Research Square · Aug 11, 2026
Baseline depressive symptoms, frailty and multimorbidity burden in relation to incident self-reported COPD among middle-aged and older Chinese adults: a prospective cohort study from CHARLS
By Haohao# H, Chen C, Jiang Y
Background: Depressive symptoms, frailty and multimorbidity often coexist in later life, but it remains unclear whether their cumulative burden precedes chronic respiratory disease. We examined the association between baseline multidomain vulnerability and incident COPD in a population-based Chinese cohort. Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS). Participants aged 45 years or older in 2011 were eligible if they had no baseline self-reported physician-diagnosed chronic lung disease and contributed follow-up outcome information. Baseline risk-domain burden was defined as the number of three domains present: depressive symptoms, high frailty and multimorbidity. The outcome was incident self-reported physician-diagnosed chronic lung disease during follow-up, interpreted as a COPD because spirometry-confirmed COPD was unavailable. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We also performed an inverse-probability-of-complete-case weighted sensitivity analysis to assess the influence of complete-case selection. Results: The complete-case cohort included 10,656 participants, with 1,128 incident events during 66,935 person-years of follow-up. Compared with participants with no risk domains, the fully adjusted HRs were 1.42 (95% CI, 1.22-1.66) for one risk domain, 1.85 (95% CI, 1.57-2.18) for two domains and 2.33 (95% CI, 1.94-2.80) for three domains. Each additional risk domain was associated with a 33% higher hazard of the outcome (HR, 1.33; 95% CI, 1.25-1.40; P for trend <0.001). The estimate was unchanged in the inverse-probability-weighted complete-case sensitivity analysis (HR, 1.33; 95% CI, 1.25-1.40; P<0.001). Conclusions: Among middle-aged and older Chinese adults, the baseline accumulation of depressive symptoms, high frailty and multimorbidity was associated with a graded increase in incident COPD. These findings support the use of multidomain vulnerability assessment in longitudinal respiratory epidemiology, while emphasizing that the outcome was not spirometry-confirmed COPD.