The rising burden of frailty among older adults in China: evidence from the China Health and Retirement Longitudinal Study (2011–2020)

BACKGROUND: Frailty is a growing public health issue among older adults worldwide, posing significant challenges to society, especially in rapidly ageing populations like China. OBJECTIVE: This study investigates trends in frailty and its impact on health and productivity among Chinese adults aged 60 and older and provides projections for the next decade. DESIGN: Longitudinal design. METHODS: Data from the China Health and Retirement Longitudinal Study were analysed, including 38 071 eligible participants surveyed across five waves between 2011 and 2020. Negative binomial and logistic regression models with random effects were used to examine the impact of frailty on outpatient visits, hospitalisations, catastrophic health expenditure and productive engagement. RESULTS: The prevalence of frailty among older adults in China rose from 16.87% in 2011 to 22.54% in 2020 and is projected to reach 32.46% by 2030. Frail individuals exhibited significantly higher healthcare utilisation, with increased outpatient visits (incidence rate ratio [IRR] = 1.92, 95% CI: 1.81-2.02) and hospitalisations (IRR = 2.78, 95% CI: 2.63-2.94). They were also more likely to experience catastrophic health expenditures (odds ratio: 2.19, 95% CI: 2.04-2.34). Additionally, frailty was associated with more than 50% reduction in productive engagement, particularly in paid working. Additionally, sex and urban-rural disparities were observed, with males and rural residents showing more pronounced reductions in productivity. CONCLUSIONS: Frailty is increasing rapidly in China, with profound implications for healthcare utilisation and productivity. This growing burden highlights the urgent need for targeted interventions to mitigate frailty, particularly for vulnerable populations, as this trend is expected to continue in the coming decade.