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Background <p>Frailty is a critical geriatric syndrome associated with modifiable lifestyle factors, yet their population-level contributions remain unclear. This study aimed to quantify the proportion of frailty incidence attributable to modifiable lifestyle factors and assess temporal trends in the US.</p> Methods <p>We analyzed data from 26,247 participants in the Health and Retirement Study (2004–2020) involving adults aged ≥ 50 years. Frailty was assessed using the Paulson-Lichtenberg Frailty Index. Lifestyle exposures included smoking, drinking, physical inactivity, and sleep disturbance. Associations between lifestyle factors and frailty were examined using Cox models. Population attributable fractions (PAFs) were calculated for each factor, with temporal trends assessed using generalized estimating equations with splines.</p> Results <p>From 2004 to 2020, frailty incidence declined from 55.2 to 46.6 per 1,000 person-years. Current smoking (HR = 1.46, 95% CI: 1.38, 1.55), physical inactivity (HR = 1.56, 95% CI: 1.48, 1.65), and sleep disturbance (HR = 1.42, 95% CI: 1.36, 1.47) were positively associated with frailty, while current drinking (HR = 0.79, 95% CI: 0.76, 0.83) was negatively associated. The PAFs analyses revealed that sleep disturbance (PAF = 14.43%) and non-current drinking (13.91%) were the leading contributors of frailty, followed by physical inactivity (5.45%) and smoking (5.08%). Only the contribution of physical inactivity increased significantly over time (<i>P</i><sub>trend</sub> &lt; 0.01).</p> Conclusion <p>Four lifestyle factors collectively accounted for nearly 40% of frailty cases among US adults aged ≥ 50 years. The apparent protective role of drinking warrants caution due to potential “sick quitter” bias. The increasing contribution of physical inactivity highlights the need for prioritizing exercise promotion in frailty prevention.</p>

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Trends and lifestyle contributions to frailty in US adults aged 50 and older: analysis of health and retirement study data (2004–2020)

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月20日

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  • Shui-Kit Cheuk,
  • Hui-Wen Xu,
  • Yuming Chen,
  • He-Xuan Su,
  • Hui Liu,
  • Kaipeng Wang,
  • Zhou Yang,
  • Le Ma,
  • Hui-Jing Zhang,
  • Yanran Deng,
  • Ngeemasara Thapa,
  • Beibei Xu

摘要

Background

Frailty is a critical geriatric syndrome associated with modifiable lifestyle factors, yet their population-level contributions remain unclear. This study aimed to quantify the proportion of frailty incidence attributable to modifiable lifestyle factors and assess temporal trends in the US.

Methods

We analyzed data from 26,247 participants in the Health and Retirement Study (2004–2020) involving adults aged ≥ 50 years. Frailty was assessed using the Paulson-Lichtenberg Frailty Index. Lifestyle exposures included smoking, drinking, physical inactivity, and sleep disturbance. Associations between lifestyle factors and frailty were examined using Cox models. Population attributable fractions (PAFs) were calculated for each factor, with temporal trends assessed using generalized estimating equations with splines.

Results

From 2004 to 2020, frailty incidence declined from 55.2 to 46.6 per 1,000 person-years. Current smoking (HR = 1.46, 95% CI: 1.38, 1.55), physical inactivity (HR = 1.56, 95% CI: 1.48, 1.65), and sleep disturbance (HR = 1.42, 95% CI: 1.36, 1.47) were positively associated with frailty, while current drinking (HR = 0.79, 95% CI: 0.76, 0.83) was negatively associated. The PAFs analyses revealed that sleep disturbance (PAF = 14.43%) and non-current drinking (13.91%) were the leading contributors of frailty, followed by physical inactivity (5.45%) and smoking (5.08%). Only the contribution of physical inactivity increased significantly over time (Ptrend < 0.01).

Conclusion

Four lifestyle factors collectively accounted for nearly 40% of frailty cases among US adults aged ≥ 50 years. The apparent protective role of drinking warrants caution due to potential “sick quitter” bias. The increasing contribution of physical inactivity highlights the need for prioritizing exercise promotion in frailty prevention.