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Associations of marital status and social participation with frailty among adults aged 50 and older in 19 countries: evidence from five prospective cohort studies

Year: 2026

Type: article

Abstract: Against the backdrop of rapid global population aging, frailty has emerged as a major challenge affecting the physical and mental health, quality of life, and the sustainability of healthcare and social systems for middle-aged and older adults. Existing research suggests that marital status and social participation may be important social determinants of health related to frailty, but the evidence remains inconsistent. This study aimed to use a harmonized methodological approach to examine the associations of marital status and social participation with frailty among adults aged 50 years and older, using data from five large-scale databases covering 19 countries/regions. This study also explored potential moderators and interaction effects within these associations. Data were drawn from five large, multinational, population-based longitudinal cohort studies: HRS, ELSA, SHARE, CHARLS, and MHAS. Logistic regression models were used to examine the associations of marital status and social participation with frailty, and subgroup analyses were conducted to assess potential moderating effects. Random-effects models were then used to pool the results. In addition, additive and multiplicative interaction effects between marital status and social participation were tested, and participants were classified into eight groups based on marital status and social participation to estimate their joint associations with frailty. The analyses showed that, except in CHARLS and MHAS, individuals with non-married statuses had significantly higher odds of frailty than married individuals (pooled OR: 1.29, 95% CI: 1.11–1.51), with the association being particularly pronounced among those who were divorced/separated or widowed. The association between marital status and frailty was significantly moderated by national development level and age. The study also found that lack of social participation was significantly associated with higher odds of frailty (pooled OR: 1.29, 95% CI: 1.12–1.50). However, the pooled additive and multiplicative interaction effects between marital status and social participation were not statistically significant. Nevertheless, compared with individuals who were married and socially active, those who were unmarried, particularly widowed, and lacked social participation had substantially higher odds of frailty (pooled OR: 1.86, 95% CI: 1.35–2.57). These findings suggest that social connectedness and targeted support for potentially vulnerable groups may be important for informing healthy aging strategies and frailty prevention efforts across different countries and populations.

Source: Humanities and Social Sciences Communications

DOI: 10.1057/s41599-026-09005-x