Association of early- and adult-life socioeconomic circumstances with muscle strength in older age

Risk factors for sarcopenia in community setting across the life course: A systematic review and a meta-analysis of longitudinal studies

BACKGROUND

Sarcopenia is generally an age-related condition in older people that impacts adverse health consequences in terms of quality of life, morbidity and mortality. With the increasing interest of clinical and research interest in sarcopenia internationally, the epidemiological evidence reveals sarcopenia risk begins in early adulthood, influenced by gene, lifestyle and a range of chronic conditions across life course.

OBJECTIVES

The purpose of this study was to systematically summarize the risk factors for sarcopenia across the life course, and to identity the high-risk population.

METHODS

Searches were performed in PubMed, Web of Science, Scopus, Embase, MEDLINE, and SPORTDiscus databases from inception to July 2024. Longitudinal studies assessing the risk factors for sarcopenia in community setting were included in the analysis. Fixed- and random-effect models were used to pool effect size. Based on the results of meta-analysis, we developed a risk predictive model for sarcopenia.

RESULTS

Fifty-three studies were included in our systematic review. Risk factors associating with sarcopenia were grouped into eight domains: sociodemographic, anthropometric, health behaviors, health condition, biomarkers, early life factors, psychosocial and living environment factors. Fifteen risk factors derived from the twenty-three included studies were eligible for meta-analysis, and ten variables were identified as statistically significant. A risk predictive model was developed for secondary sarcopenia in community setting.

CONCLUSIONS

This study provides a fully understanding of sarcopenia across the life-course. Our risk predictive model could facilitate the early identification and prevention of secondary sarcopenia in community setting.

REGISTRATION

The systematic review and meta-analysis have been registered in PROSPERO(CRD42024536346).

Do obstructive and restrictive pulmonary disorders increase the incidence risk of dynapenia in adults aged 50 and older?

OBJECTIVE

This study aims to evaluate whether obstructive or restrictive lung disorders are associated with the incidence of dynapenia in individuals aged 50 and over.

METHODS

Longitudinal study involving 4,975 participants from the English Longitudinal Study of Aging (ELSA) aged 50 or older, without dynapenia at baseline, followed for eight years. Lung function was assessed by spirometry (predicted percentage) and participants were classified as no pulmonary disorder (FEV1 ≥ 80 %, FVC ≥ 80 % and FEV1/FVC ≥ 70 %); with obstructive pulmonary disorder (FEV1 < 80 %, FEV1/FVC < 70 % and normal FVC or < 80 %); or with restrictive pulmonary disorder (FVC < 80 %, FEV1/FVC > 70 % and normal or < 80 % FEV1). The incidence of dynapenia was defined by handgrip strength < 26 kg for men and < 16 kg for women. Association between obstructive or restrictive pulmonary disorders and the incidence of dynapenia were investigated using Poisson regression models adjusted for sociodemographic, behavioural, and clinical characteristics.

RESULTS

The incidence density of dynapenia was 14.2/1000 person-years (95 %CI 12.6-15.9) in those without pulmonary disorders, 25.1/1000 person-years (95 % CI 21.2-29.7) in those with restrictive pulmonary disorders and 36.6/1000 person-years (95 % CI 23.8-56.1) in those with obstructive pulmonary disorders. Having an obstructive pulmonary disorder increased the risk of developing dynapenia by 62 % (95 % CI 1.09-2.41), while having a restrictive pulmonary disorder increased the risk by 37 % (95 % CI 1.13-1.64).

CONCLUSION

Obstructive and restrictive pulmonary disorders are risk factors for a higher incidence of dynapenia in individuals aged 50 years or older.

Associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in populations from China and England

BACKGROUND

We investigated associations of childhood socioeconomic position and health with trajectories of grip strength from middle to older ages in two distinct populations.

METHODS

We used data from the China Health and Retirement Longitudinal Study (CHARLS, n = 16,701) and English Longitudinal Study of Ageing (ELSA, n = 12,695). Hand grip strength was measured at three timepoints in CHARLS (2011-2015) and four in ELSA (2001-2020). Random-effects growth models were applied to assess associations between each childhood factor and age trajectories of grip strength.

FINDINGS

Lower parental education was associated with weaker grip strength, by 0·36 kg(95 % CI:0·17,0·56) for participants of illiterate (vs literate) parents in CHARLS and 1·88 kg(0·43,3·33) for participants of parents without education (vs ≥ high school) in ELSA, after adjusting for parental occupation and own adult socioeconomic position. Low parental occupation was associated with weaker grip strength, although the difference diminished after adjustment for adult socioeconomic position. Financial hardship was associated with weaker grip strength only in CHARLS, by 0·19 kg(0·01,0·38) after adjustment. Self-rated poor childhood health and school absenteeism were associated with weaker grip strength (both studies). Being confined to bed and hospitalised for more than a month due to health were associated with weaker grip strength only in CHARLS. Each additional childhood illness (only reported in ELSA) was associated with 0·52 kg(0·28,0·81) lower mean grip strength. Reported poor childhood health (CHARLS), low parental education and school absenteeism (ELSA) were associated with grip strength decline.

INTERPRETATION

Lower socioeconomic position and poor health in childhood were associated with weaker grip strength in later life in both Chinese and English populations. Addressing socioeconomic disparities and promoting health of children may enhance life-course physical capacity, promote healthy ageing and reduce age-related adversities.

The mediating effect of depressive symptoms on the association between childhood friendship and physical function in middle-aged and older adults: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

This study examines the extent to which depressive symptoms mediate the link between childhood friendship (CF) and physical function among middle-aged and older adults in China.

METHODS

China Health and Retirement Longitudinal Study (CHARLS) data were used; specifically, CHARLS life history survey (conducted from June 1-December 31, 2014) and follow-up health survey (conducted from July 1-September 30, 2015) data were used. The Sobel test, Bootstrap test and multivariable logistic regression were performed to examine the mediating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between CF (measured by a standardized retrospective questionnaire) and physical function, which was measured by basic activities of daily living (BADL) disability, instrumental activities of daily living (IADL) disability, and grip strength.

RESULTS

A total of 12,170 participants aged 45 years or older were included in this cross-sectional study. After controlling for covariates, low-quality CF was associated with an increased prevalence of BADL disability (OR = 1.18; 95 % CI = 1.05-1.32), IADL disability (OR = 1.25; 95 % CI = 1.12-1.40), and low grip strength (OR = 1.21; 95 % CI = 1.09-1.34). The proportion of the mediating effect of depressive symptoms was 48 % for CF and BADL, 40 % for CF and IADL, and 11 % for CF and grip strength. Depressive symptoms and worse CF have a joint effect on BADL disability (OR = 3.30; 95 % CI = 2.82-3.85), IADL disability (OR = 3.52; 95 % CI = 3.03-4.09), and low grip strength (OR = 1.65; 95 % CI = 1.43-1.92).

