Gender difference in the association of frailty and health care utilization among Chinese older adults: results from a population-based study

  • Jiao Zhang
  • Lingzhong XuEmail author
  • Long Sun
  • Jiajia Li
  • Wenzhe Qin
Original Article



Frailty is a public health concern in the ageing population. Little is known about the role of gender in the relationship between frailty and health care utilization in older adults.


The study aims to examine gender differences in the association between different frailty status and health care utilization among Chinese older people.


A total of 7070 older adults (60+) from Shandong Province, China, were enrolled in this study. Frailty was assessed by frailty index constructed using 45 health deficits. Multivariate logistic regression models were employed separately for men and women to examine the impact of frailty on self-care, outpatient, and inpatient utilization.


Overall, the prevalence of frailty was 7.9% in older adults, with 7.1% and 8.3% in men and women, respectively. 49.4% respondents reported they had self-care in the previous 2 weeks, and women were more likely to have self-care than men. Being pre-frail and frail was significantly associated with utilization of all types of health care among older men and women, and the relationship was stronger in the frail groups than that in the pre-frail groups except for self-care. Respective odds ratios for outpatient utilization were higher in men than that in women.


Frailty is a frequent condition in Chinese older adults. The association between frailty and health care utilization (except outpatient) tended to be stronger in women than men. The gender differences should be considered when designing the preventing or delaying the installation of frailty and geriatric care plans.


Older adults Frailty Health care utilization Gender China 


Author contributions

ZJ designed the study, performed the statistical analysis and drafted the initial manuscript, LZ and SL provided the concept and design of study and provided intellectual input into article. JJ and WZ were involved in the analysis and interpretation of data and revised the manuscript for important intellectual content. All authors read and approved the final manuscript.


Our work was supported by two grants of National Natural Science Foundation of China (Grant numbers: 71673169 and 71673170).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was approved by the Academic Research Ethics Committee of Shandong University. In addition, this study was performed in accordance with the ethical principles of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

40520_2019_1410_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.School of Public HealthShandong UniversityJinanChina
  2. 2.NHC, Key Laboratory of Health Economics and Policy Research (Shandong University)JinanChina
  3. 3.Shandong University Center for Health Economics Experiment and Public Policy ResearchJinanChina

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