BMC Public Health | |
Education-related differences in physical performance after age 60: a cross-sectional study assessing variation by age, gender and occupation | |
Hui-Xin Wang2  Sara Angleman2  Elisabeth Rydwik4  Ingemar Kåreholt3  Anna-Karin Welmer1  | |
[1] Karolinska University Hospital, Stockholm, Sweden;Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm University, 16, S-113 30 Stockholm, Sweden;Institute for Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden;Research and Development Unit, Jakobsbergs Hospital, Järfälla, Sweden | |
关键词: Postural balance; Walking; Muscle strength; Chronic diseases; Aging; Educational status; | |
Others : 1162041 DOI : 10.1186/1471-2458-13-641 |
|
received in 2013-01-17, accepted in 2013-07-08, 发布年份 2013 | |
【 摘 要 】
Background
Having a low level of education has been associated with worse physical performance. However, it is unclear whether this association varies by age, gender or the occupational categories of manual and non-manual work. This study examined whether there are education-related differences across four dimensions of physical performance by age, gender or occupational class and to what extent chronic diseases and lifestyle-related factors may explain such differences.
Methods
Participants were a random sample of 3212 people, 60 years and older, both living in their own homes and in institutions, from the Swedish National Study on Aging and Care, in Kungsholmen, Stockholm. Trained nurses assessed physical performance in grip strength, walking speed, balance and chair stands, and gathered data on education, occupation and lifestyle-related factors, such as physical exercise, body mass index, smoking and alcohol consumption. Diagnoses of chronic diseases were made by the examining physician.
Results
Censored normal regression analyses showed that persons with university education had better grip strength, balance, chair stand time and walking speed than people with elementary school education. The differences in balance and walking speed remained statistically significant (p < 0.05) after adjustment for chronic diseases and lifestyle. However, age-stratified analyses revealed that the differences were no longer statistically significant in advanced age (80+ years). Gender-stratified analyses revealed that women with university education had significantly better grip strength, balance and walking speed compared to women with elementary school education and men with university education had significantly better chair stands and walking speed compared to men with elementary school education in multivariate adjusted models. Further analyses stratified by gender and occupational class suggested that the education-related difference in grip strength was only evident among female manual workers, while the difference in balance and walking speed was only evident among female and male non-manual workers, respectively.
Conclusions
Higher education was associated with better lower extremity performance in people aged 60 to 80, but not in advanced age (80+ years). Our results indicate that higher education is associated with better grip strength among female manual workers and with better balance and walking speed among female and male non-manual workers, respectively.
【 授权许可】
2013 Welmer et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150413051441517.pdf | 641KB | download | |
Figure 2. | 57KB | Image | download |
Figure 1. | 56KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Cooper R, Kuh D, Cooper C, Gale CR, Lawlor DA, Matthews F, Hardy R, the FALCon and HALCyon Study Teams: Objective measures of physical capability and subsequent health: a systematic review. Age Ageing 2010, 40:14-23.
- [2]Cooper R, Kuh D, Hardy R, Mortality Review Group the FALCon and HALCyon Study Teams: Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 2010, 341:c4467.
- [3]Strand BH, Cooper R, Hardy R, Kuh D, Guralnik J: Lifelong socioeconomic position and physical performance in midlife: results from the British 1946 birth cohort. Eur J Epidemiol 2011, 26(6):475-483.
- [4]Kuh D, Bassey EJ, Butterworth S, Hardy R, Wadsworth MEJ, Musculosketal Study T: Grip strength, postural control, and functional leg power in a representative cohort of British men and women: Associations with physical activity, health status, and socioeconomic conditions. J Gerontol A Biol Sci Med Sci 2005, 60(2):224-231.
- [5]Rautio N, Heikkinen E, Ebrahim S: Socio-economic position and its relationship to physical capacity among elderly people living in Jyväskylä, Finland: five- and ten-year follow-up studies. Soc Sci Med 2005, 60:2405-2416.
- [6]Sainio P, Martelin T, Koskinen S, Heliövaara M: Educational differences in mobility: the contribution of physical workload, obesity, smoking and chronic conditions. J Epidemiol Community Health 2007, 61:401-408.
- [7]Hoogendijk E, van Groenou MB, van Tilburg T, Deeg D: Educational differences in functional limitations: comparisons of 55-65-year-olds in the Netherlands in 1992 and 2002. Int J Public Health 2008, 53:281-289.
- [8]House JS, Lantz PM, Herd P: Continuity and change in the social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans’ Changing Lives Study). J Gerontol A Biol Sci Med Sci 2005, 60:15-26.
- [9]Kim JY, Durden E: Socioeconomic status and age trajectories of health. Soc Sci Med 2007, 65(12):2489-2502.
- [10]Chandola T, Ferrie J, Sacker A, Marmot M: Social inequalities in self reported health in early old age: follow-up of prospective cohort study. BMJ 2007, 334(7601):990.
- [11]Beckett M: Converging health inequalities in later life - An artifact of mortality selection? J Health Soc Behav 2000, 41(1):106-119.
- [12]Knesebeck OV, Verde PE, Dragano N: Education and health in 22 European countries. Soc Sci Med 2006, 63(5):1344-1351.
- [13]Welmer AK, Kåreholt I, Angleman S, Rydwik E, Fratiglioni L: Can chronic multimorbidity explain the age-related differences in strength, speed and balance in older adults? Aging Clin Exp Res 2012, 24(5):5:480-481.
- [14]Camargos MC, Machado CJ, Do Nascimento Rodrigues R: Disability life expectancy for the elderly, city of Sao Paulo, Brazil, 2000: gender and educational differences. J Biosoc Sci 2007, 39:455-463.
