|Beitragstitel||Socioeconomic status and 25x25 risk factors as determinants of physical functioning: a multicohort study of 108261 participants in 23 countries|
Global health agencies have set healthy ageing as a major priority. Recent meta-analyses suggest that the association between socioeconomic status (SES) and premature mortality is comparable in strength and consistency to those of six major risk factors targeted by World Health Organization 25x25 strategy (tobacco use, alcohol consumption, insufficient physical activity, raised blood pressure, obesity, diabetes). Whether this is also the case for the association between these seven risk factors and physical functioning is unknown.
Here, we examined the extent to which low SES and the 25x25 risk factors impact physical functioning at older ages. We gathered cross-sectional data on the risk factors and walking speed, a validated index of physical functioning, from 36 studies involving 108261 participants aged 45 to 90, in 23 countries across the world. We pooled the data by harmonizing the risk factors across studies and we modelled walking speed via a non-linear mixed model.
Walking speed declined with age and as a function of risk factors. To quantify the latter, we computed years of functioning lost (YFL) attributable to low SES and suboptimal risk factors to quantify the gap in physical aging with reference subpopulations. YFL were computed by comparing the ages of participants in the reference subpopulations against their counterparts who walk at the same speed. Physical functioning in men and women with a low SES, as measured by walking speed, was at the same level as that in 6.7 [5.2-9.1] years older men and 4.6 [3.6-6.0] years older women with a high SES. Years of functioning lost due to physical inactivity, obesity, and diabetes, ranging between 4.5 and 7.5, were comparable to that for low SES, while less years of functioning were lost due to risk factors, such as hypertension, tobacco use and high alcohol consumption (range 0 to 3.5 years). Years of functioning lost were higher in high-income countries, such as Europe or the United States, compared to low- and middle-income countries, including South Africa, China or Mexico.
These findings highlight that SES and the 25x25 risk factors, in particular physical inactivity, obesity and diabetes, are important determinants of physical functioning at older age. While addressing these risk factors represents a major challenge for welfare systems, the expansion of the number of years that the elderly population will spend in good functioning represents a major public health benefit.