Life expectancy among older adults with or without frailty in China: multistate modelling of a national longitudinal cohort study

Abstract Background Little is known about life expectancy (LE) with or without frailty. We aimed to estimate the total LE and duration of the state of frailty in China. Methods This study included older adults aged 65 years and older from the Chinese Longitudinal Healthy Longevity Study (CLHLS). Frailty status was classified into robust, pre-frailty and frailty based on a cumulative deficit model. Total and specific frailty state LEs at 65 years of age were estimated and stratified by demographic characteristics, behaviours, and psychosocial factors using continuous-time multistate modelling. Results The total LE of older adults aged 65 years in China was 14.74 years on average (95% CI: 14.52–14.94), of which 4.18 years (95% CI: 4.05–4.30) were robust, 7.46 years (95% CI: 7.31–7.61) pre-frail and 3.10 years (95% CI: 3.01–3.20) frail. Older adults with higher robust LE included men (4.71 years, 95% CI: 4.56–4.88), married older adults (4.41 years, 95% CI: 4.27–4.56), those engaging in physical activity (4.41 years, 95% CI: 4.23–4.59), those consuming fruits daily (4.48 years, 95% CI: 4.22–4.77) and those with high social participation (4.39 years, 95% CI: 4.26–4.53). Increased educational attainment were gradually associated with increased robust LE. Conclusions Frailty may lead to a reduced total LE and robust LE of older adults in China. In addition to finding inequalities in total and robust LEs by socioeconomic status, our findings also highlight that healthy behaviours and social participation may ease frailty-related reductions in total and robust LE. Our findings imply that national life-course strategies aimed at frailty screening and psychosocial and behavioural interventions could be important for health aging in China.