Association Between Frailty and Chronic Liver Disease Among Middle-Aged and Older Adults in China: A Nationwide Cohort Study Based on the CHARLS.

BACKGROUND: Chronic liver disease (CLD) is a significant public health burden in China. This study aimed to investigate the unclear correlation between frailty-characterized by diminished physiological reserves-and CLD risk among middle-aged and elderly Chinese adults. METHODS: Using data from the China Health and Retirement Longitudinal Study (CHARLS), we evaluated associations between the frailty index (FI) and CLD via cross-sectional and longitudinal analyses. Multivariable logistic regression and Cox proportional hazards models were used to assess CLD prevalence and incidence, respectively. Restricted cubic spline, Kaplan-Meier, and sensitivity analyses were also performed. RESULTS: The study included 16 936 participants for cross-sectional and 14 901 for longitudinal analyses. Cross-sectionally, frailty showed a significant dose-response relationship with CLD prevalence: in fully adjusted models, pre-frail (OR = 1.84, 95% CI: 1.49-2.28) and frail (OR = 3.14, 95% CI: 2.46-4.02) groups had elevated risks compared with nonfrail individuals. Longitudinally, baseline frailty independently predicted incident CLD (prefrail: HR = 1.35, 95% CI: 1.16-1.56; frail: HR = 1.76, 95% CI: 1.45-2.12). Additionally, each 10-unit FI increase raised CLD prevalence (OR = 1.29, 95% CI: 1.22-1.37) and incidence (HR = 1.15, 95% CI: 1.09-1.22) risks. CONCLUSIONS: In middle-aged and older Chinese adults, frailty exhibits a dose-response association with CLD prevalence and incidence, with notably elevated risks even in pre-frailty. Frailty assessment may identify high-risk populations, offering new avenues for primary prevention and integrated interventions amid aging-related liver diseases.