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

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.