Key result
High-decreasing SBP trajectory linked to higher catastrophic health expenditure, mediated by frailty.
Why the study?
Routine hypertension management primarily targets acute cardiovascular events, frequently overlooking progressive frailty and its economic implications. The mediating role of frailty in the association between systolic blood pressure trajectories and catastrophic health expenditure among middle-aged and older adults needed evaluation.
Does frailty mediate the association between systolic blood pressure trajectories and catastrophic health expenditure in middle-aged and older adults?
Cohort (n=3,996)
Does frailty mediate the association between systolic blood pressure trajectories and catastrophic health expenditure in middle-aged and older adults?
Frailty mediates the relationship between a high-decreasing systolic blood pressure trajectory and subsequent catastrophic household health expenditure in middle-aged and older Chinese adults, highlighting the importance of assessing functional status alongside blood pressure.
Answers are grounded in this paper and cite their sources.
Supports frailty assessment in declining SBP trajectories to flag CHE risk; leaves open causal effects and intervention targets.
BACKGROUND: Routine hypertension management primarily targets acute cardiovascular events, frequently overlooking progressive physiological decline (frailty) and its economic implications. This study aimed to identify systolic blood pressure (SBP) trajectories and evaluate the mediating role of frailty in their association with catastrophic health expenditure (CHE) among middle-aged and older adults. METHODS: We analyzed 3996 participants from the China Health and Retirement Longitudinal Study (CHARLS). Group-based trajectory modeling identified SBP evolution patterns (2011-2015). The 2015 Frailty Index (FI), based on a 27-item deficit accumulation model, served as the mediator. The primary outcome was CHE in 2018, defined as annual household healthcare expenditure exceeding 40% of the household's capacity to pay. Mediation analysis quantified total, direct, and indirect effects. RESULTS: Three SBP trajectories emerged: "Low-stable" (50.0%), "Moderate-increasing" (41.3%), and "High-decreasing" (8.7%). Compared with the Low-stable group, the High-decreasing trajectory was significantly associated with higher 2015 FI scores (β=0.029, P<0.001). A statistically significant indirect effect through frailty was observed for the association between the High-decreasing trajectory and CHE in 2018 (ACME = 0.0084, 95% CI: 0.0031-0.0100, P < 0.001), although the direct and total effects were not statistically significant. Findings were similar in sensitivity analyses using alternative CHE definitions and BMI trajectories. CONCLUSIONS: Frailty may be one pathway linking the High-decreasing SBP trajectory with subsequent household CHE. These observational findings support considering functional health alongside blood pressure in middle-aged and older adults. Further prospective studies are needed to clarify the temporal and causal relationships and to assess whether incorporating frailty assessments into cardiovascular management improves clinical and socioeconomic outcomes.
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Liu et al. (2026) conducted a cohort in Systolic blood pressure trajectories and frailty (n=3,996). High-decreasing systolic blood pressure trajectory (mediated by 2015 Frailty Index) vs. Low-stable systolic blood pressure trajectory was evaluated on Catastrophic health expenditure (CHE) in 2018, defined as annual household healthcare expenditure exceeding 40% of the household's capacity to pay (indirect effect through frailty) (ACME 0.0084, 95% CI 0.0031-0.0100, p=<0.001). A high-decreasing SBP trajectory had a significant indirect effect via frailty on catastrophic health expenditure vs a low-stable trajectory.
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