Age-specific population attributable fractions for frailty, functional disability, and hospitalisation in Chinese older people: an ICOPE-based prospective cohort study.
Ruby Yu, Derek Lai, Grace Leung, Lok-Yan Tam, Clara Cheng, Sara Kong, Cecilia Tong, Matthew Yu, Jean Woo
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引用次数: 0
Abstract
Background: Declines in intrinsic capacity have been associated with increased risks of frailty, disability, and hospitalisation. We estimated population attributable fractions (PAFs) for these outcomes with respect to intrinsic capacity-related conditions and traditional modifiable risk factors in different age groups.
Methods: We analysed data from a territory-wide, multicentre, community-based, prospective cohort study (2023-24) in Hong Kong. Among 22 237 Chinese adults aged 60 years and older with follow-up data, we calculated age-specific PAFs for incident frailty, instrumental activities of daily living (IADL) disability, and hospitalisation associated with 13 modifiable risk factors. These risk factors included intrinsic capacity conditions, cardiometabolic conditions, and socioeconomic and lifestyle factors, and combinations of these.
Findings: Between March 21, 2023, and Dec 31, 2024, 47 776 participants were recruited to the study. 41 226 (86·3%) had complete baseline data for all intrinsic capacity conditions, cardiometabolic conditions, socioeconomic and lifestyle factors, demographic covariates, and outcome variables and were therefore included in our study sample. 22 237 (53·9%) of 41 226 participants completed follow-up assessments at least 6 months after baseline with a mean follow-up of 360·4 days (SD 71·6, median 348·0, IQR 307·0-399·0), 1398 (7·1%) of 19 777 participants had incident frailty, 1152 (6·0%) of 19 171 participants had incident IADL disability, and 2068 (11·1%) of 18 622 participants were hospitalised. Limited mobility was the leading risk factor associated across all outcomes (PAFs 9·8-25·3%). Depressive symptoms were a strong risk factor associated with frailty (PAF 19·1%). Age-stratified analyses revealed that limited mobility had the highest PAFs in adults aged 80 years and older, whereas depressive symptoms showed peak PAFs in those aged 60-69 years in most cases. Hypertension contributed to all outcomes (PAFs 8·4-19·6%) only in adults younger than 80 years. In adults aged 60-69 years physical activity was the predominant risk factor associated with frailty (PAF 21·9%) and disability (PAF 22·3%). The attributable risk of lower education with frailty increased with age, reaching its peak in adults aged 80 years and older (PAF 20·2%). Regarding the joint effects of the risk factors, intrinsic capacity decline was the factor associated with the highest overall attributable risk for all outcomes, exceeding the impact of cardiometabolic diseases and socioeconomic and lifestyle risk.
Interpretation: Our findings provide insights into age-specific risk factors for frailty, disability, and hospitalisation in older people, underlining the importance of targeted prevention strategies across age groups. Our findings further support a shift towards prioritising intrinsic capacity to better support healthy ageing at the population level.
Funding: The Hong Kong Jockey Club Charities Trust.
期刊介绍：
The Lancet Healthy Longevity, a gold open-access journal, focuses on clinically-relevant longevity and healthy aging research. It covers early-stage clinical research on aging mechanisms, epidemiological studies, and societal research on changing populations. The journal includes clinical trials across disciplines, particularly in gerontology and age-specific clinical guidelines. In line with the Lancet family tradition, it advocates for the rights of all to healthy lives, emphasizing original research likely to impact clinical practice or thinking. Clinical and policy reviews also contribute to shaping the discourse in this rapidly growing discipline.
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