Johnson Lara, Guthrie Bruce, Anand Atul, Marshall Alan, Seth Sohan
Advanced Care Research Centre, University of Edinburgh, Edinburgh, UK.
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Eur Geriatr Med. 2025 Jun 27. doi: 10.1007/s41999-025-01251-7.
Frailty, a state of increased vulnerability to adverse health outcomes, impacts individuals and healthcare systems. The cumulative deficit model provides a flexible frailty measure but its application across diverse data remains underexplored. This study compares frailty indices derived from survey and routine data.
Frailty indices in the Clinical Practice Research Datalink (CPRD) Aurum (N = 1,625,677) and the English Longitudinal Study of Ageing (ELSA) (N = 5190) were compared for adults aged 65 + in England. Deficits were categorised as "one-to-one", "one-to-many", and "one-to-none". Age-sex-standardised deficit prevalence, frailty distribution and associations with demographics were analysed using summary statistics and regression.
Mean frailty index scores were similar (CPRD: 0.13 ± 0.10; ELSA: 0.13 ± 0.12) but differences were observed in the capture of specific deficits. The majority of deficits had a "one-to-none" or "one-to-many" mapping. Among 14 comparable deficits, visual impairment, fractures and heart failure were more common in CPRD, while falls, sleep disturbance and arthritis were more frequent in ELSA. Severe frailty and greater fitness were more prevalent in ELSA than CPRD. Sex and age influenced frailty similarly in both datasets, with frailty index scores increasing more rapidly with age in CPRD.
Differences in the number and types of deficits measured offset each other overall, supporting the cumulative deficit model's premise that including a sufficient range of deficits does not significantly alter population-level frailty measures. This interchangeability may alleviate concerns about deficit selection, supporting more flexible approaches to population frailty assessment across both survey and routine data.
衰弱是一种对不良健康结局易感性增加的状态，会影响个体和医疗保健系统。累积缺陷模型提供了一种灵活的衰弱测量方法，但其在不同数据中的应用仍未得到充分探索。本研究比较了从调查数据和常规数据得出的衰弱指数。
比较了英国临床实践研究数据链（CPRD）奥鲁姆数据库（N = 1,625,677）和英国老年纵向研究（ELSA）（N = 5,190）中65岁及以上成年人的衰弱指数。缺陷被分类为“一对一”、“一对多”和“一对无”。使用汇总统计和回归分析年龄-性别标准化的缺陷患病率、衰弱分布以及与人口统计学的关联。
平均衰弱指数得分相似（CPRD：0.13±0.10；ELSA：0.13±0.12），但在特定缺陷的捕获方面存在差异。大多数缺陷具有“一对无”或“一对多”的映射关系。在14个可比缺陷中，视力障碍、骨折和心力衰竭在CPRD中更常见，而跌倒、睡眠障碍和关节炎在ELSA中更频繁。与CPRD相比，ELSA中严重衰弱和身体更健康的情况更为普遍。在两个数据集中，性别和年龄对衰弱的影响相似，CPRD中衰弱指数得分随年龄增长的速度更快。
所测量的缺陷数量和类型的差异总体上相互抵消，支持了累积缺陷模型的前提，即纳入足够范围的缺陷不会显著改变人群水平的衰弱测量。这种可互换性可能减轻对缺陷选择的担忧，支持在调查数据和常规数据中采用更灵活的人群衰弱评估方法。
