Association between possible sarcopenia, all-cause mortality, and adverse health outcomes in community-dwelling older adults in China

Abstract

The relationship between possible sarcopenia and mortality remains ambiguous within Asian populations. To clarify this, we investigated the association in older adults residing in Chinese communities. Utilizing data from the China Health and Retirement Longitudinal Study, this population-based cohort study included individuals aged ≥ 60 years, followed from 2011 to 2012 through 2020. Possible sarcopenia was defined in accordance with the Asian Working Group on Sarcopenia 2019 criteria, and Cox proportional hazards regression was used to analyze its impact on mortality, while exploratory analyses were conducted to investigate the associations of possible sarcopenia with chronic diseases, functional independence, and hospitalization frequency. The study encompassed 5,160 participants (median age: 66 years), nearly half of whom (48.8%) were identified with possible sarcopenia. Over a 9-year follow-up period, there were 1216 recorded deaths. Analysis indicated that individuals with possible sarcopenia faced a significantly elevated mortality risk compared to their counterparts (HR: 1.79, 95% CI: 1.58-2.03; P < 0.001). Further, subgroup analyses confirmed a strong association between possible sarcopenia and all-cause mortality across various subgroups, including those related to sex, obesity status, and living environment. Additionally, exploratory analyses revealed that possible sarcopenia was significantly associated with an increased likelihood of heart disease (OR = 1.18, 95% CI: 1.03-1.34, P = 0.014) and stroke (OR = 1.41, 95% CI: 1.19-1.68, P < 0.001), as well as reduced functional independence (β = -0.17, 95% CI: -0.24--0.10, P < 0.001). Possible sarcopenia was also associated with a higher frequency of hospitalizations at baseline (Exp(β) = 1.50, 95% CI: 1.25-1.81, P < 0.001), although this association was no longer significant during the follow-up period. In conclusion, in Chinese community-dwelling older adults, possible sarcopenia was associated with an increased risk of all-cause mortality, several chronic diseases, and functional dependence. Thus, alleviating or preventing possible sarcopenia may improve health outcomes and extend the lifespan of these individuals.

Keywords: Mortality; Muscle strength; Older adults; Physical performance; Possible sarcopenia.

Fig. 1

Flow diagram of participant selection. CHARLS, China Health and Retirement Longitudinal Study.

Fig. 2

Associations between possible sarcopenia and risk of all-cause mortality in terms of sex, residence, and obesity. Forest plots display hazard ratios and 95% CIs for mortality during the 2-, 4-, 7-, and 9-year follow-up periods, stratified by sex, residence, and obesity. Risk estimates were adjusted for age, sex (unadjusted in subgroup analysis stratified by sex), body mass index (unadjusted in subgroup analysis stratified by obesity), smoking and alcohol consumption status, hypertension, diabetes, cancer, chronic lung diseases, heart disease, and stroke. CI, confidence interval.