Social, economic, and environmental disparities in device-measured 24-hour movement behaviours in a nationally representative cohort of older English adults

Abstract Background: Insufficient physical activity, excessive sedentary time, and suboptimal sleep are linked to premature mortality and chronic disease and may contribute to social inequalities in health, but most evidence is self-reported. Device-measured, nationally representative data capturing the full 24-hour movement spectrum remain scarce, particularly among older adults. This study examined social, economic, and environmental disparities in 24-hour movement behaviours in the 2021-23 English Longitudinal Study of Ageing (ELSA) accelerometry sub-study. Methods: A subset of 5,382 ELSA participants (71.9%) was invited to wear an Axivity AX3 wrist accelerometer for eight days, with 4,354 (80.9%) agreeing. Raw data were processed using machine learning to derive step count, sleep duration, moderate-to-vigorous and light physical activity, sedentary time, and time in bed. Cross-sectional associations with sex, age, education, marital status, wealth, and urbanicity were examined using linear regression. Findings: Data from 3,648 participants (mean age 68.5 {+/-} 9.3 years; 44.3% men) were included in wear time analyses (median 6.6 days, IQR 6.0-6.9), with 3,161 (86.7%) having sufficient wear time for movement behaviour analyses. Older, unmarried, or lower education/wealth participants were less active, more sedentary, and slept less. Rural participants were more active than urban participants. Women accumulated fewer steps and less moderate-to-vigorous physical activity and sedentary time, but more light activity and longer sleep than men. Interpretation: Social, economic, and environmental disparities exist across the full 24-hour movement spectrum, highlighting population groups for targeted interventions. Follow-up data will clarify how 24-hour movement behaviours influence healthy ageing and contribute to social inequalities in health.