Emiel O Hoogendijk1, Judith J M Rijnhart2, Paul Kowal3, Mario U Pérez-Zepeda4, Matteo Cesari5, Pedro Abizanda6, Teresa Flores Ruano6, Astrid Schop-Etman7, Martijn Huisman8, Elsa Dent9. 1. Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: e.hoogendijk@vumc.nl. 2. Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands. 3. Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; World Health Organization, Geneva, Switzerland. 4. Clinical and Epidemiologic Research Department, Instituto Nacional de Geriatría, Mexico City, Mexico; Instituto de Envejecimiento, Pontificia Universidad Javeriana, Bogotá, Colombia. 5. Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy. 6. Department of Geriatrics, Albacete University Hospital, Albacete, Spain. 7. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Erasmus University College, Erasmus University, Rotterdam, The Netherlands. 8. Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands; Department of Sociology, VU University, Amsterdam, The Netherlands. 9. Torrens University Australia, Adelaide, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
Abstract
OBJECTIVES: The aim of this study was to investigate socioeconomic inequalities in frailty among older adults in six low- and middle-income countries (LMICs), and to examine to what extent chronic diseases account for these inequalities. STUDY DESIGN: Data were used from the Study on global AGEing and adult health (SAGE) wave 1 (2007-2010). Nationally representative samples of adults aged 50+ years from China, Ghana, India, Mexico, the Russian Federation and South Africa were analyzed (n = 31,174). MAIN OUTCOME MEASURES: Educational level and wealth were used as socioeconomic indicators. Frailty was assessed with modified criteria for the frailty phenotype. Self-reported disease diagnoses were used. A relative index of inequality (RII) was calculated to compare socioeconomic inequalities in frailty between countries. RESULTS: People in lower socioeconomic positions had higher prevalence rates of frailty. The largest inequalities in frailty were found in Mexico (RII 3.7, 95% CI 2.1-6.4), and the smallest inequalities in Ghana (RII 1.1, 95% CI 0.7-1.8). Mediation analyses revealed that the chronic diseases considered in this study do not explain the higher prevalence of frailty seen in lower socioeconomic groups. CONCLUSIONS: Substantial socioeconomic inequalities in frailty were observed in LMICs, but additional research is needed to find explanations for these. Given that the population of older adults in many LMICs is expanding at a greater rate than in many high-income countries, our results indicate an urgent public health need to address frailty in these countries.
OBJECTIVES: The aim of this study was to investigate socioeconomic inequalities in frailty among older adults in six low- and middle-income countries (LMICs), and to examine to what extent chronic diseases account for these inequalities. STUDY DESIGN: Data were used from the Study on global AGEing and adult health (SAGE) wave 1 (2007-2010). Nationally representative samples of adults aged 50+ years from China, Ghana, India, Mexico, the Russian Federation and South Africa were analyzed (n = 31,174). MAIN OUTCOME MEASURES: Educational level and wealth were used as socioeconomic indicators. Frailty was assessed with modified criteria for the frailty phenotype. Self-reported disease diagnoses were used. A relative index of inequality (RII) was calculated to compare socioeconomic inequalities in frailty between countries. RESULTS: People in lower socioeconomic positions had higher prevalence rates of frailty. The largest inequalities in frailty were found in Mexico (RII 3.7, 95% CI 2.1-6.4), and the smallest inequalities in Ghana (RII 1.1, 95% CI 0.7-1.8). Mediation analyses revealed that the chronic diseases considered in this study do not explain the higher prevalence of frailty seen in lower socioeconomic groups. CONCLUSIONS: Substantial socioeconomic inequalities in frailty were observed in LMICs, but additional research is needed to find explanations for these. Given that the population of older adults in many LMICs is expanding at a greater rate than in many high-income countries, our results indicate an urgent public health need to address frailty in these countries.
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