LIMITATIONS

Not all potential confounding factors (such as childhood behavioural problems, genetic factors, and memory function) were measured in the analysis, and there may have been recall bias in the retrospective collection of CF data.

CONCLUSIONS

Individuals with high-quality CF were more likely to have a decreased prevalence of impaired physical function in later life. Depressive symptoms acted as a mediator associated with the development of CF.

The impact of income level on skeletal muscle health in rural Chinese older residents: a study of mediating effects based on dietary knowledge

China's rural residents have basically solved the problem of subsistence, but due to aging, the prevalence of sarcopenia (abbreviated as sarcopenia) has been increasing year by year, especially the skeletal muscle health of the rural older residents has not been sufficiently paid attention to, so analyses of the impact of income level on the skeletal muscle health of the older people in rural areas of China are of great practical significance. Based on the annual data of the China Health and Nutrition Survey (CHNS) in 2006, 2009, and 2011, we introduced the mediator variable of dietary knowledge and used the Probit model regression, mediation effect model, and instrumental variable regression to assess the skeletal muscle health status of the rural older people in China and explore the mechanism of the influence of the income level on the skeletal muscle health of the rural older residents in China. The primary objectives of this study were to evaluate the impact of income level on the skeletal muscle health status of older adults living in rural areas of China and to investigate the underlying mechanisms. By analyzing the findings of this study, our aim is to establish a correlation between the economic status and skeletal muscle health of older adults in rural communities, as well as elucidate the influence of income level and dietary knowledge on their skeletal muscle health. Through the attainment of these objectives, we hope to provide valuable insights and recommendations for enhancing skeletal muscle health among the rural older population in China. Based on our research findings, it can be inferred that there was a significant association between the financial status of rural older adults and their skeletal muscle health. Additionally, the prevalence of sarcopenia was lower among individuals with higher income levels, and there was a negative correlation between the prevalence of sarcopenia and the level of dietary knowledge among rural older individuals. The knowledge of dietary knowledge level of rural older people plays a mediating role in the income level and the prevalence of sarcopenia. Moreover, with the change in income level and the increase in age, the change in skeletal muscle health status showed obvious heterogeneity, in which the effect on the relatively younger (65-70 years old) samples was greater. Therefore, sustained income growth remains an effective way to improve the skeletal muscle health of older rural residents. At the same time, improving dietary knowledge and dietary quality among the older people is important in preventing a decline in muscle strength and physical function and in preventing the onset of sarcopenia.

Early-Life Factors and Multimorbidity Risk Later in Older Age: Evidence Based on CHARLS

INTRODUCTION

Early-life factors were reported to exert influence on the health condition of individuals in the long-term. However, limited research explored the connection between early-life factors and multimorbidity in later years.

METHODS

We utilized the data from the China Health and Retirement Longitudinal Study to assess this possible association in the present cross-sectional study. Multimorbidity was determined based on 14 common chronic diseases included in the study. Logistic regression was employed to examine the link between early-life factors and subsequent multimorbidity.

RESULTS

Out of 7,578 participants who met the inclusion criteria for analysis, 3,765 (49.68%) were females. The mean age was 68.25 ± 6.70 years. Participants who rated their health during childhood as average (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.96) or better [OR 0.72, 95% CI 0.57-0.91] were significantly less likely to experience multimorbidity in older life. By contrast, experiencing violence from two of the family members was significantly associated with future multimorbidity (OR [95% CI], 1.29 [1.04-1.60]). A superior family financial situation was also negatively associated with multimorbidity, with average (OR [95% CI], 0.72 [0.63-0.83]) and better off than average (OR [95% CI], 0.76 [0.62-0.93]).

DISCUSSION

Individuals with poor health status, inferior family socioeconomic status, or experienced violence from family members in childhood were more likely to suffer from multimorbidity in later life. Enhanced social monitoring of potentially adverse conditions in youngsters and targeted interventions could help mitigate the progression of multimorbidity in later life.

Prevalence of dynapenia and overlap with disability, depression, and executive dysfunction

OBJECTIVE

This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion.

METHODS

This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls.

RESULTS

A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions.

CONCLUSIONS

Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction.

Physical activity matters for everyone's health, but individuals with multimorbidity benefit more

Multimorbidity, defined as the presence of two or more chronic conditions, is increasingly prevalent and is a major contributor to ill health in old age. Physical activity (PA) is a key protective factor for health and individuals with multimorbidity could particularly benefit from engaging in PA. However, direct evidence that PA has greater health benefits in people with multimorbidity is lacking. The objective of the present study was to investigate whether the associations between PA and health were more pronounced in individuals with (vs. without) multimorbidity. We used data from 121,875 adults aged 50 to 96 years (mean age = 67 ± 10 years, 55% women) enrolled in the Survey of Health, Ageing and Retirement in Europe (SHARE). Multimorbidity and PA were self-reported. Health indicators were assessed using tests and validated scales. Variables were measured up to seven times over a 15-year period. Confounder-adjusted linear mixed-effects models were used to investigate the moderating role of multimorbidity on the associations of PA with the levels and trajectories of health indicators across aging. Results showed that multimorbidity was associated with declines in physical, cognitive, and mental health, as well as poorer general health. Conversely, PA was positively associated with these health indicators. We found a significant interaction between multimorbidity and PA, revealing that positive associations between PA and health indicators were strengthened in people with multimorbidity - although this stronger association became less pronounced in advanced age. These findings suggest that the protective role of PA for multiple health indicators is enhanced in individuals with multimorbidity.

Sex Differences in Age-Associated Rate of Decline in Grip Strength When Engaging in Vigorous Physical Activity

Handgrip strength (GS) is used as an indicator of overall muscle strength and health outcomes for aging adults. GS has also been evaluated as a potential link with sport performances. We quantified the age-associated decline in grip strength for males and females engaged in weekly vigorous physical activity, differentiated by body mass, and investigated whether there was an acceleration of decline at any age. The Survey of Health, Ageing and Retirement in Europe is a multinational complex panel data survey with a target population of individuals aged 50 years or older. Data from 48,070 individuals from 20 European countries, collected from 2004 to 2015, were used in multivariable regression models to study the association of age and body weight with grip strength for individuals engaged in vigorous physical activity at least once a week. The annual rate of change in GS differed for males and females; it was constant from ages 50 to 55 years and then accelerated for females, possibly due to the menopausal transition. In contrast, the decline in GS accelerates with each year of increase in age for males. Higher body mass was associated with an increase in GS, but the increase was less pronounced for older males. The increase in GS diminished with a body mass above the median even with engagement in weekly vigorous physical activities. GS reference values for individuals engaged in vigorous physical activity add to existing reference values for general populations.

