Research Square · Nov 12, 2026
Joint trajectories of depressive symptoms and frailty and 2-year stroke recurrence and all-cause mortality among older Chinese stroke survivors: a national cohort study
By Yu P, Le L, Chen J et al.
Background Depressive symptoms and frailty are among the most common and disabling conditions in older adults after stroke, and both are priorities for population-level chronic disease management in ageing societies. Most studies describe them separately and at a single time point, so whether their joint trajectories mark the risk of recurrence and death is unknown. Methods We used three waves of the China Health and Retirement Longitudinal Study (CHARLS, 2013–2020); the cohort comprised participants with a physician-diagnosed stroke recorded in 2018. Joint trajectories of depressive symptoms (CESD-10) and frailty (frailty index) across 2013, 2015 and 2018 were identified by group-based trajectory modelling with a parallel-process specification. Risk ratios (RR) were estimated by multivariable log-binomial regression, with robust Poisson and logistic sensitivity analyses and multinomial logit regression for the competing risk of death; missing covariates were handled by multiple imputation by chained equations (MICE, m = 10) with Rubin's rules. Results Among 394 stroke survivors (mean age 65.6 years, 51.0% men), two joint trajectory classes were identified: a low-rising class (n = 222, 56.3%) and a high-increasing class (n = 172, 43.7%) with elevated, rising depressive symptoms and frailty. Class 2 had a higher risk of stroke recurrence than class 1 (RR 3.09, 95% CI 1.83–5.23; P < 0.001), robust across complete-case (RR 2.66), robust Poisson (RR 2.70), high-certainty membership (RR 2.59) and logistic (OR 3.29) analyses; 2-year absolute risk was 23.3% versus 8.6% (risk difference 14.7 percentage points). Adjustment for the 2013 single-timepoint CESD-10 and frailty index attenuated but retained the contrast (RR 2.19, 95% CI 1.13–4.25; P = 0.020) while the single-timepoint terms became non-significant; discrimination was similar for the joint trajectory and simpler exposures (area under the curve 0.696 vs 0.677), so added predictive value is not established. Mortality findings were exploratory (adjusted RR 2.71, 95% CI 1.07–6.83; unadjusted RR 2.21, 0.89–5.50; 19 deaths). Conclusions A jointly high and increasing depressive-symptom/frailty trajectory identifies older stroke survivors at roughly threefold risk of recurrence within two years; the association was robust but could not be separated from the 2018 level, and it remains hypothesis-generating pending external validation in an independent population.