title: Educational Inequalities and Frailty in Spain: What is the Role of Obesity?
abstract: BACKGROUND
  Evaluate how obesity is associated with the development of frailty among older adults is important. However, few studies have examined the relation between obesity and frailty within different educational backgrounds.
  
  
  OBJECTIVE
  This study aims to investigate the association between educational level and frailty and to evaluate whether obesity explains any possible associations among Spanish adults. Design, participants and settings: This is a cross-sectional study including 2,319 50-years-old and older community-dwelling Spanish adults, who participated in the first wave (2004/05) of the Survey of Health, Ageing and Retirement in Europe (SHARE).
  
  
  METHODS
  Educational differences in frailty phenotypes -defined by the SHARE's operationalized criterion- and their association with obesity -estimated through self-reports of weight and height- were evaluated using multinomial logistic regression analyses.
  
  
  RESULTS
  Women experienced frailty in a larger proportion than men (22.3% vs. 13.3%). After adjusting for all confounders, we found a marked educational gradient in frailty, where individuals with non-formal education showed increased odds of a frailty phenotype than individuals with higher education. Moreover, obesity was significantly related to frailty and the effect of obesity is similar at all levels of education after testing for interaction effects. Although there is a mediation effect of obesity, the educational gradient in frailty is robust to controls for obesity.
  
  
  CONCLUSIONS
  Our findings suggest a somehow independent effect of both educational background and obesity on frailty among Spanish individuals. This adds to the evidence of the frailty-obesity association among different educational backgrounds, and has implications for future interventions leading to reduce health disparities in elders.
authors.affiliation: Santiago Rodríguez López. Calle Darwin 2. Departamento de Biología, Universidad Autónoma de Madrid. Campus Universitario de Cantoblanco. 28049. Madrid, Spain. Phone: +34 914972561 - Fax: +34 914978638. e-mail: santiago.rodriguez@uam.es.
authors.forename: S
authors.initials: S
authors.lastname: Rodríguez López
authors.forename: P
authors.initials: P
authors.lastname: Montero
authors.forename: M
authors.initials: M
authors.lastname: Carmenate