{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:40:13Z","timestamp":1792464013135,"version":"4.5.0"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":89,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Tianjin Key Medical Discipline (Specialty) Construction Project","award":["TJYXZDXK-3-008C"],"award-info":[{"award-number":["TJYXZDXK-3-008C"]}]},{"name":"New Star of Excellence Project of Tianjin Medical University General Hospital","award":["209060403205"],"award-info":[{"award-number":["209060403205"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Public Health"],"DOI":"10.1186\/s13690-026-01970-8","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T10:29:36Z","timestamp":1784802576000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Frailty transitions and the risk of multisystem burden of chronic disease: a prospective cohort study in China"],"prefix":"10.1186","volume":"84","author":[{"given":"Jian-Cheng","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Weng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"9868","key":"1970_CR1","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","volume":"381","author":"A Clegg","year":"2013","unstructured":"Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752\u201362.","journal-title":"Lancet"},{"issue":"10206","key":"1970_CR2","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1016\/S0140-6736(19)31786-6","volume":"394","author":"EO Hoogendijk","year":"2019","unstructured":"Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365\u201375.","journal-title":"Lancet"},{"issue":"10","key":"1970_CR3","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/jgs.14902","volume":"65","author":"J Walston","year":"2017","unstructured":"Walston J, Robinson TN, Zieman S, McFarland F, Carpenter CR, Althoff KN, et al. Integrating frailty research into the medical specialties\u2014report from a U13 conference. J Am Geriatr Soc. 2017;65(10):2134\u20139.","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"1970_CR4","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1177\/0898264311428490","volume":"24","author":"R Samper-Ternent","year":"2011","unstructured":"Samper-Ternent R, Karmarkar A, Graham J, Reistetter T, Ottenbacher K. Frailty as a predictor of falls in older Mexican Americans. J Aging Health. 2011;24(4):641\u201353.","journal-title":"J Aging Health"},{"key":"1970_CR5","doi-asserted-by":"publisher","first-page":"103875","DOI":"10.1016\/j.ijnurstu.2021.103875","volume":"117","author":"H Si","year":"2021","unstructured":"Si H, Jin Y, Qiao X, Tian X, Liu X, Wang C. Predictive performance of 7 frailty instruments for short-term disability, falls and hospitalization among Chinese community-dwelling older adults: a prospective cohort study. Int J Nurs Stud. 2021;117:103875.","journal-title":"Int J Nurs Stud"},{"issue":"2","key":"1970_CR6","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/ageing\/afx162","volume":"47","author":"G Kojima","year":"2017","unstructured":"Kojima G, Iliffe S, Walters K. Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing. 2017;47(2):193\u2013200.","journal-title":"Age Ageing"},{"issue":"7","key":"1970_CR7","doi-asserted-by":"publisher","first-page":"e323","DOI":"10.1016\/S2468-2667(18)30091-4","volume":"3","author":"P Hanlon","year":"2018","unstructured":"Hanlon P, Nicholl BI, Jani BD, Lee D, McQueenie R, Mair FS. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493\u2008737 UK Biobank participants. Lancet Public Health. 2018;3(7):e323\u201332.","journal-title":"Lancet Public Health"},{"issue":"3","key":"1970_CR8","doi-asserted-by":"publisher","first-page":"e2248995","DOI":"10.1001\/jamanetworkopen.2022.48995","volume":"6","author":"J Jang","year":"2023","unstructured":"Jang J, Jung H, Shin J, Kim DH. Assessment of frailty index at 66 years of age and association with age-related diseases, disability, and death over 10 years in Korea. JAMA Netw Open. 2023;6(3):e2248995\u2013e2248995.","journal-title":"JAMA Netw Open"},{"issue":"10","key":"1970_CR9","doi-asserted-by":"publisher","first-page":"2915","DOI":"10.1111\/jgs.17941","volume":"70","author":"J Quach","year":"2022","unstructured":"Quach J, Theou O, P\u00e9rez-Zepeda MU, Godin J, Rockwood K, Kehler DS. Effect of a physical activity intervention and frailty on frailty trajectory and major mobility disability. J Am Geriatr Soc. 2022;70(10):2915\u201324.","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"1970_CR10","doi-asserted-by":"publisher","first-page":"afad012","DOI":"10.1093\/ageing\/afad012","volume":"52","author":"J Travers","year":"2023","unstructured":"Travers J, Romero-Ortuno R, Langan J, MacNamara F, McCormack D, McDermott C, et al. Building resilience and reversing frailty: A randomised controlled trial of a primary care intervention for older adults. Age Ageing. 