JOINT ASSOCIATIONS OF CARDIOVASCULAR-KIDNEY-METABOLIC SYNDROME AND DEPRESSIVE SYMPTOMS WITH INCIDENT FRAILTY: THE MEDIATING ROLE OF BODY ROUNDNESS INDEX
Author(s)
Shouchuang Zhang, PhD1, Jia Tang, PhD2, Chen Chen, PhD1, Leyang Han, MPH1, Weiyan Jian, PhD1, Jing Guo, PhD1.
1Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China, 2School of Population and Health, Renmin University of China, Beijing, China.
1Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China, 2School of Population and Health, Renmin University of China, Beijing, China.
OBJECTIVES: Frailty is a multidimensional geriatric syndrome associated with increased vulnerability to adverse outcomes in aging populations. Both cardiovascular-kidney-metabolic (CKM) syndrome and depressive symptoms have been independently linked to frailty, but their combined associations and underlying pathways remain unclear. This study aimed to examine the separate and joint associations of CKM syndrome stages and depressive symptoms with incident frailty, and to explore the potential mediating role of the body roundness index (BRI).
METHODS: We analyzed data from 5,513 adults aged ≥ 45 years without frailty at baseline in the China Health and Retirement Longitudinal Study (2011-2020). Cox proportional hazards models were used to estimate the associations of CKM-depressive symptom profiles with frailty risk. Kaplan-Meier (KM) survival curves illustrated cumulative incidence. Mediation analysis assessed the role of BRI, and exploratory subgroup analysis evaluated potential effect modification.
RESULTS: Over a median follow-up of 10 years, both advanced CKM stages (hazard ratio (HR) = 1.65; 95% confidence interval (CI): 1.42-1.91) and depressive symptoms (HR = 2.12; 95% CI: 1.88-2.39) were independently associated with higher frailty risk. Compared with non-advanced stages without depressive symptoms, individuals with both advanced stages and depressive symptoms had the highest risk (HR = 3.24; 95% CI: 2.66-3.95). KM curves showed a clear and progressive separation in frailty incidence across four profiles. BRI partially mediated the association between advanced CKM with depressive symptoms and frailty, accounting for 10.70% of the total effect.
CONCLUSIONS: The coexistence of advanced CKM syndrome and depressive symptoms markedly increases frailty risk, partly through excess visceral adiposity. Integrating cardiometabolic and mental health assessment with body composition evaluation into screening may improve early identification and enable targeted prevention strategies for high-risk populations.
METHODS: We analyzed data from 5,513 adults aged ≥ 45 years without frailty at baseline in the China Health and Retirement Longitudinal Study (2011-2020). Cox proportional hazards models were used to estimate the associations of CKM-depressive symptom profiles with frailty risk. Kaplan-Meier (KM) survival curves illustrated cumulative incidence. Mediation analysis assessed the role of BRI, and exploratory subgroup analysis evaluated potential effect modification.
RESULTS: Over a median follow-up of 10 years, both advanced CKM stages (hazard ratio (HR) = 1.65; 95% confidence interval (CI): 1.42-1.91) and depressive symptoms (HR = 2.12; 95% CI: 1.88-2.39) were independently associated with higher frailty risk. Compared with non-advanced stages without depressive symptoms, individuals with both advanced stages and depressive symptoms had the highest risk (HR = 3.24; 95% CI: 2.66-3.95). KM curves showed a clear and progressive separation in frailty incidence across four profiles. BRI partially mediated the association between advanced CKM with depressive symptoms and frailty, accounting for 10.70% of the total effect.
CONCLUSIONS: The coexistence of advanced CKM syndrome and depressive symptoms markedly increases frailty risk, partly through excess visceral adiposity. Integrating cardiometabolic and mental health assessment with body composition evaluation into screening may improve early identification and enable targeted prevention strategies for high-risk populations.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH113
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Public Health
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Geriatrics, Mental Health (including addiction)