A network comparison of Frailty Structures Among Urban and Rural Older Adults in China: Evidence from the China Health and Retirement Longitudinal Study

Yiwen Hu; Ziling Xie; Ting Yi; Yifan Chen; Yi Qi; Yan Wang; ZheQing Hu; Chaoqun Dong

doi:10.1093/geronb/gbaf120

A network comparison of Frailty Structures Among Urban and Rural Older Adults in China: Evidence from the China Health and Retirement Longitudinal Study

J Gerontol B Psychol Sci Soc Sci. 2025 Jul 1:gbaf120. doi: 10.1093/geronb/gbaf120. Online ahead of print.

Authors

Yiwen Hu^{1

2}, Ziling Xie¹, Ting Yi¹, Yifan Chen¹, Yi Qi¹, Yan Wang¹, ZheQing Hu³, Chaoqun Dong¹

Affiliations

¹ School of Nursing, Wenzhou Medical University, Wenzhou, China.
² Cixi Biomedical Research Institute, Wenzhou Medical University, Zhejiang, China.
³ Wenzhou Medical University Affiliated Cixi Hospital, Cixi, China.

PMID: 40591462
DOI: 10.1093/geronb/gbaf120

Abstract

Objectives: Global aging is intensifying, with urban-rural differences noted in frailty prevalence and severity among older adults. However, the interrelationships between various health deficit domains in frailty and how these differ between urban and rural settings remain unclear. This study examines urban-rural influences on older adults' frailty using a network perspective.

Methods: Using data from the 2018 China Health and Retirement Longitudinal Study, 4,862 older adults aged 60 and above (urban n = 1,365, rural n = 3,497) were initially included. Propensity score matching (PSM) balanced the urban and rural cohorts before conducting network analysis. Network analysis was used to visualize and characterize the network structure and to examine stability. Subsequently, a network comparison test was used to compare the frailty network structure between urban and rural older adults.

Results: After PSM, 1,974 older adults (987 per group) were analyzed. Urban older adults showed lower frailty prevalence (22.2% vs 32.0%, p < 0.0001) but higher pre-frailty prevalence (58.0% vs 54.2%, p < 0.0001) compared to rural counterparts. No significant differences were found in network structure (M = 0.315, p = 0.176) or metric indicators (S = 0.209, p = 0.61) between urban and rural groups.

Discussion: The present study indicates no significant difference in the structure of frailty networks between urban and rural older adults in China, suggesting potential similarities in the mechanisms underlying frailty development across these settings. Further research delving deeper into the complexity of the issue may provide new insights into our understanding of frailty in urban and rural older adults.

Keywords: Demographic features; Frailty; Network; Propensity score matching; Urban-rural Difference.

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