Cognitive functions and physical activity in aging when energy is lacking

Declines in subjective energy availability and cognitive functions could explain the decrease in physical activity observed across aging. However, how these factors interact remains unknown. Based on the theory of effort minimization in physical activity (TEMPA), we hypothesized that cognitive functions may help older adults to maintain physical activity even when energy availability is perceived as insufficient. This study used data of 104,590 adults from 21 European countries, from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 7 measurement occasions between 2004 and 2017. Cognitive functions were assessed with verbal fluency and delayed recall, using the verbal fluency test and the 10-word delayed recall test. Physical activity and subjective energy availability were self-reported. Results of linear mixed-effects models revealed that cognitive functions moderated the associations between subjective energy availability and physical activity. Moreover, as adults get older, cognitive functions became critical to engage in physical activity regardless the availability of perceived energy. Sensitivity and robustness analyses were consistent with the main results. These results suggest that cognitive functions may help older adults to maintain regular physical activity even when energy for goal pursuit becomes insufficient, but that the protective role of cognitive functions becomes critical at older age, irrespective of the state of perceived energy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10433-021-00654-2.

Associations between childhood and adulthood socioeconomic position and grip strength at age 46 years: findings from the 1970 British Cohort Study

BACKGROUND

Muscle weakness is a key criterion for important age-related conditions, including sarcopenia and frailty. Research suggests lower childhood socioeconomic position (SEP) may be associated with muscle weakness in later life but there is little evidence on associations in younger adults closer to peak muscle strength. We aimed to examine relationships between indicators of SEP in childhood and adulthood and grip strength at age 46y.

METHODS

We examined 7,617 participants from the 1970 British Cohort Study with grip strength measurements at 46y. We used sex-specific linear regression models to test associations between five different indicators of SEP in childhood and adulthood (paternal occupational class and parental education levels at age 5 and own occupational class and education level at age 46) and maximum grip strength. Models were adjusted for birth weight, BMI in childhood and adulthood, adult height, disability in childhood, leisure-time physical activity in childhood and adulthood, sedentary behaviour in childhood and adulthood, occupational activity and smoking at age 46.

RESULTS

Among women, lower SEP in childhood and adulthood was associated with weaker grip strength even after adjustments for covariates. For example, in fully-adjusted models, women whose mothers had no qualifications at age five had mean grip strength 0.99 kg (95% CI: -1.65, -0.33) lower than women whose mothers were educated to degree and higher. Among men, lower levels of father's education and both adult SEP indicators were associated with stronger grip. The association between own occupational class and grip strength deviated from linearity; men in skilled-manual occupations (i.e. the middle occupational group) had stronger grip than men in the highest occupational group (Difference in means: 1.33 kg (0.60, 2.06)) whereas there was no difference in grip strength between the highest and lowest occupational groups. Adjustment for occupational activity largely attenuated these associations.

CONCLUSION

Findings highlight the need to identify age and sex-specific interventions across life to tackle inequalities in important age-related conditions related to weakness.

Gender and education inequalities in dynapenia-free life expectancy: ELSI-Brazil

OBJECTIVE

To estimate the dynapenia-free life expectancy among community-dwelling older Brazilian adults and evaluate gender-related and educational differences.

METHODS

This is a cross-sectional study. The data were obtained from the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil - Brazilian Longitudinal Study of Aging), conducted from 2015 to 2016 in Brazil. Dynapenia is defined as low muscle strength (< 27kg for men and < 16kg for women), measured with a handgrip dynamometer. The dynapenia-free life expectancy was estimated using the Sullivan method based on the standard period life table and dynapenia prevalence, stratified by age groups, gender, and schooling.

RESULTS

A total of 8,827 participants, aged 50 and over (53.3% women), were investigated. The prevalence of dynapenia was 17.7% among men and 18.5% among women. The women live longer and with more years free of dynapenia than men. Those in the higher education category (four or more years) presented an advantage in the dynapenia-free life expectancy estimates.

CONCLUSIONS

The results of this study suggest the substantial impact of dynapenia on longer dynapenia-free life expectancy among older people. Understanding dynapenia prevalence and dynapenia-free life expectancy could assist in predicting care needs, as well as targeting efforts to delay the onset of complications related to it at older ages. Without the implementation of policy regarding dynapenia prevention, inequalities in health due to gender and socioeconomic status may continue to increase.

Adverse childhood experiences and handgrip strength among middle-aged and older adults: a cross-sectional study in China

BACKGROUND

Evidence on the association between adverse childhood experiences (ACEs) and handgrip strength (HGS) in later life was limited and inconclusive. We aimed to explore the impact of ACEs on HGS among middle-aged and older Chinese adults.

METHODS

We conducted a cross-sectional study with data extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey with respondents recruited from 450 villages/urban communities of 28 provinces. Participants aged 45 years or older were drawn from the CHARLS 2014 life history survey and the 2015 health survey. Twelve ACE indicators before the age of 17 years were collected. HGS was measured with a dynamometer and the maximum value of HGS obtained from both hands was used in the analyses. Low muscle strength (LMS) was defined according to the recommendation of European Working Group on Sarcopenia in Older People (EWGSOP). Multivariate linear and logistic regression models were constructed to evaluate the association of ACEs with continuous HGS and LMS, with adjustment for age, sex, marital status, ethnicity, area of residence, smoking and drinking status, body mass index, hypertension, dyslipidaemia, diabetes mellitus, cardiovascular disease, arthritis, hip fracture, and memory-related disease.

RESULTS

Of the 7209 eligible participants, 2258 (31.3%) had experienced three or more ACEs. Compared to individuals without ACEs, exposure to ≥ 3 ACEs was negatively associated with continuous HGS in kilogram (β = -0.93, 95% CI: -1.37, -0.49) and positively associated with the risk of LMS (OR = 1.34, 95% CI: 1.12, 1.61). Such associations were consistently found both in men and women who had experienced three or more ACEs. Significant dose-response relationship between the number of ACEs and outcomes was also observed in the overall population and different sex groups.

