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Social vulnerability as a predictor of mortality and disability: cross-country differences in the survey of health, aging, and retirement in Europe (SHARE)

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Abstract

Background

Social factors are important for health; the concept of social vulnerability considers them holistically and can be quantified using a social vulnerability index (SVI).

Aims

Investigate the SVI in relation to mortality and disability, independent of frailty, in middle-aged and older European adults, and examine how this relationship differs across countries.

Methods

18,289 community-dwelling participants 50 years and older from SHARE wave 1 (2004) were included in our sample. A 32-item SVI and a 57-item frailty index were calculated for individuals as the proportion of deficits present out of the total number considered. Countries were grouped based on their social model: Nordic (Denmark, Netherlands, Sweden), Continental (France, Austria, Belgium, Germany) and Mediterranean (Greece, Italy, Spain). Outcome measures were 5-year mortality and disability (≥1 dependency with activities of daily living) at wave 4 (2011–2012).

Results

High social vulnerability (highest quartile) predicted mortality (HR = 1.25, 95 % CI 1.07–1.45), and disability (OR = 1.36, 95 % CI 1.15–1.62) after controlling for age, sex, baseline disability and frailty level. When analyses were split by social model, social vulnerability remained a significant predictor of mortality for Continental (HR = 1.36, CI 1.05–1.77) and Mediterranean (HR = 1.33, CI 1.03–1.72) countries, but not the Nordic (HR = 1.02, CI 0.76–1.37) countries; the same pattern was observed for disability (Nordic OR = 1.06, CI 0.72–1.55; Continental OR = 1.53, CI 1.20–1.96; Mediterranean OR = 1.58, CI 1.13–2.23).

Discussion/Conclusions

Social vulnerability was a significant predictor of mortality and disability, though when controlling for frailty, this relationship varied by the social model of the country.

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Acknowledgments

This paper uses data from SHARE wave 4 release 1.1.1, as of March 28th 2013 or SHARE wave 1 and 2 release 2.5.0, as of May 24th 2011 or SHARELIFE release 1, as of November 24th 2010. The SHARE data collection has been primarily funded by the European Commission through the 5th Framework Programme (Project QLK6-CT-2001-00360 in the thematic programme Quality of Life), through the 6th Framework Programme (Projects SHARE-I3, RII-CT-2006-062193, COMPARE, CIT5-CT-2005-028857, and SHARELIFE, CIT4-CT-2006-028812) and through the 7th Framework Programme (SHARE-PREP, N° 211909, SHARE-LEAP, N° 227822 and SHARE M4, N° 261982). Additional funding from the US National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, R21 AG025169, Y1-AG-4553-01, IAG BSR06-11 and OGHA 04-064) and the German Ministry of Education and Research as well as from various national sources is gratefully acknowledged (see http://www.share-project.org for a full list of funding institutions).

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

Approval for secondary analyses came from the Research Ethics Committee of the Capital District Health Authority at Halifax, Nova Scotia, Canada, in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Division Geriatric Medicine, Department of Medicine, Dalhousie University, 5955 Veterans’ Memorial Lane, Halifax, NS, B3H 2E1, Canada

    Lindsay M. K. Wallace, Olga Theou, Fernando Pena, Kenneth Rockwood & Melissa K. Andrew

  2. Centre for Health Care of the Elderly, Halifax, Canada

    Kenneth Rockwood

Authors
  1. Lindsay M. K. Wallace
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  2. Olga Theou
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  3. Fernando Pena
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  4. Kenneth Rockwood
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  5. Melissa K. Andrew
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Corresponding author

Correspondence to Melissa K. Andrew.

Additional information

L. M. K. Wallace and O. Theou shared first-authorship.

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Wallace, L.M.K., Theou, O., Pena, F. et al. Social vulnerability as a predictor of mortality and disability: cross-country differences in the survey of health, aging, and retirement in Europe (SHARE). Aging Clin Exp Res 27, 365–372 (2015). https://doi.org/10.1007/s40520-014-0271-6

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  • DOI: https://doi.org/10.1007/s40520-014-0271-6

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