Association of frailty with cardiovascular and all-cause mortality in community-dwelling older adults: insights from the Chinese longitudinal healthy longevity survey

Hui Gao; Qiaoli Ma; Jiahai Li; Qinghui Zhang

doi:10.3389/fcvm.2024.1499099

Association of frailty with cardiovascular and all-cause mortality in community-dwelling older adults: insights from the Chinese longitudinal healthy longevity survey

Front Cardiovasc Med. 2024 Dec 23:11:1499099. doi: 10.3389/fcvm.2024.1499099. eCollection 2024.

Authors

Hui Gao^#^{1

2}, Qiaoli Ma^#³, Jiahai Li⁴, Qinghui Zhang⁵

Affiliations

¹ Department of Cardiovascular Medicine, The First People's Hospital of Shangqiu, Shangqiu, China.
² Graduate School, Dalian Medical University, Dalian, China.
³ Department of Cardiovascular Medicine, Central Hospital of Zibo, Zibo, China.
⁴ Department of Cardiovascular Medicine, The First People's Hospital of Qinzhou, Qinzhou, China.
⁵ Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou, China.

^# Contributed equally.

Abstract

Background: Previous studies suggest that frailty increases the risk of mortality, but the risk of cardiovascular disease (CVD) and all-cause mortality in Chinese community-dwelling older adults remains understudied. Our aim was to explore the effect of frailty on cardiovascular and all-cause mortality in older adults based on a large-scale prospective survey of community-dwelling older adults in China.

Methods: We utilized the 2014-2018 cohort of the Chinese Longitudinal Healthy Longevity Survey and constructed a frailty index (FI) to assess frailty status. Propensity score matching was used to equalize the baseline characteristics of participants to strengthen the reliability of the findings. Hazard ratios and 95% confidence intervals (CIs) were estimated using multivariate Cox models, adjusting for potential confounders, to assess the association between frailty and cardiovascular and all-cause mortality. The relationship between frailty and cardiovascular mortality was further explored using a competing risk model considering death as a competing event. The dose-response relationships between them were estimated using restricted cubic spline models.

Results: The results of the multivariate Cox model found that the frailty group had a higher risk of CVD mortality (1.94, 95% CI: 1.43-2.63) and all-cause mortality (1.87, 95% CI: 1.63-2.14) in compared with the non-frailty group. The multivariate competing risks model suggested a higher risk of CVD mortality in the frailty group (1.94, 95% CI: 1.48-2.53). The analysis found no non-linear relationship between FI and the risk of CVD mortality but a non-linear dose-response relationship with the risk of all-cause mortality.

Conclusions: Frail older adults demonstrated a stronger risk of CVD and all-cause mortality. Reversing frailty in older adults is therefore expected to reduce the risk of death in older adults.

Keywords: Chinese older adults; all-cause mortality; cardiovascular disease mortality; competing risk; frailty; geriatric epidemiology.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported in part by the Henan Province medical science and technology research plan joint construction project: The effect of lipid gene polymorphism on blood lipid level in the population of eastern Henan Province (LHGJ20210988). The funding body did not play any roles in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.