Demographic, socioeconomic, and social barriers to use of mobility assistive products: a multistate analysis of the English Longitudinal Study of Ageing

Background: Cross-sectional evidence suggests that access to essential mobility assistive products (MAPs) might be dependent on non-clinical factors. However, MAP use is better understood as a dynamic process wherein individuals pass through different states of MAP need and use. We aimed to test associations of demographic, socioeconomic, and social factors with transitions between MAP need and use states.

Methods: For this multistate modelling study, data were drawn from 13 years (May, 2006, to July, 2019) of the English Longitudinal Study of Ageing, a prospective cohort study. We included respondents aged 50-89 years who participated in at least two waves of data collection. We used multistate models to examine associations of demographic, socioeconomic, and social factors, including age, sex, education, employment, wealth, marital status, and help with activities of daily living (ADL), with transitions between three main states: no need for MAPs, unmet need for MAPs, and use of MAPs.

Findings: We used data collected from 12 080 respondents (6586 women and 5494 men). During follow-up, 5102 (42·2%) of participants had unmet MAP need and 3330 (27·6%) used MAPs. Women were more likely than men to transition from no need to unmet need (hazard ratio [HR] 1·49, 95% CI 1·38-1·60) and less likely to transition from unmet need to use (0·79, 0·72-0·86). We found an increase in risk of transitioning from no need to unmet need for each 1-year increase in age (1·06, 1·06-1·07), for those with low education level (1·34, 1·23-1·45), those with help with ADL (1·32, 1·16-1·49), and who were not employed (1·22, 1·07-1·40) or disabled (3·83, 2·98-4·93). Similarly, we found an increase in risk of transitioning unmet need to use for each 1-year increase in age (1·06, 1·05-1·06), for those with low education level (1·20, 1·10-1·31), and those with help with ADL (1·25, 1·13-1·38). Increasing wealth was associated with a reduced risk of transitioning from no need to unmet need (0·78, 0·74-0·81) and from unmet need to use (0·94, 0·89-0·99). Single people were more likely to transition from unmet need to use than partnered people (HR 1·21, 95% CI 1·10-1·33).

Interpretation: Women might be disproportionately likely to have unmet MAP needs, whereas other demographic, socioeconomic, and social factors are associated with high MAP need overall. Our findings directly support efforts towards expanding access to assistive products and identifying groups that could particularly benefit. As the first study of its kind to our knowledge, replication with other longitudinal datasets is needed.

Funding: UK Aid.