CONCLUSION

Exposure to ACEs was associated with lower HGS and increased risk of LMS among middle-aged and older Chinese adults, indicating the importance of intervention in individuals with experience of ACEs in order to mitigate its detrimental impact on HGS and promote healthy ageing.

Physical capability in a rural birth cohort at the age of 52: association with early environmental, nutritional, and developmental factors

Introduction

Midlife physical capability (PC) is associated with developmental factors in the populations of economically developed countries. As far as we know, there is no information for rural populations of low- and middle-income countries. The aim of the study was to investigate the influence of pre- and postnatal factors on midlife objective measures of PC in a 1966–67 birth cohort from a Mexican rural community. The hypothesis was that adverse developmental conditions are associated with low midlife PC.

Methods

In 1966–67, a birth cohort of all children from a poor Mexican rural community was assembled. Data on family socioeconomic status (SES), parental health and nutritional status, birth weight, postnatal growth and feeding patterns were registered. In 2018, out of the 336 cohort members, 118 were living in the community, and eighty-two of them underwent a comprehensive clinical evaluation. The evaluation included grip strength, gait velocity and chair-stand PC tests. In multivariable linear models, PC tests were the dependent variables, and prenatal, birth and postnatal factors were the independent variables. Adjustment for confounding was made with adult anthropometric, body composition, clinical and ageing status variables.

Results

Independent of adult health status and other ageing indicators, lower PC was associated with family organization and SES, parental nutritional status, birth weight, infant postnatal growth velocity, and weaning time. These results indicate that adverse family and environmental conditions that are prevalent in poor rural communities are associated with low midlife PC.

Early-Life Socioeconomic Circumstances and Physical Activity in Older Age: Women Pay the Price

Health in older age is shaped by early-life socioeconomic circumstances (SECs) and sex. However, whether and why these factors interact is unclear. We examined a cultural explanation of this interaction by distinguishing cultural and material aspects of SECs in the context of physical activity-a major determinant of health. We used data from 56,331 adults between 50 and 96 years old from the Survey of Health, Ageing and Retirement in Europe (SHARE), a 13-year, large-scale, population-based cohort. Confounder-adjusted logistic linear mixed-effects models showed an association between the cultural aspects of early-life SEC disadvantage and physical activity among women, but it was not consistently observed in men. Furthermore, these associations were compensated for only partially by adult-life socioeconomic trajectories. The material aspects of early-life SECs were not associated with adult-life physical activity. These findings highlight the need to distinguish different aspects of SECs because they may relate to health behaviors in diverse ways.

Social protection expenditure on health in later life in 20 European countries: Spending more to reduce health inequalities

BACKGROUND

This study aims to examine whether higher social protection expenditure reduces the negative association of life-course socioeconomic disadvantages with subjective and objective health status and trajectories in later life.

METHODS

We used SHARE data from participants living in 20 European countries aged 50 to 96. Seven waves allowed to examine the trajectories of health inequalities in later life. We used linear mixed-effects models stratified by sex to examine the association between life-course socioeconomic disadvantage and subjective (self-rated health, SRH, N = 55,443) and objective (grip strength, N = 54,718) health. Cross-level interactions between net social protection expenditure as percentage of gross domestic product and life-course socioeconomic disadvantage tested for the moderating effect of social expenditures on the association of disadvantage with SRH and grip strength in later life.

FINDINGS

Higher social protection expenditure reduced socioeconomic health inequalities in both men and women for grip strength, and in women but not men for SRH. For SRH, the health-inequality-reducing effect of social protection expenditure became weaker with increasing age. This was not observed in grip strength. Some separate expenditure functions (disability, family and children) were found to have inequality-widening effects in men's and women's SRH, which were either offset or overcompensated by the other functions. No inequality-widening effects were observed in grip strength.

INTERPRETATION

Higher social spending reduces life-course socioeconomic inequalities in women's subjective health and in men's and women's objective health. However, some specific social protection policies may have the unintentional effect of increasing inequalities in people's evaluation of their own health.

Muscle strength is associated with COVID-19 hospitalization in adults 50 years of age or older

BACKGROUND

Weak muscle strength has been associated with a wide range of adverse health outcomes. Yet, whether individuals with weaker muscle strength are more at risk for hospitalization due to severe COVID-19 is still unclear. The objective of this study was to investigate the independent association between muscle strength and COVID-19 hospitalization.

METHODS

Data from adults 50 years of age or older were analysed using logistic models adjusted for several chronic conditions, body-mass index, age, and sex. Hand-grip strength was repeatedly measured between 2004 and 2017 using a handheld dynamometer. COVID-19 hospitalization during the lockdown was self-reported in summer 2020 and was used as an indicator of COVID-19 severity.

RESULTS

The study was based on the Survey of Health, Ageing and Retirement in Europe (SHARE) and included 3600 older adults (68.8 ± 8.8 years, 2044 female), among whom 316 were tested positive for the severe acute respiratory syndrome coronavirus 2 (8.8%), and 83 (2.3%) were hospitalized due to COVID-19. Results showed that higher grip strength was associated with a lower risk of COVID-19 hospitalization [adjusted odds ratio (OR) per increase of 1 standard deviation in grip strength = 0.64, 95% confidence interval (95% CI) = 0.45-0.87, P = 0.015]. Results also showed that age (OR for a 10 -year period = 1.70, 95% CI = 1.32-2.20, P < 0.001) and obesity (OR = 2.01, 95% CI = 1.00-3.69, P = 0.025) were associated with higher risk of COVID-19 hospitalization. Sensitivity analyses using different measurements of grip strength as well as robustness analyses based on rare-events logistic regression and a different sample of participants (i.e. COVID-19 patients) were consistent with the main results.

CONCLUSIONS

Muscle strength is an independent risk factor for COVID-19 severity in adults 50 years of age or older.

Socioeconomic differences in handgrip strength and its association with measures of intrinsic capacity among older adults in six middle-income countries

Handgrip strength, a measure of muscular strength is a powerful predictor of declines in intrinsic capacity, functional abilities, the onset of morbidity and mortality among older adults. This study documents socioeconomic (SES) differences in handgrip strength among older adults aged 50 years and over in six middle-income countries and investigates the association of handgrip strength with measures of intrinsic capacity-a composite of all the physical and mental capacities of an individual. Secondary data analysis of cross-sectional population-based data from six countries from the WHO's Study on global AGEing and adult health (SAGE) Wave 1 were conducted. Three-level linear hierarchical models examine the association of demographic, socioeconomic status and multimorbidity variables with handgrip strength. Regression-based Relative Index of Inequality (RII) examines socioeconomic inequalities in handgrip strength; and multilevel linear and logistic hierarchical regression models document the association between handgrip strength and five domains of intrinsic capacity: locomotion, psychological, cognitive capacity, vitality and sensory. Wealth quintiles are positively associated with handgrip strength among men across all countries except South Africa while the differences by education were notable for China and India. Work and nutritional status are positively associated with handgrip strength. Our findings provide new evidence of robust association between handgrip strength and other measures of intrinsic capacity and confirms that handgrip strength is a single most important measure of capacity among older persons.

