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Global frailty: The role of ethnicity, migration and socioeconomic factors.

ABSTRACT: Frailty is an important consequence of ageing, whereby frail patients are more likely to face adverse outcomes, such as disability and death. Risk of frailty increases in people with poor biological health, and has been shown in many ethnicities and countries. In economically developed countries, 10% of older adults are living with frailty. Ethnic minorities in the West face significant health inequalities. However, little is known about frailty prevalence and the nature of frailty in different ethnic groups. This has implications for healthcare planning and delivery, especially screening and the development of interventions. Global frailty prevalence is variable: low- to middle-income countries demonstrate higher rates of frailty than high-income countries, but available evidence is low. Little is known about the characteristics of these differences. However, female sex, lower economic status, lower education levels, and multimorbidity are identified risk factors. Ethnic minority migrants in economically developed countries demonstrate higher rates of frailty than white indigenous older people and are more likely to be frail when younger. Similar patterns are also seen in indigenous ethnic minority marginalised groups in economically developed countries such as the US, Australia and New Zealand, who have a higher prevalence of frailty than the majority white population. Frailty trajectories between ethnic minority migrants and white indigenous groups in high-income countries converge in the 'oldest old' age group, with little or no difference in prevalence. Frailty risk can be attenuated in migrants with improvements in integration, citizenship status, and access to healthcare. Ethnicity may play some role in frailty pathways, but, so far, the evidence suggests frailty is a manifestation of lifetime environmental exposure to adversity and risk accumulation.

SUBMITTER: Majid Z

PROVIDER: S-EPMC8054560 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveA recent independent review on diversity and inclusivity highlighted concerns that barriers to surgical career progression exist for some groups of individuals and not others. Group-level differences in performance at the Intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examinations have been identified but are yet to be investigated. We aimed to characterise the relationship between sociodemographic differences and performance at MRCS.DesignRetrospective cohort study.SettingSecondary care.ParticipantsAll UK MRCS candidates attempting Part A (n = 5780) and Part B (n = 2600) between 2013 and 2019 with linked sociodemographic data in the UK Medical Education Database (https://www.ukmed.ac.uk).Main outcome measuresChi-square tests established univariate associations with MRCS performance. Multiple logistic regression identified independent predictors of success, adjusted for medical school performance.ResultsStatistically significant differences in MRCS pass rates were found according to gender, ethnicity, age, graduate status, educational background and socioeconomic status (all p < 0.05). After adjusting for prior academic attainment, being male (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.87-2.92) or a non-graduate (OR 1.98, 95% CI 1.44-2.74) were independent predictors of MRCS Part A success and being a non-graduate (OR 1.77, 95% CI 1.15-2.71) and having attended a fee-paying school (OR 1.51, 95% CI 1.08-2.10) were independent predictors of Part B success. Black and minority ethnic groups were significantly less likely to pass MRCS Part B at their first attempt (OR 0.41, 95% CI 0.18-0.92 for Black candidates and OR 0.49, 95% CI 0.35-0.69 for Asian candidates) compared to White candidates.ConclusionsThere is significant group-level differential attainment at MRCS, likely to represent the accumulation of privilege and disadvantage experienced by individuals throughout their education and training. Those leading surgical education now have a responsibility to identify and address the causes of these attainment differences.

Project description:So far, it has not yet been studied whether socioeconomic status is associated with distinct frailty components and for which frailty component this association is the strongest. We aimed to examine the association between socioeconomic status and frailty and frailty components. In addition we assessed the mediating effect of the number of morbidities on the association between socioeconomic status and other frailty components.This is a cross-sectional study of pooled data of The Older Persons and Informal Caregivers Survey Minimum DataSet in the Netherlands among community-dwelling persons aged 55 years and older (n = 26,014). Frailty was measured with a validated Frailty Index that consisted of 45 items. The Frailty Index contained six components: morbidities, limitations in activities of daily living (ADL), limitations in instrumental ADL (IADL), health-related quality of life, psychosocial health and self-rated health. Socioeconomic indicators used were education level and neighbourhood socioeconomic status.Persons with primary or secondary education had higher overall frailty and frailty component scores compared to persons with tertiary education (P < .001). Lower education levels were most consistently associated with higher overall frailty, more morbidities and worse self-rated health (P < .05 in all age groups). The strongest association was found between primary education and low psychosocial health for persons aged 55-69 years and more IADL limitations for persons aged 80+ years. Associations between neighborhood socioeconomic status and frailty (components) also showed inequalities, although less strong. The number of morbidities moderately to strongly mediated the association between socioeconomic indicators and other frailty components.There are socioeconomic inequalities in frailty and frailty components. Inequalities in frailty, number of morbidities and self-rated health are most consistent across age groups. The number of morbidities a person has play an important role in explaining socioeconomic inequalities in frailty and should be taken into account in the management of frailty.

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Global frailty: The role of ethnicity, migration and socioeconomic factors.

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