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Factors across life associated with remaining free from functional limitations despite lifelong exposure to socioeconomic adversity
  1. Almar A L Kok1,2,
  2. Mai Stafford3,
  3. Theodore D Cosco4,5,
  4. Martijn Huisman1,2,
  5. Dorly Deeg1,
  6. Diana Kuh6,
  7. Rachel Cooper6
  1. 1 Epidemiology and Biostatistics, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
  2. 2 Sociology, VU University, Amsterdam, The Netherlands
  3. 3 The Health Foundation, London, UK
  4. 4 Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
  5. 5 Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
  6. 6 MRC Unit for Lifelong Health and Ageing, University College London, London, UK
  1. Correspondence to Almar A L Kok, Epidemiology & Biostatistics, VU University Medical Center, Amsterdam 1081 HV, The Netherlands; a.kok1{at}


Background There are substantial socioeconomic inequalities in functional limitations in old age. Resilience may offer new insights into these inequalities by identifying constellations of factors that protect some individuals from developing functional limitations despite socioeconomic adversity.

Methods Data from 1973 participants in the Medical Research Council National Survey of Health and Development (Great Britain), followed from birth until age 60–64, were used. Functional limitations were defined as reporting difficulty with at least 1 of 16 activities at age 60–64. Lifetime socioeconomic adversity was based on socioeconomic trajectories, categorised into three adversity levels. Analysis of covariance and regression models were used to compare psychosocial factors and health-related behaviours between a ‘Resilient’ group (high adversity but no functional limitations) and five groups with other combinations of adversity and limitations.

Results Prevalence of functional limitations in high, intermediate and low adversity groups was 44%, 30% and 23% in men, and 61%, 55% and 49% in women, respectively. Compared with the other high adversity group, the resilient group had a lower prevalence of childhood illness (12% vs 19%) and obesity throughout ages 43–64 (70% vs 55%). Partially adjusted models also showed higher adolescent self-management, lower neuroticism, higher prevalence of volunteer work and physical activity (age 60–64) and lower prevalence of smoking (age 43) in the resilient. Marital status and contact frequency were not associated with resilience.

Conclusion Results suggest protection against childhood illness, health-behavioural factors and self-regulation as targets for interventions across life that may particularly benefit those with long-term exposure to socioeconomic adversity.

  • socio-economic
  • physical function
  • psychosocial factors
  • health behaviour

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  • Contributors AALK, MH and DD conceived of the idea of the study. AALK was responsible for preparing the data set, carrying out the statistical analyses and writing the manuscript. MS, TDC, DK and RC provided continuous advice, support and textual suggestions during the analysis and writing stages. MH and DD provided feedback on and textual suggestions for all versions of the manuscript.

  • Funding The MRC National Survey of Health and Development is funded by the UK Medical Research Council. TDC is supported by a Canadian Institutes of Health Research Postdoctoral Fellowship (MFE-146676). AALK and MH are supported by a VIDI Fellowship from the Netherlands Organisation for Scientific Research (grant number 452-11-017 to MH). This study has further been supported by a travel grant to AALK from the EMGO+ Institute for Health and Care Research, Amsterdam, the Netherlands.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Ethical approval for each data collection was obtained.

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

  • Data sharing statement Data used in this publication are available to bona fide researchers upon request to the NSHD Data Sharing Committee via a standard application procedure. Further details can be found at; doi: 10.5522/NSHD/Q101; doi: 10.5522/NSHD/Q102.