3177 Sex differences in the associations between social vulnerability, frailty, 5-year survival and long-term care home entry
Bibliographic record
Abstract
Abstract Introduction Frailty and social vulnerability use deficit accumulation approaches to understand heterogeneity in older adult health outcomes. We examined sex differences in the effect of frailty and social vulnerability on 5-year mortality and long-term care home (LTCH) entry in Nova Scotia, Canada. Methods We followed community-dwelling older adults 65 years and over who were assessed for public home care supports from 2005 to 2018 using data from the Resident Assessment Instrument. We conducted sex-stratified and sex-disaggregated Cox proportional hazards analyses, adjusting for age, Cognitive Performance Scale and cohort year of entry. Results Of 5520 home care clients, mean age was 80.5 (SD 7.5), frailty Index (FI) was 0.23 (SD 0.10) and Social Vulnerability Index (SVI) was 0.22 (SD 0.69). The cohort was 66.6% female who were significantly less frail, more socially vulnerable and more cognitively intact at baseline. At five years, 49.1% females and 63.0% males had died, and 36.3% females and 29.5% males required admission to LTCH. In sex-stratified models, higher SVI was associated with decreased 5-year mortality and increased LTCH entry; while higher FI was associated with increased 5-year mortality and LTCH entry. In sex-disaggregated analyses, higher SVI remained significantly associated with decreased 5-year mortality for females (aHR 0.92; CI: 0.86–0.99, p = 0.02), but not for males (aHR 0.94; 0.86–1.02, p = 0.11). There was a weaker association between FI and 5-year LTCH placement for males. Conclusion Greater frailty was associated with LTCH placement and mortality across sexes, as we hypothesized. However, in sex-disaggregated analyses, the association between frailty and LTCH entry was weaker for males and higher social vulnerability was associated with decreased mortality only in female models. This raises the importance of evaluating these populations separately, as well as the question of how current LTCH placement policies may be inadvertently perpetuating the sex (and gendered) differences of ageing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".