Social frailty and risk factors in Chinese elderly- a national cross-sectional study

Abstract Background: Social frailty has not yet been comprehensively studied in China. We aim to study the prevalence of social frailty in the Chinese elderly population, as well as identify related factors and urban-rural differences.Methods: Data were obtained from the database of the Fourth SSAPUR (Survey of the Aged Population in Urban and Rural China), a national cross-sectional study using a multistage, stratified, cluster-sampling method for which 224,142 adults aged 60 years or older were recruited between Aug. 1, 2015, and Aug. 31, 2015. Participants were interviewed to obtain demographic data and information regarding family, health and medical conditions, health care service status, living environment conditions, social participation, protected rights status, spiritual and cultural life, and health. Social frailty was assessed in five areas (HALFE Social Frailty Index) including inability to help others, limited social participation, loneliness, financial difficulty, and living alone, with scores of three and above being defined as social frailty.Results: A total of 222,179 cases were analyzed, of which 33,773 (15.2%) met the criteria for social frailty. By age, we found the highest prevalence of social frailty in participants 75-79 years old. By gender, we found a higher prevalence in men than women for ages 60-64, but a higher prevalence in women than men for ages 70-84. The prevalence in rural populations was higher than in urban populations for all ages. The prevalence was higher among women than men in urban areas (11.7% in women vs. 9.9% in men, P<0.0001), while it was higher among men than women in rural areas (19.2% in women vs. 20.6% in men, P<0.0001). Physical exercise had a significant effect on urban prevalence of social frailty (P<0.0001) but not on rural prevalence (P=0.446). Cataract glaucoma had a significant effect on rural prevalence of social frailty (P<0.0001) but not on urban prevalence (P=0.526).Conclusions: Based on the HALFE social frailty index, the prevalence of social frailty among the elderly in China is 15.2%, with the highest prevalence in those between 75 and 79 years old and more prevalent in rural than urban areas.