Guo Yujia, Yang Fan
School of Health Policy & Management, Nanjing Medical University, Nanjing, Jiangsu, China.
School of Public Health, Fudan University, Shanghai, China.
Innov Aging. 2024 Jan 27;8(2):igae003. doi: 10.1093/geroni/igae003. eCollection 2024.
Evidence remains unclear on the impact of life-course socioeconomic position (SEP) mobility on frailty trajectories in later life. We aim to examine the longitudinal effects of social mobility on frailty trajectories among Chinese middle-aged and older populations.
A total of 13 239 participants aged 45 and older from the 2011-2018 China Health and Retirement Longitudinal Study were analyzed. Based on changes in SEP from childhood to adulthood, 5 patterns of social mobility were established. A 32-item deficit cumulative frailty index (FI) was developed to evaluate frailty trajectories at each follow-up. Linear mixed-effects models were used to examine the longitudinal association of the 5 social mobility patterns with the frailty trajectory.
The trajectory of late-life FI increased across all 5 social mobility groups during the follow-up. The FI trajectory had the largest disparity between stable high SEP and stable low SEP, with a faster increase in FI of 0.489 (95% confidence interval [CI]: 0.327-0.650, < .001) in the stable low versus stable high SEP group. The FI trajectories of individuals in the upward and downward mobility groups fall between those in the stable high SEP and low SEP groups. Specifically, compared to the stable high SEP group, the increase in FI was 0.229 (95% CI: 0.098-0.360, = .001) faster in the downward mobility group, and 0.145 (95% CI: 0.017-0.273, = .03) faster in the upward mobility group. The impact of social mobility on frailty trajectories was more pronounced among middle-aged adults and women.
These findings emphasize that policies to identify vulnerable populations and reduce frailty inequalities should focus on the socioeconomic environment across the life course, with particular attention paid to those with consistently low SEP and downward mobility.
关于生命历程社会经济地位（SEP）流动对晚年衰弱轨迹的影响，证据仍不明确。我们旨在研究社会流动对中国中老年人群衰弱轨迹的纵向影响。
对2011 - 2018年中国健康与养老追踪调查中13239名年龄在45岁及以上的参与者进行了分析。根据从童年到成年SEP的变化，确定了5种社会流动模式。开发了一个包含32个项目的缺陷累积衰弱指数（FI），以评估每次随访时的衰弱轨迹。使用线性混合效应模型来研究5种社会流动模式与衰弱轨迹的纵向关联。
在随访期间，所有5个社会流动组的晚年FI轨迹均有所增加。FI轨迹在稳定高SEP组和稳定低SEP组之间差异最大，稳定低SEP组的FI增长速度比稳定高SEP组快0.489（95%置信区间[CI]：0.327 - 0.650，P <.001）。向上和向下流动组个体的FI轨迹介于稳定高SEP组和低SEP组之间。具体而言，与稳定高SEP组相比，向下流动组的FI增长速度快0.229（95% CI：0.098 - 0.360，P =.001），向上流动组快0.145（95% CI：0.017 - 0.273，P =.03）。社会流动对衰弱轨迹的影响在中年成年人和女性中更为明显。
这些发现强调，识别弱势群体和减少衰弱不平等的政策应关注整个生命历程的社会经济环境，尤其要关注那些SEP持续较低和向下流动的人群。
