Using longitudinal data from a representative UK panel, we focus on a group of apparently healthy individuals with no history of disability or major chronic health condition at baseline. A latent variable structural equation model is used to analyse the predictive role of latent baseline biological health, indicated by a rich set of biomarkers, and other personal characteristics, in determining the individual’s disability state and health service utilisation five years later. We find that baseline biological health affects future health service utilisation very strongly, via progression to functional disability channel. We also find systematic income gradients in future disability risks, with those of higher income experiencing a lower progress to disability. Our model reveals that observed pro-rich inequity in health care utilisation, is driven by the fact that higher-income people tend to make greater use of health care treatment, for any given biological health and disability status; this is despite the lower average need for treatment shown by the negative association of income with both baseline ill biological health and disability progression risk. Factor loadings for latent baseline health show that a broader set of blood-based biomarkers, rather than the current focus mainly on blood pressure, cholesterol and adiposity, may need to be considered for public health screening programs.

使用来自英国代表小组的纵向数据，我们关注一组在基线时没有残疾史或主要慢性健康状况的表面健康的个体。潜在变量结构方程模型用于分析潜在基线生物健康（由丰富的生物标志物和其他个人特征所指示）在确定个人的残疾状况和五年后的医疗服务利用方面的预测作用。我们发现，基线生物健康通过发展为功能障碍通道，对未来卫生服务的利用非常重要。我们还发现未来残疾风险中的系统性收入梯度，收入较高的人经历的残疾进展较低。我们的模型表明，在医疗保健利用中观察到的亲富人不平等现象，受到以下事实的驱动：对于任何给定的生物健康和残疾状况，高收入者倾向于更多地使用卫生保健治疗；尽管收入与基线疾病生物健康和残疾发展风险呈负相关，但平均治疗需求较低。潜在基线健康的因素负荷表明，对于公共健康筛查计划，可能需要考虑更广泛的基于血液的生物标志物，而不是当前主要关注血压，胆固醇和肥胖症的标志物。尽管收入与基线疾病生物健康和残疾发展风险呈负相关，但平均治疗需求较低。潜在基线健康的因素负荷表明，对于公共健康筛查计划，可能需要考虑更广泛的基于血液的生物标志物，而不是当前主要关注血压，胆固醇和肥胖症的标志物。尽管收入与基线疾病生物健康和残疾发展风险呈负相关，但平均治疗需求较低。潜在基线健康的因素负荷表明，对于公共健康筛查计划，可能需要考虑更广泛的基于血液的生物标志物，而不是当前主要关注血压，胆固醇和肥胖症的标志物。