衰弱指数可预测中老年人的听力损失：基于全球、队列和遗传数据的三重分析

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中文摘要

目的： 通过整合GBD 2021、CHARLS和孟德尔随机化（MR）进行三角验证，探讨衰弱（衰弱指数，FI）与听力损失发病之间的关联。
方法： 使用GBD 2021分析全球趋势。在CHARLS（2011-2020）中，计算≥45岁成年人的FI。使用逻辑回归、限制性立方样条和ROC曲线评估其与听力损失发病的关联。两样本MR采用逆方差加权、加权中位数和MR-Egger方法。
结果： GBD显示全球听力损失负担不断增加，尤其是在低收入和中等收入国家的老年人中。在CHARLS中，较高的FI独立预测听力损失发病：中度衰弱使风险增加66%（OR = 1.66，95% CI：1.29-2.12），重度衰弱增加141%（OR = 2.41，95% CI：1.47-3.95）。FI每增加一个单位，风险增加9%（OR = 1.09，95% CI：1.04-1.14）。RCS识别出非线性阈值（FI ≈ 0.29）。将FI加入传统危险因素可改善预测（AUC：0.586至0.685）。MR支持遗传预测的衰弱对听力损失存在因果效应，且无多效性证据。
结论： 衰弱指数是听力损失发病的稳健、独立且非线性的预测因子。整合衰弱评估可增强早期识别并支持针对性预防。
证据等级： II。

英文摘要

OBJECTIVE: To examine the association between frailty (Frailty Index, FI) and incident hearing loss using triangulation across GBD 2021, CHARLS, and Mendelian Randomization (MR).
METHODS: Global trends were analyzed with GBD 2021. In CHARLS (2011-2020), FI was calculated for adults ≥ 45-years. Associations with incident hearing loss were assessed using logistic regression, restricted cubic splines, and ROC curves. Two-sample MR employed inverse-variance weighted, weighted median, and MR-Egger methods.
RESULTS: GBD revealed increasing hearing loss burden globally, especially among older adults in low- and middle-income countries. In CHARLS, higher FI independently predicted incident hearing loss: moderate frailty increased odds by 66% (OR = 1.66, 95% CI: 1.29-2.12) and severe frailty by 141% (OR = 2.41, 95% CI: 1.47-3.95). Each unit FI increase conferred a 9% higher risk (OR = 1.09, 95% CI: 1.04-1.14). RCS identified a nonlinear threshold (FI ≈ 0.29). Adding FI to conventional risk factors improved prediction (AUC: 0.586 to 0.685). MR supported a causal effect of genetically predicted frailty on hearing loss with no evidence of pleiotropy.
CONCLUSION: The Frailty Index is a robust, independent, and nonlinear predictor of incident hearing loss. Integrating frailty assessment enhances early identification and supports targeted prevention.
LEVEL OF EVIDENCE: II.