B40-07 Comparing Frailty Across Chronic Lung Disease Subtypes Using the All of Us Research Program

Rationale

Defined by an increased vulnerability to stressors, frailty is associated with increased hospitalization, functional decline, and mortality. Patients with chronic lung disease (CLD) may be uniquely susceptible to frailty due to systemic inflammation, functional limitation, and comorbidity, yet frailty burden and its distribution across CLD subtypes remains poorly understood. We hypothesize that participants with CLD will have greater mean frailty than controls, with heterogeneity among CLD subtypes.

Methods

An experimental cohort (n = 31,712) was created by including participants with ≥1 diagnosis of asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, interstitial lung disease (ILD), pulmonary hypertension (PH), pulmonary sarcoidosis, or cystic fibrosis. Those diagnosed with a single disease were grouped into “Pure” groups (e.g. Pure COPD). To handle multimorbidity, groups were created for the four most common diagnostic combinations (e.g. Asthma + COPD). The remainder were grouped into an “Other Multi Lung” group. The control cohort (n = 107,165) included those without any of the above CLDs. A deficit-accumulation model of frailty, which adds all the deficits a participant has and divides by the available deficits, was adapted from the validated index created by Wong et al. Comparisons of mean deficit index scores were done between groups using independent sample T-tests. Ordinary least squares (OLS) linear regression was used to assess for associations with mean frailty, controlling for relevant covariates. All analyses were performed in the All of Us Jupyter notebook, with python coding assistance from artificial intelligence software Gemini.

Results

The CLD group was older than the control with a mean age of 63.9 (95% Confidence interval [CI], 63.7 - 64.0) versus 60.7 (95% CI, 60.6 - 60.8). Participants with CLD demonstrated significantly higher frailty than control, with means of 0.173 (95% CI, 0.172 - 0.175) and 0.125 (95% CI, 0.125 - 0.126). Subgroup analysis revealed a gradient of frailty, with COPD exhibiting the greatest frailty among single-disease groups at 0.196 (95% CI, 0.193 - 0.199). All CLD subgroups demonstrated significantly increased frailty relative to control, except for cystic fibrosis, with a mean score of 0.135 (95% CI, 0.107 - 0.163). Participants with multiple diagnoses had higher scores than those with single conditions, peaking at 0.257 (95% CI, 0.244 - 0.270) among individuals with asthma, COPD, and pulmonary hypertension.

Conclusions

Participants with chronic lung disease exhibit substantially higher frailty compared to those without, with marked heterogeneity across disease subtypes and a pronounced increase among individuals with multimorbid respiratory conditions.

This abstract is funded by: None