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dc.contributor.advisorKeenan, Katherine
dc.contributor.advisorKulu, Hill
dc.contributor.advisorMyrskylä, Mikko
dc.contributor.authorLam, Anastasia
dc.coverage.spatial270en_US
dc.date.accessioned2024-10-18T19:26:12Z
dc.date.available2024-10-18T19:26:12Z
dc.date.issued2024-12-03
dc.identifier.urihttps://hdl.handle.net/10023/30721
dc.description.abstractThis thesis aims to understand how population inequalities in multimorbid life expectancy and inequalities in disease accumulation vary within and between countries and over time. Using a combination of advanced demographic methods and sociological theory, this thesis estimates and interprets the extent of inequality due to various macro- and micro-level factors on MMLE and disease accumulation across five countries with different patterns of development and ageing: South Africa, Costa Rica, Mexico, the United States, and South Korea. Based on a foundation of demographic, epidemiologic, and health transition theories and the life course approach, this thesis applied intersectionality and cumulative (dis)advantage as frameworks to understand the extent and variation of inequalities in a comparative perspective and across several non-Western and/or non-high-income settings. It finds evidence for intersectional inequalities in multimorbid life expectancy across race, education, and sex in South Africa; substantial heterogeneity within and between countries in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States; an increasing rate of disease accumulation amongst younger birth cohorts in South Korea; and considerable disparities in older age working life expectancy with and without multimorbidity across sex, education, and place of residence in South Korea. These findings highlight the flexibility and value of these data and methods for population health and ageing research. This thesis also identifies important social groups which should be targeted in policies aimed at reducing social, structural, and health inequalities, and raises the importance of contextual factors for guiding research and policy decisions. Lastly, it suggests incorporating ageing profiles into estimates of health expectancy and expanding on the relationships between work, family, social security, education systems, and health systems, as valuable areas for future research and policy.en_US
dc.description.sponsorship"This work was supported by a St Andrews-Max Planck PhD Studentship in Population Health, a Handsel Tuition Fee Scholarship, a St Leonard’s College International Doctoral Scholarship, and by the School of Geography and Sustainable Development at the University St Andrews, the Max Planck Institute for Demographic Research, and the International Max Planck Research School for Population, Health, and Data Science (IMPRS-PHDS)."--Fundingen
dc.language.isoenen_US
dc.rightsCreative Commons Attribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectDemographyen_US
dc.subjectPopulation healthen_US
dc.subjectAgeingen_US
dc.subjectMultimorbidityen_US
dc.subjectLife expectancyen_US
dc.subjectHealth inequalitiesen_US
dc.subjectEpidemiologyen_US
dc.subjectIntersectionalityen_US
dc.subjectCumulative disadvantage theoryen_US
dc.subjectLife courseen_US
dc.titleGrowing old with multimorbidity : how our differences shape the years we live with diseaseen_US
dc.typeThesisen_US
dc.contributor.sponsorSt Andrews-Max Planck PhD Studentship in Population Healthen_US
dc.contributor.sponsorUniversity of St Andrews. Handsel Scholarship Schemeen_US
dc.contributor.sponsorUniversity of St Andrews. St Leonard's Collegeen_US
dc.contributor.sponsorUniversity of St Andrews. School of Geography and Sustainable Developmenten_US
dc.contributor.sponsorMax Planck Institute for Demographic Research (MPIDR)en_US
dc.contributor.sponsorInternational Max Planck Research School for Population, Health, and Data Science (IMPRS-PHDS)en_US
dc.type.qualificationlevelDoctoralen_US
dc.type.qualificationnamePhD Doctor of Philosophyen_US
dc.publisher.institutionThe University of St Andrewsen_US
dc.publisher.departmentMax Planck Institute for Demographic Researchen_US
dc.rights.embargodate2025-10-07
dc.rights.embargoreasonThesis restricted in accordance with University regulations. Restricted until 07 Oct 2025en
dc.identifier.doihttps://doi.org/10.17630/sta/1121


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    Except where otherwise noted within the work, this item's licence for re-use is described as Creative Commons Attribution 4.0 International