Gordon E H, Peel N M, Samanta M, Theou O, Howlett S E, Hubbard R E
School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia.
Exp Gerontol. 2017 Mar;89:30-40. doi: 10.1016/j.exger.2016.12.021. Epub 2016 Dec 31.
It is a well-described clinical phenomenon that females live longer than males, yet tend to experience greater levels of co-morbidity and disability. Females can therefore be considered both more frail (because they have poorer health status) and less frail (because they have a lower risk of mortality). This systematic review aimed to determine whether this ageing paradox is demonstrated when the Frailty Index (FI) is used to measure frailty.
Medline, EMBASE and CINAHL databases were searched for observational studies that measured FI and mortality in community-dwellers over 65years of age. In five-year age groups, meta-analysis determined the sex differences in mean FI (MD=mean FI-mean FI) and mortality rate.
Of 6482 articles screened, seven articles were included. Meta-analysis of data from five studies (37,426 participants) found that MD values were positive (p<0.001; MD range=0.02-0.06) in all age groups, indicating that females had higher FI scores than males at all ages. This finding was consistent across individual studies. Heterogeneity was high (I=72.7%), reflecting methodological differences. Meta-analysis of mortality data (13,127 participants) showed that male mortality rates exceeded female mortality rates up until the 90 to 94-years age group. Individual studies reported higher mortality for males at each level of FI, and higher risk of death for males when controlling for age and FI.
The pattern of sex differences in the FI and mortality of older adults was consistent across populations and confirmed a 'male-female health-survival paradox'.
女性比男性寿命更长，但往往合并症和残疾水平更高，这是一种广为人知的临床现象。因此，女性既可以被认为更脆弱（因为她们的健康状况较差），也可以被认为不那么脆弱（因为她们的死亡风险较低）。本系统评价旨在确定当使用衰弱指数（FI）来衡量衰弱时，这种衰老悖论是否成立。
检索Medline、EMBASE和CINAHL数据库，查找测量65岁以上社区居民FI和死亡率的观察性研究。在五年年龄组中，通过荟萃分析确定平均FI（MD =平均FI - 平均FI）和死亡率的性别差异。
在筛选的6482篇文章中，纳入了7篇文章。对五项研究（37426名参与者）的数据进行荟萃分析发现，所有年龄组的MD值均为阳性（p < 0.001；MD范围 = 0.02 - 0.06），表明女性在所有年龄段的FI得分均高于男性。这一发现在各个研究中是一致的。异质性较高（I = 72.7%），反映了方法学上的差异。对死亡率数据（13127名参与者）的荟萃分析表明，直到90至94岁年龄组，男性死亡率均超过女性死亡率。各个研究报告称，在FI的每个水平上男性死亡率更高，在控制年龄和FI时男性死亡风险更高。
老年人FI和死亡率的性别差异模式在不同人群中是一致的，并证实了“男女健康生存悖论”。
