两个前瞻性队列中中老年人衰弱变化与听力损失发生的关系

文献信息

中文摘要

目的： 虽然横断面研究已确立衰弱与听力损失患病率升高之间的关联，但其纵向关系尚未被探索。关键的是，此前没有任何研究考虑随访期间衰弱状态的动态变化。因此，本研究在多个队列中探讨了衰弱状态变化与听力损失发生之间的纵向关联。
方法： 我们分析了欧洲健康、老龄与退休调查（SHARE）和健康与退休研究（HRS）的纵向数据。衰弱状态采用Rockwood衰弱指数评估，并分为健壮、衰弱前期或衰弱，通过比较基线与两年随访评估来评价状态变化。使用Cox比例风险模型计算风险比（HR）。
结果： 分析队列包括13 429名HRS参与者和28 475名SHARE参与者。与始终保持健壮者相比，从健壮进展为衰弱前期或衰弱的参与者发生听力损失的风险显著更高（HRS：HR = 1.27，95% CI 1.04-1.56；SHARE：HR = 1.22，95% CI 1.06-1.40）。相反，与始终保持衰弱者相比，从衰弱改善至较轻衰弱状态的参与者发生听力损失的风险更低（HRS：HR = 0.84，95% CI 0.71-0.99；SHARE：HR = 0.72，95% CI 0.58-0.90）。在衰弱前期参与者中，改善至健壮状态与SHARE中较低的风险相关（HR = 0.71，95% CI 0.55-0.90），HRS中呈相似但无统计学意义的关联（HR = 0.79，95% CI 0.62-1.01），而进展为衰弱与听力损失发生风险升高相关（HRS：HR = 1.15，95% CI 1.00-1.33；SHARE：HR = 1.21，95% CI 1.03-1.43）。
结论： 衰弱进展与听力损失发生风险升高相关，而改善至较轻衰弱状态与较低风险相关，突显了衰弱变化在听力健康中的潜在重要性。

英文摘要

AIM: While cross-sectional studies established an association between frailty and elevated hearing loss prevalence, the longitudinal relationship of them remains unexplored. Critically, no prior investigation has accounted for dynamic changes in frailty status during follow-up. This study therefore explored longitudinal associations between changes in frailty status and incident hearing loss across multiple cohorts.
METHODS: We analyzed longitudinal data from the Survey of Health, Aging and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). Frailty status was assessed using the Rockwood frailty index and categorized as robust, pre-frail, or frail, with changes in status evaluated by comparing baseline and two-year follow-up assessments. Cox proportional hazard models were used to calculate the hazard ratio (HR).
RESULTS: The analytical cohorts included 13 429 HRS participants and 28 475 SHARE participants. Compared to those who remained robust, participants progressing from robust to pre-frail or frail status exhibited significantly higher risks of incident hearing loss (HRS: HR = 1.27, 95% CI 1.04-1.56; SHARE: HR = 1.22, 95% CI 1.06-1.40). Conversely, frail participants who improved to a less frail state showed lower risks of incident hearing loss (HRS: HR = 0.84, 95% CI 0.71-0.99; SHARE: HR = 0.72, 95% CI 0.58-0.90) relative to those who remained frail. Among pre-frail participants, improvement to robust status was associated with a lower risk in SHARE (HR = 0.71, 95% CI 0.55-0.90), with a similar but non-significant association in HRS (HR = 0.79, 95% CI 0.62-1.01), whereas progression to frailty was associated with a higher risk of incident hearing loss (HRS: HR = 1.15, 95% CI 1.00-1.33; SHARE: HR = 1.21, 95% CI 1.03-1.43).
CONCLUSION: Frailty progression was associated with an increased risk of incident hearing loss, whereas improvement to a less frail state was associated with a lower risk, highlighting the potential importance of frailty changes in hearing health.