Growing up in poverty, growing old in frailty: The life course shaping of health in America, Britain, and Europe – a prospective and retrospective study

Background Childhood poverty is directly associated with many health outcomes in late life irrespective of youth health and of variation in health systems. The childhood poor in America, Britain and Europe have reported worse cognitive, muscle and mental functions in their fifties to nineties. But it is not known whether they have higher probabilities of experiencing frailty as their childhood recollections are likely to be erroneous.

Some 79428 adults aged 50 and older retrospectively recalled their childhood conditions at ten and underwent prospective examinations to construct their Fried’s frailty phenotype. Childhood conditions in ELSA and SHARE include number of books, number of rooms, number of people, presence of running hot or cold water, fixed bath, indoor lavatory and central heating. Across in America, these are mostly replaced with financial hardship indicators including having to move because of family debt. Childhood poverty is a latent construct of error-laced recollection and its distal fully adjusted association with frailty phenotype is estimated with fixed effects probit model.

Childhood poverty associates with higher probabilities of being frail (0.1097 ± 0.0169, p < 0.001) in 29 countries of America, Britain and Europe. Furthermore, women have higher probabilities of being frail (0.3051 ± 0.0152, p < 0.001). Age, education, wealth, marital status and youth illness exert influences on the probabilities of being frail. Sensitivity analyses were conducted using random effects model and by stratifying on sex.

Evidence is mounting that childhood can last a life time, affecting cognitive and muscle function, mental health and now frailty. This evidence calls for urgent actions to eliminate child poverty on account of its lifelong rewards. (271 + 4476 words) Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used (or will use) ONLY openly available human data that were originally located at: https://www.elsa-project.ac.uk, https://hrs.isr.umich.edu, DOI: 10.6103/SHARE.w3.800, 10.6103/SHARE.w7.800, 10.6103/SHARE.w9ca800 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data used are available online at https://www.elsa-project.ac.uk, https://hrs.isr.umich.edu, DOI: 10.6103/SHARE.w3.800, 10.6103/SHARE.w7.800, 10.6103/SHARE.w9ca800 https://www.elsa-project.ac.uk https://doi.org/10.6103/SHARE.w3.800