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BMJ. 2018 Mar 23;360:k1046. doi: 10.1136/bmj.k1046.

Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study.

Author information

1
Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland silvia.stringhini@chuv.ch.
2
Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland.
3
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
4
Department of Global Health and Social Medicine, King's College London, London, UK.
5
Harvard T.H. Chan School of Public Health, Boston MA, USA.
6
The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland.
7
Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy.
8
EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal.
9
Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
10
MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
11
INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France.
12
Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France, and Paris Descartes University, Paris, France.
13
Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia.
14
University College London, Department of Epidemiology and Public Health, London, UK.
15
Department of Sociology, Trinity College Dublin, Dublin, Ireland.
16
Global Research Analytics for Population Health, Health Policy and Management, Columbia University, New York, NY, USA.
17
CESP, Inserm U1018, Université Paris-Saclay, Villejuif, France.
18
Human Genetics Foundation (HuGeF), Turin, Italy.
19
Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
20
Clinicum, Faculty of Medicine, University of Helsinki, Finland.

Abstract

OBJECTIVE:

To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages.

DESIGN:

Multi-cohort population based study.

SETTING:

37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017.

PARTICIPANTS:

109 107 men and women aged 45-90 years.

MAIN OUTCOME MEASURE:

Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors.

RESULTS:

According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors.

CONCLUSIONS:

The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.

PMID:
29572376
PMCID:
PMC5865179
DOI:
10.1136/bmj.k1046
[Indexed for MEDLINE]
Free PMC Article

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