Frailty and Socioeconomic Development in the European Region-Associations with Mortality in Middle-Aged and Older...

The Sociodemographic Index (SDI) captures a country's or region's relative socioeconomic development and has been linked to age-related disease burden and life expectancy. Frailty is a multidimensional geriatric syndrome associated with adverse health outcomes and mortality. This study examined the relationship between country-level SDI, frailty prevalence, and mortality across Europe. We conducted a secondary analysis of community-dwelling adults aged 50 years and older from 12 countries participating in the Survey of Health, Ageing and Retirement in Europe (SHARE). Frailty status and SDI were assessed at Wave 2 (2007), with mortality follow-up at Wave 4 (2011). Countries were categorised into lower- and higher-SDI groups using the median as a cut-off. Frailty was measured using a 70-item frailty index (FI ≥ 0.25) and a modified Fried frailty phenotype (FP ≥ 3 criteria). Frailty prevalence varied substantially by country and assessment method, ranging from 7 to 40% using the FI and 4-21% using the FP. Prevalence was lowest in Switzerland and highest in Poland and was strongly correlated with national SDI scores (r ≥ 0.8). After adjustment for age and sex, lower SDI was independently associated with higher odds of frailty using both frailty measures. Although mortality was lower in higher-SDI countries, this association was not statistically significant after adjusting for age, sex, and frailty. Lower social development was strongly associated with frailty prevalence but did not independently predict mortality, highlighting frailty as a potential pathway linking social context to later-life health outcomes in Europe.