Frailty and the risk of infection-related hospitalizations in older age: Differences by sex. (February 2023)

• Record Type: Journal Article
• Authors: Trevisan, Caterina; Noale, Marianna; Amidei, Claudio Barbiellini; Ferroni, Eliana; Basso, Cristina; Fedeli, Ugo; Baggio, Giovannella; Maggi, Stefania; Sergi, Giuseppe
• Is Part Of: Maturitas. Volume 168(2023)
• Page Start: 1
• Page End: 6
• Publication Date: 2023-02
• Subjects: Frailty -- Infectious diseases -- Hospitalization -- Sex differences; Climacteric -- Periodicals; Menopause -- Periodicals; Climacteric -- Periodicals; Geriatrics -- Periodicals; Menopause -- Periodicals; Middle Aged -- Periodicals; Climatère -- Périodiques; Ménopause -- Périodiques; Climacterium; Climacteric; Menopause; Electronic journals; Periodicals; 612.66
• DOI: 10.1016/j.maturitas.2022.10.009
• Languages: English
• ISSNs: 0378-5122

Abstract

Highlights: Frailty is associated with infection-related hospitalization, especially in men. Frail women who had experienced only one or no pregnancy had a higher risk of infection-related hospitalization. Age at menopause did not modify the relationship between frailty and infection-related hospitalization. Sex-/gender-specific approaches may help to stratify the risk of acute diseases. Abstract: Objectives: To investigate the extent to which frailty is associated with infection-related hospitalizations in older men and women, and to explore whether, among women, previous exposure to endogenous estrogens in terms of age at menopause and number of pregnancies modify such a relationship. Study design: The sample comprised 2784 participants in the Progetto Veneto Anziani aged ≥65 years. At baseline and after 4.4 years, frailty was identified according to the presence of three or more of the following: weakness, exhaustion, weight loss, low physical activity, and low walking speed. A passive follow-up on infection-related hospitalizations and mortality was performed for 10 years of observation through linkage with regional registers. Main outcome measures: The association between frailty and infection-related hospitalizations was assessed through mixed-effects Cox regressions. Results: Frailty was significantly associated with a 78 % higher risk of infection-related hospitalization, with stronger results in men (hazard ratio = 2.32, 95 % confidence interval 1.63–3.30) than in women (hazard ratio = 1.54, 95 % confidence interval 1.18–2.02). Focusing on women, we found a possible modifying effect for the number of pregnancies but not menopausal age. Women who had experienced one or no pregnancy demonstrated a higher hazard of infection-related hospitalization as a function of frailty (hazard ratio = 3.00, 95 % confidence interval 1.58–5.71) than women who had experienced two or more pregnancies (hazard ratio = 1.68, 95 % confidence interval 1.18–2.39). Conclusion: Frailty in older age increases the risk of infection-related hospitalizations, especially in men. The "immunologic advantage" of the female sex in younger age seems to persist also after menopause as a function of the number of pregnancies a woman has experienced.