Socioeconomic status is associated with frailty: the Women’s Health and Aging Studies

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.

[1]  L. Fried,et al.  Multiple hormonal deficiencies in anabolic hormones are found in frail older women: the Women's Health and Aging studies. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[2]  L. Fried,et al.  The association of race with frailty: the cardiovascular health study. , 2006, Annals of epidemiology.

[3]  Aaron Aragaki,et al.  Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women's Health Initiative Observational Study , 2005, Journal of the American Geriatrics Society.

[4]  K Bandeen-Roche,et al.  Preclinical mobility disability predicts incident mobility disability in older women. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[5]  L. Ferrucci,et al.  Phenotype of frailty: characterization in the women's health and aging studies. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[6]  C. Victora,et al.  Socioeconomic and racial/ethnic differentials of C-reactive protein levels: a systematic review of population-based studies , 2007, BMC public health.

[7]  Shelley E. Taylor,et al.  Health psychology: what is an unhealthy environment and how does it get under the skin? , 1997, Annual review of psychology.

[8]  A. D. Diez Roux,et al.  Neighbourhood characteristics and mortality in the Atherosclerosis Risk in Communities Study. , 2004, International journal of epidemiology.

[9]  J. Lynch,et al.  Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood. , 2006, Annals of epidemiology.

[10]  A. D. Diez Roux,et al.  Neighborhood characteristics and availability of healthy foods in Baltimore. , 2008, American journal of preventive medicine.

[11]  J. Woo,et al.  Social Determinants of Frailty , 2005, Gerontology.

[12]  D. Zeng,et al.  Early-life and adult socioeconomic status and inflammatory risk markers in adulthood , 2007, European Journal of Epidemiology.

[13]  L. Ferrucci,et al.  Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the Women's Health and Aging Studies I and II. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[14]  L. Fried,et al.  Frailty in older adults: evidence for a phenotype. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[15]  L. Fried,et al.  Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. , 2007, Archives of internal medicine.

[16]  K. Steenland,et al.  All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 US states, 1984-1997. , 2004, American journal of public health.

[17]  L. Pearlin,et al.  Financial Strain over the Life Course and Health among Older Adults∗ , 2006, Journal of health and social behavior.

[18]  C. Maganaris,et al.  Adaptability of elderly human muscles and tendons to increased loading , 2006, Journal of anatomy.

[19]  G. Willemsen,et al.  Stress responsivity and socioeconomic status: a mechanism for increased cardiovascular disease risk? , 2002, European heart journal.

[20]  L. Fried,et al.  Low serum micronutrient concentrations predict frailty among older women living in the community. , 2006, The journals of gerontology. Series A, Biological sciences and medical sciences.

[21]  D. Dunlop,et al.  Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: findings from the Health and Retirement Study, 1992 2002. , 2007, The journals of gerontology. Series B, Psychological sciences and social sciences.

[22]  L. Fried,et al.  Inflammation and Frailty in Older Women , 2007, Journal of the American Geriatrics Society.

[23]  M. Cesari,et al.  Lifetime occupation and physical function: a prospective cohort study on persons aged 80 years and older living in a community , 2006, Occupational and Environmental Medicine.

[24]  M. Metzler,et al.  Socioeconomic status in health research: one size does not fit all. , 2005, JAMA.

[25]  S. Studenski,et al.  Research Agenda for Frailty in Older Adults: Toward a Better Understanding of Physiology and Etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults , 2006, Journal of the American Geriatrics Society.

[26]  N. Adler,et al.  Socioeconomic Disparities In Health: Pathways And Policies Inequality in education, income, and occupation exacerbates the gaps between the health “haves” and “have-nots.” , 2002 .

[27]  D R Jacobs,et al.  Area characteristics and individual-level socioeconomic position indicators in three population-based epidemiologic studies. , 2001, Annals of epidemiology.

[28]  J. Cauley,et al.  Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[29]  D R Jacobs,et al.  Test-retest reliability of the Minnesota Leisure Time Physical Activity Questionnaire. , 1986, Journal of chronic diseases.

[30]  John Bound,et al.  "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. , 2006, American journal of public health.

[31]  J. Flory,et al.  Socio-economic status covaries with central nervous system serotonergic responsivity as a function of allelic variation in the serotonin transporter gene-linked polymorphic region , 2004, Psychoneuroendocrinology.

[32]  R. Cooper,et al.  RE: Hirsch C, Anderson ML, Newman A, Kop W, Jackson S, Gottdiener J, et al, for the Cardiovascular Health Study Research Group. The association of race with frailty: The Cardiovascular Health Study. Ann Epidemiol. 2006;16:545-553. , 2007, Annals of epidemiology.

[33]  Katherine Newman,et al.  Socioeconomic disparities in health: pathways and policies. , 2002, Health affairs.

[34]  S. Ibrahim.  Critical Perspectives on Racial and Ethnic Differences in Health in Late Life , 2005, Annals of Internal Medicine.

[35]  Alexander Bucur,et al.  Cumulative biological risk and socio-economic differences in mortality: MacArthur studies of successful aging. , 2004, Social science & medicine.

[36]  Linda P. Fried,et al.  The Women's Health and Aging Study: Health and Social Characteristics of Older Women with Disability , 1995 .

[37]  J. Manly,et al.  Deconstructing Race and Ethnicity: Implications for Measurement of Health Outcomes , 2006, Medical care.

[38]  Brent C Taylor,et al.  Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. , 2008, Archives of internal medicine.

[39]  N. Anderson,et al.  Panel on Race, Ethnicity, and Health in Later Life , 2004 .

[40]  A. Steptoe,et al.  Socioeconomic status, C-reactive protein, immune factors, and responses to acute mental stress , 2003, Brain, Behavior, and Immunity.