Highlights
- •Frailty is associated with infection-related hospitalization, especially in men.
- •Frail women who had experienced only one or no pregnancy had a higher risk of infection-related hospitalization.
- •Age at menopause did not modify the relationship between frailty and infection-related hospitalization.
- •Sex-/gender-specific approaches may help to stratify the risk of acute diseases.
Abstract
Objectives
To investigate the extent to which frailty is associated with infection-related hospitalizations
in older men and women, and to explore whether, among women, previous exposure to
endogenous estrogens in terms of age at menopause and number of pregnancies modify
such a relationship.
Study design
The sample comprised 2784 participants in the Progetto Veneto Anziani aged ≥65 years.
At baseline and after 4.4 years, frailty was identified according to the presence
of three or more of the following: weakness, exhaustion, weight loss, low physical
activity, and low walking speed. A passive follow-up on infection-related hospitalizations
and mortality was performed for 10 years of observation through linkage with regional
registers.
Main outcome measures
The association between frailty and infection-related hospitalizations was assessed
through mixed-effects Cox regressions.
Results
Frailty was significantly associated with a 78 % higher risk of infection-related
hospitalization, with stronger results in men (hazard ratio = 2.32, 95 % confidence
interval 1.63–3.30) than in women (hazard ratio = 1.54, 95 % confidence interval 1.18–2.02).
Focusing on women, we found a possible modifying effect for the number of pregnancies
but not menopausal age. Women who had experienced one or no pregnancy demonstrated
a higher hazard of infection-related hospitalization as a function of frailty (hazard
ratio = 3.00, 95 % confidence interval 1.58–5.71) than women who had experienced two
or more pregnancies (hazard ratio = 1.68, 95 % confidence interval 1.18–2.39).
Conclusion
Frailty in older age increases the risk of infection-related hospitalizations, especially
in men. The “immunologic advantage” of the female sex in younger age seems to persist
also after menopause as a function of the number of pregnancies a woman has experienced.
Keywords
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Article info
Publication history
Published online: November 03, 2022
Accepted:
October 26,
2022
Received in revised form:
October 20,
2022
Received:
June 29,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