Socioeconomic Inequality and Risk of Sarcopenia in Community-Dwelling Older Adults

Introduction

Maintaining skeletal muscle function throughout life is a crucial component of successful aging. Disadvantaged socioeconomic position (SEP) is associated with adverse health outcomes, but has not been extensively studied for the muscle disease sarcopenia. We aimed to determine the prevalence of probable sarcopenia, a precursor to sarcopenia diagnosis, based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines overall, and according to SEP.

Methods

This cross-sectional study comprised 3342 community-dwelling older adults [mean age (SD) 68.9 ± 6.3 years] from Wave 1 of the Irish Longitudinal Study on Ageing. Probable sarcopenia was identified using gender-specific cut-off values for handgrip strength as recommended by EWGSOP2. SEP was defined by educational attainment. Multivariate regression analysis was employed to determine associations between probable sarcopenia and pre-defined risk factors.

Results

Overall, 23.4% of the population had probable sarcopenia and was significantly higher in the subset with low compared with high SEP (28.9% vs 18.1%, p<0.001). Consistent with this, multivariate logistic regression analysis showed that disadvantaged SEP was a significant determinant of probable sarcopenia [OR, CI 1.48 (1.17, 1.87) p<0.001]. Other known risk factors, namely, increased age, low physical activity, comorbidity, and osteoarthritis were significantly associated with an increased likelihood of probable sarcopenia, while overweight/obesity appeared to be protective.

Conclusion

Disadvantaged SEP was an independent determinant of probable sarcopenia in community-dwelling older adults. These findings highlight that SEP and health inequality should be considered in prevention and treatment policy for sarcopenia in the community.

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Association of life course socioeconomic status and adult height with cognitive functioning of older adults in India and China

BACKGROUND

Cognitive functioning is an important measure of intrinsic capacity. In this study, we examine the association of life course socioeconomic status (SES) and height with cognitive functioning among older adults (50+) in India and China. The age pattern of cognitive functioning with measures of life course socioeconomic status has also been examined.

METHODS

Cross-sectional comparative analysis was conducted using the WHO's Study on global AGEing and adult health (SAGE) data for India and China. Multilevel mixed-effect linear regression analysis was used to examine the association of life course socioeconomic status and adult height with cognitive functioning.

RESULTS

In both India and China, parental education as a measure of childhood socioeconomic status was positively associated with cognitive functioning. The association between adult socioeconomic status and cognitive functioning was positive and significant. Height was significantly and positively associated with improved cognitive functioning of older adults in India and China. Furthermore, the age-related decline in cognitive functioning score was higher among older adults whose parents had no schooling, particularly in China. The cognitive functioning score with age was much lower among less-educated older adults than those with higher levels of education in China. Wealthier older adults in India had higher cognitive functioning in middle ages, however, wealth differences narrowed with age.

CONCLUSIONS

The results of this study suggest a significant association of lifetime socioeconomic status and cumulative net nutrition on later-life cognitive functioning in middle-income settings.

Height and quality of life among older adults (50+) in India: a cross-sectional study

Adult height is a summary measure of health and net nutrition in early childhood. This study examines the association between height and quality-of-life outcomes in older adults (50+) in India. Cross-sectional data from Wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted in 2007 were analysed. The association between height and quality of life was assessed using bivariate and multivariate logistic and linear regression models. The mean WHO quality-of-life score (WHO-QoL) increased from 45.2 among the older adults in the lowest height quintile to 53.2 for those in the highest height quintile. However, the prevalence of self-rated poor quality of life declined from 16.4% in the lowest height quintile to 6.1% in the highest height quintile. In the fully adjusted regression model, height was found to be positively associated with quality-of-life outcomes among both men and women, independent of socioeconomic and physical health confounders. The association was particularly strong for women. Women in the highest height quintile had a 2.65 point higher WHO-QoL score than those in the lowest height quintile. Similarly, the likelihood of reporting a poor quality of life was lower among women in the highest height quintile. Furthermore, measures of economic status, handgrip strength, cognitive ability and poor self-rated health were significantly associated with WHO-QoL and self-rated poor quality of life. Overall, this study revealed a significant association between height and quality of life among older adults in India, suggesting a significant role of childhood circumstances in quality of life in later life.

Diet quality and a traditional dietary pattern predict lean mass in Australian women: Longitudinal data from the Geelong Osteoporosis Study

Low muscle mass is associated with reduced independence and increased risk for falls and fractures. Identification of modifiable risk factors for low muscle mass is thus imperative. This study aimed to examine the longitudinal relationship between both diet quality and patterns and lean mass in Australian women. Data from n = 494 participants of the Geelong Osteoporosis Study's 10- and 15-year women's follow-ups were used (conducted in 2004-08 and 2011-14, respectively), and participants were aged 21-89 years. Self-reported lifestyle and demographics were collected, and food frequency questionnaire data informed the dietary exposure variables: the Australian Recommended Food Score (ARFS); the Dietary Inflammatory Index (DII); and a posteriori dietary patterns. The outcome, Skeletal Muscle Index (SMI), was calculated from DXA-derived appendicular lean mass (ALM) relative to height (ALM kg/m2). Analyses employed Generalised Estimating Equations. A higher ARFS score positively predicted SMI over 5-years, and adjustments for age and physical activity did not attenuate this relationship (B:0.044, (95%CI 0.004, 0.084) kg/m2). Following adjustment, both an anti-inflammatory diet (B:-0.034, (95%CI -0.070, -0.002) kg/m2) and a 'traditional' dietary pattern predicted higher SMI (B:0.081, (95%CI 0.004, 0.158) kg/m2). No other associations were observed. Our study reinforces the importance of diet quality for healthy, aging muscle mass. Furthermore, a less inflammatory diet and a diet comprising a wide variety of plant and animal foods may be conducive to maintenance of muscle mass in women. Further studies investigating diet quality's impact on various muscle health measures over longer time periods are warranted.

Why Are Individuals With Diabetes Less Active? The Mediating Role of Physical, Emotional, and Cognitive Factors

BACKGROUND

Despite the key role of physical activity in the management of diabetes, many individuals with diabetes do not engage in the recommended levels of physical activity. However, our knowledge of the mechanisms underlying the relationship between diabetes and physical inactivity is limited.

