title: Frailty and migration in middle-aged and older Europeans.
abstract: We evaluated life course influences on health by investigating potential differences in levels of frailty between middle-aged and older European immigrants born in low- and middle-income countries (LMICs), immigrants born in high income countries (HICs), and their native-born European peers. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), we constructed a frailty index from 70 age-related health measures for 33,745 participants aged 50+ (mean=64.9 ± 10.2 years; 54% women) in 14 European countries. Participants were grouped as native-born or as immigrants born in LMICs or in HICs, and further by current residence in Northern/Western or Southern/Eastern Europe. Seven percent of participants (n=2369) were immigrants (mean=64.4 ± 10.2 years; 56% women; LMIC-born=3.4%, HIC-born=3.6%). In Northern/Western Europe, after adjustment for age, gender, and education, LMIC-born immigrants demonstrated higher frailty index scores (mean=0.18, 95% confidence interval=0.17-0.19) than both HIC-born immigrants (0.16, 0.16-0.17) and native-born participants (0.15, 0.14-0.15 both p<0.001). In Southern/Eastern Europe, frailty index scores did not differ between groups (p=0.2). Time since migration explained significant variance in frailty index scores only in HIC-born immigrants to Southern/Eastern Europe (4.3%, p=0.03). Despite differences in frailty, survival did not differ between groups (p=0.2). LMIC-born immigrants demonstrated higher levels of frailty in Northern/Western Europe, but not Southern/Eastern Europe. Country of birth and current country of residence were each associated with frailty. Life course influences are demonstrable, but complex.
authors.affiliation: Geriatric Medicine Research, Dalhousie University, 1315-5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada. Electronic address: thomas.brothers@dal.ca.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Brothers
authors.forename: Olga
authors.initials: O
authors.lastname: Theou
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000368:Aged; D000375:Aging; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
keywords: Aging; Frailty; Health status disparities; Migration; Socioeconomic factors