Objective: Older people in rural areas are possibly more frail due to the limited medical resources and lower socioeconomic status. Given the negative healthy outcomes caused by frailty, knowing the epidemiology of frailty in rural areas is of great importance. We tried to synthesise the existing evidences for the prevalence and risk factors of frailty in rural areas.

Design: A systematic review and meta-analysis.

Data sources: PubMed, Embase, MEDLINE, Cochrane Library, Web of Science and Scopus were used to identify the articles from inception to 30 April 2019.

Eligibility criteria: Observational studies providing cross-sectional data on the prevalence of frailty in rural elderly were extracted.

Data extraction and synthesis: Two independent investigators selected studies, extracted data and assessed the methodological quality of included studies. The pool prevalence of frailty was calculated by the random effects model and the OR and 95% CI were used to calculate the risk factors.

Results: The literature search yielded 2219 articles, of which 23 met the study criteria and were included in this analysis. The pooled prevalence of frailty and pre-frailty were 18% (95% CI 15% to 21%, I(2)=98.5%, p<0.001) and 50% (95% CI 45% to 56%, I(2)=98.4%, p<0.001), respectively. The pooled frailty prevalence was 15% for the Fried Phenotype, 18% for the Frailty Index and 23% for other criteria. The pooled prevalence of frailty was 17% for males and 26% for females. The pooled prevalence of frailty was 17% in developing countries and 23% in developed countries. Age, cognitive impairment, depressive symptom, risk of malnutrition, activity of daily living (ADL) disability and poor self-perception of health were associated with frailty. There was no publication bias.

Conclusions: Frailty influences almost one in five older people in rural areas, and increasing age, cognitive impairment, depressive symptom, risk of malnutrition, ADL disability and poor self-perception of health were all risk factors for frailty. We should be cautious about the research results due to the heterogeneity between studies.