The epidemiology of frailty in urban and rural KwaZulu Natal, South Africa; a cross-sectional study

Introduction We investigated the prevalence and clinical risk factors associated with frailty, and frailty’s relationship with health-related quality of life (HRQoL) in urban and rural South Africa. Methods In a population-based cross-sectional study, using age- and sex-stratified random sampling of adults aged ≥40 years, researcher-administered questionnaires collected socio-demographic and clinical data. Physical assessments included body mass index (BMI), grip strength, short physical performance battery (SPPB), vision and hearing, and EuroQol 5-Dimensions 5-Levels measured HRQoL. A modified Fried’s Frailty Phenotype defined frailty. Multivariable logistic regression calculated the odds of frailty for associated risk factors, and logistic and quantile regression examined HRQoL by frailty status. Results Amongst 1,893 participants, median age 60 years [IQR 50-70], 54% female, the overall study prevalence of frailty was 16.4%. Frailty was more common in those ≥70 years than those 40–49-years old (32.5% vs. 7.5%; OR 6.0 [95%CI 3.7,8.4], p < 0.001), and in females compared to males (19.2% vs. 13.1%; OR 1.6 [1.2,2.0], p < 0.001). Older age (≥60 years), urban residence, low educational attainment, moderate to severe food insecurity, visual and hearing impairments, self-reported disability, BMI<18kg/m 2 , and impaired SPPB were all independently associated with frailty. Compared to being robust, frailty was associated with a lower HRQoL utility score (median 0.81(IQR 0.71-0.86) in frail vs. 0.86 (0.83-0.90) in robust/prefrail, β -0.05 ([95%CI -0.07,-0.03], p < 0.001). Conclusion Frailty is common and associated with poorer HRQoL. The identified clinical risk factors can be used to prioritise individuals for referral for clinical assessment of frailty in SA.