We evaluated life course influences on health by investigating potential differences in levels of frailty between middle-aged and older European immigrants born in low- and middle-income countries (LMICs), immigrants born in high income countries (HICs), and their native-born European peers. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), we constructed a frailty index from 70 age-related health measures for 33,745 participants aged 50+ (mean. = 64.9. ±. 10.2. years; 54% women) in 14 European countries. Participants were grouped as native-born or as immigrants born in LMICs or in HICs, and further by current residence in Northern/Western or Southern/Eastern Europe. Seven percent of participants (n= 2369) were immigrants (mean = 64.4. ±. 10.2. years; 56% women; LMIC-born = 3.4%, HIC-born = 3.6%). In Northern/Western Europe, after adjustment for age, gender, and education, LMIC-born immigrants demonstrated higher frailty index scores (mean = 0.18, 95% confidence interval = 0.17-0.19) than both HIC-born immigrants (0.16, 0.16-0.17) and native-born participants (0.15, 0.14-0.15 both p<. 0.001). In Southern/Eastern Europe, frailty index scores did not differ between groups (p= 0.2). Time since migration explained significant variance in frailty index scores only in HIC-born immigrants to Southern/Eastern Europe (4.3%, p= 0.03). Despite differences in frailty, survival did not differ between groups (p= 0.2). LMIC-born immigrants demonstrated higher levels of frailty in Northern/Western Europe, but not Southern/Eastern Europe. Country of birth and current country of residence were each associated with frailty. Life course influences are demonstrable, but complex. © 2013 Elsevier Ireland Ltd.

Migration aging frailty Health status disparities Socioeconomic factors

immigrant Frail Elderly lowest income group Europe European Northern Europe Health Status Disparities human middle aged aging ethnic group controlled study priority journal health status Aged Western Europe Health Surveys retirement Humans male Emigrants and Immigrants female Socioeconomic Factors scoring system Article Southern Europe migration frailty