Objective To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages.

Design Multi-cohort population based study.
Setting 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017.
Participants 109 107 men and women aged 45-90 years.
Main outcome measure Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors.
Results According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors.
Conclusions The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.

目的评估社会经济地位低下和非传染性疾病风险因素（糖尿病、高酒精摄入、高血压、肥胖、缺乏运动、吸烟）与老年人身体机能丧失之间的关系。

设计基于多队列人群的研究。
1990-2017年，来自欧洲、美国、拉丁美洲、非洲和亚洲 24 个国家的 37 个队列研究。
参与者109 107 名 45-90 岁的男性和女性。
主要结果测量使用步行速度测试评估身体机能，步行速度测试是整体功能能力的有效指标。计算功能丧失年数作为量化暴露和未暴露于低社会经济地位和风险因素的人之间步行速度差异的指标。
结果根据混合模型估计，社会经济地位较低的 60 岁男性与社会经济地位较高的 66.6 岁男性具有相同的步行速度（功能年限减少 6.6 年，95% 置信区间为 5.0 至 9.4）。女性丧失功能的年限为 4.6 年（3.6 至 6.2）。在男性和女性中，由于体力活动不足，到 60 岁时分别失去 5.7（4.4 到 8.1）和 5.4（4.3 到 7.3）年的功能，5.1（3.9 到 7.0）和 7.5（6.1 到 9.5）年由于肥胖, 2.3 (1.6 到 3.4) 和 3.0 (2.3 到 4.0) 由于高血压, 5.6 (4.2 到 8.0) 和 6.3 (4.9 到 8.4) 由于糖尿病, 3.0 (2.2 到 4.3) 和 0.7 (0.1 到 1.5) 由于到烟草使用。在仅限于高收入国家的分析中，到 60 岁时，由于社会经济地位低下而导致的功能丧失年数为男性 8.0（5.7 至 13.1）和 5.4（4. 女性为 0 至 8.0），而在低收入和中等收入国家，男性为 2.6（0.2 至 6.8），女性为 2.7（1.0 至 5.5）。在高收入国家，美国因 60 岁时社会经济地位低下而丧失的机能年数高于欧洲。在 60 至 85 岁之间，由于不利的风险因素，身体机能继续下降。由于社会经济地位低和非传染性疾病风险因素，机能损失的年数大于生命损失的年数。
结论老年人社会经济地位和身体机能之间的独立关联在强度和一致性上与已确定的非传染性疾病危险因素的关联具有可比性。这项研究的结果表明，解决所有这些风险因素可能会大大增加在良好身体机能上花费的生命年数。