Archives of osteoporosis · 2026
Longitudinal trajectories of anxiety-related symptoms and risk of incident hip fracture among middle-aged and older adults in China: a CHARLS analysis.
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Yi Ye, Shi Lixin, Qiu Changjian, Yu Xijie
Аннотация
UNLABELLED: Using CHARLS data, we examined whether longitudinal patterns of anxiety-related symptoms were associated with hip fracture risk. With the lower-decreasing anxiety-related symptom trajectory as the reference group, participants in the higher-increasing anxiety-related symptom trajectory had a significantly greater risk of incident hip fracture. Repeated assessment of anxiety-related symptoms may improve understanding of fracture vulnerability in ageing populations.
PURPOSE: To identify longitudinal trajectories of anxiety-related symptoms among middle-aged and older adults in China and to examine their associations with incident hip fracture risk.
METHODS: We conducted a secondary analysis of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative cohort of adults aged 45 years and older. Anxiety-related symptoms were assessed in 2011, 2013, and 2015 using three anxiety-related items from the Center for Epidemiologic Studies Depression Scale. Latent class mixed models were used to identify distinct anxiety-related symptom trajectories. Incident hip fracture was ascertained by self-report during follow-up interviews in 2018 and 2020. Cox proportional hazards models estimated hazard ratios (HRs) with sequential adjustment for sociodemographic characteristics, health behaviours, and functional status.
RESULTS: Among 9271 participants (mean age 61.7 years; 52.8% women), two trajectories were identified: the lower-decreasing anxiety-related symptom trajectory (84.7%) and the higher-increasing anxiety-related symptom trajectory (15.3%). During follow-up, 170 participants experienced an incident hip fracture. Compared with the lower-decreasing trajectory, the higher-increasing trajectory was associated with a greater risk of hip fracture in crude analyses (HR 2.07, 95% CI 1.48-2.91) and after multivariable adjustment (HR 1.49, 95% CI 1.02-2.17). Sensitivity analyses restricted to a fixed complete-case sample showed similar results.
CONCLUSIONS: A higher-increasing trajectory of anxiety-related symptoms was associated with increased hip fracture risk among middle-aged and older adults in China. These findings suggest that repeated assessment of anxiety-related symptoms may improve understanding of fracture vulnerability and inform future prevention research that considers mental health.
PURPOSE: To identify longitudinal trajectories of anxiety-related symptoms among middle-aged and older adults in China and to examine their associations with incident hip fracture risk.
METHODS: We conducted a secondary analysis of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative cohort of adults aged 45 years and older. Anxiety-related symptoms were assessed in 2011, 2013, and 2015 using three anxiety-related items from the Center for Epidemiologic Studies Depression Scale. Latent class mixed models were used to identify distinct anxiety-related symptom trajectories. Incident hip fracture was ascertained by self-report during follow-up interviews in 2018 and 2020. Cox proportional hazards models estimated hazard ratios (HRs) with sequential adjustment for sociodemographic characteristics, health behaviours, and functional status.
RESULTS: Among 9271 participants (mean age 61.7 years; 52.8% women), two trajectories were identified: the lower-decreasing anxiety-related symptom trajectory (84.7%) and the higher-increasing anxiety-related symptom trajectory (15.3%). During follow-up, 170 participants experienced an incident hip fracture. Compared with the lower-decreasing trajectory, the higher-increasing trajectory was associated with a greater risk of hip fracture in crude analyses (HR 2.07, 95% CI 1.48-2.91) and after multivariable adjustment (HR 1.49, 95% CI 1.02-2.17). Sensitivity analyses restricted to a fixed complete-case sample showed similar results.
CONCLUSIONS: A higher-increasing trajectory of anxiety-related symptoms was associated with increased hip fracture risk among middle-aged and older adults in China. These findings suggest that repeated assessment of anxiety-related symptoms may improve understanding of fracture vulnerability and inform future prevention research that considers mental health.