Education mediating the associations between early life factors and frailty: a cross-sectional study of the UK Biobank

• Published in: BMJ open Vol. 13; no. 3; p. e057511
• Main Authors: Maharani, Asri, Didikoglu, Altug, O'Neill, Terence W, Pendleton, Neil, Canal, Maria Mercè, Payton, Antony
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 02.03.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adults; Age; Aged; Alcohol use; Biobanks; Biological Specimen Banks; Birth Weight; Breastfeeding & lactation; Cross-Sectional Studies; Disability; Education; Educational Status; Epidemiology; Ethnicity; Female; Frailty; Frailty - epidemiology; Geriatric Medicine; Health behavior; Humans; Infant; Middle Aged; Older people; Population; Pregnancy; Public health; Questionnaires; Smoking; social medicine; Socioeconomic factors; Structural equation modeling; United Kingdom - epidemiology; Variables; White people; United Kingdom; United Kingdom > UK; social medicine; epidemiology; geriatric medicine
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-057511

ObjectivesExposures in utero and during infancy may impact the development of diseases later in life. They may be linked with development of frailty, although the mechanism is unclear. This study aims to determine the associations between early life risk factors and development of frailty among middle-aged and older adults as well as potential pathways via education, for any observed association.DesignA cross-sectional study.SettingsThis study used data from UK Biobank, a large population-based cohort.Participants502 489 individuals aged 37–73 years were included in the analysis.Primary and secondary outcome measuresEarly life factors in this study included being breast fed as a baby, maternal smoking, birth weight, the presence of perinatal diseases, birth month and birth place (in or outside the UK). We developed a frailty index comprising 49 deficits. We used generalised structural equation modelling to examine the associations between early life factors and development of frailty and whether any observed association was mediated via educational attainment.ResultsA history of breast feeding and normal birth weight were associated with a lower frailty index while maternal smoking, the occurrence of perinatal diseases and birth month with a longer day length were associated with a higher frailty index. Educational level mediated the relationship between these early life factors and frailty index.ConclusionsThis study highlights that biological and social risk occurring at different stages of life are related to the variations in frailty index in later life and suggests opportunities for prevention across the life course.