Intersecting Gender, Racial, and Socioeconomic Inequalities in Multimorbid Life Expectancy in South Africa: A Multistate Modelling Approach

Anastasia Lam , University of St Andrews
Katherine Keenan , University of St Andrews
Mikko Myrskyla, Max Planck Institute for Demographic Research
Hill Kulu , University of St Andrews

The effect of multimorbidity on life expectancy is unclear, as is how it varies by gender, race, and socioeconomic factors. This is particularly true for South Africa, whose apartheid history adds further complexity to the roles of gender, race, and socioeconomic inequalities. This underlines the importance of taking an intersectional perspective to understand the interplay of these factors and how they influence health and mortality. Thus, this study aims to understand the extent to which gender, race, and socioeconomic factors may impact life expectancy and the time spent living with multimorbidity in South Africa. Five waves of data were used (2008-2017) from the National Income Dynamics Study. We applied a discrete-time multistate Markov approach to model transitions between the following states: no disease, one disease, 2+ diseases (multimorbidity), and death. We adjusted the models by geography and stratified by gender, race, and education. Females had higher average life expectancy at age 20 than males (51.0 years vs 48.3 years) but spent more time with multimorbidity. Africans had the lowest average life expectancy, with Whites and Asian/Indians having the highest. More education resulted in higher life expectancy and less time with multimorbidity. Coloured women with multimorbidity seemed to benefit the most from more education, gaining about 10 years of expected life compared to those with some secondary school. By quantifying the impact of gender, race, and socioeconomic inequalities on multimorbidity and life expectancy, our findings highlight the need for interventions and policies to account for these disparities.

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 Presented in Session 71. Flash Session: Inequalities in Life Expectancy, Disability and Health