Spangler Hillary B, Lynch David H, Howard Annie Green, Tien Hsiao-Chuan, Du Shufa, Zhang Bing, Wang Huijun, Gordon-Larsen Penny, Batsis John A
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Appl Gerontol. 2025 May 6:7334648251336538. doi: 10.1177/07334648251336538.
A frailty index (FI) can identify individuals with frailty in a population of interest. Previous literature suggests a need for frailty assessment methods for older adults in China and that urbanization may impact frailty status. We used a FI to examine the association between frailty and urbanization as living in a less urbanized area may put older adults at a higher risk frailty and poor healthcare outcomes. We included adults aged 55 years and older ( = 7695) from the China Health and Nutrition Survey (2018). The FI was based on health outcomes correlating with a deficit score divided by number of health items: robust (<0.08), pre-frail (0.08-0.24), and frail (≥0.25). We used multinomial logistic regression models to examine associations between urbanization tertile (low, medium, and high) and frailty, using our novel FI. We also conducted sub-analyses examining how urbanization level modifies the relationship between frailty status and region of residence, and education and income levels. Living in an area of low versus high urbanization was associated with higher odds of frail versus robust (1.5; 1.2-2.0), and pre-frail versus robust (1.6; 1.4-2.0) status in the fully adjusted model. Generally, higher odds of worse frailty status (e.g., pre-frail or frail) was associated with lower tertiles of urbanization for region, income, and education when compared to the highest urbanization tertile. A FI can help identify specific characteristics that may benefit from individualized interventions to counteract frailty. Living in less urbanized areas was associated with higher odds of pre-frailty and frailty. Inclusion of urbanization level, geographic residence, and social determinants of health in FI development can help identify older adults most at risk of frailty and contribute to individual and policy-level frailty prevention interventions.
衰弱指数（FI）可以在感兴趣的人群中识别出衰弱个体。以往文献表明，中国需要针对老年人的衰弱评估方法，且城市化可能会影响衰弱状况。我们使用衰弱指数来研究衰弱与城市化之间的关联，因为生活在城市化程度较低的地区可能会使老年人面临更高的衰弱风险和较差的医疗保健结果。我们纳入了中国健康与营养调查（2018年）中55岁及以上的成年人（n = 7695）。衰弱指数基于与缺陷分数除以健康项目数量相关的健康结果：健康（<0.08）、衰弱前期（0.08 - 0.24）和衰弱（≥0.25）。我们使用多项逻辑回归模型，利用我们新的衰弱指数来研究城市化三分位数（低、中、高）与衰弱之间的关联。我们还进行了亚组分析，研究城市化水平如何改变衰弱状况与居住地区、教育和收入水平之间的关系。在完全调整模型中，生活在低城市化地区与高城市化地区相比，衰弱与健康（比值比为1.5；95%置信区间为1.2 - 2.0）以及衰弱前期与健康（比值比为1.6；95%置信区间为1.4 - 2.0）状态的几率更高。一般来说，与最高城市化三分位数相比，在地区、收入和教育方面，城市化三分位数较低与更差的衰弱状况（如衰弱前期或衰弱）几率更高相关。衰弱指数可以帮助识别可能从个体化干预中受益以对抗衰弱的特定特征。生活在城市化程度较低的地区与更高的衰弱前期和衰弱几率相关。在衰弱指数的制定中纳入城市化水平、地理居住情况和健康的社会决定因素，有助于识别最有衰弱风险的老年人，并为个体和政策层面的衰弱预防干预做出贡献。
