Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA.
Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Nov 1;79(11). doi: 10.1093/geronb/gbae157.
The objective of this study is to examine differences in socioeconomic gradients (i.e., education, income, and wealth) in frailty by gender in the United States and England.
We used harmonized data from the Health and Retirement Study and the English Longitudinal Study of Ageing in 2016. Frailty status was determined from measured and self-reported signs and symptoms in 5 domains: unintentional weight loss, exhaustion, low physical activity, slow walking speed, and weakness. Respondents were classified as robust (no signs or symptoms of frailty), prefrail (signs or symptoms in 1-2 domains), or frail (signs or symptoms in 3 or more domains). Gender-stratified multinomial logistic regression models were used to assess the relationship between educational attainment, household income, and household wealth with the risk of frailty and prefrailty, with and without covariates. We also calculated the slope index of inequalities on the predicted probabilities of frailty by income and wealth quintiles.
We found socioeconomic gradients in prefrailty and frailty by education, income, and wealth. Furthermore, the educational gradient in frailty was significantly steeper for U.S. women compared to English women, and the income gradient was steeper for U.S. men and women compared to English men and women. The between-country differences were not accounted for by adjusting for race/ethnicity and behavioral factors.
Socioeconomic gradients in prefrailty and frailty differ by country setting and gender, suggesting contextual factors such as cultural norms, healthcare access and quality, and economic policy may contribute to the effect of different measures of socioeconomic status on prefrailty and frailty risk.
本研究旨在检验美国和英国在性别层面上，社会经济梯度（即教育、收入和财富）对虚弱程度的差异。
我们使用了 2016 年健康与退休研究（Health and Retirement Study）和英国老龄化纵向研究（English Longitudinal Study of Ageing）中经协调的数据。虚弱状况通过 5 个领域的测量和自我报告的体征和症状来确定：非故意体重减轻、疲惫、低体力活动、缓慢步行速度和虚弱。受访者被分为健康（无虚弱体征或症状）、虚弱前期（1-2 个领域有体征或症状）或虚弱（3 个或更多领域有体征或症状）。使用性别分层多项逻辑回归模型，评估教育程度、家庭收入和家庭财富与虚弱和虚弱前期风险之间的关系，包括和不包括协变量。我们还计算了按收入和财富五分位数预测的虚弱概率的不平等斜率指数。
我们发现，在教育、收入和财富方面，虚弱前期和虚弱存在社会经济梯度。此外，与英国女性相比，美国女性的虚弱程度存在更为显著的教育梯度，而美国男性和女性的收入梯度比英国男性和女性更为陡峭。通过调整种族/民族和行为因素，无法解释国家间的差异。
虚弱前期和虚弱的社会经济梯度因国家背景和性别而异，这表明文化规范、医疗保健可及性和质量以及经济政策等背景因素可能会影响不同社会经济地位衡量指标对虚弱前期和虚弱风险的影响。
