Frailty, social deprivation, and mortality among Medicare fee-for-service beneficiaries

The geographic distribution of frailty and social deprivation, and their association with mortality in the United States, have not been well studied.

We estimated claims-based frailty index (CFI) (range: 0-1) and area-level social deprivation index (SDI) (range: 0-100) in a 5% random sample of 1,207,323 Medicare fee-for-service beneficiaries 65 years and older. We examined the prevalence of frailty (defined as CFI ≥ 0.25) and the mean SDI and estimated their correlation by state and county. The association of frailty and social deprivation with one-year mortality was estimated using logistic regression, adjusting for age, sex, and dual eligibility status.

The study population had the following characteristics: mean age of 76 years, 56% female, 10.3% with frailty, and 24.0% with high social deprivation (SDI ≥ 67). The correlation between frailty and social deprivation was weak (ρ = 0.39 by state and 0.28 by county). The risk of death for the total study population was 4.5%. The age, sex, dual eligibility, and SDI-adjusted risk of death for robust, pre-frail, and frail individuals was 1.8%, 4.4%, and 13.3%, respectively. The age, sex, dual eligibility-adjusted risk of death for low, medium, and high SDI regardless of frailty was 4.4%, 4.7%, and 4.6%, respectively. In robust beneficiaries, the adjusted risk of death for low, medium, and high social deprivation was 1.6%, 1.9% (odds ratio [OR]: 1.21 [95% confidence interval, CI: 1.15, 1.27]), and 2.0% (1.31 [1.24, 1.38]), respectively, whereas in beneficiaries with frailty, the corresponding risk by social deprivation was 13.4%, 13.7% (1.03 [0.99, 1.07]), and 12.9% (0.96 [0.92, 1.00]).

This study identifies regions of the United States that may be most vulnerable from frailty and social deprivation. These findings emphasize the significance of frailty and social deprivation on mortality and the need for community-based preventative health programs such as frailty screening to improve health outcomes for Medicare beneficiaries living with frailty.