2023;52(2):afad012.","journal-title":"Age Ageing"},{"issue":"4","key":"1970_CR11","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1002\/agm2.12349","volume":"7","author":"U Bhattarai","year":"2024","unstructured":"Bhattarai U, Bashyal B, Shrestha A, Koirala B, Sharma SK. Frailty and chronic diseases: a bi-directional relationship. Aging Med. 2024;7(4):510\u20135.","journal-title":"Aging Med"},{"issue":"8","key":"1970_CR12","doi-asserted-by":"publisher","first-page":"e463","DOI":"10.1093\/geront\/gnaa061","volume":"61","author":"M Welstead","year":"2020","unstructured":"Welstead M, Jenkins ND, Russ TC, Luciano M, Muniz-Terrera G. A systematic review of frailty trajectories: their shape and influencing factors. Gerontologist. 2020;61(8):e463\u201375.","journal-title":"Gerontologist"},{"issue":"1","key":"1970_CR13","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1093\/ije\/dys203","volume":"43","author":"Y Zhao","year":"2012","unstructured":"Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: The China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol. 2012;43(1):61\u20138.","journal-title":"Int J Epidemiol"},{"issue":"1","key":"1970_CR14","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1471-2318-8-24","volume":"8","author":"SD Searle","year":"2008","unstructured":"Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8(1):24.","journal-title":"BMC Geriatr"},{"issue":"3","key":"1970_CR15","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.chest.2023.07.020","volume":"165","author":"D He","year":"2024","unstructured":"He D, Yan M, Zhou Y, Ge H, Zhang X, Xu Y, et al. Preserved ratio impaired spirometry and COPD accelerate frailty progression: evidence from a prospective cohort study. Chest. 2024;165(3):573\u201382.","journal-title":"Chest"},{"issue":"12","key":"1970_CR16","doi-asserted-by":"publisher","first-page":"e650","DOI":"10.1016\/S2468-2667(20)30113-4","volume":"5","author":"J Fan","year":"2020","unstructured":"Fan J, Yu C, Guo Y, Bian Z, Sun Z, Yang L, et al. Frailty index and all-cause and cause-specific mortality in Chinese adults: a prospective cohort study. Lancet Public Health. 2020;5(12):e650\u201360.","journal-title":"Lancet Public Health"},{"key":"1970_CR17","doi-asserted-by":"publisher","first-page":"110145","DOI":"10.1016\/j.diabres.2022.110145","volume":"194","author":"D He","year":"2022","unstructured":"He D, Li J, Li Y, Zhu J, Zhou T, Xu Y, et al. Frailty is associated with the progression of prediabetes to diabetes and elevated risks of cardiovascular disease and all-cause mortality in individuals with prediabetes and diabetes: evidence from two prospective cohorts. Diabetes Res Clin Pract. 2022;194:110145.","journal-title":"Diabetes Res Clin Pract"},{"issue":"1","key":"1970_CR18","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1093\/biomet\/69.1.239","volume":"69","author":"D Schoenfeld","year":"1982","unstructured":"Schoenfeld D. Partial residuals for the proportional hazards regression model. Biometrika. 1982;69(1):239\u201341.","journal-title":"Biometrika"},{"issue":"1","key":"1970_CR19","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/1471-2288-9-57","volume":"9","author":"A Marshall","year":"2009","unstructured":"Marshall A, Altman DG, Holder RL, Royston P. Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelines. BMC Med Res Methodol. 2009;9(1):57.","journal-title":"BMC Med Res Methodol"},{"key":"1970_CR20","unstructured":"R:A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2014;1. https:\/\/www.R-project.org\/."},{"key":"1970_CR21","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.jad.2024.04.024","volume":"356","author":"J-H Chen","year":"2024","unstructured":"Chen J-H, Lei H, Wan Y-F, Zhu X-C, Zeng L-Y, Tang H-X, et al. Frailty and psychiatric disorders: a bidirectional Mendelian randomization study. J Affect Disord. 2024;356:346\u201355.","journal-title":"J Affect Disord"},{"issue":"6","key":"1970_CR22","first-page":"1383","volume":"81","author":"J-Y Choi","year":"2024","unstructured":"Choi J-Y, Ryu DR, Lee H-Y, Lee J-H, Hong Y, Park SK, et al. Association between orthostatic hypertension and frailty among older patients with hypertension. Hypertension. 