Duke Kunshan University, Kunshan, Jiangsu, China.
Department of Neurosurgery, The Affiliated Kunshan Hospital of Jiangsu University, Suzhou, China.
J Gerontol A Biol Sci Med Sci. 2024 Apr 1;79(4). doi: 10.1093/gerona/glad286.
The relationship between subjective and objective health is complex and not always matched. Although frailty and self-rated health (SRH) have been separately associated with adverse outcomes, their joint effects remained unclear.
Participants were 5 300 adults ≥60 years from the China Health and Retirement Longitudinal Study in 2011. Frailty, measured by the validated physical frailty phenotype approach, was classified as nonfrail, prefrail, and frail. SRH was categorized into 3 groups: excellent/very good/good, fair, and poor/very poor. We used the Cox models to examine the independent and joint association of frailty and SRH with mortality. We used the interaction approach to determine whether the association of SRH with mortality differed by frailty. Subgroup analyses were conducted by depression and cognitive impairment.
About 8.1% of frail participants reported excellent/very good/good health; 21.2% of the nonfrail reported poor/very poor health. Prefrailty and frailty were associated with a 1.63- and 2.38-fold increase in the hazard of mortality than the nonfrail, respectively, after adjusting for SRH. Reporting fair and poor/very poor health was associated with a 29% and 100% increase in the hazard of mortality, respectively, after adjusting for frailty. No significant interaction was found. Prefrail and frail older adults with excellent/very good/good health had a similar mortality as the nonfrail with poor/very poor SRH. The association of SRH with mortality was less pronounced among individuals with depression or cognitive impairment.
SRH is a potential marker of resilience among people living with frailty that may be a target for ameliorating health risks induced by frailty.
主观健康和客观健康之间的关系很复杂，并不总是匹配的。虽然衰弱和自我报告的健康状况（SRH）分别与不良结局相关，但它们的联合作用尚不清楚。
参与者为 2011 年中国健康与退休纵向研究中的 5300 名≥60 岁的成年人。采用经过验证的身体衰弱表型方法测量衰弱，将衰弱分为非衰弱、衰弱前期和衰弱。SRH 分为 3 组：优秀/非常好/好、一般和差/非常差。我们使用 Cox 模型来检查衰弱和 SRH 与死亡率的独立和联合关联。我们使用交互方法来确定 SRH 与死亡率的关联是否因衰弱而不同。通过抑郁和认知障碍进行亚组分析。
约 8.1%的衰弱参与者报告优秀/非常好/好健康；21.2%的非衰弱参与者报告差/非常差健康。调整 SRH 后，与非衰弱者相比，衰弱前期和衰弱者的死亡风险分别增加了 1.63 倍和 2.38 倍。报告一般和差/非常差健康状况的死亡风险分别增加了 29%和 100%，调整衰弱后。未发现显著的交互作用。报告优秀/非常好/好健康的衰弱前期和衰弱老年人的死亡率与报告差/非常差 SRH 的非衰弱老年人相似。在有抑郁或认知障碍的个体中，SRH 与死亡率的关联不那么明显。
SRH 是衰弱人群中适应能力的潜在标志物，可能是改善衰弱引起的健康风险的目标。
