(PTFS13-02-26) Understanding Frailty Through a Multilevel Lens: The Role of Socioeconomic, Neighborhood, and Food Environment Factors

Objectives: To examine how individual socioeconomic factors and neighborhood deprivation, social vulnerability, and food environment are associated with frailty status among older U.S. adults (55+ y).

Methods: We conducted a cross-sectional analysis of self-reported health data from the MedProfiler survey, which is an opt-in survey of Circana Consumer Network participants (a nationally representative panel of households continuously recording food purchases). Participant census-tract GEOIDs were linked to USDA food access measures (low-income/low-access (LILA) and low-access status (no income consideration)), the CDC Social Vulnerability Index, and the (Modified Retail Food Environment Index (mRFEI), which measures the percentage of healthy food retailers out of all retailers in a tract. The Area Deprivation Index was linked at the census-block level and urbanization at the county level. Frailty was assessed with a 37-item frailty index; participants were classified as robust, pre-frail, or frail. Associations were estimated using survey-weighted ordinal logistic regression models; models including neighborhood-level predictors used robust standard errors to account for census-tract clustering.

Results: 38% of older adults (N= 27,100) classified as frail. Higher frailty status was more common among women, older adults, those with lower income and educational status, and unmarried individuals. Hispanic and non-Hispanic Asian adults had lower odds of frailty vs non-Hispanic White adults (OR = 0.8 & OR=0.6 respectively, p < 0.01)). Residence in LILA tracts was associated with higher odds of frailty (OR= 1.2; p < 0.001), as was living in more deprived or socially vulnerable neighborhoods. Urbanization was not associated with frailty after adjustment for individual level factors. Food access alone and mRFEI status was not associated with frailty status in unadjusted or adjusted models.

Conclusions: Frailty in older U.S. adults reflects both individual socioeconomic disadvantage and neighborhood context. Multilevel strategies that address socioeconomic risk and neighborhood deprivation may improve identification of at-risk populations and help reduce inequities.

Funding Sources: This research was supported in part by the U.S. Department of Agriculture, Agricultural Research Service.