Frontiers in public health · 2026
Independent and joint associations of intrinsic capacity and frailty index with incident disability and all-cause mortality among older Chinese adults.
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Feng Bing, Wang Ji, Li Yaowen, Ma Liangliang, Yin Yue, Xu Juan, Dong Yuhan
Аннотация
BACKGROUND: Intrinsic capacity (IC) and the frailty index (FI) constitute two conceptually distinct frameworks for evaluating health status in later life; however, their comparative and combined prognostic utility for incident disability and all-cause mortality has not been fully elucidated.
METHODS: This prospective cohort study included 7,168 adults aged ≥60 years from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey. IC was evaluated across five domains and aggregated into a composite score ranging from 0 to 10. FI was derived using a deficit accumulation approach. Incident disability was defined as new-onset limitation in at least one of six basic activities of daily living in 2018. All-cause mortality was ascertained during follow-up. Multivariable logistic regression and Cox proportional hazards models were applied, together with joint association and incremental predictive analyses.
RESULTS: In fully adjusted models, higher IC was independently associated with lower odds of incident disability [odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.74-0.84], whereas higher FI was associated with greater odds of disability (OR per 0.1 increase = 1.93, 95% CI: 1.67-2.23). Similarly, higher IC was associated with reduced risk of all-cause mortality [hazard ratio (HR) = 0.84, 95% CI: 0.82-0.85], whereas higher FI was associated with increased mortality risk (HR per 0.1 increase = 1.25, 95% CI: 1.19-1.31). After mutual adjustment, both IC and FI remained significantly associated with incident disability, whereas only IC remained significantly associated with all-cause mortality. Participants with concomitantly lower IC and higher FI exhibited the greatest risks of both disability (OR = 4.31, 95% CI: 2.65-7.04) and mortality (HR = 2.66, 95% CI: 2.32-3.04).
CONCLUSION: Both IC and FI were significantly associated with incident disability and all-cause mortality among older Chinese adults. The combination of IC and FI identified distinct profiles of functional and mortality risk, while IC showed a stronger association with mortality than FI.
METHODS: This prospective cohort study included 7,168 adults aged ≥60 years from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey. IC was evaluated across five domains and aggregated into a composite score ranging from 0 to 10. FI was derived using a deficit accumulation approach. Incident disability was defined as new-onset limitation in at least one of six basic activities of daily living in 2018. All-cause mortality was ascertained during follow-up. Multivariable logistic regression and Cox proportional hazards models were applied, together with joint association and incremental predictive analyses.
RESULTS: In fully adjusted models, higher IC was independently associated with lower odds of incident disability [odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.74-0.84], whereas higher FI was associated with greater odds of disability (OR per 0.1 increase = 1.93, 95% CI: 1.67-2.23). Similarly, higher IC was associated with reduced risk of all-cause mortality [hazard ratio (HR) = 0.84, 95% CI: 0.82-0.85], whereas higher FI was associated with increased mortality risk (HR per 0.1 increase = 1.25, 95% CI: 1.19-1.31). After mutual adjustment, both IC and FI remained significantly associated with incident disability, whereas only IC remained significantly associated with all-cause mortality. Participants with concomitantly lower IC and higher FI exhibited the greatest risks of both disability (OR = 4.31, 95% CI: 2.65-7.04) and mortality (HR = 2.66, 95% CI: 2.32-3.04).
CONCLUSION: Both IC and FI were significantly associated with incident disability and all-cause mortality among older Chinese adults. The combination of IC and FI identified distinct profiles of functional and mortality risk, while IC showed a stronger association with mortality than FI.