Oude Voshaar R C, Jeuring H W, Borges M K, van den Brink R H S, Marijnissen R M, Hoogendijk E O, van Munster B, Aprahamian I
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department and Institute of Psychiatry, University of São Paulo (USP), São Paulo, Brazil.
BMC Med. 2021 Feb 8;19(1):29. doi: 10.1186/s12916-021-01904-x.
The frailty index (FI) is a well-recognized measurement for risk stratification in older people. Among middle-aged and older people, we examined the prospective association between the FI and mortality as well as its course over time in relation to multimorbidity and specific disease clusters.
A frailty index (FI) was constructed based on either 64 (baseline only) or 35 health deficits (baseline and follow-up) among people aged ≥ 40 years who participated in LifeLines, a prospective population-based cohort living in the Northern Netherlands. Among 92,640 participants, multivariable Cox proportional hazard models were fitted to study the hazard ratio (HR) of the FI at baseline, as well as for 10 chronic disease clusters for all-cause mortality over a 10-year follow-up. Among 55,426 participants, linear regression analyses were applied to study the impact of multimorbidity and of specific chronic disease clusters (independent variables) on the change of frailty over a 5-year follow-up, adjusted for demographic and lifestyle characteristics.
The FI predicted mortality independent of multimorbidity and specific disease clusters, with the highest impact in people with either endocrine, lung, or heart diseases. Adjusted for demographic and lifestyle characteristics, all chronic disease clusters remained independently associated with an accelerated increase of frailty over time.
Frailty may be seen as a final common pathway for premature death due to chronic diseases. Our results suggest that initiating frailty prevention at middle age, when the first chronic diseases emerge, might be relevant from a public health perspective.
衰弱指数（FI）是老年人风险分层中一种广为人知的测量方法。在中年及老年人中，我们研究了FI与死亡率之间的前瞻性关联及其随时间的变化过程，以及与多种疾病和特定疾病集群的关系。
基于参与“生命线”研究的40岁及以上人群中的64项（仅基线）或35项健康缺陷（基线和随访）构建衰弱指数（FI）。“生命线”是一项基于荷兰北部人群的前瞻性队列研究。在92640名参与者中，采用多变量Cox比例风险模型研究基线时FI以及10种慢性病集群对10年随访期间全因死亡率的风险比（HR）。在55426名参与者中，应用线性回归分析研究多种疾病和特定慢性病集群（自变量）对5年随访期间衰弱变化的影响，并对人口统计学和生活方式特征进行了调整。
FI可独立于多种疾病和特定疾病集群预测死亡率，在内分泌、肺部或心脏病患者中影响最大。在对人口统计学和生活方式特征进行调整后，所有慢性病集群均与衰弱随时间加速增加独立相关。
衰弱可能被视为慢性病导致过早死亡的最终共同途径。我们的结果表明，从中年首次出现慢性病时就开始预防衰弱，从公共卫生角度来看可能是有意义的。
