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.
Szanton
S L
SL
Johns Hopkins University Center on Aging and Health, 525 N. Wolfe Street, Baltimore, MD 21205 424, USA. sszanton@son.jhmi.edu
Seplaki
C L
CL
Thorpe
R J
RJ
Allen
J K
JK
Fried
L P
LP
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D015995:Prevalence; D012307:Risk Factors; D012923:Social Class; D044465:White People
Eur J Epidemiol. 2007;22(1):55-66
17225957
Arch Intern Med. 2008 Feb 25;168(4):382-9
18299493
BMC Public Health. 2007 Aug 17;7:212
17705867
Ann Epidemiol. 2006 Feb;16(2):91-104
16257232
Eur Heart J. 2002 Nov;23(22):1757-63
12419295
Arch Intern Med. 2007 Apr 9;167(7):635-41
17420420
Annu Rev Psychol. 1997;48:411-47
9046565
J Gerontol A Biol Sci Med Sci. 2006 Mar;61(3):262-6
16567375
Am J Public Health. 2006 May;96(5):826-33
16380565
Occup Environ Med. 2006 Jul;63(7):438-42
16782827
J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
11253156
Ann Epidemiol. 2001 Aug;11(6):395-405
11454499
J Gerontol A Biol Sci Med Sci. 2000 Jan;55(1):M43-52
10719772
Brain Behav Immun. 2003 Aug;17(4):286-95
12831831
J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):744-51
17634322
Psychoneuroendocrinology. 2004 Jun;29(5):651-68
15041087
J Am Geriatr Soc. 2006 Jun;54(6):991-1001
16776798
J Gerontol B Psychol Sci Soc Sci. 2007 Jul;62(4):S209-17
17673534
J Gerontol A Biol Sci Med Sci. 2006 Jun;61(6):594-9
16799142
Med Care. 2006 Nov;44(11 Suppl 3):S10-6
17060816
J Am Geriatr Soc. 2007 Jun;55(6):864-71
17537086
Ann Epidemiol. 2006 Jul;16(7):545-53
16388967
JAMA. 2005 Dec 14;294(22):2879-88
16352796
Gerontology. 2005 Nov-Dec;51(6):402-8
16299422
Soc Sci Med. 2004 May;58(10):1985-97
15020014
J Gerontol A Biol Sci Med Sci. 2005 Jun;60(6):729-35
15983175
J Am Geriatr Soc. 2005 Aug;53(8):1321-30
16078957
J Chronic Dis. 1986;39(7):505-11
3722314
Am J Prev Med. 2008 Dec;35(6):561-7
18842389
Health Aff (Millwood). 2002 Mar-Apr;21(2):60-76
11900187
J Anat. 2006 Apr;208(4):433-43
16637869
Am J Public Health. 2004 Jun;94(6):1037-42
15249312
Int J Epidemiol. 2004 Apr;33(2):398-407
15082648
J Health Soc Behav. 2006 Mar;47(1):17-31
16583773