Social Science and Medicine
Volume 213, 2018, Pages 1-11

Frailty in older-age European migrants: Cross-sectional and longitudinal analyses of the Survey of Health, Aging and Retirement in Europe (SHARE) (Article) (Open Access)

Walkden G.J.* , Anderson E.L. , Vink M.P. , Tilling K. , Howe L.D. , Ben-Shlomo Y.
  • a Population Health Science Institute, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
  • b Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
  • c Department of Political Science, Faculty of Arts and Social Sciences, Maastricht University, Grote Gracht 90-92, PO Box 616, Maastricht, MD 6200, Netherlands
  • d Population Health Science Institute, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
  • e Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
  • f Population Health Science Institute, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom

Abstract

Frailty correlates with morbidity and is superior to chronological age in predicting mortality. Frailty of older migrants has important implications for the demands placed on healthcare systems. Examining 95,635 Europeans in the Survey of Health, Aging and Retirement in Europe, we investigated cross-sectional and longitudinal associations between migration and frailty at ages >50 years. We examined whether associations differed by countries’ level of healthcare coverage and access for migrants and tested mediation by home-ownership and citizenship. Cross-sectionally, first-generation migrants >50 years old were, on average, 16.4% (95% confidence interval [CI]: 14.6, 18.2%) frailer than non-migrants after confounder-adjustment. This decreased to 12.1% (95% CI: 10.1, 14.1%) after adjustment for citizenship. The strength of association between migrant status and frailty was greater in migrants from low-or-middle-income countries, compared with migrants from high-income countries. Migrants into Northern, Western and Eastern Europe were 37.3% (95% CI: 33.2, 41.5%), 12.2% (95% CI: 10.0, 14.6%) and 5.0% (95% CI: 0.5, 9.6%) frailer than non-migrants, respectively, but migrants into Southern Europe were no frailer than non-migrants. The strength of association between migrant status and frailty was greater in countries with lower healthcare coverage and access for migrants. However, citizenship attenuated this difference. Longitudinally, migrants were frailer than non-migrants at 50 years old and trajectories converged over time until migrants and non-migrants were equally frail by 80–90 years. Our work finds no evidence of the ‘healthy migrant effect’ outside of Southern Europe in older migrants and suggests that acculturation is a key determinant of migrant health. © 2018

Author Keywords

Migration healthcare policy Trajectories frailty Acculturation

Index Keywords

descriptive research strategic planning immigrant longitudinal study health care policy Europe Northern Europe health insurance human Longitudinal Studies middle aged aging middle income country statistics and numerical data controlled study Aged sensitivity analysis Eastern Europe Western Europe Health Surveys retirement high income country Cross-Sectional Studies cross-sectional study migrant post hoc analysis Humans male Acculturation Aged, 80 and over trajectory very elderly female Northern European Article health care Southern Europe major clinical study adult migration health care access low income country Health Policy Transients and Migrants frailty citizenship health survey
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85050299495&doi=10.1016%2fj.socscimed.2018.07.033&partnerID=40&md5=5174914512ffa4bc10c58f793512793b
DOI: 10.1016/j.socscimed.2018.07.033
ISSN: 02779536
Cited by: 2
Original Language: English