Abstract
BackgroundSo far, it has not yet been studied whether socioeconomic status is associated with distinct frailty components and for which frailty component this association is the strongest. We aimed to examine the association between socioeconomic status and frailty and frailty components. In addition we assessed the mediating effect of the number of morbidities on the association between socioeconomic status and other frailty components.MethodsThis is a cross-sectional study of pooled data of The Older Persons and Informal Caregivers Survey Minimum DataSet in the Netherlands among community-dwelling persons aged 55 years and older (n = 26,014). Frailty was measured with a validated Frailty Index that consisted of 45 items. The Frailty Index contained six components: morbidities, limitations in activities of daily living (ADL), limitations in instrumental ADL (IADL), health-related quality of life, psychosocial health and self-rated health. Socioeconomic indicators used were education level and neighbourhood socioeconomic status.ResultsPersons with primary or secondary education had higher overall frailty and frailty component scores compared to persons with tertiary education (P < .001). Lower education levels were most consistently associated with higher overall frailty, more morbidities and worse self-rated health (P < .05 in all age groups). The strongest association was found between primary education and low psychosocial health for persons aged 55–69 years and more IADL limitations for persons aged 80+ years. Associations between neighborhood socioeconomic status and frailty (components) also showed inequalities, although less strong. The number of morbidities moderately to strongly mediated the association between socioeconomic indicators and other frailty components.ConclusionThere are socioeconomic inequalities in frailty and frailty components. Inequalities in frailty, number of morbidities and self-rated health are most consistent across age groups. The number of morbidities a person has play an important role in explaining socioeconomic inequalities in frailty and should be taken into account in the management of frailty.
Highlights
Frailty can be defined as a state of increased vulnerability to external stressors and adverse outcomes such as death and hospitalization[1, 2]
We aimed to examine the association between socioeconomic status and frailty and frailty components
Lower education levels were most consistently associated with higher overall frailty, more morbidities and worse selfrated health (P < .05 in all age groups)
Summary
Frailty can be defined as a state of increased vulnerability to external stressors and adverse outcomes such as death and hospitalization[1, 2]. In addition to the study of ‘overall’ frailty, the assessment of frailty components could uncover important information about the specific domain in which a person is frail. Yang et al have studied the associations of frailty components with mortality and found that IADL and ADL limitations played a greater role in mortality compared to other components [14]. It has not yet been studied whether socioeconomic status is associated with distinct frailty components and for which frailty component this association is the strongest. In addition we assessed the mediating effect of the number of morbidities on the association between socioeconomic status and other frailty components.
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