those in good health.

In 2018, Nicola Shelton and colleagues looked at whether gender and place were linked to the likelihood of remaining in work. They looked at those aged 40-49 in 2001, following them up in 2011 to ask whether they were still in work. Both men and women in the North East were the most likely to leave work early, they found, though most regional differences were ironed out when socio-economic status, housing tenure, qualifications and car ownership were taken into account.Women working for larger employers or further from home were more likely to leave work, whereas access to a car and higher working hours increased the likelihood of staying on.

Later work carried out under the HOPE (Health of Older People in Places) project, led by Emily Murray, explored the ways in which where we live affects disability-free life expectancy – which in turn affects exit from the labour market. In 2022 Emily Murray and colleagues looked at life expectancy for men and women aged 50–74, the stage at which people tend to move from jobs into retirement or to different types of work. They found while those in rural and coastal areas had mixed outcomes, health inequalities in former industrial and coalfield areas were deeply entrenched and were strongly linked to how those areas had fared in terms of deprivation.

The HOPE project was also able to shed further light on the factors driving employment in older age, looking at how levels of poor health within a place were linked to the chances of residents being in paid work. They found older workers from the unhealthiest places were 60 per cent more likely to be out of work than those in the healthiest places. Historically disadvantaged areas continued to struggle, it found: areas where people left paid work at a younger age due to poor health in 1991 were much more likely to experience this trend in 2011 as well. This disproportionately affected those in manual occupations, who were much more likely to experience ill health and to expect fewer years of healthy life beyond age 50, compared with workers in administrative or professional roles.

Further work published in 2024 looked at these area level health effects in relation to employment outcomes for different occupational groups, finding the gap between the healthiest and unhealthiest areas was most marked for skilled trades; process, plant and machine operatives; and elementary occupations.

The way we measure health matters, too: a study using the ONS-LS looked at which health factors were most closely linked to employment outcomes. It considered seven indicators for older working age: self-rated health at age 50-74, long-term illness at age 50-74, age-specific mortality rate at 50-74, avoidable mortality, life expectancy at birth and at 65 years, disability-free life expectancy at 50 years, and healthy life expectancy at 50. The strongest associations were found for self-reported long-term illness and health, and were slightly more so for men than women. Improving the health of older populations could lead to wider economic benefits for all, the work concluded.

 Reference list

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