Changes in the severity and lethality of age-related health deficit accumulation in the USA between 1999 and 2018: a population-based cohort study
Changes in the severity and lethality of age-related health deficit accumulation in the USA between 1999 and 2018: a population-based cohort study
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DOI：
10.1016/s2666-7568(20)30059-3
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发表时间：
2021-02-01
影响因子：
13.1
通讯作者：
Theou, Olga
中科院分区：
文献类型：
--
作者：
Blodgett, Joanna M.;Rockwood, Kenneth;Theou, Olga
背景随着人口老龄化，体弱者的数量正在增加。尽管有这一趋势，虚弱的严重性和致命性随时间的变化程度还没有得到很好的理解。我们的目的是调查如何脆弱的严重程度和致命性已经改变了18年的时间在美国。方法在这项基于人群的观察性研究中，我们使用的数据从国家健康和营养检查调查（NHANES），以确定1999年和2018年之间在美国社区居住的个人（年龄>= 20岁）。我们分析了来自NHANES的一系列为期2年的全国代表性横断面前瞻性研究（1999-2000年至2017-18年）的数据。脆弱性是通过使用赤字累积法（即46项脆弱指数）来衡量的。在队列中比较了被归类为非虚弱或患有极轻度虚弱、轻度虚弱、中度虚弱和重度虚弱的个体的比例。随机效应模型被用来检查虚弱指数评分与性别、年龄和队列之间的关系。截至2015年12月31日的死亡率状况通过使用国家死亡指数数据来确定，前六个队列（1999-2010）的5年死亡率可用。考克斯回归模型和Kaplan-Meier曲线被用来估计脆弱指数得分和mortality.Findings之间的关联在总的，49 004人被纳入我们的研究。相关性主要是非线性的（二次），在最近的队列中，虚弱程度以更快的速度增加。1999年至2018年期间，非体弱者的比例下降了10.4%（从4307例中的2747例[63.8%; 95% CI 61.9-65.6]至2884例[53.4%; 51.3-55.5]的5399人），而极轻度虚弱的比例则增加了2.4%（从987人[22.9%; 21.3-24.6]增加到1365人[25.3%; 23.5-27.2]），增加2.7%（从370 [8.6%; 7.7-9.6]到609 [11.3%; 10.1-12.5]），轻度虚弱者增加了3.1%中度虚弱的患者增加了2.1%（从140 [3.3%; 2.7-3.9]增加到347 [6.4%; 5.6-7.4]），重度虚弱的患者增加了2.1%（从63 [1.5%; 1.1-1.9]增加到195 [3.6%; 3.0-4.3]）。女性、年龄较大、来自较新的队列与更高的虚弱指数评分相关（所有P
Background With an ageing population, the number of people with frailty is increasing. Despite this trend, the extent to which the severity and lethality of frailty have changed over time is not well understood. We aimed to investigate how frailty severity and lethality have changed over an 18-year period in the USA.Methods In this population-based observational study, we used data from the National Health and Nutrition Examination Survey (NHANES) to identify community-dwelling individuals (aged >= 20 years) in the USA between 1999 and 2018. We analysed data from a series of ten 2-year, nationally representative, cross-sectional, prospective studies (from 1999-2000 to 2017-18) from the NHANES. Frailty was measured by use of the deficit accumulation approach (ie, a 46-item frailty index). The proportion of individuals categorised as non-frail, or living with very mild frailty, mild frailty, moderate frailty, and severe frailty were compared across cohorts. Random-effects models were used to examine the association between frailty index score and sex, age, and cohort. Mortality status as of Dec 31, 2015, was ascertained by use of National Death Index data, and 5-year mortality was available in the first six cohorts (1999-2010). Cox regression models and Kaplan-Meier curves were used to estimate the association between frailty index scores and mortality.Findings In total, 49 004 individuals were included in our study. Associations were mainly non-linear (quadratic), with frailty increasing at a faster rate in more recent cohorts. Between 1999 and 2018, the proportion of non-frail individuals decreased by 10.4% ( from 2747 [63.8%; 95% CI 61.9-65.6] of 4307 to 2884 [53.4%; 51.3-55.5] of 5399), whereas the proportion of individuals with very mild frailty increased by 2.4% (from 987 [22.9%; 21.3-24.6] to 1365 [25.3%; 23.5-27.2]), by 2.7% (from 370 [8.6%; 7.7-9.6] to 609 [11.3%; 10.1-12.5]) in those with mild frailty, by 3.1% (from 140 [3.3%; 2.7-3.9] to 347 [6.4%; 5.6-7.4]) in those with moderate frailty, and by 2.1% ( from 63 [1.5%; 1.1-1.9] to 195 [3.6%; 3.0-4.3]) in those with severe frailty. Being a woman, older, and from a more recent cohort were associated with higher frailty index scores (all p