Associations of chronic lung disease, insufficient sleep, and pain with incident frailty in Chinese middle-aged and older adults

Objectives: Chronic lung disease, insufficient sleep, and chronic pain are prevalent among middle-aged and older adults and may synergistically accelerate frailty. This study was conducted to examine the independent and combined associations of chronic lung disease, insufficient sleep, and pain with frailty risk among middle-aged and older Chinese adults. Methods: This study used data from the China Health and Retirement Longitudinal Study. Multivariable logistic regression and mediation analyses were used to examine the associations among chronic lung disease, insufficient sleep, pain, and frailty. Pain was categorized into any bodily pain and chest pain, with the latter analyzed separately due to its potential relationship with chronic lung disease. Subgroup analyses stratified by age and sex were also conducted to assess effect modification. Results: Chronic lung disease combined with insufficient sleep (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.70-4.22), pain (OR, 3.04; 95% CI, 1.86-4.86), or chest pain (OR, 2.58; 95% CI, 1.07-5.56) was significantly associated with higher odds of frailty. Subgroup analyses showed an interaction among chronic lung disease, chest pain, and age (p for interaction <0.05). Mediation analysis revealedanalyses indicated that sleep, pain, and chest pain mediated 10.1%, 26.2%, and 14.0% of the association between chronic lung disease and frailty, respectively. Conclusion: The combined presence of chronic lung disease with insufficient sleep or pain was associated with an increased risk of incident frailty. Screening and interventions targeting these factors may help mitigate frailty among middle-aged and older adults.