Childhood socioeconomic disadvantage and frailty in older men and women from 26 European countries

Background

Early-life exposures shape health across the life course through biological and social pathways, but its lasting influence on health in later life remains unclear. In this study we examine the association between childhood socioeconomic conditions and frailty in later life in Europe, it’s persistence independently of adult socioeconomic conditions and welfare policies.

Methods

We analysed data from 34,842 individuals aged ≥50 years from 26 countries from the Survey of Health, Ageing and Retirement in Europe (waves 7 and 9). Childhood socioeconomic conditions were assessed using indicators of financial hardship, overcrowding, and books in the household, combined into a four-level index. Frailty was measured using a multidimensional 40-item frailty index, including physical, psychological and cognitive deficits. Negative binomial regressions with a log link were used to estimate incidence rate ratios, stratified by sex and adjusted for year of birth and country. Models were further adjusted for adult education and financial status and countries’ GDP and its percentage spent on social policies, out-of-pocket expenditure, and GINI coefficient.

Results

Frailty showed a clear social gradient, with larger ratios among most disadvantaged women (women: IRR=1.38, 95%CI: 1.30–1.47; men: IRR=1.24, 95%CI: 1.15–1.33). These associations remained significant after adjustment for adult socioeconomic status (women: IRR=1.24, 95%CI: 1.16–1.31; men: IRR=1.15, 95%CI: 1.07–1.23). Country-level factors did not significantly alter these ratios, despite the protective effect of expenditure on social policies among men and women.

Conclusions

Childhood socioeconomic disadvantage is associated with higher frailty in later life, independently of adult socioeconomic conditions and country-level factors, suggesting lasting effects of early-life exposures on ageing trajectories. This study reinforces the need to intervene in early life conditions to prevent later life vulnerability.

Key messages

• Childhood socioeconomic disadvantage is associated with higher frailty in later life, independently of adult socioeconomic conditions. This association is stronger among women.

• Country-level social policies can have a role in preventing later life frailty, yet they should be complemented with policies promoting early-life socioeconomic conditions.