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Background:  Lifestyle contributors to frailty among the elderly were previously reported in the developed Western countries, while evidence from the less developed East Asian regions was still lacking. Due to the well-acknowledged sex-based disparity of frailty and sex-difference of socioeconomic status and lifestyle, it is worth investigating the sex-specific association between the social and behavioral contributors and the risk of frailty among the East Asian longevous population.   Methods:  The present study was an observational study based on the four waves of interviews of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. The participants aged ≥65 years and without frailty at baseline were included. Fried criteria (exhaustion, shrink, weakness, low mobility, and inactivity) were adopted to identify the incidence of frailty (≥3 domains) and pre-frailty (1–2 domains) during the follow-up. The sex-specific association between lifestyle (smoke status, drinking status, food intake, sleep, exercise, and physical activity) and the risk of incident pre-frailty and frailty was analyzed using the multinomial logistic regression models.   Results:  Altogether, 3,327 participants aged 81.2 ± 10.3 (range 65–116) years were included. In total, 964 (29.0%) and 1,249 (37.5%) participants were recognized as having incident pre-frailty and frailty, respectively. Older women were disproportionately uneducated, frequently did housework and labor work, but seldom did exercise. Men had diverse dietary and recreational activities but were frequently exposed to tobacco and alcohol. The protective effects of higher income, exercise, doing housework, and daily intake of fresh fruits/vegetables were found in both the sexes ( P  < 0.05). Sleep disorders (odds ratio [ OR ] = 2.16, 95%  CI : 1.28–3.62) and labor work ( OR  = 2.18, 95%  CI : 1.42–3.33) were associated with the increased risk of frailty among women. For men, diverse dietary (four types of food added:  OR  = 0.21, 95%  CI : 0.09–0.50) showed a protective effect on the risk of frailty, but daily intake of pickled vegetables showed the opposite effect ( OR  = 1.86, 95%  CI : 1.12–3.07).   Conclusion:  Socioeconomic status, lifestyle, and the association with the risk of frailty showed substantial difference between the sexes among the longevous population in China. To establish the individualized strategy of behavioral improvement for the frailty prevention should consider the sex disparity.

Sex-Specific Association Between Socioeconomic Status, Lifestyle, and the Risk of Frailty Among the Elderly in China