Impact of socioeconomic position on frailty trajectories in 10 European countries: evidence from the Survey of Health, Ageing and Retirement in Europe (2004–2013)

Stolz, Erwin; Mayerl, Hannes; Waxenegger, Anja; Rásky, Éva; Freidl, Wolfgang

doi:10.1136/jech-2016-207712

Cited by 100 publications

(131 citation statements)

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“…Although these cohort studies have shown that health inequality strongly depends on the context in which individual life courses unfold, cross-national comparative studies of health trajectories remain scarce (Stolz et al 2017). Longitudinal evidence on how education shapes health across the life course is largely limited to the U.S. context.…”

Section: Introductionmentioning

confidence: 99%

Education and Physical Health Trajectories in Later Life: A Comparative Study

Leopold

2018

Demography

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The cumulative (dis)advantage hypothesis states that health disparities between education groups increase with age. The present study examined this hypothesis in a comparative analysis of the United States, the United Kingdom, the Netherlands, and Sweden. These countries offer sharp contrasts in the social conditions that may intensify or inhibit processes of cumulative (dis)advantage. Using harmonized panel data from the HRS, ELSA, and SHARE, the study applied Poisson multilevel regression models to trace changes in the number of chronic conditions and functional limitations of people aged 50–76 (N = 16,887 individuals; 71,154 observations). The four countries showed a clear gradient in levels of physical health and in the extent to which health trajectories were shaped by education. Across all ages and cohorts, health problems were most prevalent in the United States, less prevalent in the United Kingdom and the Netherlands, and least prevalent in Sweden. A similar cross-national gradient was found for the size of health gaps between education groups and for the extent to which these gaps widened with age. Gaps were largest in the United States, smaller in the United Kingdom and in the Netherlands, and smallest in Sweden.Electronic supplementary materialThe online version of this article (10.1007/s13524-018-0674-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Education and Physical Health Trajectories in Later Life: A Comparative Study

Leopold

2018

Demography

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“…Such studies may indicate whether the development of frailty in lower socioeconomic groups will be quicker than that in higher socioeconomic groups throughout later life. So far, two studies have pointed into the direction of persisting (not widening) SEP inequalities in frailty in old age [16,17] .…”

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confidence: 99%

Socioeconomic Inequalities in Frailty among Older Adults: Results from a 10-Year Longitudinal Study in the Netherlands

et al. 2017

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Background: Frailty is an important risk factor for adverse outcomes in older people. Substantial variation in frailty prevalence between socioeconomic groups exists, but longitudinal evidence for the association between socioeconomic position (SEP) and frailty is scarce. Objective: To investigate the course of socioeconomic inequalities in frailty among older adults during 10 years of follow-up. Methods: Data were used from the Longitudinal Aging Study Amsterdam (n = 1,509). Frailty was measured with the functional domains approach, based on deficiencies in four domains: physical, nutritive, cognitive, and sensory. Mixed-model analyses were performed to estimate the course of frailty and its association with SEP during a 10-year follow-up. We investigated whether similar patterns of associations held in different scenarios, comparing results of survivor analyses with those based on two imputation methods accounting for dropout due to death (substitution of first missing value and missing values imputed with a prediction model). Results: All scenarios showed a linear increase in frailty with aging (survivor analyses OR = 1.87, 95% CI = 1.66-2.11) and associations of low education and low income with frailty (adjusted OR for low education = 1.76, 95% CI = 1.05-2.97; adjusted OR for low income = 1.90, 95% CI = 1.20-3.01; both for survivor analyses). Sex-stratified analyses indicated that socioeconomic inequalities were mainly present in men, not in women. Similar patterns of associations of SEP with frailty were observed in all scenarios, but the increase in frailty prevalence over time differed substantially between the scenarios. There were no statistically significant interactions between time and SEP on frailty (all scenarios), suggesting that inequalities in frailty did not increase or decrease during follow-up. Conclusion: SEP inequalities in frailty among older adults were observed, mainly among men, and persisted during 10 years of follow-up.

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“…In our study, we found a non-linear, pro- gressive increase of mean frailty levels as people age, which followed a cubic growth pattern with steep increases beginning around the age of 70 years. Such a non-linear growth pattern -with steeper increases among women than men -has been found to be a characteristic for the FI in previous studies of the general older population (e.g., [2,3,5,[7][8][9]11]). It should be noted that there was also a considerable level of individual-level heterogeneity behind these patterns of average frailty levels and increments (Fig.…”

Section: Discussionmentioning

confidence: 93%

“…Country was not used as a level, as the proportion of variance on the country-level was limited (see also [8]) and also because the joint model would not converge under a 3-level structure. We first tested the form of the within-person frailty trajectories using age (centred at age 50, divided by 10 years for readability) as the central time variable and found a non-linear, cubic model of change in frailty to provide the best fit.…”

Section: Methodsmentioning

confidence: 99%

“…These studies [2,[4][5][6][7][8][9][10][11] have found frailty to increase progressively with chronological age, with higher average levels and steeper increases in women. Respondents with low SES, for example, a low level of education, were also frailer and these SES-related gaps in frailty remained substantial or even increased throughout old age [4,6,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Does Sample Attrition Affect the Assessment of Frailty Trajectories Among Older Adults? A Joint Model Approach

et al. 2018

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Background: Frailty constitutes an important risk factor for adverse outcomes among older adults. In longitudinal studies on frailty, selective sample attrition may threaten the validity of results. Objective: To assess the impact of sample attrition on frailty index trajectories and gaps related to socio-economic status (education) therein among older adults in Europe. Methods: A total of 64,143 observations from 21,044 respondents (50+) from the Survey of Health, Ageing and Retirement in Europe across 12 years of follow-up (2004–2015) and subject to substantial sample attrition (59%) were analysed. We compared results of a standard linear mixed model assuming missing at random (MAR) sample attrition with a joint model assuming missing not at random sample attrition. Results: Estimated frailty trajectories of both the mixed and joint models were identical up to an age of 80 years, above which modest underestimation occurred when a standard linear mixed model was used rather than a joint model. The latter effect was larger for men than women. Substantial education-based inequality in frailty continued throughout old age in both the mixed and joint models. Conclusion: Linear mixed models assuming MAR sample attrition provided good estimates of frailty trajectories up until high age. Thus, the validity of existing studies estimating frailty trajectories based on standard linear mixed models seems not threatened by substantial sample attrition.

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Impact of socioeconomic position on frailty trajectories in 10 European countries: evidence from the Survey of Health, Ageing and Retirement in Europe (2004–2013)

Cited by 100 publications

References 38 publications

Education and Physical Health Trajectories in Later Life: A Comparative Study

Education and Physical Health Trajectories in Later Life: A Comparative Study

Socioeconomic Inequalities in Frailty among Older Adults: Results from a 10-Year Longitudinal Study in the Netherlands

Does Sample Attrition Affect the Assessment of Frailty Trajectories Among Older Adults? A Joint Model Approach

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