Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Roux Institute, Northeastern University, Portland, Maine, USA.
J Gerontol A Biol Sci Med Sci. 2023 Oct 28;78(11):2111-2118. doi: 10.1093/gerona/glad149.
Despite known disparities in health status among older sexual and gender minority adults (OSGM), the prevalence of frailty is unknown. The aim of this study was to develop and validate a deficit-accumulation frailty index (AoU-FI) for the All of Us database to describe and compare frailty between OSGM and non-OSGM participants.
Developed using a standardized approach, the AoU-FI consists of 33 deficits from baseline survey responses of adults aged 50+. OSGM were self-reported as "not straight" or as having discordant gender and sex assigned at birth. Descriptive statistics characterized the AoU-FI. Regression was used to assess the association between frailty, age, and gender. Validation of the AoU-FI used Cox proportional hazard models to test the association between frailty categories (robust <0.15, 0.15 ≤ pre-frail ≤ 0.25, frail >0.25) and mortality.
There were 9 110 OSGM and 67 420 non-OSGM with sufficient data to calculate AoU-FI; 41% OSGM versus 50% non-OSGM were robust, whereas 34% versus 32% were pre-frail, and 26% versus 19% were frail. Mean AoU-FI was 0.19 (95% confidence interval [CI]: 0.187, 0.191) for OSGM and 0.168 (95% CI: 0.167, 0.169) for non-OSGM. Compared to robust, odds of mortality were higher among frail OSGM (odds ratio [OR] 6.40; 95% CI: 1.84, 22.23) and non-OSGM (OR 3.96; 95% CI: 2.96, 5.29).
The AoU-FI identified a higher burden of frailty, increased risk of mortality, and an attenuated impact of age on frailty among OSGM compared to non-OSGM. Future work is needed to understand how frailty affects the OSGM population.
尽管老年跨性别和性别少数群体成年人（OSGM）的健康状况存在明显差异，但衰弱的患病率尚不清楚。本研究旨在为“所有人”数据库开发和验证一个基于缺陷积累的衰弱指数（AoU-FI），以描述和比较 OSGM 和非 OSGM 参与者之间的衰弱程度。
使用标准化方法开发的 AoU-FI 由 33 项来自 50 岁以上成年人基线调查的缺陷组成。OSGM 自我报告为“非直”或性别不一致，或出生时性别与指定性别不一致。AoU-FI 的描述性统计特征。回归用于评估衰弱与年龄和性别之间的关联。AoU-FI 的验证使用 Cox 比例风险模型来检验衰弱类别（稳健<0.15、0.15≤轻度衰弱≤0.25、衰弱>0.25）与死亡率之间的关联。
有 9110 名 OSGM 和 67420 名非 OSGM 有足够的数据来计算 AoU-FI；41%的 OSGM 为稳健型，而 34%为轻度衰弱型，26%为衰弱型，而非 OSGM 分别为 50%、32%和 19%。OSGM 的平均 AoU-FI 为 0.19（95%置信区间[CI]：0.187，0.191），而非 OSGM 为 0.168（95% CI：0.167，0.169）。与稳健型相比，衰弱型 OSGM（比值比[OR] 6.40；95% CI：1.84，22.23）和非 OSGM（OR 3.96；95% CI：2.96，5.29）的死亡率更高。
与非 OSGM 相比，AoU-FI 确定了 OSGM 更高的衰弱负担、更高的死亡率风险以及年龄对衰弱的影响减弱。需要进一步研究来了解衰弱如何影响 OSGM 人群。
