Association of Long-Term Conditions and Multimorbidity With Frailty and Sarcopenia: Evidence From the UK Biobank

Abstract

Background

Frailty and sarcopenia are common conditions among older adults and may also be highly prevalent among adults with long-term conditions (LTCs). This study investigates associations between individual LTCs and multimorbidity with the prevalence of frailty and sarcopenia in a large community-based adult cohort.

Methods

A cross-sectional analysis of 155 639 UK Biobank participants examined the 25 most common self-reported LTCs. Frailty was defined using the Fried criteria, and sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Poisson regression was used to estimate prevalence ratios (PRs) for frailty and sarcopenia by individual LTCs and multimorbidity, adjusting for age, Townsend deprivation index, alcohol intake, smoking, ethnicity, physical activity and sedentarism. Participants without LTCs were the reference group.

Results

Frailty (4.54% vs. 2.63%) and sarcopenia (2.27% vs. 1.28%) were higher in women. Compared to individuals without LTCs, the top three LTCs most strongly associated with frailty in men were rheumatoid arthritis (PR: 8.16, 95% CI: 3.95–16.9), Type 2 diabetes (PR: 5.37, 95% CI: 4.46–6.46) and stroke (PR: 4.23, 95% CI: 2.85–6.28). In women, the strongest associations were observed for type 2 diabetes (PR: 4.16, 95% CI: 3.39–5.11), rheumatoid arthritis (PR: 3.59, 95% CI: 2.37–5.45) and osteoarthritis (PR: 2.94, 95% CI: 2.57–3.36). For sarcopenia, the strongest associations in men were for rheumatoid arthritis (PR: 18.5, 95% CI: 12.6–27.1), osteoporosis (PR: 6.97, 95% CI: 3.44–14.1) and stroke (PR: 5.29, 95% CI: 3.69–7.59). In women, the strongest associations were observed for rheumatoid arthritis (PR: 15.2, 95% CI: 12.6–18.3), osteoporosis (PR: 7.47, 95% CI: 6.46–8.60) and osteoarthritis (PR: 2.87, 95% CI: 2.44–3.37). There was a positive gradient between the number of LTCs and the risk of frailty and sarcopenia, with higher risks observed in men than in women (p-interaction < 0.0001). Compared to individuals without LTCs, those with five or more LTCs had 10.1 and 7.51 times higher prevalence of frailty and 27.2 and 13.8 times higher prevalence of sarcopenia in men and women, respectively.

Conclusions

These findings highlight the significant association between LTCs, particularly stroke, rheumatoid arthritis, Type 2 diabetes and osteoporosis, with frailty and sarcopenia prevalence. The observed trend of increased risk with higher LTC counts could suggest cumulative effects of multimorbidity, particularly in men. These results emphasize the importance of early intervention and targeted strategies to identify and address frailty and sarcopenia in high-risk individuals.