Volume 49 - Article 2 | Pages 13–30  

Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017

By Sergi Trias-Llimos, Magali Barbieri, Viviana Egidi, Luisa Frova, Francesco Grippo, France Meslé, Marilena Pappagallo, Aline Désesquelles

Abstract

Background: The increasing prevalence of frailty in ageing populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process.

Objective: To examine frailty-related mortality as reported on death certificates in France, Italy, Spain, and the United States in 2017.

Methods: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain, and the United States. We estimate the proportions of deaths by sex, age group, and country using specific frailty-related ICD-codes on the death certificate, (1) as the underlying cause of death (UC), (2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and (3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death).

Results: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0%) followed by France (24.1%) and Spain (17.3%), and lowest in the United States (14.0%). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code.

Conclusions: Notable cross-country differences were found in the prevalence and type of frailty-related symptoms at death, even after adjusting for differential age distributions.

Contribution: Strong similarities between countries were found that warrant monitoring frailty at death in low-mortality countries to complement information on frailty prevalence in the living population.

Author's Affiliation

• Sergi Trias-Llimos - Centre d'Estudis Demogràfics (CED), Spain EMAIL
• Magali Barbieri - Institut National d'Études Démographiques (INED), France EMAIL
• Viviana Egidi - Università degli Studi di Roma La Sapienza, Italy EMAIL
• Luisa Frova - Istituto Nazionale di Statistica (ISTAT), Italy EMAIL
• Francesco Grippo - Istituto Nazionale di Statistica (ISTAT), Italy EMAIL
• France Meslé - Institut National d'Études Démographiques (INED), France EMAIL
• Marilena Pappagallo - Istituto Nazionale di Statistica (ISTAT), Italy EMAIL
• Aline Désesquelles - Institut National d'Études Démographiques (INED), France EMAIL

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