As a key developmental period of life, childhood is regarded as the period in which people are most vulnerable to external influences. These influences include not just individual-level behaviors, but also structural factors such as neighborhood poverty, lack of access to education, and lower-quality health care. Previous research suggests that the inequalities experienced during childhood may persist throughout life. Poor childhood socioeconomic conditions (CSC) have already shown to be associated with poorer health outcomes in adulthood, including higher risk of cardiovascular disease, lower quality of life, lower physical capabilities, and higher mortality rates.
In a new Journal of Gerontology study, Bernadette van der Linden and colleagues investigated the relationship between poor CSC and risk of frailty in old age, with the support of the European Union’s Horizon 2020 LONGPOP Project “Methodologies and Data mining techniques for the analysis of Big Data based on Longitudinal Population and Epidemiological Registers” and the Swiss National Centre of Competence in Research “LIVES – Overcoming vulnerability: Life course perspectives”. “Frailty” is a term used in geriatric medicine to refer to biological decline and increased vulnerability to stressors. It includes the presence of at least three of these attributes: presenting weakness, shrinking, exhaustion, slowness, and low activity. Presence of one or two of the attributes indicates pre-frailty. Van der Linden et al also considered whether adulthood socioeconomic conditions (ASC) influence the association between CSC and frailty.
They used data from the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE), including 21,185 individuals aged 50 and older. They adapted the data to measure the original attributes from the phenotype of frailty; for example, a measure of weakness was derived from grip strength measures, and shrinking was measured through questions about appetite. The SHARE survey also asks questions about childhood circumstances, enabling the researchers to construct a measurement of CSC in addition to ASC. The CSC measurement comprises four main indicators: the occupational position of the main breadwinner, number of books at home, overcrowding, and housing quality.
The researchers’ analysis indicated that both women and men who grew up in disadvantaged CSC suffer higher odds of being both frail and pre-frail later in life. However, this association is mediated by ASC. Adulthood factors such as lower education, having a lower-skilled job, smoking, and living without a partner increase likelihood of (pre-)frailty. Personal attributes and demographics, including birth cohort, chronic conditions, and difficulties with activities of daily living, increase the odds of being (pre-)frail.
Through their analysis, Van der Linden et al provide strong evidence of a relationship between CSC and frailty later in life, corroborating previous research, but also showed that people can compensate a bad start in life with their socioeconomic life course. Furthermore, by using longitudinal and cross-national SHARE data, their study is the first longitudinal and cross-national European study to indicate that pathways to (pre-)frailty already begin during childhood and continue over the life course. Their research also supports the hypothesis that socioeconomic circumstances throughout life, and not just CSC, are determinants of frailty in later life. The authors conclude that policymakers aiming to improve public health conditions in later life could consider the beneficial effects of improving socioeconomic conditions throughout the life course.
Van Der Linden, B., Cheval, B., Sieber, S., Orsholits, D., Guessous, I., Stringhini, S., ... & Cullati, S. (2019). Life course socioeconomic conditions and frailty at older ages. Journals of Gerontology. B, Psychological Sciences and Social Sciences.