PURPOSE

To investigate the associations between diabetes and the levels and evolution of physical activity across aging, and to determine whether physical, emotional, and cognitive factors mediate these associations.

METHODS

Data from 105,622 adults aged 50-96 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were used in adjusted linear mixed models to examine whether diabetes was associated with physical activity levels and variations across aging. The potential mediators were subjective energy, muscle strength, physical and cognitive disability, sleep problems, depressive symptoms, and cognitive functions. The variables were measured up to seven times over a 13-year period.

RESULTS

Individuals with diabetes demonstrated a lower level and a steeper decrease in physical activity across aging than individual without diabetes. Mediators explained ~53% and 94% of the association of diabetes with the level of physical activity and with the linear evolution of physical activity across aging, respectively. All mediators were significantly associated with physical activity. Physical and cognitive disability as well as depressive symptoms were the strongest mediators, while sleep was the lowest one.

CONCLUSIONS

These findings suggest that the etiology of physical inactivity in individuals with diabetes can result from several physical, emotional, and cognitive changes associated with the emergence of this disease.

The effect of early-life and adult socioeconomic position on development of lifestyle-related diseases

BACKGROUND

Early-life socioeconomic position (SEP) is associated with lifestyle-related diseases in adulthood. However, evidence is lacking on the extent to which adult SEP mediates this association.

METHODS

Time to either chronic obstructive pulmonary disease (COPD), cardiovascular disease or diabetes were assessed in the Danish population born between 1961 and 1971 (n = 793 674) from age 30 until 2015. Early-life position was assessed in 1981 (by parental) and again at age 30 (own) by four markers; income, occupation, education-divided into high, middle, low-and a combined score for all markers. Using a counterfactual approach, we estimated the total effect of early-life position on disease onset and the degree to which adult position mediated this effect.

RESULTS

Results of the time-to-event analysis showed a gradient of all early-life markers on the risk of developing all lifestyle-related diseases. Notably, comparing those in the lowest to the highest educational position, the hazard of COPD was 130% higher for women [hazard ratio = 2.30(95% confidence interval = 2.20-2.41)] and 114% higher for men [2.14 (2.05-2.25)]. About 67%(63-70%) of the effect of educational position was mediated through adult position for COPD, 55% for cardiovascular disease and 50% for diabetes. For the combined score 44, 29 and 33%, respectively, was mediated.

CONCLUSION

About one-tenth to two-thirds of the effect of early-life position is mediated by the position attained in adulthood. The degree mediated depend on the outcome investigated, gender and the social position marker used indicating that alternative pathways may play a key role in developing effective policies targeting early-life behaviours.

Does the association between physical capability and mortality differ by deprivation? Findings from the UK Biobank population-based cohort study

BACKGROUND

To investigate whether the excess risk of adverse health outcomes associated with a lower physical capability in adulthood differs by deprivation levels.

METHODS

279,030 participants from the UK Biobank were included. Handgrip strength and walking pace were the exposures. All-cause mortality, CVD mortality and incidence were the outcomes. Townsend deprivation index was treated as a potential effect modifier. The associations were investigated using Cox-regression models with years of follow-up as the time-varying covariate.

RESULTS

A significant interaction between deprivation and handgrip strength was found for all-cause mortality (p = 0.024), CVD mortality (p = 0.006) and CVD incidence (p = 0.001). The hazard ratio for all-cause mortality was 1.18 [1.09; 1.29] per 1-tertile higher level of grip strength in the least deprived group, whereas it was 1.30 [1.18; 1.43] in the most deprived individuals. Similar results were found for CVD mortality and incidence per tertile increment in handgrip strength in the least and most deprived quintiles, respectively. No significant interactions between deprivation and walking pace were found for any of the outcomes.

CONCLUSION

Low handgrip strength is a stronger predictor of morbidity and mortality in individuals living in more deprived areas.

Lower socioeconomic status and the acceleration of aging: An outcome-wide analysis

Lower socioeconomic status (SES) is a determinant of many of the health problems that emerge at older ages. The extent to which lower SES is associated with faster decline in age-related functions and phenotypes independently of health conditions is less clear. This study demonstrates that lower SES (defined by wealth) is related to accelerated decline over 6 to 8 y in 16 outcomes from physical, sensory, physiological, cognitive, emotional, and social domains, independently of diagnosed health conditions, self-rated health, education, and other factors. It provides evidence for the pervasive role of social circumstances on core aging processes and suggests that less affluent sectors of society age more rapidly than more privileged groups.

Aging involves decline in a range of functional abilities and phenotypes, many of which are also associated with socioeconomic status (SES). Here we assessed whether lower SES is a determinant of the rate of decline over 8 y in six domains—physical capability, sensory function, physiological function, cognitive performance, emotional well-being, and social function—in a sample of 5,018 men and women aged 64.44 (SD 8.49) y on average at baseline. Wealth was used as the marker of SES, and all analyses controlled for age, gender, ethnicity, educational attainment, and long-term health conditions. Lower SES was associated with greater adverse changes in physical capability (grip strength, gait speed, and physical activity), sensory function (sight impairment), physiological function (plasma fibrinogen concentration and lung function), cognitive performance (memory, executive function, and processing speed), emotional well-being (enjoyment of life and depressive symptoms), and social function (organizational membership, number of close friends, volunteering, and cultural engagement). Effects were maintained when controlling statistically for other factors such as smoking, marital/partnership status, and self-rated health and were also present when analyses were limited to participants aged ≤75 y. We conclude that lower SES is related to accelerated aging across a broad range of functional abilities and phenotypes independently of the presence of health conditions and that social circumstances impinge on multiple aspects of aging.

Life-Course Circumstances and Frailty in Old Age Within Different European Welfare Regimes: A Longitudinal Study With SHARE

OBJECTIVES

This study aimed to assess whether cumulative disadvantage in childhood misfortune and adult-life socioeconomic conditions influence the risk of frailty in old age and whether welfare regimes influence these associations.

METHOD

Data from 23,358 participants aged 50 years and older included in the longitudinal SHARE survey were used. Frailty was operationalized according to Fried's phenotype as presenting either weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted mixed-effects logistic regression models were used to analyze associations of childhood misfortune and life-course socioeconomic conditions with frailty.

RESULTS

Childhood misfortune and poor adult-life socioeconomic conditions increased the odds of (pre-)frailty at older age. With aging, differences narrowed between categories of adverse childhood experiences (driven by Scandinavian welfare regime) and adverse childhood health experiences (driven by Eastern European welfare regime), but increased between categories of occupational position (driven by Bismarckian welfare regime).

