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Peer-reviewedCC BY 4.0Brazilian Journal of Otorhinolaryngology

Frailty index predicts hearing loss in middle-aged and older adults: A triangulated analysis of global, cohort, and genetic data

  • Liang Ren1
  • Xiangling Jiang2
  • Maohua Wang3
  • Xu Zhang4
4 affiliations
  1. 1Ankang Gaoxin Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Ankang, Shanxi Province, China. Electronic address: [email protected].
  2. 2The First People's Hospital of Foshan, Hearing and Balance Medical Engineering Technology Center of Guangdong, Department of Otolaryngology, Head and Neck Surgery, Foshan, China. Electronic address: [email protected].
  3. 3The First People's Hospital of Foshan, Hearing and Balance Medical Engineering Technology Center of Guangdong, Department of Otolaryngology, Head and Neck Surgery, Foshan, China. Electronic address: [email protected].
  4. 4Nanchang University, Jiangxi Medical College, The Second Affiliated Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Nanchang, Jiangxi Province, China. Electronic address: [email protected].
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Abstract

Objective: To examine the association between frailty (Frailty Index, FI) and incident hearing loss using triangulation across GBD 2021, CHARLS, and Mendelian Randomization (MR).

Methods: Global trends were analyzed with GBD 2021. In CHARLS (2011–2020), FI was calculated for adults ≥ 45-years. Associations with incident hearing loss were assessed using logistic regression, restricted cubic splines, and ROC curves. Two-sample MR employed inverse-variance weighted, weighted median, and MR-Egger methods.

Results: GBD revealed increasing hearing loss burden globally, especially among older adults in low- and middle-income countries. In CHARLS, higher FI independently predicted incident hearing loss: moderate frailty increased odds by 66% (OR = 1.66, 95% CI: 1.29–2.12) and severe frailty by 141% (OR = 2.41, 95% CI: 1.47–3.95). Each unit FI increase conferred a 9% higher risk (OR = 1.09, 95% CI: 1.04–1.14). RCS identified a nonlinear threshold (FI ≈ 0.29). Adding FI to conventional risk factors improved prediction (AUC: 0.586 to 0.685). MR supported a causal effect of genetically predicted frailty on hearing loss with no evidence of pleiotropy.

Conclusion: The Frailty Index is a robust, independent, and nonlinear predictor of incident hearing loss. Integrating frailty assessment enhances early identification and supports targeted prevention.

Level of evidence: II.

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Cite

BibTeXRIS
BibTeX
@article{ren2026frailty,
  title = {{Frailty index predicts hearing loss in middle-aged and older adults: A triangulated analysis of global, cohort, and genetic data}},
  author = {Liang Ren and Xiangling Jiang and Maohua Wang and Xu Zhang},
  journal = {Brazilian Journal of Otorhinolaryngology},
  year = {2026},
  month = oct,
  doi = {10.1016/j.bjorl.2026.101919},
  url = {https://doi.org/10.1016/j.bjorl.2026.101919},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Frailty index predicts hearing loss in middle-aged and older adults: A triangulated analysis of global, cohort, and genetic data
AU  - Liang Ren
AU  - Xiangling Jiang
AU  - Maohua Wang
AU  - Xu Zhang
PY  - 2026
DA  - 2026/10/16
JO  - Brazilian Journal of Otorhinolaryngology
DO  - 10.1016/j.bjorl.2026.101919
UR  - https://doi.org/10.1016/j.bjorl.2026.101919
AB  - Objective: To examine the association between frailty (Frailty Index, FI) and incident hearing loss using triangulation across GBD 2021, CHARLS, and Mendelian Randomization (MR).  Methods: Global trends were analyzed with GBD 2021. In CHARLS (2011–2020), FI was calculated for adults ≥ 45-years. Associations with incident hearing loss were assessed using logistic regression, restricted cubic splines, and ROC curves. Two-sample MR employed inverse-variance weighted, weighted median, and MR-Egger methods.  Results: GBD revealed increasing hearing loss burden globally, especially among older adults in low- and middle-income countries. In CHARLS, higher FI independently predicted incident hearing loss: moderate frailty increased odds by 66% (OR = 1.66, 95% CI: 1.29–2.12) and severe frailty by 141% (OR = 2.41, 95% CI: 1.47–3.95). Each unit FI increase conferred a 9% higher risk (OR = 1.09, 95% CI: 1.04–1.14). RCS identified a nonlinear threshold (FI ≈ 0.29). Adding FI to conventional risk factors improved prediction (AUC: 0.586 to 0.685). MR supported a causal effect of genetically predicted frailty on hearing loss with no evidence of pleiotropy.  Conclusion: The Frailty Index is a robust, independent, and nonlinear predictor of incident hearing loss. Integrating frailty assessment enhances early identification and supports targeted prevention.  Level of evidence: II.
SN  - 1808-8694
SN  - 1808-8686
ER  -