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Frailty Index as a Measure of Biological Age in a Chinese Population

¹ School of Public Health
² Department of Community & Family Medicine, Faculty of Medicine, The Chinese University of Hong Kong.

Address correspondence to Professor Jean Woo, Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, N.T., Hong Kong. E-mail: jeanwoowong{at}cuhk.edu.hk

Background. The concept of a frailty index, developed in Canadian elderly populations as an indicator of biological age as opposed to chronological age, was tested in an elderly Chinese population to determine whether it is applicable in a different ethnic and cultural setting.

Methods. A data set including 62 physical, psychological, and socioeconomic variables from a cohort of 2032 persons 70 years and older (999 men, 1033 women) was used. The distribution of the index was evaluated using the Cramer-von Mises goodness-of-fit test, and multiple linear regression was used to assess its relationship with age and sex. A biological age for each participant was calculated based on an inverse regression of age on mean frailty index and sex. The Cox proportional hazards regression model was used to assess the ability of biological age to predict death.

Results. The distribution of the frailty index most closely resembled a Weibull distribution. The frailty index increased with age until the mid-80s, when it leveled off, and was higher in women than men for each age group. The distribution of biological age is wider than that for chronological age, and it strongly predicted death. Women had an estimated 20% lesser chance of dying at a given time than did men of the same chronological age and degree of frailty.

Conclusions. The study confirms the robustness of the concept and method of calculating the frailty index developed in elderly Canadian populations. It also suggests that the sex difference in life expectancy may have an underlying genetic basis independent of frailty.