- [15]Sekine M, Chandola T, Martikainen P, Marmot M, Kagamimori S: Socioeconomic inequalities in physical and mental functioning of British, Finnish, and Japanese civil servants: Role of job demand, control, and work hours. Soc SciMed 2009, 69(10):1417-1425.
- [16]Adamson J, Hunt K, Ebrahim S: Socioeconomic position, occupational exposures, and gender: the relation with locomotor disability in early old age. J Epidemiol Community Health 2003, 57(6):453-455.
- [17]Hooftman WE, van Poppel MNM, van der Beek AJ, Bongers PM, van Mechelen W: Gender differences in the relations between work-related physical and psychosocial risk factors and musculoskeletal complaints. Scand J Work Environ Health 2004, 30(4):261-278.
- [18]Cavelaars A, Kunst AE, Geurts JJM, Crialesi R, Grotvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Rasmussen NK, Regidor E, Do Rosario-Giraldes M, Spuhler T, Mackenbach JP: Educational differences in smoking: international comparison. Br Med J 2000, 320(7242):1102-1107.
- [19]Clarke P, O’Malley PM, Johnston LD, Schulenberg JE: Social disparities in BMI trajectories across adulthood by gender, race/ethnicity and lifetime socio-economic position: 1986–2004. Int J Epidemiol 2009, 38(2):499-509.
- [20]Cerin E, Leslie E: How socio-economic status contributes to participation in leisure-time physical activity. Soc Sci Med 2008, 66(12):2596-2609.
- [21]Koster A, Bosma H, van Groenou MIB, Kempen G, Penninx B, van Eijk J, Deeg DJH: Explanations of socioeconomic differences in changes in physical function in older adults: results from the Longitudinal Aging Study Amsterdam. BMC Publ Health 2006, 6:244. BioMed Central Full Text
- [22]Beland F, Zunzunegui MV: Predictors of functional status in older people living at home. Age Ageing 1999, 28(2):153-159.
- [23]Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers M, McAlindon T, Spector TD, Poole AR, Yanovski SZ, Ateshian G, Sharma L, Buckwalter JA, Brandt KD, Fries JF: Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med 2000, 133(8):635-646.
- [24]Leino-Arjas P, Solovieva S, Riihimaki H, Kirjonen J, Telama R: Leisure time physical activity and strenuousness of work as predictors of physical functioning: a 28 year follow up of a cohort of industrial employees. Occup Environ Med 2004, 61(12):1032-1038.
- [25]Lagergren M, Fratiglioni L, Hallberg IR, Berglund J, Elmståhl S, Hagberg B, Holst G, Rennemark M, Sjölund BM, Thorslund M, Wiberg I, Winblad B, Wimo A: A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC). Aging Clin Exp Res 2004, 16:158-168.
- [26]Guralnik JM, Simonsick EM, Ferrucci L, Glynn JR, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994, 49:M85-M94.
- [27]Nordenskiöld UM, Grimby G: Grip force in patients with rheumatoid arthritis and fibromyalgia and in healthy subjects. A study with the Grippit instrument. Scand J Rheumatol 1993, 22:14-19.
- [28]Rossiter-Fornoff JE, Wolf SL, Wolfson LI, Buchner DM: A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Gerontol A Biol Sci Med Sci 1995, 50:M291-M297.
- [29]Seeman TE, Charpentier PA, Beerkman LF, Tinetti ME, Guralnik JM, Albert M, Blazer D, Rowe JW: Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging. J Gerontol 1994, 49:M97-M108.
- [30]Marengoni A: Multimorbidity: the syndrome of the aging population. Occurrence and patterns of multimorbidity. J Nutr Health Ageing 2009, 13:1-73.
- [31]Rydwik E, Welmer AK, Kåreholt I, Angleman S, Fratiglioni L, Wang HX: Adherence to physical exercise recommendations in people over 65--The SNAC-Kungsholmen study. Eur J Public Health 2012. [Epub ahead of print]
- [32]WHO: Physical status: the use and interpretation of anthropometry. Geneva: World Health Organization; 1995. [Report of a WHO Expert Committee. WHO Technical Report Series 854]
- [33]Järvenpää T, Rinne JO, Koskenvuo M, Räihä I, Kaprio J: Binge drinking in midlife and dementia risk. Epidemiology 2005, 16:766-771.
- [34]Breen R: Regression Models: Censored, Sample-Selected, or Truncated Data. London: SAGE; 1996.
- [35]Lally F, Crome P: Understanding frailty. Postgrad Med J. 2007, 83:16-20.
- [36]Gall B, Parkhouse W: Changes in physical capacity as a function of age in heavy manual work. Ergonomics 2004, 15:671-687.
- [37]Russo A, Onder G, Cesari M, Zamboni V, Barillaro C, Capoluongo E, Pahor M, Bernabei R, Landi F, Ferrucci L: Lifetime occupation and physical function: a prospective cohort study on persons aged 80 years and older living in a community. Occup Environ Med 2006, 63:438-442.
- [38]Bohannon RW: Population representative gait speed and its determinants. J Geriatr Phys Ther 2008, 31:49-52.
- [39]Bramell-Risberg E, Jarnlo GB, Minthon L, Elmståhl S: Lower gait speed in older women with dementia compared with controls. Dement Geriatr Cogn Disord 2005, 20:298-305.
- [40]Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J: Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 2005, 37:75-82.
- [41]Laaksonen M, Talala K, Martelin T, Rahkonen O, Roos E, Helakorpi S, Laatikainen T, Prattala R: Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60000 men and women over 23 years. Eur J Public Health 2008, 18(1):38-43.
- [42]Lahelma E, Lundberg O, Manderbacka K, Roos E: Changing health inequalities in the Nordic countries? Scand J Public Health 2001, 55:1-5.