DISCUSSION

These findings suggest that childhood misfortune is linked to frailty in old age. Such a disadvantaged start in life does not seem to be compensated by a person's life-course socioeconomic trajectory, though certain types of welfare regimes affected this relationship. Apart from main occupational position, our findings do not support the cumulative dis/advantage theory, but rather show narrowing differences.

Life Course Socioeconomic Conditions and Frailty at Older Ages

OBJECTIVES

This article aimed to assess associations of childhood socioeconomic conditions (CSC) with the risk of frailty in old age and whether adulthood socioeconomic conditions (ASC) influence this association.

METHODS

Data from 21,185 individuals aged 50 years and older included in the longitudinal Survey of Health, Ageing, and Retirement in Europe were used. Frailty was operationalized as a sum of presenting weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted multilevel logistic regression models were used to analyze associations of CSC and ASC with frailty.

RESULTS

While disadvantaged CSC was associated with higher odds of (pre-)frailty in women and men (odds ratio [OR] = 1.73, 95% confidence interval [CI] 1.34, 2.24; OR = 1.84, 95% CI 1.27, 2.66, respectively), this association was mediated by ASC. Personal factors and demographics, such as birth cohort, chronic conditions, and difficulties with activities of daily living, increased the odds of being (pre-)frail.

DISCUSSION

Findings suggest that CSC are associated with frailty at old age. However, when taking into account ASC, this association no longer persists. The results show the importance of improving socioeconomic conditions over the whole life course in order to reduce health inequalities in old age.

Welfare regimes modify the association of disadvantaged adult-life socioeconomic circumstances with self-rated health in old age

BACKGROUND

Welfare regimes in Europe modify individuals' socioeconomic trajectories over their life-course, and, ultimately, the link between socioeconomic circumstances (SECs) and health. This paper aimed to assess whether the associations between life-course SECs (early-life, young adult-life, middle-age and old-age) and risk of poor self-rated health (SRH) trajectories in old age are modified by welfare regimes (Scandinavian [SC], Bismarckian [BM], Southern European [SE], Eastern European [EE]).

METHODS

We used data from the longitudinal SHARE survey. Early-life SECs consisted of four indicators of living conditions at age 10. Young adult-life, middle-age, and old-age SECs indicators were education, main occupation and satisfaction with household income, respectively. The association of life-course SECs with poor SRH trajectories was analysed by confounder-adjusted multilevel logistic regression models stratified by welfare regime. We included 24 011 participants (3626 in SC, 10 256 in BM, 6891 in SE, 3238 in EE) aged 50 to 96 years from 13 European countries.

RESULTS

The risk of poor SRH increased gradually with early-life SECs from most advantaged to most disadvantaged. The addition of adult-life SECs differentially attenuated the association of early-life SECs and SRH at older age across regimes: education attenuated the association only in SC and SE regimes and occupation only in SC and BM regimes; satisfaction with household income attenuated the association across regimes.

CONCLUSIONS

Early-life SECs have a long-lasting effect on SRH in all welfare regimes. Adult-life SECs attenuated this influence differently across welfare regimes.

Early predictors of impaired sleep: a study on life course socioeconomic conditions and sleeping problems in older adults

Objectives: This study aimed to assess how childhood socioeconomic conditions are associated with sleeping problems in older adults and how this association may be mediated by socioeconomic conditions across the lives of individuals using a life course perspective. Since the life course opportunities differ systematically between men and women, attention was given to gender differences in the association.Methods: Data from 23,766 individuals aged over 50 years of the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Logistic mixed-effect models were estimated to examine the associations between childhood socioeconomic conditions and the presence of sleeping problems.Results: For women, the analyses showed an association between childhood socioeconomic conditions and sleeping problems. For men, only current socioeconomic conditions were found to be relevant for sleep. The importance of childhood socioeconomic conditions for sleeping problems did not affect the evolution of sleeping problems over ageing.Conclusion: In this study no empirical support was found for processes of cumulative advantage/disadvantage or age-as-leveler. However, childhood does seem to be a critical period for the sleep of women, because the association with childhood socioeconomic conditions remains even when the circumstances later in life are considered. These findings, in particular the gender differences in the association, underline the importance of tracking life course patterns in the study of sleeping problems in older adults.

A nationwide study on prevalence and factors associated with dynapenia in older adults: ELSI-Brazil

This study aimed to assess the prevalence and factors associated with dynapenia in a nationally representative sample of Brazilians aged 50 years and older. A cross-sectional study was performed with baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Dynapenia was defined as low muscle strength (< 27kg for men and < 16kg for women). Explanatory variables were sociodemographic characteristics, health conditions, health behaviors and physical performance. Analyses were based on multivariate logistic regression and population attributable fractions. Among the 8,396 participants, the prevalence of dynapenia was 17.2% (16.6% among men and 17.7% among women); for those aged 65 years and older, the prevalence was 28.2% (29.1% and 27.5% among men and women, respectively). Dynapenia was positively associated with age, low gait speed, limitations in performing two or more basic daily activities, falls and self-reported chronic diseases; and negatively associated with education level, physical activity and body mass index (overweight/obese, OR = 0.26). Prevalence of dynapenia is high in Brazilian older adults. Educational skills and physical activity improvement present greater potential to reduce dynapenia in this population.

Childhood and adulthood circumstances predicting affective suffering and motivation among older adults: a comparative study of European welfare systems

The aims of the study are, first, to examine the effect of childhood and adulthood predictors on affective suffering and motivational symptoms among older adults in Europe and, second, to assess differentials across European welfare systems. The mediating role of adulthood circumstances is also explored. Data are derived from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 2 (cross-sectional material) and 3 (retrospective information). The sample includes 23,050 respondents aged 50 +. The EUROD subscales were obtained using factor analysis; scores were transformed to binary constructs; logistic regression models were used to identify predictors; mediation was assessed employing a decomposition technique. Prevalence of both subscales is higher in Southern and Central/Eastern Europe and lower in Nordic countries, which are characterised by more equitable and generous welfare provisions. Though health, childhood socioeconomic status and childhood adversity are significant for both subscales, there are also differences; female gender, adulthood socioeconomic status and stress are associated with affective suffering, whereas age and educational attainment are of greater consequence for motivational symptoms. These findings are quite consistent across regions, indicating that the subscales represent different aspects of depression. By contrast, childhood circumstances are attenuated differentially by adulthood factors across Europe. Nevertheless, important mediating circumstances are stress for affective suffering and poor health for motivational symptoms. The importance of childhood circumstances in all aspects of later life mental health highlights the need for policy interventions across welfare systems, which should target vulnerable groups early in life.

