衰弱对全因死亡风险的影响——上海市45岁及以上社区居民的12年随访研究

目的分析衰弱状况对上海市≥45岁不同特征社区人群死亡风险的影响，为衰弱人群的干预和不良结局的预防提供进一步依据。方法使用世界卫生组织全球老龄化与成人健康研究（SAGE）上海现场第一轮基线数据，以2021年10月30日为随访终点，通过主动随访和被动随访获取生存结局，由40个变量构建衰弱指数（FI）得分，将FI≥0.2者判定为处在衰弱状态。控制年龄、社会经济特征（居住地、婚姻状态、受教育程度和家庭经济水平等）及健康相关行为（吸烟、饮酒、水果蔬菜摄入、社会参与等）因素后，采用多因素Cox回归模型计算风险比（HR），分析衰弱状况对不同年龄组各性别人群死亡风险的影响。结果纳入7 978例≥45岁研究对象，其中处于衰弱状态777例（9.7%）；经过（11.3±1.8）年随访，共死亡1 043例（13.1%），其中衰弱人群死亡214例（27.5%）。多因素Cox回归分析结果显示，衰弱对各亚组人群死亡风险的影响程度由大至小依次为中年组（45~岁）男性（HR=2.92，95%CI:1.38~6.19）、低龄老人组（60~岁）女性（HR=1.68，95%CI:1.08~2.60）以及高龄老人组（≥75岁）女性（HR=1.59，95%CI:1.22~2.06）。结论衰弱与死亡风险相关，须重点关注45~岁男性、≥60岁女性人群的衰弱状况，开展衰弱状况的早期筛查与评估，并采取适当的预防性干预措施，减少不良结局和过早死亡的发生。

Effect of frailty on the risk of all-cause mortality—a 12-year follow-up study of community residents aged 45 years and above in Shanghai

ObjectiveTo analyze the effect of frailty status on the risk of mortality in a community-based population aged 45 years and above in Shanghai with different characteristics， and to provide further basis for population-based interventions for frailty and prevention of adverse outcomes.MethodsData were derived from baseline data from the Shanghai prospective study on AGEing and adult health （2009-2010） and cohort follow-up of causes of death up to October 30， 2021. Frailty index （FI） scores were constructed from 40 variables. Those with frailty index FI≥0.2 were judged to be in a frail state， and a multifactorial Cox regression model was used to calculate the hazard ratio （HR） to evaluate the effect of frailty status on the risk of death in different age groups by gender. Socioeconomic characteristics （age， residence， marital status， education and family economic level， etc.） and health-related behaviors （smoking， alcohol consumption， fruit and vegetable intake， social participation， etc.） were included as control variables.ResultsThe study included 7 978 subjects， 777 （9.7%） of whom were in a frail state. After （11.3±1.8） years of follow-up， 1 043 （13.1%） individuals were dead， including 214 （27.5%） who were frail. The results of the multifactorial Cox regression analysis showed that the effect of frailty on the risk of death in each subgroup was in descending order of men in the middle-aged group （45? years） （HR=2.92， 95%CI: 1.38-6.19）， women in the low-aged elderly group （60? years） （HR=1.68， 95% CI: 1.08-2.60）， and women in the old-aged elderly group （≥75 years and older） （HR=1.59， 95%CI: 1.22?2.06）.ConclusionFrailty is associated with the risk of death， and we should focus on the frailty status of men aged 45~59 years and women aged 60 years and above. Early screening and assessment of frailty status and taking appropriate preventive interventions may reduce the occurrence of adverse outcomes and premature death.