title: Social vulnerability and survival across levels of frailty in the Honolulu-Asia Aging Study.
abstract: OBJECTIVE
  we evaluated mortality risk in relation to social vulnerability across levels of frailty among a cohort of older Japanese-American men.
  
  
  METHODS
  in secondary analysis of the Honolulu-Asia Aging Study (HAAS), participants (n = 3,271) were aged 72-93 years at baseline. A frailty index (FI) created using 58 potential health deficits to quantify participants' frailty level at baseline, with four frailty strata: 0.0 < FI ≤ 0.1 (n = 1,074); 0.1 < FI ≤ 0.20 (n = 1,549); 0.2 < FI ≤ 0.30 (n = 472); FI > 0.3 (n = 176). Similarly, a social vulnerability index was created using 19 self-reported social deficits. Cox proportional hazard modelling was employed to estimate the impact of social vulnerability across the four levels of frailty, accounting for age, smoking, alcohol use and variation in health deficits within each frailty level.
  
  
  RESULTS
  for the fittest participants, social vulnerability was associated with mortality (hazards ratio (HR) = 1.04, 95% confidence interval (CI) = 1.01, 1.07; P value = 0.008). Similarly, for those considered at risk for frailty, each social deficit was associated with a 5% increased risk of mortality. For frail individuals, the Cox regression analyses indicated that social vulnerability was not significantly associated with mortality (0.2 < FI ≤ 0.3: HR = 1.016, 95% CI = 0.98, 1.06; P value = 0.442; FI > 0.3: HR = 0.98, 95% CI = 0.93, 1.04).
  
  
  CONCLUSIONS
  for the fittest and at-risk HAAS participants, the accumulation of social deficits was associated with significant increases in mortality risk. For frail individuals (FI > 0.20), the estimation of mortality risk may depend more so on intrinsic factors related to their health.
authors.affiliation: Geriatric Medicine Research, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Armstrong
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Andrew
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.affiliation: Laboratory of Epidemiology, Demography and Biometry, Institute of Aging, Bethesda, MD, USA.
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: Department of Medicine, Pacific Health Research and Education Institute, Honolulu, HI, USA.
authors.forename: Lon R
authors.initials: LR
authors.lastname: White
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000208:ethnology*; D001213:Asian; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D035862:Vulnerable Populations / Q000208:ethnology* / Q000523:psychology
keywords: aged; frailty; frailty index; social vulnerability