2024;81(6):1383\u201390.","journal-title":"Hypertension"},{"issue":"1","key":"1970_CR23","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s40520-024-02867-8","volume":"36","author":"G-Y Feng","year":"2024","unstructured":"Feng G-Y, Li J-X, Li G-S, Liu J, Gao X, Yan G-Q, et al. Association between frailty status and risk of chronic lung disease: an analysis based on two national prospective cohorts. Aging Clin Exp Res. 2024;36(1):215.","journal-title":"Aging Clin Exp Res"},{"issue":"S2","key":"1970_CR24","doi-asserted-by":"publisher","first-page":"e091773","DOI":"10.1002\/alz.091773","volume":"20","author":"FB Soares","year":"2025","unstructured":"Soares FB, Leite REP, Grinberg LT, Paes VR, Rodriguez RD, Pasqualucci CA, et al. Association of frailty and neuropathology of neurodegenerative and brain vascular diseases. Alzheimers Dement. 2025;20(S2):e091773.","journal-title":"Alzheimers Dement"},{"issue":"14","key":"1970_CR25","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.2169\/internalmedicine.4399-19","volume":"59","author":"D Asaoka","year":"2020","unstructured":"Asaoka D, Takeda T, Inami Y, Abe D, Shimada Y, Matsumoto K, et al. The association between frailty and abdominal symptoms: a hospital-based cross-sectional study. Intern Med. 2020;59(14):1677\u201385.","journal-title":"Intern Med"},{"issue":"1","key":"1970_CR26","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1186\/s12944-024-02147-4","volume":"23","author":"H Yin","year":"2024","unstructured":"Yin H, Guo L, Zhu W, Li W, Zhou Y, Wei W, et al. Association of the triglyceride-glucose index and its related parameters with frailty. Lipids Health Dis. 2024;23(1):150.","journal-title":"Lipids Health Dis"},{"issue":"suppl_1","key":"1970_CR27","doi-asserted-by":"publisher","first-page":"A30","DOI":"10.1161\/str.43.suppl_1.A30","volume":"43","author":"S Haque","year":"2012","unstructured":"Haque S, Reeves MJ, Sucharew H, Alwell KA, Moomaw CJ, Woo D, et al. Abstract 30: The frailty index: A novel predictor of stroke outcomes. Stroke. 2012;43(suppl_1):A30\u2013A30.","journal-title":"Stroke"},{"key":"1970_CR28","doi-asserted-by":"crossref","unstructured":"Huang S-T, Chen L-K, Hsiao F-Y. Clinical impacts of frailty on 123,172 people with diabetes mellitus considering the age of onset and drugs of choice: a nationwide population-based 10-year trajectory analysis. Age Ageing. 2023;52(7):afad128.","DOI":"10.1093\/ageing\/afad128"},{"issue":"12","key":"1970_CR29","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1093\/eurheartj\/ehad885","volume":"45","author":"D He","year":"2024","unstructured":"He D, Wang Z, Li J, Yu K, He Y, He X, et al. Changes in frailty and incident cardiovascular disease in three prospective cohorts. Eur Heart J. 2024;45(12):1058\u201368.","journal-title":"Eur Heart J"},{"key":"1970_CR30","doi-asserted-by":"crossref","unstructured":"O\u2019Brien MW, Maxwell SP, Moyer R, Rockwood K, Theou O. Development and validation of a frailty index for use in the osteoarthritis initiative. Age Ageing. 2024;53(6):afae125.","DOI":"10.1093\/ageing\/afae125"},{"key":"1970_CR31","doi-asserted-by":"crossref","unstructured":"Wang S, Whitlock R, Xu C, Taneja S, Singh S, Abraldes JG, Burak KW, Bailey RJ, Lai JC, Tandon P. Frailty is associated with increased risk of cirrhosis disease progression and death. Hepatology. 2022;75(3):600\u20139.","DOI":"10.1002\/hep.32157"},{"issue":"1","key":"1970_CR32","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1007\/s40520-024-02906-4","volume":"37","author":"P Ning","year":"2024","unstructured":"Ning P, Mu X, Guo X, Zhou R, Tian G, Li R. The causal association between asthma and the risk of frailty: a two-sample Mendelian randomization study. Aging Clin Exp Res. 2024;37(1):10.","journal-title":"Aging Clin Exp Res"},{"issue":"1","key":"1970_CR33","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1007\/s40520-024-02777-9","volume":"36","author":"J Wei","year":"2024","unstructured":"Wei J, Wang J, Chen J, Yang K, Liu N. Stroke and frailty index: a two-sample Mendelian randomisation study. Aging Clin Exp Res. 2024;36(1):114.","journal-title":"Aging Clin Exp Res"},{"key":"1970_CR34","doi-asserted-by":"crossref","unstructured":"Li S, Shi Y, Fang W, Feng Y. A bidirectional Mendelian randomisation study of the association between rheumatoid arthritis and frailty. Clin Exp Rheumatol. 