Dynamic frailty and depressive symptoms in relation to incident stroke: findings from five harmonized longitudinal cohorts

作者：Jiang Y, Wang Q, Zhang J, Shan M, Guo Q · 发表于：Frontiers in neurology · 年份：2026 · DOI：10.3389/fneur.2026.1880619 · 被引用次数：45 · 研究领域：aging cohorts、competing risk、depressive symptoms、frailty index、incident stroke、mediation analysis、restricted cubic spline、two-wave cross-lagged panel model

BACKGROUND: Frailty and depressive symptoms are common in later life and may be related to cerebrovascular risk. Evidence remains limited on whether frailty burden and frailty change are associated with incident stroke across diverse aging cohorts. METHODS: We analyzed harmonized longitudinal data from five population-based aging cohorts: the Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Ageing (ELSA), and Mexican Health and Aging Study (MHAS). Frailty was measured using a harmonized 24-item deficit-accumulation frailty index (FI). The primary analysis used cohort-specific Cox proportional hazards models to estimate associations between baseline FI and first observed incident stroke during follow-up. Secondary exploratory analyses evaluated nonlinearity, FI change, competing mortality, depressive symptoms as a pathway marker, and two-wave cross-lagged associations. RESULTS: The analytic sample included 81482 participants and 5,089 incident stroke events. In fully adjusted cohort-specific Cox models, each 0.1-unit increase in FI was associated with higher stroke risk in HRS, CHARLS, SHARE, and MHAS, but not in ELSA. Substantial between-cohort heterogeneity was observed; therefore, cohort-specific estimates were interpreted as the primary results and the random-effects pooled estimate was treated as descriptive. Fine-Gray sensitivity analyses ...