title: Do lifestyle, health and social participation mediate educational inequalities in frailty worsening?
abstract: BACKGROUND
  Lower educated older persons are at increased risk of becoming frail as compared with higher educated older persons. To reduce educational inequalities in the development of frailty, we investigated whether lifestyle, health and social participation mediate this relationship.
  
  
  METHODS
  Longitudinal data of 14 082 European community-dwelling persons aged 55 years and older participating in the Survey on Health, Ageing, and Retirement in Europe (SHARE) in 2004 and 2006, were used. Associations of lifestyle (smoking behaviour and alcohol consumption), health (depression, memory function, chronic diseases) and social participation, with educational level and frailty worsening were investigated using regression models. In multinomial logistic regression analysis, mediators were added to models in which educational level was associated with worsening in frailty over 2 years follow-up.
  
  
  RESULTS
  In all countries, frailty worsening was more prevalent among lower as compared with higher educated persons, although odds ratios were only statistically significant in five of the 11 countries included [ORs varying from 1.40 (95% CI: 1.06-1.84) to 1.61 (95% CI: 1.21-2.14)]. Except for smoking behaviour and memory function, the factors under study all showed associations with educational level and frailty worsening that met the conditions for mediation. After inclusion of the four relevant mediators, attenuation of odds ratios varied between 4.9 and 31.5%.
  
  
  CONCLUSIONS
  While lifestyle, health and social participation were associated with frailty worsening over 2 years among European community-dwelling older persons, only small to moderate parts of educational inequalities in frailty worsening were explained by these factors.
authors: 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands a.etman@erasmusmc.nl.
authors: Astrid
authors: A
authors: Etman
authors: 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands.
authors: Carlijn B M
authors: CB
authors: Kamphuis
authors: 2 Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 3 Department of Medicine, Brighton and Sussex Medical School, Brighton, UK 4 Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
authors: Tischa J M
authors: TJ
authors: van der Cammen
authors: 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands.
authors: Alex
authors: A
authors: Burdorf
authors: 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands.
authors: Frank J
authors: FJ
authors: van Lenthe
mesh_terms: D000368:Aged; D004522:Educational Status; D005060:Europe; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D058992:Social Participation