Socioeconomic Inequalities and Regional Variation in Intrinsic Capacity Decline Among Older Adults in
C
hina: A Multicenter Cross‐Sectional Study
Yutong Liu, Yuting Shi, Guangli Feng, Zeyu Yin, Lianmei Zhong ABSTRACT
Background
Intrinsic capacity (IC) is a core component of the WHO Healthy Aging framework and the Integrated Care for Older People guidelines. However, evidence from large multicenter samples spanning diverse care settings and geographic regions in China remains limited. This study aimed to characterize IC decline in a multicenter sample of older adults in China and to examine its associations with socioeconomic indicators and regional variation.
Methods
A multicenter cross‐sectional study was conducted among 8375 adults aged ≥ 60 years recruited through 20 centers from community settings, healthcare facilities, and long‐term care facilities in China between June 2024 and June 2025. Participants' long‐term residences spanned 25 provincial‐level administrative regions. IC was assessed across five domains: cognition, mobility, vitality, psychological capacity, and sensory function, and was summarized as a composite score ranging from 0 to 10. IC decline was operationally defined as a composite score ≤ 8. Associations between IC decline and socioeconomic indicators, including educational attainment, income, and self‐rated economic status, were evaluated using multivariable logistic regression models. Sensitivity analyses included cross‐classified mixed‐effects models accounting for participant source/residence province and recruitment center and use of a stricter IC cutoff of ≤ 7. Regional variation was assessed through provincial mapping and Global Moran's I statistic.
Results
Among the 8375 participants, 59.5% were classified as having IC decline. Higher educational attainment, higher income, and more favorable self‐rated economic status were independently associated with lower odds of IC decline after adjustment for demographic characteristics, recruitment setting, Charlson Comorbidity Index, and body mass index (all p < 0.001). The directions of the principal socioeconomic associations were generally maintained in the mixed‐effects and stricter cut‐off sensitivity analyses. Greater comorbidity burden was associated with increased odds of IC decline, whereas higher body mass index was associated with reduced odds. Province‐specific observed proportions of IC decline ranged from 37.0% to 76.9%, with no significant global spatial clustering identified.
Conclusions
IC decline was common in this multicenter sample of older adults in China and demonstrated consistent socioeconomic gradients. Considering socioeconomic indicators alongside IC assessment may help identify individuals with greater functional vulnerability and inform targeted care strategies.