Abstract
BACKGROUND: Prior research has identified one's own education level as a risk factor for frailty. However, the association between spousal education and frailty in later life is uncertain. We aim to examine the longitudinal association between spousal education and frailty levels among Chinese older populations. METHODS: 3856 participants aged 60 and older from the 2011-2018 China Health and Retirement Longitudinal Study were analyzed. A 54-item deficit cumulative frailty index was developed to evaluate frailty levels at each follow-up. Linear mixed-effects models were used to examine the longitudinal association of spousal education with frailty levels, and whether this association varied by sex and own education level. RESULTS: Higher spouse education was associated with lower frailty levels, and this association decreased with age. Compared with older adults whose spouses had no formal education, older adults whose spouses had less than middle school education had an 8.82 lower level of frailty (95% CI: 15.05 to -2.58, P < 0.01); those with spouses with middle school education and above had a 23.44 lower level (95% CI: 31.43 to -15.44, P < 0.001). Stratified analysis showed that every additional year of spouse education was also associated with lower frailty levels in non-frail participants at baseline, but stronger among those already frail. The association between high spousal education and lower frailty did not vary by sex or own education. CONCLUSION: This study reveals a significant association between having a more educated spouse and lower later-life frailty levels for both older men and women, regardless of one's own educational background. It emphasizes the importance of leveraging educated spouses to prevent and manage frailty.