Socioeconomic status, healthy lifestyle, and the risk of frailty: Evidence from two prospective cohort studies.

BACKGROUND: The intricate interplay between socioeconomic status (SES) and healthy lifestyle behaviors in the development of frailty remains incompletely understood.

METHODS: Using data from two nationally representative cohort studies: the Health and Retirement Study (HRS, 2008-2020; n = 23,183) and the English Longitudinal Study of Ageing (ELSA, 2004-2018; n = 11,182). SES was derived using latent class analysis (LCA) incorporating education level, total household income and wealth. A composite healthy lifestyle score included four factors: never smoking, low to moderate alcohol consumption, top tertile of physical activity, and active social contact.

RESULTS: Participants with low SES had significantly increased risks of developing frailty compared to those with high SES (HRS: HR: 2.03; 95 % CI, 1.86-2.21; ELSA: HR: 4.58; 95 % CI, 3.84-5.45). The mediating effect of a lifestyle on the SES-frailty association accounted for 5.3 % (95 % CI, 1.9-8.8) in HRS and -2.3 % (95 % CI, -3.3 to -1.3) in ELSA. Compared to individuals with both high SES and a favorable lifestyle, those with low SES and an unfavorable lifestyle exhibited a markedly elevated risk of frailty (HRS: HR: 3.70; 95 % CI, 3.20-4.27; ELSA: HR: 6.18; 95 % CI, 3.61-10.56), and persistently higher frailty index scores.

CONCLUSIONS: Among older adults in the U.S. and U.K., favorable lifestyle behaviors modestly attenuated-but did not eliminate-the impact of socioeconomic disadvantage on frailty risk. Structural interventions targeting social determinants are warranted to reduce disparities in late-life health.