General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland, United Kingdom.
School of Mathematics and Statistics, University of Glasgow, Glasgow, UK.
Lancet Public Health. 2018 Jul;3(7):e323-e332. doi: 10.1016/S2468-2667(18)30091-4. Epub 2018 Jun 14.
Frailty is associated with older age and multimorbidity (two or more long-term conditions); however, little is known about its prevalence or effects on mortality in younger populations. This paper aims to examine the association between frailty, multimorbidity, specific long-term conditions, and mortality in a middle-aged and older aged population.
Data were sourced from the UK Biobank. Frailty phenotype was based on five criteria (weight loss, exhaustion, grip strength, low physical activity, slow walking pace). Participants were deemed frail if they met at least three criteria, pre-frail if they fulfilled one or two criteria, and not frail if no criteria were met. Sociodemographic characteristics and long-term conditions were examined. The outcome was all-cause mortality, which was measured at a median of 7 years follow-up. Multinomial logistic regression compared sociodemographic characteristics and long-term conditions of frail or pre-frail participants with non-frail participants. Cox proportional hazards models examined associations between frailty or pre-frailty and mortality. Results were stratified by age group (37-45, 45-55, 55-65, 65-73 years) and sex, and were adjusted for multimorbidity count, socioeconomic status, body-mass index, smoking status, and alcohol use.
493 737 participants aged 37-73 years were included in the study, of whom 16 538 (3%) were considered frail, 185 360 (38%) pre-frail, and 291 839 (59%) not frail. Frailty was significantly associated with multimorbidity (prevalence 18% [4435/25 338] in those with four or more long-term conditions; odds ratio [OR] 27·1, 95% CI 25·3-29·1) socioeconomic deprivation, smoking, obesity, and infrequent alcohol consumption. The top five long-term conditions associated with frailty were multiple sclerosis (OR 15·3; 99·75% CI 12·8-18·2); chronic fatigue syndrome (12·9; 11·1-15·0); chronic obstructive pulmonary disease (5·6; 5·2-6·1); connective tissue disease (5·4; 5·0-5·8); and diabetes (5·0; 4·7-5·2). Pre-frailty and frailty were significantly associated with mortality for all age strata in men and women (except in women aged 37-45 years) after adjustment for confounders.
Efforts to identify, manage, and prevent frailty should include middle-aged individuals with multimorbidity, in whom frailty is significantly associated with mortality, even after adjustment for number of long-term conditions, sociodemographics, and lifestyle. Research, clinical guidelines, and health-care services must shift focus from single conditions to the requirements of increasingly complex patient populations.
CSO Catalyst Grant and National Health Service Research for Scotland Career Research Fellowship.
衰弱与年龄较大和多种疾病（两种或两种以上的长期疾病）有关；然而，关于其在年轻人群中的流行程度或对死亡率的影响知之甚少。本文旨在研究中年和老年人群中衰弱、多种疾病、特定长期疾病与死亡率之间的关系。
数据来自英国生物银行。衰弱表型基于五个标准（体重减轻、疲惫、握力、体力活动少、行走速度慢）。如果满足至少三个标准，则被认为是衰弱；如果满足一个或两个标准，则被认为是衰弱前期；如果不满足任何标准，则被认为是未衰弱。检查了社会人口特征和长期疾病。结果是全因死亡率，在中位数为 7 年的随访中进行测量。多分类逻辑回归比较了衰弱或衰弱前期参与者与非衰弱参与者的社会人口特征和长期疾病。Cox 比例风险模型检查了衰弱或衰弱前期与死亡率之间的关联。结果按年龄组（37-45、45-55、55-65、65-73 岁）和性别分层，并根据多种疾病计数、社会经济地位、体重指数、吸烟状况和饮酒情况进行了调整。
共纳入 37-73 岁的 493737 名参与者，其中 16538 人（3%）被认为是衰弱，185360 人（38%）是衰弱前期，291839 人（59%）是非衰弱。衰弱与多种疾病（在患有四种或更多种长期疾病的人群中患病率为 18%[4435/25338]；比值比[OR]27.1，95%CI25.3-29.1）、社会经济剥夺、吸烟、肥胖和饮酒不频繁显著相关。与衰弱相关的前五种长期疾病是多发性硬化症（OR15.3；99.75%CI12.8-18.2）；慢性疲劳综合征（12.9；11.1-15.0）；慢性阻塞性肺疾病（5.6；5.2-6.1）；结缔组织疾病（5.4；5.0-5.8）；和糖尿病（5.0；4.7-5.2）。在调整了混杂因素后，衰弱前期和衰弱与男性和女性所有年龄组的死亡率显著相关（除了 37-45 岁的女性）。
为了识别、管理和预防衰弱，应包括患有多种疾病的中年人群，因为即使在调整了长期疾病数量、社会人口统计学和生活方式因素后，衰弱与死亡率也有显著关联。研究、临床指南和医疗保健服务必须将重点从单一疾病转移到日益复杂的患者群体的需求上。
CSO 催化剂拨款和苏格兰国民健康服务研究职业研究奖学金。
