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Epidemiology
Original research
Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA)
  1. Lauren E Griffith1,
  2. Parminder Raina1,
  3. David Kanters1,
  4. David Hogan2,
  5. Christopher Patterson3,
  6. Alexandra Papaioannou3,
  7. Julie Richardson4,
  8. Anne Gilsing1,
  9. Mary Thompson5,
  10. Edwin van den Heuvel6
  1. 1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
  5. 5Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
  6. 6Department of Mathematics and Computer Science, Technische Universiteit Eindhoven, Eindhoven, Noord-Brabant, The Netherlands
  1. Correspondence to Dr Lauren E Griffith; griffith{at}mcmaster.ca

Abstract

Objective To evaluate the pattern of frailty across several of social stratifiers associated with health inequalities.

Design, setting and participants Cross-sectional baseline data on 51 338 community-living women and men aged 45–85 years from the population-based Canadian Longitudinal Study on Aging (collected from September 2011 to May 2015) were used in this study.

Primary outcomes and measures A Frailty Index (FI) was constructed using self-reported chronic conditions, psychological function and cognitive status and physical functioning variables. Social stratifiers were chosen based on the Pan-Canadian Health Inequalities Reporting Initiative, reflecting key health inequalities in Canada. Unadjusted and adjusted FIs and domain-specific FIs (based on chronic conditions, physical function, psychological/cognitive deficits) were examined across population strata.

Results The overall mean FI was 0.13±0.08. It increased with age and was higher in women than men. Higher mean FIs were found among study participants with low income (0.20±0.10), who did not complete secondary education (0.17±0.09) or had low perceived social standing (0.18±0.10). Values did not differ by Canadian province of residence or urban/rural status. After simultaneously adjusting for population characteristics and other covariates, income explained the most heterogeneity in frailty, especially in younger age groups; similar patterns were found for men and women. The average frailty for people aged 45–54 in the lowest income group was greater than that for those aged 75–85 years. The heterogeneity in the FI among income groups was greatest for the psychological/cognitive domain.

Conclusions Our results suggest that especially in the younger age groups, psychological/cognitive deficits are most highly associated with both overall frailty levels and the gradient in frailty associated with income. If this is predictive of later increases in the other two domains (and overall frailty), it raises the question whether targeting mental health factors earlier in life might be an effective approach to mitigating frailty.

  • epidemiology
  • geriatric medicine
  • public health

Data availability statement

Data are available upon reasonable request. Data are available from the Canadian Longitudinal Study on Aging (www.clsa-elcv.ca) for researchers who meet the criteria for access to de-identified CLSA data.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-047945

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    Data availability statement

    Data are available upon reasonable request. Data are available from the Canadian Longitudinal Study on Aging (www.clsa-elcv.ca) for researchers who meet the criteria for access to de-identified CLSA data.

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    Footnotes

    • Twitter @LaurenGriff1

    • Contributors LEG and PR designed the project with the input from all authors. All authors (LEG, PR, DK, DH, CP, AP, JR, AG, MT and EvdH) worked together to obtain funding for and deciding the scope and structure of the study. DK conducted all analyses with statistical input from MT and EvdH. LEG wrote the first draft of the manuscript. All authors (LEG, PR, DK, DH, CP, AP, JR, AG, MT and EvdH) contributed to the interpretation, writing and critical revision of the manuscript and approved the final manuscript.

    • Funding This research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the CLSA is provided by the Government of Canada through the Canadian Institutes of Health Research under grant reference: LSA 94473 and the Canada Foundation for Innovation. This research has been conducted using the CLSA dataset Baseline Tracking V.3.1 and Baseline Comprehensive V.2.0, under application number 150306. The CLSA is led by Drs. Parminder Raina, Christina Wolfson and Susan Kirkland. This study was supported by a Canadian Institutes of Health Research Catalyst Grant (FRN 151287). Lauren Griffith is supported by the McLaughlin Foundation Professorship in Population and Public Health. Parminder Raina holds a Tier 1 Canada Research Chair in Geroscience and the Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.