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<p>Relationships between social vulnerability, physical frailty and mortality have been observed in several countries, yet how they apply to China’s massive middle-aged and older adult population remains unclear. This study investigated these relationships among middle-aged and older Chinese adults by developing a Social Vulnerability Index (SVI) and Physical Frailty Index (PFI). Using 2011–2018 data from the China Health and Retirement Longitudinal Survey (CHARLS), this study tracked mortality as the outcome. The key independent variables were the SVI, which comprised 21 self-reported social deficits, and the PFI, which includes 50 health deficits to categorize baseline physical frailty into four levels: 0 &lt; PFI ≤ 0.10, 0.10 &lt; PFI ≤ 0.20, 0.20 &lt; PFI ≤ 0.30, and PFI &gt; 0.30. Latent class analysis (LCA) was used to classify social vulnerability, and Cox regression and the Kaplan-Meier method examined its associations with physical frailty and mortality. Among 8884 participants aged 45 years and above (median age: 59.00, IQR: 52.00–67.00), 1002 (11.28%) died over the 7-year follow-up. Median PFI score was 0.11 (IQR: 0.01–0.18) and median SVI score was 0.48 (IQR: 0.42–0.56). LCA identified three social vulnerability classes: low social vulnerability (Class 1), medium social vulnerability (Class 2), and high social vulnerability (Class 3). Adjusting for sex, age, and physical frailty, Cox regression found that compared to Class 1, participants in Class 2 (HR = 1.57, <i>P</i> &lt; 0.001) and Class 3 (HR = 1.33, <i>P</i> &lt; 0.01) had higher mortality risk. Social vulnerability is associated with adverse health outcomes among middle-aged and older adults, and both social vulnerability and physical frailty are associated with higher mortality risk independently. Community-based frailty screening and prevention activities may promote social participation and support, and potentially reduce mortality risk among middle-aged and older adults.</p>

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Social vulnerability, physical frailty, and mortality among middle-aged and older adults in China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月6日

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  • Jian Yang,
  • Jinhua Wang,
  • Yi Li,
  • Bo Hu,
  • Yanwei Lin

摘要

Relationships between social vulnerability, physical frailty and mortality have been observed in several countries, yet how they apply to China’s massive middle-aged and older adult population remains unclear. This study investigated these relationships among middle-aged and older Chinese adults by developing a Social Vulnerability Index (SVI) and Physical Frailty Index (PFI). Using 2011–2018 data from the China Health and Retirement Longitudinal Survey (CHARLS), this study tracked mortality as the outcome. The key independent variables were the SVI, which comprised 21 self-reported social deficits, and the PFI, which includes 50 health deficits to categorize baseline physical frailty into four levels: 0 < PFI ≤ 0.10, 0.10 < PFI ≤ 0.20, 0.20 < PFI ≤ 0.30, and PFI > 0.30. Latent class analysis (LCA) was used to classify social vulnerability, and Cox regression and the Kaplan-Meier method examined its associations with physical frailty and mortality. Among 8884 participants aged 45 years and above (median age: 59.00, IQR: 52.00–67.00), 1002 (11.28%) died over the 7-year follow-up. Median PFI score was 0.11 (IQR: 0.01–0.18) and median SVI score was 0.48 (IQR: 0.42–0.56). LCA identified three social vulnerability classes: low social vulnerability (Class 1), medium social vulnerability (Class 2), and high social vulnerability (Class 3). Adjusting for sex, age, and physical frailty, Cox regression found that compared to Class 1, participants in Class 2 (HR = 1.57, P < 0.001) and Class 3 (HR = 1.33, P < 0.01) had higher mortality risk. Social vulnerability is associated with adverse health outcomes among middle-aged and older adults, and both social vulnerability and physical frailty are associated with higher mortality risk independently. Community-based frailty screening and prevention activities may promote social participation and support, and potentially reduce mortality risk among middle-aged and older adults.