{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:59:29Z","timestamp":1790823569275,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS\u20102025\u201000519997"],"award-info":[{"award-number":["RS\u20102025\u201000519997"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","award":["2025ER060700"],"award-info":[{"award-number":["2025ER060700"]}],"id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Frailty and chronological age are major prognostic factors in chronic obstructive pulmonary disease (COPD), yet their combined effects have not been fully examined in large population\u2010based cohorts. We investigated whether low frailty attenuates the adverse impact of aging on COPD outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a nationwide retrospective cohort study using the Korean National Health Insurance Service database. Patients aged \u2265 40\u2009years diagnosed with COPD between 2010 and 2021 were included. Frailty was assessed using a claims\u2010based frailty index and categorized as low, intermediate, or high. The primary outcome was all\u2010cause mortality, and the secondary outcome was severe exacerbation. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,505,638 patients with COPD, 784,962 were aged &lt;\u200970\u2009years and 720,676 were aged \u2265\u200970\u2009years. Over a median follow\u2010up of 7.0\u2009years (interquartile range, 3.0\u201310.3), 500,097 deaths and 169,102 severe exacerbations occurred. Compared with older patients (\u2265\u200970\u2009years) with low frailty, intermediate frailty was associated with higher mortality risk in both younger (HR 1.19; 95% CI 1.17\u20131.21) and older patients (HR 1.21; 95% CI 1.20\u20131.21). High frailty showed highest risk (HR 2.66; 95% CI 2.54\u20132.78 in &lt;\u200970\u2009years; HR 1.90; 95% CI 1.87\u20131.93 in \u2265\u200970\u2009years). Similar graded associations were observed for severe exacerbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with COPD, frailty risk provided prognostic information beyond chronological age, highlighting the importance of biological vulnerability in determining outcomes in COPD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/resp.70324","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:43:32Z","timestamp":1790822612000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Frailty, Chronological Age, and Clinical Outcomes in\n                    <scp>COPD<\/scp>\n                    : A Nationwide Cohort Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7786-5051","authenticated-orcid":false,"given":"Taeyun","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine Kosin University Gospel Hospital, Kosin University College of Medicine  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5241-289X","authenticated-orcid":false,"given":"Hyunsoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology Samsung Medical Center  Seoul Republic of Korea"},{"name":"Office of Management and Support, Samsung Comprehensive Cancer Center Samsung Medical Center  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seoyoung","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3164-889X","authenticated-orcid":false,"given":"Sun Hye","family":"Shin","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunji","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaiyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine Ewha Womans University  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhee","family":"Cho","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology Samsung Medical Center  Seoul Republic of Korea"},{"name":"Department of Clinical Research Design and Evaluation SAIHST, Sungkyunkwan University  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0244-7714","authenticated-orcid":false,"given":"Danbee","family":"Kang","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology Samsung Medical Center  Seoul Republic of Korea"},{"name":"Department of Clinical Research Design and Evaluation SAIHST, Sungkyunkwan University  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5937-9671","authenticated-orcid":false,"given":"Hye Yun","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine  Seoul Republic of Korea"},{"name":"Department of Clinical Research Design and Evaluation SAIHST, Sungkyunkwan University  Seoul South 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