Longitudinal trajectories of anxiety-related symptoms and risk of incident hip fracture among middle-aged and older adults in China: a CHARLS analysis.

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.