2023;42(3):689\u201395.","DOI":"10.55563\/clinexprheumatol\/uuli6y"},{"issue":"1","key":"1970_CR35","doi-asserted-by":"publisher","first-page":"21862","DOI":"10.1038\/s41598-024-71881-7","volume":"14","author":"HJ Chen","year":"2024","unstructured":"Chen HJ, Qiu J, Guo Y, Chen F. Genetically predicted frailty index and risk of chronic kidney disease. Sci Rep. 2024;14(1):21862.","journal-title":"Sci Rep"},{"key":"1970_CR36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.arr.2016.08.006","volume":"31","author":"P Soysal","year":"2016","unstructured":"Soysal P, Stubbs B, Lucato P, Luchini C, Solmi M, Peluso R, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis. Ageing Res Rev. 2016;31:1\u20138.","journal-title":"Ageing Res Rev"},{"issue":"5","key":"1970_CR37","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/j.cmet.2024.03.012","volume":"36","author":"M Mishra","year":"2024","unstructured":"Mishra M, Wu J, Kane AE, Howlett SE. The intersection of frailty and metabolism. Cell Metab. 2024;36(5):893\u2013911.","journal-title":"Cell Metab"},{"issue":"11","key":"1970_CR38","doi-asserted-by":"publisher","first-page":"3318","DOI":"10.1038\/s41591-024-03184-3","volume":"30","author":"C Li","year":"2024","unstructured":"Li C, Wang L, Ding L, Zhou Y. Determinants and inequities in healthy working life expectancy in China. Nat Med. 2024;30(11):3318\u201326.","journal-title":"Nat Med"},{"issue":"11","key":"1970_CR39","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1093\/gerona\/glv133","volume":"70","author":"K Bandeen-Roche","year":"2015","unstructured":"Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, et al. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70(11):1427\u201334.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"8","key":"1970_CR40","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.je.2016.09.008","volume":"27","author":"G Kojima","year":"2017","unstructured":"Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of frailty in Japan: a systematic review and meta-analysis. J Epidemiol. 2017;27(8):347\u201353.","journal-title":"J Epidemiol"},{"key":"1970_CR41","doi-asserted-by":"publisher","first-page":"2842","DOI":"10.3390\/ijms20112842","volume":"20","author":"ME G\u00f3mez-G\u00f3mez","year":"2019","unstructured":"G\u00f3mez-G\u00f3mez ME, Zapico SC. Frailty, cognitive decline, neurodegenerative diseases and nutrition interventions. Int J Mol Sci. 2019;20:2842.","journal-title":"Int J Mol Sci"},{"issue":"5","key":"1970_CR42","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.jacc.2021.11.029","volume":"79","author":"N Ijaz","year":"2022","unstructured":"Ijaz N, Buta B, Xue Q-L, Mohess DT, Bushan A, Tran H, et al. Interventions for frailty among older adults with cardiovascular disease: JACC\u00a0state-of-the-art review. J Am Coll Cardiol. 2022;79(5):482\u2013503.","journal-title":"J Am Coll Cardiol"},{"issue":"11","key":"1970_CR43","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1016\/j.amjmed.2015.06.017","volume":"128","author":"TP Ng","year":"2015","unstructured":"Ng TP, Feng L, Nyunt MSZ, Feng L, Niti M, Tan BY, et al. Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: a randomized controlled trial. Am J Med. 2015;128(11):1225-1236.e1221.","journal-title":"Am J Med"}],"container-title":["Archives of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13690-026-01970-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-026-01970-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-026-01970-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T02:18:28Z","timestamp":1792462708000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13690-026-01970-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1970"],"URL":"https:\/\/doi.org\/10.1186\/s13690-026-01970-8","relation":{},"ISSN":["2049-3258"],"issn-type":[{"value":"2049-3258","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"assertion":[{"value":"14 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval for this study was conducted by the China Health and Retirement Longitudinal Study was approved by the Ethics Review Committee of Peking University (IRB00001052-11015). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All participants were informed about the purpose of the study, assured of confidentiality, and provided written consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"226"}}