# Regional and Socioeconomic Disparities in Frailty Across Tasmania: Evidence From Island Study Linking Ageing and Neurodegenerative Disease

## TL;DR

Frailty is higher in rural and socioeconomically disadvantaged areas of Tasmania, suggesting a need for targeted health interventions.

## Contribution

This study provides adjusted evidence linking geographic remoteness and socioeconomic disadvantage to higher frailty in older adults.

## Key findings

- Frailty index scores were significantly higher in rural and remote areas compared to regional centres.
- Frailty increased with lower socioeconomic advantage after adjusting for demographic factors.
- Spatial mapping revealed higher frailty in central and western Tasmania.

## Abstract

Although frailty appears higher in rural and socioeconomically disadvantaged areas, existing evidence often lacks adjustment for possible population confounders. This study examined the independent associations between geographic remoteness and area‐level socioeconomic status with frailty.

We constructed a 33‐item frailty index using data from 5740 participants of the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND), a web‐based longitudinal cohort of adults aged 50 years and over in Tasmania, Australia. After linking participant postcodes to Modified Monash Model remoteness and Index of Relative Socioeconomic Advantage and Disadvantage, we examined frailty distribution and its associations with geographic and sociodemographic factors using descriptive statistics, spatial mapping and multivariable linear regression models.

The analytical sample mean age was 69.3 years (SD = 8.0) and most were women (72%). Frailty index scores followed a gamma distribution (mean score = 0.16, SD = 0.09), increased with age and were highest in central and western areas of Tasmania. After adjustment for age, gender, education, retirement and migrant status, frailty index scores were significantly higher in rural towns (β = 0.011 [95% confidence interval, CI = 0.005, 0.016]) and remote communities (β = 0.023 [95% CI = 0.009, 0.038]) than regional centres. Similarly, after full adjustment, compared with areas of the highest socioeconomic advantage, frailty was significantly higher in areas of middle (β = 0.013 [95% CI = 0.007, 0.018]) or low (β = 0.024 [95% CI = 0.018, 0.030]) socioeconomic advantage.

The distribution of frailty across Tasmania varied by geographic remoteness and socioeconomic disadvantage. Integrating frailty assessment into regional health planning may support targeted interventions for vulnerable subpopulations, particularly in rural and disadvantaged communities.

Frailty is higher in rural and disadvantaged areas. Incorporating frailty screening into health system planning and targeting resources to remote and deprived communities might support equitable ageing and guide service investment where health vulnerability is greatest.