BACKGROUND Frailty is a common condition among older adults increasing risk of adverse outcomes including mortality; however, little is known about the incidence or risk of specific causes of death among frail individuals. METHODS Data came from the Health and Retirement Study (2004 - 2012), linked to underlying cause-of-death information from the National Death Index (NDI). Community-dwelling HRS participants aged 65 and older who completed a general health interview and physical measurements (n=10,490) were included in analysis. Frailty was measured using phenotypic model criteria - exhaustion, low weight, low energy expenditure, slow gait, and weakness. Underlying causes of death were determined using International Classification of Diseases, Version 10 codes. We used Cox proportional hazards and competing risks regression models to calculate and compare incidence of cause-specific mortality by frailty status. RESULTS During follow-up, pre-frail and frail older adults had significantly greater hazard of all-cause mortality compared to individuals without symptoms (adjusted hazard ratio (HR) pre-frail: 1.85, 95% CI: 1.51, 2.25; HR frail: 2.75, 95% CI: 2.14, 3.53). Frailty was associated with 2.96 (95% CI: 2.17, 4.03), 2.82 (95% CI: 2.02, 3.94), 3.48 (95% CI: 2.17, 5.59) and 2.87 (95% CI: 1.47, 5.59) times greater hazard of death from heart disease, cancer, respiratory illness, and dementia, respectively. CONCLUSIONS Significantly greater risk of mortality from several different causes should be considered alongside the potential costs of screening and intervention for frailty in subspecialty and general geriatric clinical practice. Findings may help investigators estimate the potential impact of frailty reduction approaches on mortality.

中文翻译：

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美国的脆弱表型和特定病因死亡率。

背景技术脆弱是老年人中的常见病，其增加包括死亡在内的不良后果的风险；然而，对于脆弱个体中特定死亡原因的发生率或风险知之甚少。方法数据来自《健康与退休研究》（2004-2012年），与来自国家死亡指数（NDI）的潜在死亡原因信息相关。分析中包括65岁及65岁以上的社区居民HRS参与者，他们完成了一次全面的健康采访和体格测量（n = 10,490）。使用表型模型标准测量虚弱程度-疲劳，体重轻，能量消耗低，步态缓慢和虚弱。使用《国际疾病分类》第10版代码确定了潜在的死亡原因。我们使用Cox比例风险和竞争风险回归模型来计算和比较脆弱状态下特定原因死亡率的发生率。结果在随访期间，与没有症状的个体相比，脆弱和衰老的老年人的全因死亡率危险更大（脆弱前的校正危险比（HR）：1.85、95％CI：1.51、2.25； HR脆弱） ：2.75，95％CI：2.14，3.53）。脆弱与危险度乘以2.96（95％CI：2.17，4.03），2.82（95％CI：2.02，3.94），3.48（95％CI：2.17，5.59）和2.87（95％CI：1.47，5.59）相关。分别来自心脏病，癌症，呼吸系统疾病和痴呆的死亡。结论应考虑到因多种原因引起的更大的死亡风险，以及在亚专业和一般老年医学实践中筛查和干预体弱的潜在成本。研究结果可能有助于调查人员估计减少虚弱方法对死亡率的潜在影响。