Prevalence of Social Frailty Status and its Educational Gradients Among Middle-Aged and Older Adults Across 6 Longitudinal Aging Cohorts.

Authors

Xinyue Xiang, Yingchao Zeng, Simu Huang, Peiyi Lu, Mingxuan Liu, Luyang Guo, Chihua Li

Published in

Journal of the American Medical Directors Association. Volume 27. Issue 9. Pages 106356. Jul 14, 2026. Epub Jul 14, 2026.

Abstract

Social frailty is common among older adults and is associated with adverse health outcomes, yet cross-national evidence on its prevalence and relationship with education remains limited. This study examined the prevalence of social frailty across countries and its association with educational attainment.
Cross-sectional study.
A total of 83,869 adults aged ≥50 years from 6 longitudinal aging studies in the United States, England, European countries, South Korea, Mexico, and China.
We estimated the age- and gender-standardized prevalence and examined associations between education and social frailty status within each country and in a pooled meta-analysis.
Social prefrailty ranged from 54.0% in the United States to 74.1% in South Korea; social frailty ranged from 5.9% in Mexico to 14.4% in European countries. A clear educational gradient was observed across most countries, with lower educational attainment associated with higher odds of both social prefrailty and frailty, except in South Korea. Despite substantial between-country heterogeneity, the pooled meta-analysis revealed that, compared with the lowest education group, the middle-education group had reduced odds of prefrailty (odds ratio [OR], 0.72; 95% CI, 0.60, 0.86) and frailty (OR, 0.54; 95% CI, 0.44, 0.67). The high-education group exhibited stronger reductions (prefrailty OR, 0.53; 95% CI, 0.36, 0.78; frailty OR, 0.29; 95% CI, 0.17, 0.51).
Social prefrailty and frailty are prevalent and follow a clear educational gradient. Integrating social frailty assessments into routine clinical screenings and directing targeted policy interventions toward less-educated older adults are urgently needed to promote healthy aging.

PMID:
42447552
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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