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Objectives Exposures in utero and during infancy may impact the development of diseases later in life. They may be linked with development of frailty, although the mechanism is unclear. This study aims to determine the associations between early life risk factors and development of frailty among middle-aged and older adults as well as potential pathways via education, for any observed association.Design A cross-sectional study.Settings This study used data from UK Biobank, a large population-based cohort.Participants 502 489 individuals aged 37–73 years were included in the analysis.Primary and secondary outcome measures Early life factors in this study included being breast fed as a baby, maternal smoking, birth weight, the presence of perinatal diseases, birth month and birth place (in or outside the UK). We developed a frailty index comprising 49 deficits. We used generalised structural equation modelling to examine the associations between early life factors and development of frailty and whether any observed association was mediated via educational attainment.Results A history of breast feeding and normal birth weight were associated with a lower frailty index while maternal smoking, the occurrence of perinatal diseases and birth month with a longer day length were associated with a higher frailty index. Educational level mediated the relationship between these early life factors and frailty index.Conclusions This study highlights that biological and social risk occurring at different stages of life are related to the variations in frailty index in later life and suggests opportunities for prevention across the life course.

Objectives This study aims to examine sociodemographic characteristics and health access associated with COVID-19 infection and death in Malang District, Indonesia.Design A non-random cross-sectional study.Setting Population in 390 villages in Malang District, East Java Province, Indonesia.Participants We used Malang District government COVID-19 contact tracing data from 14 264 individuals, spanning from 1 March 2020 to 29 July 2020.Primary outcome measures The outcome variables in this study are COVID-19 infections and COVID-19 deaths. The associations between sociodemographic characteristics and health access of COVID-19 infection and death were analysed using multilevel logistic regression.Results Among the 14 264 samples, 551 individuals were confirmed as being infected with COVID-19; 62 individuals died of COVID-19. Women, individuals with direct contact with confirmed COVID-19 cases and individuals with hypertension constituted the groups most vulnerable to COVID-19 infection. Among respondents with confirmed COVID-19 cases, men, individuals aged 61 years and older, individuals with hypertension, and those diagnosed with pneumonia and respiratory failure were at higher risk of death. The number of community-based healthcare interventions was significantly associated with lower COVID-19 infection and COVID-19 mortality. Greater distance to a COVID-19 referral hospital increased risk of COVID-19 mortality.Conclusions COVID-19 infection and death were related not only to sociodemographic characteristics of individuals but also to the presence of community-based healthcare interventions and access to hospital care. Strategies in public health, including improving healthcare access, are required to reduce COVID-19 infections among the most susceptible groups in Indonesia.