Global frailty: The role of ethnicity, migration and socioeconomic factors

Abstract

Frailty is an important consequence of ageing, whereby frail patients are more likely to face adverse outcomes, such as disability and death. Risk of frailty increases in people with poor biological health, and has been shown in many ethnicities and countries. In economically developed countries, 10% of older adults are living with frailty. Ethnic minorities in the West face significant health inequalities. However, little is known about frailty prevalence and the nature of frailty in different ethnic groups. This has implications for healthcare planning and delivery, especially screening and the development of interventions. Global frailty prevalence is variable: low- to middle-income countries demonstrate higher rates of frailty than high-income countries, but available evidence is low. Little is known about the characteristics of these differences. However, female sex, lower economic status, lower education levels, and multimorbidity are identified risk factors. Ethnic minority migrants in economically developed countries demonstrate higher rates of frailty than white indigenous older people and are more likely to be frail when younger. Similar patterns are also seen in indigenous ethnic minority marginalised groups in economically developed countries such as the US, Australia and New Zealand, who have a higher prevalence of frailty than the majority white population. Frailty trajectories between ethnic minority migrants and white indigenous groups in high-income countries converge in the 'oldest old' age group, with little or no difference in prevalence. Frailty risk can be attenuated in migrants with improvements in integration, citizenship status, and access to healthcare. Ethnicity may play some role in frailty pathways, but, so far, the evidence suggests frailty is a manifestation of lifetime environmental exposure to adversity and risk accumulation.

Keywords: Ethnicity; Frailty; Global ageing; Migration.

Fig. 1.. Global frailty prevalence based on pooled means from studies reviewed using Fried Frailty Phenotype of adults aged > 60 years.

The countries reviewed were ranked according to frailty prevalence and then stratified into quintiles. The frailty prevalence globally ranges from 4.9–65.2%. The higher rates of frailty prevalence are exhibited in largely LMICs. The countries with the highest frailty prevalence are Thailand (65.2%, CI 57.4–73.1%) and Chile (42.6%, CI 39.8–45.4%). The lowest frailty prevalence are seen in Western HICs, such as Switzerland (5.8%, CI 3.5–8.1%) and the UK (7.8%, CI 6.9–8.7%), but this group is also made up of HICs from the far East, such as Japan (8.2%, CI 7.8–8.7%) and Taiwan having the lowest prevalence at frailty at 4.9% (CI 4.0–5.8%).

Fig. 2.. Factors associated with frailty in ageing populations.

Age itself is the strongest correlator with frailty, and in general, frailty prevalence increases with age in both men and women across the world. Other factors associated with frailty persistently demonstrated in the literature in these worldwide ageing populations include: female sex, being less educated (including illiteracy), lower income, lower socioeconomic status, high disease burden and multimorbidity.