TY - JOUR T1 - Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis JF - The Lancet Healthy Longevity Y1 - 2021 A1 - Mikaela Bloomberg A1 - Aline Dugravot A1 - Benjamin Landré A1 - Annie Britton A1 - Andrew Steptoe A1 - Archana Singh-Manoux A1 - Séverine Sabia KW - Activities of Daily Living KW - ELSA KW - Functional limitations KW - Sex differences KW - SHARE KW - Sister studies KW - Socioeconomic factors KW - TILDA AB - Summary Background Women are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations. Methods Longitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895–1929, 1930–38, 1939–45, and 1946–60) were analysed before and after adjustment for socioeconomic factors (education and labour force status). Findings The prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895–1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6–4·7) and 1·7% (1·1–2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895–1929 cohort) was 3·2% (2·3–4·1) before adjustment for socioeconomic factors and 1·4% (0·9–1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4–17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7–15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations. Interpretation Socioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions. Funding National Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration. VL - 2 IS - 12 ER - TY - JOUR T1 - Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study JF - BMJ Y1 - 2018 A1 - Stringhini, Silvia A1 - Carmeli, Cristian A1 - Markus Jokela A1 - Mauricio Avendano A1 - McCrory, Cathal A1 - d’Errico, Angelo A1 - Bochud, Murielle A1 - Barros, Henrique A1 - Costa, Giuseppe A1 - Chadeau-Hyam, Marc A1 - Delpierre, Cyrille A1 - Gandini, Martina A1 - Fraga, Silvia A1 - Goldberg, Marcel A1 - Giles, Graham G A1 - Lassale, Camille A1 - Kenny, Rose Anne A1 - Kelly-Irving, Michelle A1 - Paccaud, Fred A1 - Layte, Richard A1 - Muennig, Peter A1 - Michael Marmot A1 - Ribeiro, Ana Isabel A1 - Severi, Gianluca A1 - Andrew Steptoe A1 - Shipley, Martin J A1 - Zins, Marie A1 - Johan P Mackenbach A1 - Vineis, Paolo A1 - Mika Kivimäki KW - Cross-National KW - Gait speed KW - Risk Factors KW - Socioeconomic factors AB - 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. VL - 360 UR - http://www.bmj.com/lookup/doi/10.1136/bmj.k1046https://syndication.highwire.org/content/doi/10.1136/bmj.k1046http://data.bmj.org/tdm/10.1136/bmj.k1046 JO - BMJ ER -