Prevalence of Social Frailty Status and its Educational Gradients Among Middle-Aged and Older Adults Across 6 Longitudinal Aging Cohorts.

OBJECTIVES: Social frailty is common among older adults and is associated with adverse health outcomes, yet cross-national evidence on its prevalence and relationship with education remains limited. This study examined the prevalence of social frailty across countries and its association with educational attainment.

DESIGN: Cross-sectional study.

SETTING AND PARTICIPANTS: A total of 83,869 adults aged ≥50 years from 6 longitudinal aging studies in the United States, England, European countries, South Korea, Mexico, and China.

METHODS: We estimated the age- and gender-standardized prevalence and examined associations between education and social frailty status within each country and in a pooled meta-analysis.

RESULTS: Social prefrailty ranged from 54.0% in the United States to 74.1% in South Korea; social frailty ranged from 5.9% in Mexico to 14.4% in European countries. A clear educational gradient was observed across most countries, with lower educational attainment associated with higher odds of both social prefrailty and frailty, except in South Korea. Despite substantial between-country heterogeneity, the pooled meta-analysis revealed that, compared with the lowest education group, the middle-education group had reduced odds of prefrailty (odds ratio [OR], 0.72; 95% CI, 0.60, 0.86) and frailty (OR, 0.54; 95% CI, 0.44, 0.67). The high-education group exhibited stronger reductions (prefrailty OR, 0.53; 95% CI, 0.36, 0.78; frailty OR, 0.29; 95% CI, 0.17, 0.51).

CONCLUSIONS AND IMPLICATIONS: Social prefrailty and frailty are prevalent and follow a clear educational gradient. Integrating social frailty assessments into routine clinical screenings and directing targeted policy interventions toward less-educated older adults are urgently needed to promote healthy aging.