The prevalence of frailty and its relationship with socio-demographic factors, regional healthcare disparities, and healthcare utilisation in the aging population across India

Abstract Background The burden of frailty in developing countries and its relationship with complex social structures, such as caste, religion and regional healthcare differences and its effect on healthcare outcomes are not well characterized. The aim of the study was to estimate frailty prevalence and its relationship with the socio-economic and regional factors and healthcare outcomes. Methods In this study, participants from the harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) were included. The frailty index (FI) was calculated using a 32-variable deficit model, with a value of ≥ 25% considered as frail. Data on demographic (including caste and religion) and socioeconomic profiles and healthcare utilization were obtained. The state-wise health index maintained by the government based on various health-related parameters was used to group the participants’ residential states into high-, intermediate-, and low-performing states. Multivariable and zero-inflated negative binomial regression was used to assess the relationship of frailty index with socio-demographic characteristics, health index and healthcare expenditure or hospitalization. Results Among the 3,953 eligible participants, the prevalence of frailty was 42.34% (men: 34.99%; women: 49.35%). Compared to high-performing states, intermediate- and low-performing states had a higher proportion of frail individuals (49.7% vs. 46.8% vs. 34.5%, p < 0.001). In the adjusted analysis, frailty was positively associated with age, female sex, rural locality, lower education level, and caste (scheduled caste and other backward classes). After adjusting for socio-economic profile, FI was inversely associated with the composite health index of a state (p < 0.001). FI was also significantly correlated with total one-year healthcare expenditure and hospitalization (p-value = < 0.001 and 0.02 respectively). Conclusion There is a high prevalence of frailty among older Indian adults that is associated with socio-demographic factors and regional healthcare performance. Furthermore, frailty is associated with increased healthcare utilization and expenditure.