Midlife contributors to socioeconomic differences in frailty during later life: a prospective cohort study

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dc.contributor.author Brunner, Eric J
dc.contributor.author Shipley, Martin J
dc.contributor.author Ahmadi-Abhari, Sara
dc.contributor.author Valencia Hernandez, Carlos
dc.contributor.author Abell, Jessica G
dc.contributor.author Singh-Manoux, Archana
dc.contributor.author Kawachi, Ichiro
dc.contributor.author Kivimaki, Mika
dc.date.accessioned 2018-08-14T06:40:01Z
dc.date.available 2018-08-14T06:40:01Z
dc.date.issued 2018-07
dc.identifier.citation Brunner , E J , Shipley , M J , Ahmadi-Abhari , S , Valencia Hernandez , C , Abell , J G , Singh-Manoux , A , Kawachi , I & Kivimaki , M 2018 , ' Midlife contributors to socioeconomic differences in frailty during later life: a prospective cohort study ' , The Lancet Public Health , vol. 3 , no. 7 , pp. e313-e322 . https://doi.org/10.1016/S2468-2667(18)30079-3
dc.identifier.other PURE: 115067359
dc.identifier.other PURE UUID: c35ac3b4-d257-4532-a2d9-686ad4f76d95
dc.identifier.other RIS: urn:0A6FC6013DD5FDD288D1715A410A5188
dc.identifier.other WOS: 000437222600007
dc.identifier.other Scopus: 85048324208
dc.identifier.uri http://hdl.handle.net/10138/238330
dc.description.abstract Background Health inequalities persist into old age. We aimed to investigate risk factors for socioeconomic differences in frailty that could potentially be modified through policy measures. Methods In this multi-wave longitudinal cohort study (Whitehall II study), we assessed participants' socioeconomic status, behavioural and biomedical risk factors, and disease status at age 45-55 years, and frailty (defined according to the Fried phenotype) at baseline and at one or more of three clinic visits about 18 years later (mean age 69 years [SD 5.9]). We used logistic mixed models to examine the associations between socioeconomic status and risk factors at age 50 years and subsequent prevalence of frailty (adjusted for sex, ethnic origin, and age), with sensitivity analyses and multiple imputation for missing data. Findings Between Sept 9, 2007, and Dec 8, 2016, 6233 middle-aged adults were measured for frailty. Frailty was present in 562 (3%) of 16 164 person-observations, and varied by socioeconomic status: 145 (2%) person-observations had high socioeconomic status, 241 (4%) had intermediate status, and 176 (7%) had low socioeconomic status, adjusting for sex and age. Risk factors for frailty included cardiovascular disease, depression, smoking, high or abstinent alcohol consumption, low fruit and vegetable consumption, physical inactivity, poor lung function, hypertension, and overweight or obesity. Cardiometabolic markers for future frailty were high ratio of total to high-density lipoprotein cholesterol, and raised interleukin-6 and C-reactive protein concentrations. The five most important factors contributing to the frailty gradient, assessed by percent attenuation of the association between socioeconomic status and frailty, were physical activity (13%), interleukin-6 (13%), body-mass index category (11%), C-reactive protein (11%), and poor lung function (10%). Overall, socioeconomic differences in frailty were reduced by 40% in the maximally-adjusted model compared with the minimally-adjusted model. Interpretation Behavioural and cardiometabolic risk factors in midlife account for more than a third of socioeconomic differences in frailty. Our findings suggest that interventions targeting physical activity, obesity, smoking, and low-grade inflammation in middle age might reduce socioeconomic differences in later-life frailty. Copyright (c) 2018 The Author(s). Published by Elsevier Ltd. en
dc.format.extent 10
dc.language.iso eng
dc.relation.ispartof The Lancet Public Health
dc.rights cc_by
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject 3142 Public health care science, environmental and occupational health
dc.subject OLDER-ADULTS
dc.subject WHITEHALL-II
dc.subject RISK-FACTORS
dc.subject BRITISH MEN
dc.subject HEALTH
dc.subject DISABILITY
dc.subject PROFILE
dc.subject PEOPLE
dc.title Midlife contributors to socioeconomic differences in frailty during later life: a prospective cohort study en
dc.type Article
dc.contributor.organization Clinicum
dc.contributor.organization Department of Public Health
dc.contributor.organization University of Helsinki
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1016/S2468-2667(18)30079-3
dc.relation.issn 2468-2667
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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