The effect of frailty on mortality and hospital admission in patients with benign pleural disease in Wales: a cohort study

Short, Roxanna, Carter, Ben, Verduri, Alessia, Barton, Eleanor, Maskell, Nick and Hewitt, Jonathan ORCID: https://orcid.org/0000-0002-7924-1792 2024. The effect of frailty on mortality and hospital admission in patients with benign pleural disease in Wales: a cohort study. The Lancet Healthy Longevity 5 (8) , e534-e541. 10.1016/S2666-7568(24)00114-4

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Abstract

Background Pleural disease is common, representing 5% of the acute medical workload, and its incidence is rising, partly due to the ageing population. Frailty is an important feature and little is known about disease progression in patients with frailty and pleural disease. We aimed to examine the effect of frailty on mortality and other relevant outcomes in patients diagnosed with pleural disease. Methods In this cohort study in Wales, the national Secure Anonymised Information Linkage databank was used to identify a cohort of individuals diagnosed with non-malignant pleural disease between Jan 1, 2005, and March 1, 2023, who were not known to have left Wales. Frailty was assessed at diagnosis of pleural disease using an electronic Frailty Index. The primary outcome was time from diagnosis to all-cause mortality for all patients. Data were analysed using multilevel mixed-effects Cox proportional hazards regression adjusting for the prespecified covariates of age, sex, Welsh Index of Multiple Deprivation quintile, smoking status, comorbidity, and subtype of pleural disease. Findings 54 566 individuals were included in the final sample (median age 66 years [IQR 47–77]; 26 477 [48·5%] were female and 28 089 [51·5%] were male). By the end of the study period, 25 698 (47·1%) participants had died, with a median follow-up of 1·0 years (IQR 0·2–3·6). There was an association between frailty and all-cause mortality, which increased as frailty worsened. Compared with fit individuals, there was increasing mortality for those with mild frailty (adjusted hazard ratio 1·11 [95% CI 1·08–1·15]; p<0·0001), moderate frailty (1·25 [1·20–1·31]; p<0·0001), and severe frailty (1·36 [1·28–1·44]; p<0·0001). Interpretation Independent of age and comorbidities, frailty status at diagnosis of pleural disease appeared to be useful as a prognostic indicator. Patients with moderate or severe frailty had a rapid decline in health. Future patients should be assessed for frailty at the time of diagnosis of pleural disease and might benefit from optimised care and advance care planning.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	2666-7568
Funders:	Cardiff University's Wellcome Trust iTPA funding award.
Date of First Compliant Deposit:	30 August 2024
Date of Acceptance:	10 June 2024
Last Modified:	02 Sep 2024 09:12
URI:	https://orca.cardiff.ac.uk/id/eprint/171685

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