Zhu Yuanpeng, Zhang Haoran, Zhang Terry Jianguo, Wu Nan
State Key Laboratory of Complex Severe and Rare Diseases, Department of Orthopedic Surgery, Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China.
Beijing Key Laboratory for Genetic Research of Skeletal Deformity Beijing China.
Aging Med (Milton). 2024 Oct 10;7(5):596-605. doi: 10.1002/agm2.12365. eCollection 2024 Oct.
The burden of pain in middle-aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts.
This longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk.
We included 41,171 participants in the final analysis, with a mean follow-up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all -values for interaction >0.05).
Our findings suggest that HGS can be used as an independent predictor of pain in middle-aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations.
中老年人群的疼痛负担相当大，且显著增加了医疗保健支出。我们旨在调查握力（HGS）减弱和不对称在四个具有全国代表性的队列中预测疼痛方面的作用。
这项纵向研究利用了四项主要调查的数据：健康与退休研究（HRS）；英国老龄化纵向研究（ELSA）；欧洲健康、老龄化和退休调查（SHARE）；以及中国健康与退休纵向研究（CHARLS）。采用多变量三次回归样条来直观地探索每个队列中HGS与疼痛之间的非线性关联。应用Cox比例风险模型来分析HGS减弱和不对称与疼痛风险之间的独立及联合关系。
我们在最终分析中纳入了41171名参与者，平均随访期为4.68±2.61年（女性占50.7%，平均年龄64.3±9.3岁）。未发现HGS与疼痛发生率之间存在非线性关系（ELSA和SHARE中非线性<0.05；CHARLS和HRS中>0.05）。调整后，与所有队列中最低四分位数组相比，最高四分位数组的疼痛风险显著降低，CHARLS中的风险比为0.81（0.74，0.89），HRS中为0.86（0.77，0.97），ELSA中为0.88（0.77，0.98），SHARE中为0.78（0.73，0.84）。与HGS较弱的参与者相比，HGS正常的参与者疼痛风险大约低20%。HGS每增加5千克，疼痛的风险比就会降低：CHARLS中为0.95（
