Frailty in middle adulthood and associations with negative health-related outcomes in NHANES
Finamore, Panaiotis ; Pedone, Claudio ; Ekström, Magnus LU
; Mannino, David M.
; Incalzi, Raffaele Antonelli
and Scarlata, Simone
(2026)
In Aging clinical and experimental research
38(1).
- Abstract
Background: Frailty represents a state of compromised ability to cope with environmental stressors and is associated with negative health-related outcomes in older adults. The study objective is to investigate the prevalence and whether frailty associates with negative health-related outcomes in middle-aged adults. Methods: Data were sourced from three 2-year cycles of NHANES surveys and combined with Public-use Linked Mortality Files. A frailty index incorporating thirty variables was developed according to recommended criteria. “Prefrail” individuals were defined with a frailty index value ranging from 0.08 to 0.25, while “Frail” ≥0.25. A 10-year survival analysis was conducted using the Kaplan-Meier estimator, stratified by frailty... (More)
Background: Frailty represents a state of compromised ability to cope with environmental stressors and is associated with negative health-related outcomes in older adults. The study objective is to investigate the prevalence and whether frailty associates with negative health-related outcomes in middle-aged adults. Methods: Data were sourced from three 2-year cycles of NHANES surveys and combined with Public-use Linked Mortality Files. A frailty index incorporating thirty variables was developed according to recommended criteria. “Prefrail” individuals were defined with a frailty index value ranging from 0.08 to 0.25, while “Frail” ≥0.25. A 10-year survival analysis was conducted using the Kaplan-Meier estimator, stratified by frailty state, and hazard ratios were calculated. Associations between frailty and outcomes were quantified using logistic regression models. Bootstrapped C-index and Brier score were calculated in the overall sample and stratified by decades of age. Results: In a sample of 5,745 middle-aged adults, 11% were identified as frail. Over a median follow-up of 5.9 years, 3% of participants died. The frailty index increased with age and its determinants differed across decades of age. Frail, middle aged, individuals faced a three-to-fourfold higher mortality risk, with a C-index of around 65%. Additionally, frailty was associated with a higher likelihood of hospitalization, increased health-care utilization, and changes in health status. Multimorbidity represented a confounder of frailty in the fourth decade, but not in the fifth. Conclusion: Frailty associates with negative health-related outcomes in middle-aged adults, emphasizing the importance of a comprehensive assessment. Multimorbidity only partially accounts for this association.
(Less)
- author
- Finamore, Panaiotis
; Pedone, Claudio
; Ekström, Magnus
LU
; Mannino, David M.
; Incalzi, Raffaele Antonelli
and Scarlata, Simone
- organization
- publishing date
- 2026-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Frailty, Frailty index, Middle aged, Mortality, Outcomes
- in
- Aging clinical and experimental research
- volume
- 38
- issue
- 1
- article number
- 150
- publisher
- Kurtis
- external identifiers
-
- pmid:42001373
- scopus:105041340266
- ISSN
- 1594-0667
- DOI
- 10.1007/s40520-026-03400-9
- language
- English
- LU publication?
- yes
- id
- 32e88a55-707a-4c58-81ef-97fc42d1249b
- date added to LUP
- 2026-07-01 11:45:17
- date last changed
- 2026-08-26 20:14:00
@article{32e88a55-707a-4c58-81ef-97fc42d1249b,
abstract = {{<p>Background: Frailty represents a state of compromised ability to cope with environmental stressors and is associated with negative health-related outcomes in older adults. The study objective is to investigate the prevalence and whether frailty associates with negative health-related outcomes in middle-aged adults. Methods: Data were sourced from three 2-year cycles of NHANES surveys and combined with Public-use Linked Mortality Files. A frailty index incorporating thirty variables was developed according to recommended criteria. “Prefrail” individuals were defined with a frailty index value ranging from 0.08 to 0.25, while “Frail” ≥0.25. A 10-year survival analysis was conducted using the Kaplan-Meier estimator, stratified by frailty state, and hazard ratios were calculated. Associations between frailty and outcomes were quantified using logistic regression models. Bootstrapped C-index and Brier score were calculated in the overall sample and stratified by decades of age. Results: In a sample of 5,745 middle-aged adults, 11% were identified as frail. Over a median follow-up of 5.9 years, 3% of participants died. The frailty index increased with age and its determinants differed across decades of age. Frail, middle aged, individuals faced a three-to-fourfold higher mortality risk, with a C-index of around 65%. Additionally, frailty was associated with a higher likelihood of hospitalization, increased health-care utilization, and changes in health status. Multimorbidity represented a confounder of frailty in the fourth decade, but not in the fifth. Conclusion: Frailty associates with negative health-related outcomes in middle-aged adults, emphasizing the importance of a comprehensive assessment. Multimorbidity only partially accounts for this association.</p>}},
author = {{Finamore, Panaiotis and Pedone, Claudio and Ekström, Magnus and Mannino, David M. and Incalzi, Raffaele Antonelli and Scarlata, Simone}},
issn = {{1594-0667}},
keywords = {{Frailty; Frailty index; Middle aged; Mortality; Outcomes}},
language = {{eng}},
number = {{1}},
publisher = {{Kurtis}},
series = {{Aging clinical and experimental research}},
title = {{Frailty in middle adulthood and associations with negative health-related outcomes in NHANES}},
url = {{http://dx.doi.org/10.1007/s40520-026-03400-9}},
doi = {{10.1007/s40520-026-03400-9}},
volume = {{38}},
year = {{2026}},
}