Temporal association between chronic pain and frailty occurrence, and the modifiable role of a healthy lifestyle in Chinese middle-aged and older population: a community based, prospective cohort study

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Abstract

Background

While western studies suggest a temporal association between chronic pain and frailty, as well as the impacts of healthy lifestyle interventions, these relationships remain underexplored in the Chinese population.

Methods

We conducted a longitudinal study with 13,601 participants from the China Health and Retirement Longitudinal Study, covering 2011–2018. Pain was assessed via self-report, and frailty was evaluated using a 29-item deficit-accumulation frailty index. Five lifestyle factors, such as physical activity, alcohol consumption, smoking, body mass index, and sleep duration, were assessed, and the participants were categorized into favorable, intermediate, and unfavorable lifestyle groups.

Results

During the 7-year follow-up, 3,356 cases of frailty were discerned. Participants who reported pain at baseline assessment had a higher risk of developing frailty compared to those without pain (hazard ratio [HR] = 1.10; 95%confidence interval [CI], 1.03–1.19). This association was particularly evident in middle-aged individuals (HR = 1.13; 95% CI, 1.01–1.26). Participants with severe pain at baseline assessment had a 1.16-fold higher risk of frailty (95%CI, 1.05–1.28, P _trend= 0.0067). Among the participants with mild or moderate pain at baseline assessment, the risk of developing frailty was significantly reduced by a favorable lifestyle (HR = 0.62; 95% CI, 0.51–0.76) or intermediate lifestyle (HR = 0.83; 95% CI, 0.70–0.98). Additionally, a favorable lifestyle was significantly associated with a decreased risk of developing frailty in the participants with severe pain at baseline assessment (HR = 0.75; 95%CI, 0.59–0.96). Mediation analysis indicated that a healthy lifestyle could mitigate 2.97% of frailty risk associated with chronic pain.

Conclusions

Chronic pain is strongly associated with an increased risk of developing frailty in Chinese older population, but the implementation of healthy lifestyles can significantly reduce this risk.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-025-03042-3.

Related collections

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Author and article information

Contributors

Fu-Shan Xue:

ORCID: http://orcid.org/0000-0002-1028-6036

fushanxue@outlook.com , xuefushan@mail.ccmu.edu.cn

Journal

Journal ID (nlm-ta): Aging Clin Exp Res

Journal ID (iso-abbrev): Aging Clin Exp Res

Title: Aging Clinical and Experimental Research

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1594-0667

ISSN (Electronic): 1720-8319

Publication date (Electronic): 30 April 2025

Publication date PMC-release: 30 April 2025

Publication date (Print): 2025

Volume: 37

Issue: 1

Electronic Location Identifier: 136

Affiliations

[1 ]Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, ( https://ror.org/013xs5b60) NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050 China

[2 ]Department of Infection Control, Peking University First Hospital, ( https://ror.org/02z1vqm45) NO. 8 Xishiku Street, Xi-Cheng District, 100034 Beijing, China

[3 ]Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, ( https://ror.org/045wzwx52) NO. 134 Dongji, Gulou District, 350001 Fuzhou, China

Author information

Chao Li http://orcid.org/0009-0001-4645-9496

Na Zeng http://orcid.org/0000-0001-9522-918X

Fu-Shan Xue http://orcid.org/0000-0002-1028-6036

Article

Publisher ID: 3042

DOI: 10.1007/s40520-025-03042-3

PMC ID: 12041107

PubMed ID: 40301176

SO-VID: c2b97872-146a-4913-8e7a-86bf94388a91

License:

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

History

Date received : 19 February 2025

Date accepted : 11 April 2025

Custom metadata

Keywords: pain,frailty,prospective cohort,chinese population

Data availability:

Keywords: pain, frailty, prospective cohort, chinese population