Frailty is an important and increasing clinical and public health problem. Within the United Kingdom (UK). Most data relating to the occurrence of frailty is derived from Caucasian groups. This study aimed to determine the influence of ethnicity on the occurrence of frailty in a large UK urban conurbation. We also looked at frailty-related risk of severe illness related to COVID-19 infection.

Using data from the Greater Manchester Health Record (GMCR), we analysed primary care electronic medical records of 534,367 men and women aged 60 years and over who were alive on 1st January 2020. We assessed frailty using an electronic frailty index (eFI) and categorised subjects as fit, mild, moderate, and severe frailty. We used logistic regressions to examine the association between moderate and severe frailty (eFI ≥ 0.25) and ethnicity adjusted with age, sex and area deprivation (as measured using Townsend Index). We also looked among those with a first positive COVID test, the influence of frailty on subsequent admission to the hospital within 28 days.

The majority of subjects were White (84 %), with 4.7 % describing themselves as Asian or Asian British, and 1.3 % Black or Black British. The unadjusted prevalence of moderate to severe frailty (eFI ≥ 0.25) was 22.1 %. Compared to the prevalence of frailty in Whites (22.5 %), the prevalence was higher in those of Asian or Asian British ethnicity (28.1 %) and lower in those of Black/Black British descent (18.7 %). After adjustment for age, gender, and deprivation, the risk of frailty remained higher in Asians (Odds Ratio = 1.61; 95 % Confidence Intervals = 1.56–1.66) and lower in Black British (OR = 0.73; 95 % CI 0.68–0.78) compared to White British. Among those with a positive COVID-19 test, those with frailty were more likely to require admission to the hospital within 28 days (OR = 1.61; 95 % CI = 1.53, 1.69).

There is variation in the occurrence of frailty across Greater Manchester across ethnic groups, with higher frequency among those of Asian or Asian British descent and lower frequency among those of Black or Black British descent. This study has added to our understanding of the way that frailty prevalence maps across communities, in this case in a large European conurbation. Further research is required to understand the causes of ethnic variation in frailty and whether ethnicity influences frailty outcomes.