Article Text

Download PDFPDF
Socioeconomic status is associated with frailty: the Women’s Health and Aging Studies
  1. S L Szanton1,
  2. C L Seplaki2,
  3. R J Thorpe Jr3,
  4. J K Allen4,
  5. L P Fried5
  1. 1
    Johns Hopkins University Center on Aging and Health, Baltimore, Maryland, USA
  2. 2
    Johns Hopkins University Bloomberg School of Public Health, Center on Aging and Health, Baltimore, Maryland, USA
  3. 3
    Johns Hopkins University Bloomberg School of Public Health, Hopkins Center for Health Disparities Solutions, Baltimore, Maryland, USA
  4. 4
    Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5
    Columbia University Mailman School of Public Health, New York, USA
  1. Correspondence to Dr S L Szanton, Johns Hopkins University Center on Aging and Health, 525 N. Wolfe Street, Baltimore, MD 21205 424, USA; sszanton{at}


Background: Frailty is a common risk factor for morbidity and mortality in older adults. Although both low socioeconomic status (SES) and frailty are important sources of vulnerability, there is limited research examining their relationship. A study was undertaken to determine (1) the extent to which low SES was associated with increased odds of frailty and (2) whether race was associated with frailty, independent of SES.

Methods: A cross-sectional analysis of the Women’s Health and Aging Studies using multivariable ordinal logistic regression modelling was conducted to estimate the relationship between SES measures and frailty status in 727 older women. Control variables included race, age, smoking status, insurance status and co-morbidities.

Results: Of the sample, 10% were frail, 46% were intermediately frail and 44% were robust. In adjusted models, older women with less than a high school degree had a threefold greater odds of frailty compared with more educated individuals. Those with an annual income of less than $10 000 had two times greater odds of frailty than wealthier individuals. These findings were independent of age, race, health insurance status, co-morbidity and smoking status. African-Americans were more likely to be frail than Caucasians (p<0.01). However, after adjusting for education, race was not associated with frailty. The effect of race was confounded by socioeconomic position.

Conclusions: In this population-based sample, the odds of frailty were increased for those of low education or income regardless of race. The growing population of older adults with low levels of education and income renders these findings important.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This work was supported by National Institutes of Nursing grants 1F31NR009470-01, 1-T32 NR07968-01, National Institutes of Aging grants R01 AG11703, 1R37AG1990502, 1KL2RR025006-01 from the National Center for Research Resources (NCRR), the John A Hartford Foundation Building Academic Geriatric Nursing Capacity Scholars Program and by the Johns Hopkins Older Americans Independence Center (1P50AG 021334-01).

  • Competing interests None.

  • Ethics approval The Johns Hopkins Medical Institutional Review Board approved the research protocols and each participant provided written informed consent.

  • Provenance and Peer review Not commissioned; externally peer reviewed.