Is there a compression of morbidity and does it vary across social strata among older European adults? A retrospective cohort study of two waves 15 years apart

[Background:] Compression of morbidity may be linked to belonging to particular social strata defined by intersections of age, gender, migration and occupation. Extending the approach by Crimmins and Beltrán-Sánchez, we investigated compression of morbidity, defined as reduced socially stratified prevalence of self-reported heart disease, stroke, cancer, diabetes and functional limitations, using two samples 15 years apart. [Methods:] We used data of eleven European countries from the Survey of Health, Ageing and Retirement in Europe (SHARE), comparing 2004 (N = 29,224) and 2019/2020 (N = 46,498) samples, to apply multilevel logistic regressions within an intersectional MAIHDA (Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy) framework. [Findings:] Overall patterns did not show compression of morbidity in terms of lower prevalence after 15 years, but intersectional analyses revealed specific compression patterns. Certain strata showed reduced heart disease prevalence, with older men with migration background experiencing the strongest declines from initially high levels. However, no social stratum showed morbidity compression for stroke. Blue-collar low-skill men exhibited particularly increased cancer prevalence across waves. Among older men, diabetes prevalence increased substantially. Reductions in functional limitation prevalence emerged across waves for all female groups aged 70–79, and for blue-collar high-skill men. [Interpretation:] Overall, we found that compression of morbidity was largely intersectionally stratified, evidencing the impact of social inequalities in healthy life expectancy. This calls for stratified preventive measures at public health level in the future. [Funding:] Einstein Foundation Berlin (EZ-2019–555–2).