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. 2021 Aug-Sep;33(7-8):531-544.
doi: 10.1177/0898264321997675. Epub 2021 Mar 12.

Development and Validation of a Clinical Frailty Index for the World Trade Center General Responder Cohort

Ghalib A Bello  1 , Katherine A Ornstein  2 , Roberto G Lucchini  1   3   4 , William W Hung  2   5 , Fred C Ko  2   5 , Elena Colicino  6 , Emanuela Taioli  7   8   9 , Michael A Crane  10 , Andrew C Todd  1
Affiliations

Development and Validation of a Clinical Frailty Index for the World Trade Center General Responder Cohort

Ghalib A Bello et al. J Aging Health. 2021 Aug-Sep.

Abstract

Objectives: To develop and validate a clinical frailty index to characterize aging among responders to the 9/11 World Trade Center (WTC) attacks. Methods: This study was conducted on health monitoring data on a sample of 6197 responders. A clinical frailty index, WTC FI-Clinical, was developed according to the cumulative deficit model of frailty. The validity of the resulting index was assessed using all-cause mortality as an endpoint. Its association with various cohort characteristics was evaluated. Results: The sample's median age was 51 years. Thirty items were selected for inclusion in the index. It showed a strong correlation with age, as well as significant adjusted associations with mortality, 9/11 exposure severity, sex, race, pre-9/11 occupation, education, and smoking status. Discussion: The WTC FI-Clinical highlights effects of certain risk factors on aging within the 9/11 responder cohort. It will serve as a useful instrument for monitoring and tracking frailty within this cohort.

Keywords: 9/11 responders; World Trade Center cohort; frailty index.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure A1.
Figure A1.
Distribution of age at index visit.
Figure 1.
Figure 1.
WTC FI-Clinical distribution.
Figure 2.
Figure 2.
Relationship between age and WTC FI-Clinical. The scatter plot in Figure 2 shows the mean WTC FI-Clinical for each year of age up to 70 (ages beyond 70 excluded due to insufficient sample size). Smooth fit (solid blue curve) was computed using locally weighted scatterplot smoothing (LOWESS).
Figure 3.
Figure 3.
Association between WTC FI-Clinical and cohort characteristics.
Figure 4.
Figure 4.
Kaplan-Meier survival curves for low and high WTC FI-Clinical.
Figure 5.
Figure 5.
Relationship between WTC FI-Clinical and FI-Lab. In Figure 5, the continuous WTC FI-Clinical scale was divided into 7 segments, each of length 0.1 ([0–0.1], (0.1–0.2], (0.2–0.3], etc.). Within each segment, the mean and standard deviation of WTC FI-Lab was computed. The midpoint of each WTC FI-Clinical segment was plotted against the mean WTC FI-Lab within that segment. Standard deviations around the mean are denoted by error bars.
See this image and copyright information in PMC

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