Frailty transitions and incident stroke in older adults: A comparative longitudinal cohort study between China and...

To examine the association between frailty status, its dynamic changes, and the risk of incident stroke among older adults in China and England.

A total of 19,723 participants (CHARLS: n = 9048; ELSA: n = 10,675) were included in the baseline analysis. Among them, 14,682 participants (CHARLS: n = 6419; ELSA: n = 8236) with complete data for both baseline and the second survey (2-year interval) were included in the analysis of frailty transitions. Frailty was assessed using a 28-item frailty index (FI) and categorized as robust (FI ≤0.10), pre-frail (0.10

Baseline frailty was associated with an increased risk of stroke in both cohorts. Participants whose frailty progressed from robust to pre-frail or frail had a significantly higher stroke risk, while those who recovered from frail to robust or pre-frail showed a reduced risk. Additionally, higher cumulative FI was strongly associated with increased stroke incidence, with a significant dose-response relationship (all trend P-values < 0.0001). Sensitivity analyses using alternative FI thresholds yielded consistent results.

Frailty status and its dynamic changes are significant predictors of stroke in older adults. Monitoring frailty transitions may help identify individuals at high risk of stroke and inform early intervention strategies.