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Published on: July 24, 2013
Quantifying the impact of modifiable risk factors on frailty: A population-attributable fraction analysis in older
Chi-Shin Wu1, Shao-Yuan Chuang2, Shu-Chun Chuang2
1National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan.
Background:
Many risk factors for frailty have been reported, but their relative population-level contributions are not well quantified. This study quantified the population-level impact of modifiable risk factors on incident frailty among older adults using population-attributable fractions.
Methods:
We analyzed data from the Healthy Aging Longitudinal Study in Taiwan, a nationwide cohort of community-dwelling adults aged 55 years and over. Frailty was defined using the Fried frailty phenotype, and participants with baseline frailty were excluded. Educational attainment was treated as a life-course socioeconomic indicator, whereas lifestyle behaviors, sleep disturbance, and clinical factors were measured at baseline and reflected current or later-life status. Associations with incident frailty were examined using Cox proportional hazards models with age as the time scale, adjusting for sex. Population-attributable fractions were calculated for statistically significant risk factors in the multivariable model.
Results:
The analytical sample comprised 5334 participants (mean age approximately 69 years; 47% men), among whom 509 incident cases of frailty occurred during follow-up. Lower educational attainment was the strongest contributor to frailty, accounting for 19.9% of cases. Other significant contributors included lack of regular exercise (14.2%), current smoking (9.8%), diabetes mellitus (8.0%), falls (7.0%), cognitive impairment (5.6%), arthritis (4.9%), and stroke (3.6%). Together, these factors accounted for about 51.6% of the frailty burden.
Conclusions:
Incident frailty reflects both life-course socioeconomic disadvantage and modifiable current health and behavioral factors. Multidomain prevention strategies targeting social, lifestyle, and clinical risks may help reduce frailty at the population level.
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