Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults.

TitleSocial Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults.
Publication TypeJournal Article
Year of Publication2023
AuthorsShah, SJ, Oreper, S, Jeon, SYoung, W Boscardin, J, Fang, MC, Covinsky, KE
JournalProc Natl Acad Sci U S A
Date Published2023 Feb 14
ISSN Number1091-6490
KeywordsAged, Child, Frailty, Humans, Longitudinal Studies, Retirement, Sociological Factors

While social characteristics are well-known predictors of mortality, prediction models rely almost exclusively on demographics, medical comorbidities, and function. Lacking an efficient way to summarize the prognostic impact of social factor, many studies exclude social factors altogether. Our objective was to develop and validate a summary measure of social risk and determine its ability to risk-stratify beyond traditional risk models. We examined participants in the Health and Retirement Study, a longitudinal, survey of US older adults. We developed the model from a comprehensive inventory of 183 social characteristics using least absolute shrinkage and selection operator, a penalized regression approach. Then, we assessed the predictive capacity of the model and its ability to improve on traditional prediction models. We studied 8,250 adults aged ≥65 y. Within 4 y of the baseline interview, 22% had died. Drawn from 183 possible predictors, the Social Frailty Index included age, gender, and eight social predictors: neighborhood cleanliness, perceived control over financial situation, meeting with children less than yearly, not working for pay, active with children, volunteering, feeling isolated, and being treated with less courtesy or respect. In the validation cohort, predicted and observed mortality were strongly correlated. Additionally, the Social Frailty Index meaningfully risk-stratified participants beyond the Charlson score (medical comorbidity index) and the Lee Index (comorbidity and function model). The Social Frailty Index includes age, gender, and eight social characteristics and accurately risk-stratifies older adults. The model improves upon commonly used risk prediction tools and has application in clinical, population health, and research settings.

Citation Key13144
PubMed ID36749720
PubMed Central IDPMC9963593
Grant ListR03 AG060090 / AG / NIA NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States
K24 HL141354 / HL / NHLBI NIH HHS / United States