Exploring the relationship between national economic indicators and relative fitness and frailty in middle-aged and older Europeans

Age Ageing. 2013 Sep;42(5):614-9. doi: 10.1093/ageing/aft010. Epub 2013 Feb 25.


Background: on an individual level, lower-income has been associated with disability, morbidity and death. On a population level, the relationship of economic indicators with health is unclear.

Objective: the purpose of this study was to evaluate relative fitness and frailty in relation to national income and healthcare spending, and their relationship with mortality.

Design and setting: secondary analysis of data from the Survey of Health, Ageing and Retirement in Europe (SHARE); a longitudinal population-based survey which began in 2004.

Subjects: a total of 36,306 community-dwelling people aged 50 and older (16,467 men; 19,839 women) from the 15 countries which participated in the SHARE comprised the study sample. A frailty index was constructed as the proportion of deficits present in relation to the 70 deficits available in SHARE. The characteristics of the frailty index examined were mean, prevalence of frailty and proportion of the fittest group.

Results: the mean value of the frailty index was lower in higher-income countries (0.16 ± 0.12) than in lower-income countries (0.20 ± 0.14); the overall mean frailty index was negatively correlated with both gross domestic product (r = -0.79; P < 0.01) and health expenditure (r = -0.63; P < 0.05). Survival in non-frail participants at 24 months was not associated with national income (P = 0.19), whereas survival in frail people was greater in higher-income countries (P < 0.05).

Conclusions: a country's level of frailty and fitness in adults aged 50+ years is strongly correlated with national economic indicators. In higher-income countries, not only is the prevalence of frailty lower, but frail people also live longer.

Keywords: Europe; SHARE; ageing; frailty; older people.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aging*
  • Europe / epidemiology
  • Female
  • Frail Elderly* / statistics & numerical data
  • Geriatric Assessment* / statistics & numerical data
  • Gross Domestic Product
  • Health Care Costs
  • Health Expenditures
  • Health Status Indicators*
  • Health Surveys
  • Humans
  • Income
  • Kaplan-Meier Estimate
  • Life Expectancy
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Models, Economic
  • Physical Fitness*
  • Proportional Hazards Models
  • Socioeconomic Factors*
  • Time Factors