Mortality, Falls, and Fracture Risk Are Positively Associated With Frailty: A SIDIAP Cohort Study of 890 000 Patients

Background: Frail subjects are at increased risk of adverse outcomes. We aimed to assess their risk of falls, all-cause mortality, and fractures. Method: We used a retrospective cohort study using the Sistema d'Informacio per al Desenvolupament de l'Investigaci6 en Atencio Primaria database (>6 million residents). Subjects aged 75 years and older with 21 year of valid data (2007-2015) were included. Follow-up was carried out from (the latest of) the date of cohort entry up to migration, end of the study period or outcome (whichever came first). The eFRAGICAP classified subjects as fit, mild, moderate, or severely frail. Outcomes (10th revision of the International Classification of Diseases) were incident falls, fractures (overall/hip/vertebral), and all-cause mortality during the study period. Statistics: hazard ratios (I IRs), 95% CI adjusted (per age, sex, and socioeconomic status), and unadjusted cause-specific Cox models, accounting for competing risk of death (fit group as the reference). Results: A total of 893 211 subjects were analyzed; 54.4% were classified as fit, 34.0% as mild, 9.9% as moderate, and 1.6% as severely frail. Compared with the fit, frail had an increased risk of falls (adjusted HR [95% CI] of 1.55 [1.52-1.58], 2.74 [2.66-2.84], and 5.94 [5.52-6.40]), all-cause mortality (adjusted HR [95% CI] of 1.36 [1.35-1.37], 2.19 [2.16-2.23], and 4.29 [4.13-4.45]), and fractures (adjusted HR [95% CI] of 1.21 [1.20-1.23], 1.51 [1.47-1.55], and 2.36 [2.20-2.53]) for mild, moderate, and severe frailty, respectively. Severely frail had a high risk of vertebral (HR of 2.49 [1.99-3.11]) and hip fracture (HR [95% CI] of 1.85 [1.50-2.28]). Accounting for competing risk of death did not change results. Conclusion: Frail subjects are at increased risk of death, fractures, and falls. The eFRAGICAP tool can easily assess frailty in electronic primary care databases in Spain.