Aims: To investigate residential remoteness as a determinant of frailty among patients admitted to public Queensland hospitals.
Methods: We calculated an electronic frailty index (eFI) for every adult patient admitted to a Queensland Health hospital using the statewide electronic medical record system between January 2023 and June 2024. Residential postcodes were linked to a condensed Modified Monash Model (MMM) 2023 and categorised as metropolitan (MM1), regional (MM2–5) or remote (MM6–7). Patient characteristics were compared across remoteness groups and logistic regression was used to compare the likelihood of frailty (eFI>0.20) and severe frailty (eFI>0.40) by remoteness.
Results: Among 103,707 patients with a valid eFI and MMM classification, 61,478 (59.3%) originated from metropolitan, 35,209 (34.0%) from regional, and 5,566 (5.4%) from remote areas. Metropolitan patients were slightly older than regional or remote patients (median ages 67, 66, 64, respectively) and were more likely to be females (48.9%, 45.3%, 43.5%, respectively). After adjusting for age and sex, frailty (eFI>0.20) was slightly more common in remote areas compared with metropolitan areas (OR 1.17; 95%CI 1.09–1.25), with 32.0%, 31.8% and 34.9% classified as frail in metropolitan, regional and remote areas, respectively. In contrast, severe frailty (eFI>0.40) was less common in more remote areas (OR 0.677; 95%CI 0.45–0.96), with prevalence decreasing from 1.0% (metropolitan) to 0.8% (regional) and 0.7% in remote areas.
Conclusions: After accounting for demographic differences, there was a modest but clear gradient of increasing frailty being associated with greater remoteness, whereas the opposite trend was noted for severe frailty.