Comparing the Relationship Between Social Determinants of Health and Frailty Status of Medicare Beneficiaries in Rural and Urban Areas in the United States

Background: Frailty is a geriatric syndrome of increased physiological vulnerability, decreasing an older adult’s ability to successfully cope with health stressors. Social determinants of health (SDOH), including rural residence, can amplify healthcare disparities for older adults due to less accessibility to resources and lead to worse health outcomes. While the impact of rurality on older adult health is well-established, little is known about how the interaction of SDOH and geographical residence impact frailty status in older adults. Methods: Older adults (65+ years) in the National Health and Aging Trend Study (2011–2021) were categorized using Fried’s frailty phenotype (robust, pre-frail, frail). Rurality was defined using the 2013 Rural–Urban Continuum Codes. Generalized estimation equations with generalized logit link function determined the relationship between SDOHs (healthcare access, community support, income, education) and frailty status. Results: Of n = 6082 participants (56.4% female), the mean age was 75.12 years (SE 0.10), 1133 (18.6%) lived in rural residence, and 2652 (53.0%) had pre-frailty. Although there was no relationship between geographical residence and frailty status (p = 0.73), we did observe lower associated odds of worse frailty status for those with Medigap insurance coverage (0.81, SE 0.08; p = 0.04) and inconsistent frailty status trends for those of divorced (1.12, SE 0.05; p = 0.007) and never married (0.20, SE 0.03; p < 0.001) status in urban areas. Conclusions: Our findings suggest that geographic residence may modify the relationship between SDOH and frailty status in older adults, providing novel insight into the complexity of these interactions. This work is important for identifying modifiable areas where additional support interventions may be important for mitigating frailty development and progression for older adults with efforts at both the individual and system levels.