Guo Yanfei, Ng Nawi, Hassler Sven, Wu Fan, Jonasson Junmei Miao
School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China.
Innov Aging. 2024 Oct 1;9(2):igae080. doi: 10.1093/geroni/igae080. eCollection 2025.
Early-life risk factors influence the aging process in the short term and shape its trajectory in the long term. We aim to (1) explore the association between childhood socioeconomic position (cSEP) and frailty trajectories and (2) test whether adult socioeconomic position (aSEP) mediates the association between cSEP and frailty trajectories.
We analyzed 4 waves of the China Health and Retirement Longitudinal Study data. The frailty index was estimated based on the number of individual deficits across 40 indicator variables. Principal component analysis was used to generate cSEP and aSEP. Group-based trajectory models were used to identify the patterns of frailty trajectories over time. Causal mediation analysis was conducted to determine whether the aSEP mediated the association between cSEP and frailty trajectories.
We identified 3 distinct trajectories of frailty progression. Low cSEP was significantly associated with "High and increasing frailty trajectory" (odds ratio [OR] = 1.76, 95% confidence intervals [95% CI]: 1.38-2.23; adjusted OR = 1.55, 95% CI: 1.22-1.97). About 30% of the cSEP effect on rising frailty trajectory was mediated through the aSEP, and there is a significant gender disparity in the mediating effect of aSEP (18% among men and 51% among women, respectively).
Our findings suggest that policies that initially benefit children will yield well-being benefits as they reach adulthood. Promoting ongoing cSEP advantages increases the likelihood of delaying frailty progression in later life. This study underscores the critical importance of addressing social determinants of health throughout one's life course to foster healthy aging and diminish health disparities in later stages of life.
早期生活风险因素在短期内影响衰老过程，并在长期内塑造其轨迹。我们旨在（1）探讨儿童社会经济地位（cSEP）与衰弱轨迹之间的关联，以及（2）检验成人社会经济地位（aSEP）是否介导cSEP与衰弱轨迹之间的关联。
我们分析了中国健康与养老追踪调查数据的4个波次。基于40个指标变量中的个体缺陷数量估计衰弱指数。主成分分析用于生成cSEP和aSEP。基于群体的轨迹模型用于识别衰弱轨迹随时间的模式。进行因果中介分析以确定aSEP是否介导cSEP与衰弱轨迹之间的关联。
我们确定了3种不同的衰弱进展轨迹。低cSEP与“高且不断增加的衰弱轨迹”显著相关（优势比[OR]=1.76，95%置信区间[95%CI]：1.38 - 2.23；调整后的OR = 1.55，95%CI：1.22 - 1.97）。cSEP对衰弱轨迹上升的影响约30%通过aSEP介导，并且aSEP的中介效应存在显著的性别差异（男性为18%，女性为51%）。
我们的研究结果表明，最初使儿童受益的政策在他们成年后将产生福祉效益。促进持续的cSEP优势增加了延缓晚年衰弱进展的可能性。本研究强调了在整个生命过程中解决健康的社会决定因素对于促进健康老龄化和减少生命后期健康差距的至关重要性。
