Cuts to local government spending, multimorbidity and health-related quality of life: A longitudinal ecological study in England

Stokes, J. , Bower, P., Guthrie, B., Mercer, S. W., Rice, N., Ryan, A. M. and Sutton, M. (2022) Cuts to local government spending, multimorbidity and health-related quality of life: A longitudinal ecological study in England. Lancet Regional Health - Europe, 19, 100436. (doi: 10.1016/j.lanepe.2022.100436) (PMID:36039277) (PMCID:PMC9417904)

Abstract

Background: Population health has stagnated or is declining in many high-income countries. We analysed whether nationally administered austerity cuts in England were associated with prevalence of multimorbidity (individuals with two or more long-term conditions) and health-related quality of life. Methods: We conducted an observational, longitudinal study on 147 local authorities in England. We examined associations of changes in spending over time (2009/10-2017/18), in total and by budget line, with (i) prevalence of multimorbidity, 2+ conditions (2011/12-2017/18), and (ii) health-related quality of life (EQ-5D-5L) score (2012/13-2016/17). We estimated linear, log-log regression models, incorporating local authority fixed-effects, time-varying demographic and socio-economic confounders, and time trends. Findings: All local authorities experienced real spending cuts, varying from 42% (Barking and Dagenham) to 0·3% (Sefton). A 1% cut in per capita total service expenditure was associated with a 0·10% (95% CI 0·03 to 0·16) increase in prevalence of multimorbidity. We found no association (0·003%; 95% CI -0·01 to 0·01) with health-related quality of life. By budget line, after controlling for other spending, a 1% cut in public health expenditure was associated with a 0·15% (95% CI 0·11 to 0·20) increase in prevalence of multimorbidity, and a 1% cut in adult social care expenditure was associated with a 0·01% (95% CI 0·002 to 0·02) decrease in average health-related quality of life. Interpretation: Fiscal austerity is associated with worse multimorbidity and health-related quality of life. Policymakers should consider the potential health consequences of local government expenditure cuts and knock-on effects for health systems.

• Item Type: Articles
• Additional Information: The work is part of JS's personal research Fellowship, funded by the Medical Research Council (MRC Grant Ref: MR/T027517/1).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stokes, Dr Jonathan
• Authors: Stokes, J., Bower, P., Guthrie, B., Mercer, S. W., Rice, N., Ryan, A. M., and Sutton, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Lancet Regional Health - Europe
• Publisher: Elsevier
• ISSN: 2666-7762
• ISSN (Online): 2666-7762
• Published Online: 10 June 2022
• Copyright Holders: Copyright © The Author(s) 2022
• First Published: First published in Lancet Regional Health - Europe 19: 100436
• Publisher Policy: Reproduced under a Creative Commons License