Soler-Vila Hosanna, García-Esquinas Esther, León-Muñoz Luz Ma, López-García Esther, Banegas José R, Rodríguez-Artalejo Fernando
Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain Department of Public Health Sciences, Leonard Miller School of Medicine, University of Miami, Miami, Florida, USA.
Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
J Epidemiol Community Health. 2016 Apr;70(4):354-60. doi: 10.1136/jech-2015-206406. Epub 2015 Nov 13.
To examine the association between socioeconomic status (SES) and risk of frailty, and to assess whether behavioural and clinical factors (BCF) mediate this association.
Cohort of 1857 non-institutionalised individuals aged ≥ 60 years recruited in 2008-2010 and followed through 2012. Education, occupation, and BCF were ascertained at baseline, and incident frailty was assessed at follow-up with the Fried frailty criteria.
Men showed no differences in frailty risk by education or occupation. Compared with women with university education, the adjusted OR (aOR) adjusted for age and the number of frailty criteria at baseline for incident frailty in women with primary or lower education was 3.02 (95% CI 1.25 to 7.30); once fully adjusted for BCF, the OR was 2.00 (95% CI 0.76 to 5.23). No alcohol intake (vs light-moderate), longer time spent watching TV, less time spent reading, and a higher frequency of obesity, depression and musculoskeletal disease in those with primary or lower education accounted for most of the decline in OR. BCF explained 50.5% of the excess frailty risk associated with lower education. The aOR of frailty incidence for manual versus non-manual occupation was 2.24 (95% CI 1.41 to 3.56) versus a fully aOR of 2.05 (95% CI 1.24 to 3.37). BCF explained 15.3% of the association, with individual mediators being similar to those for education-related differences.
A lower education or a manual occupation was associated with higher frailty risk in older women. These associations were partly explained by lower alcohol consumption, higher sedentariness, and higher obesity and chronic disease rates in women with lower SES.
研究社会经济地位（SES）与衰弱风险之间的关联，并评估行为和临床因素（BCF）是否介导这种关联。
2008 - 2010年招募了1857名年龄≥60岁的非机构化个体组成队列，并随访至2012年。在基线时确定教育程度、职业和BCF，并在随访时根据Fried衰弱标准评估新发衰弱情况。
男性在衰弱风险方面，按教育程度或职业无差异。与受过大学教育的女性相比，小学及以下教育程度的女性发生衰弱的校正比值比（aOR）（校正年龄和基线时衰弱标准数量）为3.02（95%可信区间1.25至7.30）；在对BCF进行完全校正后，比值比为2.00（95%可信区间0.76至5.23）。小学及以下教育程度者不饮酒（与少量适度饮酒相比）、看电视时间较长、阅读时间较少以及肥胖、抑郁和肌肉骨骼疾病发生率较高，这些因素占比值比下降的大部分原因。BCF解释了与较低教育程度相关的额外衰弱风险的50.5%。体力劳动者与非体力劳动者的衰弱发生率aOR为2.24（95%可信区间1.41至3.56），完全校正后的aOR为2.05（95%可信区间1.24至3.37）。BCF解释了这种关联的15.3%，个体介导因素与教育程度相关差异的介导因素相似。
较低的教育程度或体力劳动职业与老年女性较高的衰弱风险相关。这些关联部分可由社会经济地位较低女性的低酒精摄入量、较高久坐程度以及较高肥胖和慢性病发生率来解释。
