Provenance FAK inhibition and peer review: Not commissioned; externally peer reviewed. Data sharing statement: Extra data can be accessed via the Dryad data repository at with the doi:10.5061/dryad.pd670.

is associated with poor health, poor access to healthcare and poor health outcomes in many countries and across different healthcare systems.1–3 Much of this variation is caused by recognised broad social determinants of health.4 Considerable political effort has been directed at attempts to narrow health inequalities by reducing poverty and social exclusion. However, as healthcare has become more effective at improving health, its potential contribution to ameliorating health inequalities has increased. McKeown demonstrated in the 1970s that health services had contributed little to health improvement,5 but the same claim could not be made today. The past 30 years have seen the introduction of a wide range of effective interventions, particularly for the prevention and management of chronic disease.6 Yet although these new interventions improve health, they are not necessarily applied equally across the population.

Health inequalities will widen if effective services are offered, or taken up, with greater frequency by wealthier than less wealthy people. The reverse is also true, however, and there is an opportunity for healthcare to reduce social inequalities if it reaches those most in need.7 Little is known about pathways into poor health. The National Health Service provides medical

care free at point-of-need to all UK residents, but there is scope for inequalities to occur in the pathway from identification of early symptoms through diagnosis and on to effective treatment. Individuals in more deprived social groups may be more reluctant to present to doctors with their symptoms and so may not receive a diagnosis.8 9 Diagnosis is a key step that has meaning for both patient and physician in all health systems, and ‘diagnostic confusion’ may act as a barrier to healthcare for vulnerable populations.8 10 11 Previous studies have found socioeconomic variation in either diagnosis Carfilzomib or treatment rates, but have not been able to compare inequalities in illness burden, rates of diagnosis and treatment modalities in the same population.12–14 The English Longitudinal Study of Ageing (ELSA) provides new data that can be used to identify barriers to equitable receipt of healthcare, and constitutes a unique source of information on illness burden, self-reported medical diagnosis and treatment. Other data sources cover symptoms or diagnosis or treatment, but no other single source covers all three. ELSA collects data on symptoms and validated markers of common health conditions, as well as diagnosis and treatment.

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