Background Frailty is a state of increased vulnerability to stressors in older age, which increases risks of disability, falls and mortality. Prevalence of frailty is very high in older populations. The extent to which socioeconomic factors are associated with frailty is less well studied. We investigated the extent to which socioeconomic factors at individual and area level are associated with frailty in two studies of older populations in the UK.
Methods Data are from two studies of older populations: the British Regional Heart Study (BRHS) comprised a socially representative sample of men (n=1622) from 24 British towns aged 71–92 years in 2010–12; the English Longitudinal Study of Ageing (ELSA) comprised a representative sample of older men and women (n=5344) aged ≥60 years in 2004 from England. Using the Fried phenotype, frailty was defined by the presence of ≥3 of the following components: unintentional weight loss, low grip strength, low physical activity, slow walking pace and exhaustion. Socioeconomic measures included occupational social class and area-level deprivation was based on the Index of Multiple Deprivation (IMD). Logistic regressions models were used.
Results Prevalence of frailty was 19% and 9% in the BRHS and ELSA populations respectively. In the BRHS sample, the risk of frailty increased from the highest (social class I) to lowest social class V; age-adjusted odds ratio was 1.18 (95% confidence interval (CI)=1.07–1.31) for each category from social class I to V, which remained significant on adjustment for smoking, history of cardiovascular disease (CVD) or diabetes, body mass index (BMI) and alcohol consumption. The risk of frailty also increased from the least (quintile 1) to most deprived IMD quintile (quintile 5); OR per quintile=1.19 (95% CI 1.08 to 1.30). This increased risk remained significant on further adjustment for covariates. Similarly, in the ELSA population of older men and women, frailty risk was greater in lower social classes (OR=1.21 (95% CI 1.16 to 1.27) for each group from highest to lowest social classes. Frailty risk was greater also in deprived quintiles (OR=1.35, 95% CI 1.28 to 1.43, for every increase in quintile of deprivation). These associations remained significant on adjustment for covariates.
Conclusion Adverse socioeconomic factors are associated with risk of frailty in older populations. These associations were independent of lifestyle factors and comorbidities, and were observed both for individual and area-level socioeconomic factors. Socioeconomic factors are potentially important in reducing the burden of frailty in older people. These findings merit further investigation prospectively.
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