Shuyuan Li and colleagues from the Thoracic Surgery Laboratory, Xuzhou Medical University, Jiangsu, China, and colleagues analyzed data from four national prospective cohort studies—the China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS), and Survey of Health, Ageing and Retirement in Europe (SHARE)—comprising 38,122 adults. Frailty transitions were assessed using the Rockwood Frailty Index, and CLD incidence was determined through self-reported, physician-diagnosed cases of chronic bronchitis, emphysema, and cor pulmonale.
The study led to the following findings:
- Individuals who transitioned from a robust to prefrail or frail state had a significantly higher risk of developing chronic lung disease (CLD) compared to those who remained robust, with hazard ratios ranging from 1.58 to 1.85 across the cohorts (CHARLS: HR 1.85; HRS: HR 1.84; ELSA: HR 1.58; SHARE: HR 1.70).
- Participants who recovered from prefrail or frail status to robust health had a significantly lower risk of developing CLD compared to those who remained in prefrail or frail states, with hazard ratios ranging from 0.57 to 0.71 (CHARLS: HR 0.59; HRS: HR 0.71; ELSA: HR 0.57; SHARE: HR 0.71).
According to the authors, these findings highlight that frailty progression and recovery are dynamic processes that can serve as early indicators of CLD risk. Individuals showing signs of increasing frailty may benefit from targeted screening and preventive interventions to mitigate respiratory decline.
While the study offers robust evidence linking frailty transitions with CLD risk, the researchers acknowledged several limitations. The reliance on self-reported physician diagnoses could introduce misclassification bias, and the inability to combine datasets from all cohorts limited cross-population comparisons. Furthermore, unmeasured confounding factors—such as genetic predispositions, dietary habits, and varying rates of deficit accumulation—could not be fully excluded.
Another limitation noted was the exclusion of participants lost to follow-up, which may have introduced selection bias. The researchers suggested that future investigations incorporate advanced statistical techniques, such as multiple imputation, to minimize bias related to attrition. They also emphasized the need to include data from countries with lower economic status to enhance the global applicability of the findings.
Despite these limitations, the study provides compelling evidence that frailty changes are strong predictors of future CLD risk. Progression in frailty status amplifies susceptibility, whereas recovery from frailty significantly reduces it. The authors concluded that regular assessment of frailty dynamics may play a vital role in identifying individuals at risk for chronic lung disease and guiding timely preventive strategies.
Reference:
Li, S., Tang, X., Ge, Y. et al. Association between frailty transitions and chronic lung disease incidence: findings from four national cohort studies. BMC Public Health 25, 3313 (2025). https://doi.org/10.1186/s12889-025-24361-0
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