THE SOCIAL GRADIENT OF FRAILTY IN INDIA: A MULTI-STATE ANALYSIS USING WHO-SAGE DATA

This study derives a composite frailty index for adults aged 50 and above in India, examines the distribution of frailty conditions across socioeconomic and demographic strata, and estimates the independent effects of background characteristics on frailty using multivariate analysis. Data and Methods: Data from the WHO Study on Global Ageing and Adult Health (SAGE) India Wave 1 (2007) were used, encompassing 6,560 respondents aged 50 and above across six Indian states. A modified frailty index incorporating seven deficit indicators - low grip strength, slowness, low body mass index, low physical activity, cognitive limitation, psychological limitation, and exhaustion - was constructed. Participants were classified as robust (0 deficits), pre-frail (1–2), intermediate (3–4), or frail (5–7). Multinomial logistic regression was employed to estimate the association between socioeconomic variables and frailty categories. Results: Frailty prevalence was 15.5% overall, rising sharply with age from 7.1% in the 50–59 group to 50.8% in those aged 80 and above. Female sex, no formal education, low wealth, rural residence, and scheduled caste/tribe status were consistently associated with higher frailty burden. Multinomial logistic regression confirmed that advanced age, low education, and low wealth quintile were the strongest predictors of frailty, with statistically significant odds ratios at p < 0.01.