Socioeconomic inequalities in frailty and multimorbidity progression in a cohort of older adults

Background

Frailty and multimorbidity are two conceptually distinct but related conditions that develop and interact throughout the ageing process. Among the risk factors, lower socioeconomic position (SEP) appears to play a key role. In the current literature, few studies examined how SEP influences frailty and multimorbidity progression over time. This study aimed to assess this association in older adults, stratifying by sex.

Methods

Using Turin Longitudinal Study data, this study included all residents of Turin aged ≥65 in 2002. For each subject, yearly frailty (Elders Risk Assessment) and multimorbidity (Charlson Index) measures were computed from 2002 to 2013, analysing subjects with available indices for at least the first three years. Education was used as proxy of SEP. Cluster analysis was then performed to identify distinct trajectory patterns, and the association between SEP and cluster membership was assessed using Multinomial models and Average Marginal Effects, stratified by sex.

Results

75,710 men and 111,659 women were analysed. Cluster analysis on multimorbidity identified six groups: healthy; unhealthy but ?show $132#?>stable/improving; slight worsening; slight worsening and then improvement; persistent worsening; and acute worsening. In both sexes, lower SEP was associated with belonging to the clusters showing persistent or acute worsening over time. For frailty, seven clusters were identified: never frail; from non-frail to slight worsening; from non-frail to acute worsening; moderate frailty with stability/improvement; from moderate to high frailty; high frailty with improvement; and from high frailty to further worsening. Lower SEP was associated with higher frailty levels at baseline or over time in both sexes.

Conclusions

Lower SEP has a strong impact on the risk of belonging to groups with worse trajectories of multimorbidity and frailty, highlighting the importance of targeted interventions to reduce inequalities and promote healthier lifestyles.

Key messages

• The findings highlight the importance of targeting individuals with lower socioeconomic position for early prevention strategies to reduce the burden of multimorbidity and frailty over time.

• This research highlights the need for public health policies prioritising disadvantaged groups to reduce health inequalities through prevention and promotion of healthy ageing.