Early-life socioeconomic position and the accumulation of health-related deficits by midlife in the 1958 British birth cohort study

Reducing population levels of frailty is an important goal and preventing its development in mid-adulthood could be pivotal. There is limited evidence on associations between childhood socioeconomic position (SEP) and frailty. Using 1958 British birth cohort data (followed from 1958 to 2016; N=8711), we aimed to: (i) establish the utility of measuring frailty in mid-life, by examining associations between a 34-item frailty index at 50y (FI50y) and mortality (50-58y) and, (ii) examine associations between early-life SEP and FI50y, and investigate whether these associations were explained by adult SEP. Hazard ratios (HRs) for mortality increased with increasing frailty, e.g., HRsex-adjusted was 4.07(95% CI:2.64,6.25) for highest vs. lowest fifth of FI50y. Lower early-life SEP was associated with higher FI50y. Compared with participants born in the highest social class, the estimated total effect on FI50y was 42.0%(35.5%,48.4%) for participants born in the lowest class, with the proportion mediated by adult SEP being 0.45(0.35,0.55). Mediation by adult SEP was negligible, for other early-life SEP classes. Findings suggest that early-life SEP is associated with frailty and that adult SEP only partially explains this association. Results highlight the importance of improving socioeconomic circumstances across the life course to reduce inequalities in mid-life frailty.