A longitudinal study of neighbourhood conditions and depression in ageing European adults: Do the associations vary by exposure to childhood stressors?

Emerging literature emphasises the association between neighbourhood conditions and late life depression. Childhood experiences, crucial for life course development of mental health, may modify how neighbourhood affects subsequent depression. This study assessed the longitudinal associations of access to services and neighbourhood nuisance with depression among older adults, and tested whether these associations varied by exposure to childhood stressors. Data were drawn from the cross-national Survey of Health, Ageing and Retirement in Europe, a prospective cohort study between 2004/2005 and 2015, representative for European adults over the age of 50. Individual perceptions of neighbourhood were measured at baseline; childhood stressors, defined as socioeconomic conditions, adverse experiences and health problems, were collected retrospectively. Multilevel logistic regression estimated the risk of depression (n = 10,328). Access to services were negatively (OR = 0.78, 95% CI 0.68-0.90) and neighbourhood nuisance positively (OR = 1.36, 95% CI 1.18-1.56) associated with the probability of depression during follow-up. We found interactions between neighbourhood and childhood socioeconomic conditions, but not with adverse experiences and health problems. While older adults who grew up in better childhood socioeconomic conditions benefited more from living in a residential area with good access to services, they were at higher risk of developing depression when residing in areas with more neighbourhood nuisances. Older adults' mental health can benefit from better access to public transportation and neighbourhood amenities, while physical and social problems in the local area increase the risk of depression. Importantly, socioeconomic circumstances in early life may influence vulnerability to neighbourhood effects in older age.

The role of adult socioeconomic and relational reserves regarding the effect of childhood misfortune on late-life depressive symptoms

Background

Childhood misfortune is associated with late-life depressive symptoms, but it remains an open question whether adult socioeconomic and relational reserves could reduce the association between childhood misfortune and late-life depressive symptoms.

Methods

Using the Survey of Health, Ageing and Retirement in Europe (SHARE), data from 8'357 individuals (35'260 observations) aged 50–96 years and living in 11 European countries were used to examine associations between three indicators of childhood misfortune (adverse childhood events, poor childhood health, and childhood socioeconomic circumstances) and late-life depressive symptoms. Subsequently, we tested whether these associations were mediated by education, occupational position, the ability to make ends meet, and potential or perceived relational reserves; that is family members or significant others who can provide help in case of need, respectively. Analyses were stratified by gender and adjusted for confounding and control variables.

Results

Adult socioeconomic reserves partly mediated the associations between adverse childhood events, poor childhood health and late-life depressive symptoms. The associations with the third indicator of childhood misfortune (childhood socioeconomic circumstances) were fully mediated by adult socioeconomic reserves in men, and partly mediated in women. None of the associations were mediated by relational reserves. However, perceived relational reserves were associated with fewer late-life depressive symptoms.

Conclusion

Childhood socioeconomic disadvantage can be mitigated more easily over the life course than adverse childhood events and poor childhood health, especially in men. Perceived relational reserves work primarily as a protective force against late-life depressive symptoms and may be particularly important in the context of the cumulative effect of childhood adversities.

•

Socioeconomic reserves can mediate the effect of childhood socioeconomic disadvantage on late-life depressive symptoms.

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Education turned out to be the strongest mediator.

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Findings showed a lasting effect of adverse childhood experiences and poor childhood health on late-life depressive symptoms.

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Relational reserves did not mediate the effect of any of the childhood misfortune indicators on late-life depressive symptoms.

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Relational reserves were associated with fewer late-life depressive symptoms suggesting a potential protective function.

Disadvantaged Early-Life Socioeconomic Circumstances Are Associated With Low Respiratory Function in Older Age

BACKGROUND

Poor lung function in late life may stem from early-life risk factors, but the epidemiological evidence is inconsistent. We investigated whether individuals who experienced disadvantageous socioeconomic circumstances (SEC) in early life showed lower levels of respiratory function in older age, a steeper decline over time, and whether these relationships were explained by adult-life SEC, body mass index, and physical inactivity in older age.

METHODS

We used data from the Survey of Health Ageing and Retirement in Europe (2004-2015). Participants' peak expiratory flow (PEF) was assessed with a mini-Wright peak flow meter at second, fourth, and sixth waves. Confounder-adjusted linear mixed-effect models were used to examine the associations between early-life SEC and PEF in older age. A total of 21,734 adults aged 50-96 years (46,264 observations) were included in the analyses.

RESULTS

Older adults with disadvantaged early-life SEC showed lower levels of PEF compared with those with advantaged early-life SEC. The association between early-life SEC and late-life PEF persisted after adjusting for adult-life SEC, smoking, physical inactivity, and body mass index. PEF declined with age, but the effect of early-life SEC on this decline was not consistent across robustness and sensitivity analyses.

CONCLUSIONS

Early life is a sensitive period for respiratory health. Further considering the effect of SEC arising during this period may improve the prevention of chronic respiratory diseases.

Early-life socioeconomic circumstances explain health differences in old age, but not their evolution over time

BACKGROUND

Early-life socioeconomic circumstances (SEC) are associated with health in old age. However, epidemiological evidences on the influence of these early-life risk factors on trajectories of healthy ageing are inconsistent, preventing drawing solid conclusion about their potential influence. Here, to fill this knowledge gap, we used a statistical approach adapted to estimating change over time and an outcome-wide epidemiology approach to investigate whether early-life SEC were associated with the level of and rate of decline of physical, cognitive and emotional functioning over time.

METHODS

We used data on more than 23 000 adults in older age from the Survey of Health, Ageing and Retirement in Europe, a 12-year large-scale longitudinal study with repeated measurements of multiple health indicators of the same participants over time (2004 -2015, assessments every 2 years). Confounder-adjusted linear growth curve models were used to examine the associations of early-life SEC with the evolution of muscle strength, lung function, cognitive function, depressive symptoms and well-being over time.

RESULTS

We consistently found an association between early-life SEC and the mean levels of all health indicators at age 63.5, with a critical role played by the cultural aspect of disadvantage. These associations were only partly explained by adult-life SEC factors. By contrast, evidences supporting an association between early-life SEC and the rate of change in health indicators were weak and inconsistent.

CONCLUSIONS

Early-life SEC are associated with health in old age, but not with trajectories of healthy ageing. Conceptual models in life course research should consider the possibility of a limited influence of early-life SEC on healthy ageing trajectories.