Growing up in poverty, growing old in frailty: The life course shaping of health in America, Britain, and Europe – a prospective and retrospective study

Background: Childhood poverty is directly associated with many health outcomes in late life
irrespective of youth health and of variation in health systems. The childhood poor in
America, Britain and Europe have reported worse cognitive, muscle and mental functions in
their fifties to nineties. But it is not known whether they have higher probabilities of
experiencing frailty as their childhood recollections are likely to be erroneous.
Materials and methods: Some 79428 adults aged 50 and older retrospectively recalled their
childhood conditions at ten and underwent prospective examinations to construct their Fried’s
frailty phenotype. Childhood conditions in ELSA and SHARE include number of books,
number of rooms, number of people, presence of running hot or cold water, fixed bath, indoor
lavatory and central heating. Across in America, these are mostly replaced with financial
hardship indicators including having to move because of family debt. Childhood poverty is a
latent construct of error-laced recollection and its distal fully adjusted association with frailty
phenotype is estimated with fixed effects probit model.
Results: Childhood poverty associates with higher probabilities of being frail (0.1097 ±
0.0169, p < 0.001) in 29 countries of America, Britain and Europe. Furthermore, women have
higher probabilities of being frail (0.3051 ± 0.0152, p < 0.001). Age, education, wealth,
marital status and youth illness exert influences on the probabilities of being frail. Sensitivity
analyses were conducted using random effects model and by stratifying on sex.
Discussion: Evidence is mounting that childhood can last a life time, affecting cognitive and
muscle function, mental health and now frailty. This evidence calls for urgent actions to
eliminate child poverty on account of its lifelong rewards. (271 + 4476 words)