Frailty status transitions and chronic diseases incidence: A dual-cohort prospective study
Qinwen Fei, Tian Lv, Yu-Jun Xiong, Huazhao XuBackground
Frailty is a dynamic geriatric syndrome characterized by accumulated physiological deficits and heightened vulnerability to adverse health outcomes. Although frailty is widely recognized as a precursor of chronic illness, comparative evidence on how longitudinal frailty status transitions predict incident disease across populations remains limited.
Objectives
To evaluate the associations between dynamic frailty status transitions and the incidence of major chronic diseases in two nationally representative aging cohorts.
Design
Prospective cohort study using repeat assessments of frailty status from two consecutive survey waves.
Methods
We included 6,645 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 5,510 participants from the English Longitudinal Study of Ageing (ELSA). Frailty status transitions were categorized into four groups: stable non-frail, worsened, stable pre-frail/frail, and reversion. Incident chronic diseases—including cardiovascular disease, stroke, diabetes, COPD, psychiatric disorders, cognitive impairment/dementia, arthritis, asthma, and cancer—were identified through self-report and objective measures. Cox proportional hazards models were applied to estimate associations between frailty transitions and disease onset, adjusting for demographic characteristics, lifestyle factors, and baseline comorbidities.
Results
Across both cohorts, individuals with worsened, stable pre-frail/frail, or reversion transitions had higher risks of multiple chronic diseases compared with the stable non-frail group. In CHARLS, the worsened group had the strongest association with stroke. In ELSA, nominal associations were observed for heart disease, diabetes and psychiatric disorders.
Conclusion
Dynamic frailty transitions serve as robust predictors of incident chronic diseases across different populations. Incorporating longitudinal frailty assessments into routine aging evaluations may support early identification of high-risk individuals and guide targeted interventions to prevent multimorbidity in aging societies.