Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE)

Emiel O. Hoogendijk, Judith J.M. Rijnhart, Paul Kowal, Mario U. Pérez-Zepeda, Matteo Cesari, Pedro Abizanda, Teresa Flores Ruano, Astrid Schop-Etman, Martijn Huisman, Elsa Dent

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalMaturitas
Volume115
DOIs
Publication statusPublished - Sep 1 2018

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Aging of materials
Health
Public health
Ghana
Mexico
Chronic Disease
South Africa
India
China
Public Health
Outcome Assessment (Health Care)
Phenotype
Research
Population

Keywords

  • Frail older adults
  • Low- and middle-income countries
  • SAGE
  • Socioeconomic position

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Obstetrics and Gynaecology

Cite this

Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries : Results from the WHO Study on global AGEing and adult health (SAGE). / Hoogendijk, Emiel O.; Rijnhart, Judith J.M.; Kowal, Paul; Pérez-Zepeda, Mario U.; Cesari, Matteo; Abizanda, Pedro; Flores Ruano, Teresa; Schop-Etman, Astrid; Huisman, Martijn; Dent, Elsa.

In: Maturitas, Vol. 115, 01.09.2018, p. 56-63.

Research output: Contribution to journalArticle

Hoogendijk, EO, Rijnhart, JJM, Kowal, P, Pérez-Zepeda, MU, Cesari, M, Abizanda, P, Flores Ruano, T, Schop-Etman, A, Huisman, M & Dent, E 2018, 'Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE)', Maturitas, vol. 115, pp. 56-63. https://doi.org/10.1016/j.maturitas.2018.06.011
Hoogendijk, Emiel O. ; Rijnhart, Judith J.M. ; Kowal, Paul ; Pérez-Zepeda, Mario U. ; Cesari, Matteo ; Abizanda, Pedro ; Flores Ruano, Teresa ; Schop-Etman, Astrid ; Huisman, Martijn ; Dent, Elsa. / Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries : Results from the WHO Study on global AGEing and adult health (SAGE). In: Maturitas. 2018 ; Vol. 115. pp. 56-63.
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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.",
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AU - Rijnhart, Judith J.M.

AU - Kowal, Paul

AU - Pérez-Zepeda, Mario U.

AU - Cesari, Matteo

AU - Abizanda, Pedro

AU - Flores Ruano, Teresa

AU - Schop-Etman, Astrid

AU - Huisman, Martijn

AU - Dent, Elsa

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N2 - 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.

AB - 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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KW - Low- and middle-income countries

KW - SAGE

KW - Socioeconomic position

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