Mediation of Healthy Behaviour on the Association of Frailty with Respiratory Diseases Mortality among 0.4 Million Participants: A Prospective Cohort Study from UK Biobank

Abstract

The mutual relationship between frailty and healthy behaviour and its effect on respiratory diseases mortality remains largely unknown; this study aims to supplement related analysis on it by using a large sample cohort study. We included 411,987 participants from the UK Biobank study (2006–2021), and measured participants’ frailty phenotype and healthy behaviour index by using questionnaires and physical measurement. Mortality from respiratory diseases were obtained through linkage to registries. We used the cox proportional hazards model to explore the association of frailty with respiratory diseases mortality, and calculated the mediation proportion of the healthy behaviour. During a median follow-up of 12.48 years, and after adjustment for other covariates and healthy behaviour index, when compared with non-frail participants, being frail was associated with 2.68 times, 3.27 times, and 3.31 times higher risk of total respiratory diseases mortality, influenza and pneumonia mortality and chronic lower respiratory diseases mortality, respectively. The attenuated proportions mediated by healthy behaviour were 5.1% (95% CI: 4.4%, 5.9%), 3.0% (95% CI: 2.1%, 4.2%) and 6.0% (95% CI: 4.9%, 7.4%), respectively. Compared with non-frail individuals with four or five healthy behaviours, frail individuals with no or one healthy behaviour had higher risks of total respiratory diseases mortality (aHR = 4.59; 95% CI: 3.27, 6.45), influenza and pneumonia mortality (aHR = 4.55; 95% CI: 2.30, 9.03), as well as chronic lower respiratory diseases mortality (aHR = 12.70; 95% CI: 5.76, 27.96). Adherence to a healthy lifestyle therefore represents a potentially modifiable target for improving the harmful impact of frailty on reduced life expectancy as a result of respiratory diseases.

The prevalence of mpox and its association with sexual behavior among Chinese men who have sex with men in early August 2023

“…We measured the interaction of the product term. 26,27 To further assess the robustness of results, we did the sensitivity analysis 1: we used continuous mode of these variables including age, mpox-related knowledge and sexual diseases scores in model 3. To compare the estimates of specific sexual behaviors, we supplemented the associations of three sexual behaviors including condomless anal intercourse, commercial sex, and group sex in the last month with mpox.…”

“…The significance of an interaction was tested by including a product term in the model 3 in the stratified analysis. We measured the interaction of the product term 26,27 . To further assess the robustness of results, we did the sensitivity analysis 1: we used continuous mode of these variables including age, mpox‐related knowledge and sexual diseases scores in model 3.…”

Lower rate of mpox vaccination hesitancy and medical consultation among Chinese men who have sex with men living with HIV in comparison with those living without HIV: A national observational study

“…We measured the interaction of the product term. 26 , 27 All analyses were conducted using R 4.2.0. A two-sided P value less than .05 was considered to be statistically significant.…”

Healthy aging, early screening, and interventions for frailty in the elderly

“…A study in the UK has shown that frailty was associated with mortality from respiratory diseases, while healthy behavior was able to mediate frailty to a certain extent. Therefore, promotion of a healthy lifestyle may be able to substantially attenuate the contribution of frailty to mortality from respiratory diseases (72).…”