Systematic Review and Meta‐Analysis of the Transitions, Trajectories, and Associations With Mortality of Frailty in China

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Abstract
Frailty care needs are increasing in China's ageing population, but evidence on frailty progression and outcomes in this context has remained limited. This study aims to synthesize existing evidence on frailty trajectories as well as on the associations between frailty and mortality. English‐language databases (MEDLINE, Embase, Web of Science, PsycINFO, CINAHL) and Chinese databases (China National Knowledge Infrastructure, Wanfang Data, VIP Information) were searched up to October 2024. Random‐effects meta‐analysis was applied to estimate pooled frailty transitions and mortality risks, and frailty trajectories derived by statistical modelling were narratively summarized. Frailty status was stable for 61% (95% confidence interval [CI]: 57%–66%) of individuals, worsened for 29% (95% CI: 24%–34%), and improved for 10% (95% CI: 7%–13%) among Chinese adults aged ≥ 30 years with 2–11 years of follow‐up. Levels or changes of frailty were used to define trajectory patterns. A 1% increase in the frailty index was associated with a 5% higher mortality risk (hazard ratio = 1.05, 95% CI: 1.03–1.06), while frailty was linked to over a twofold higher mortality risk compared with robustness (hazard ratio = 2.34, 95% CI: 1.51–3.63). Frailty is associated with increased mortality risk among Chinese community‐dwelling adults, and progression is not inevitable, with many remaining stable. Distinct subpopulations can be identified by frailty levels or changes. Future research should examine determinants and outcomes of frailty transitions and trajectories to guide targeted interventions.

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