Life-course socio-economic factors associated with frailty in later life

PURPOSE: Frailty increases with age and is associated with negative health outcomes as falls, hospitalization, and mortality. Socio-economic situation (SES) in childhood and adulthood are associated with frailty. It is unclear how the interaction of childhood hardship and adulthood SES effects frailty.

METHODS: A register-based study using data from national registers and from the Lolland-Falster Health Study, involving individuals aged 50 and above. Frailty status was assessed using a modified version of Fried's phenotype. Logistic regression models with multiple adjustments were used to analyze the odds of frailty. Causal interactions between economic hardship in adulthood, perception of childhood, self-reported stressful events in childhood, and self-reported educational level were assessed by estimating the relative excess risk due to interaction (RERI).

RESULTS: The study included 10,163 individuals. The percentage of individuals fulfilling 2-5 frailty criteria varied between 17 % in the 50-65 age group and 44.9 % in the 85+ age group. Women had a higher proportion of fulfilling 2-5 frailty criteria (21.5 %) compared to men (17.2 %). Socio-economic factors associated with frailty status included perception of childhood, stressful childhood events, educational attainment, and economic hardship in adulthood. A significant causal additive effect on the percentage of individuals fulfilling 2-5 frailty criteria was demonstrated for two composite outcomes: perception of childhood + educational attainment and stressful events in childhood + economic hardship in adulthood.

CONCLUSION: The study showed that joint exposure to adverse socio-economic factors in childhood and adulthood, potentiated the odds of frailty in older adults. Our findings corroborate the theory of cumulative dis/advantage.