{"id":"https://openalex.org/W7224359682","doi":"https://doi.org/10.1016/j.jnha.2026.101021","title":"Mediating role of frailty in the association between systolic blood pressure trajectories and catastrophic health expenditure among middle-aged and older adults: A longitudinal cohort study","display_name":"Mediating role of frailty in the association between systolic blood pressure trajectories and catastrophic health expenditure among middle-aged and older adults: A longitudinal cohort study","publication_year":2026,"publication_date":"2026-10-30","ids":{"openalex":"https://openalex.org/W7224359682","doi":"https://doi.org/10.1016/j.jnha.2026.101021","pmid":"https://pubmed.ncbi.nlm.nih.gov/42950708"},"language":"en","primary_location":{"id":"doi:10.1016/j.jnha.2026.101021","doi":"https://doi.org/10.1016/j.jnha.2026.101021","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jnha.2026.101021","pdf_url":"https://www.sciencedirect.com/science/article/pii/S127977072600254X/pdf","source":{"id":"https://openalex.org/S94854268","display_name":"The journal of nutrition health & aging","issn_l":"1279-7707","issn":["1279-7707","1760-4788"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","vabb-shw"],"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of nutrition, health and aging","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.sciencedirect.com/science/article/pii/S127977072600254X/pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5160098064","display_name":"Weili Liu","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Weili Liu","raw_affiliation_strings":["Shifang People's Hospital, Shifang, China. Electronic address: 1442330515@qq.com"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Shifang People's Hospital, Shifang, China. Electronic address: 1442330515@qq.com","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5125054937","display_name":"Zhonghua Yin","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I150229711","display_name":"University of Electronic Science and Technology of China","ror":"https://ror.org/04qr3zq92","country_code":"CN","type":"education","lineage":["https://openalex.org/I150229711"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Zhonghua Yin","raw_affiliation_strings":["School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China","institution_ids":["https://openalex.org/I150229711"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5100343530","display_name":"Ke Li","orcid":"https://orcid.org/0000-0003-0019-3300","observed_orcids":["https://orcid.org/0000-0003-0019-3300"]},"institutions":[{"id":"https://openalex.org/I150229711","display_name":"University of Electronic Science and Technology of China","ror":"https://ror.org/04qr3zq92","country_code":"CN","type":"education","lineage":["https://openalex.org/I150229711"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Ke Li","raw_affiliation_strings":["School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China. Electronic address: colinlike@163.com"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China. Electronic address: colinlike@163.com","institution_ids":["https://openalex.org/I150229711"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5100343530","https://openalex.org/A5160098064"],"corresponding_institution_ids":["https://openalex.org/I150229711"],"apc_list":{"value":3450,"currency":"USD","value_usd":3450},"apc_paid":{"value":3450,"currency":"USD","value_usd":3450},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.82315067,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"30","issue":"12","first_page":"101021","last_page":"101021"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11011","display_name":"Frailty in Older Adults","score":0.5410000085830688,"subfield":{"id":"https://openalex.org/subfields/2717","display_name":"Geriatrics and Gerontology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11011","display_name":"Frailty in Older Adults","score":0.5410000085830688,"subfield":{"id":"https://openalex.org/subfields/2717","display_name":"Geriatrics and Gerontology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10144","display_name":"Blood Pressure and Hypertension Studies","score":0.10329999774694443,"subfield":{"id":"https://openalex.org/subfields/2705","display_name":"Cardiology and Cardiovascular Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.06589999794960022,"subfield":{"id":"https://openalex.org/subfields/2003","display_name":"Finance"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/frailty","display_name":"frailty","score":0.9649999737739563},{"id":"https://openalex.org/keywords/catastrophic-health-expenditure","display_name":"catastrophic health expenditure","score":0.8999999761581421},{"id":"https://openalex.org/keywords/hypertension","display_name":"hypertension","score":0.7739999890327454},{"id":"https://openalex.org/keywords/frailty-index","display_name":"frailty index","score":0.9490000009536743},{"id":"https://openalex.org/keywords/mediation-analysis","display_name":"mediation analysis","score":0.6340000033378601},{"id":"https://openalex.org/keywords/middle-aged-and-older-adults","display_name":"middle-aged and older adults","score":0.9279999732971191},{"id":"https://openalex.org/keywords/household-health-expenditure","display_name":"household health expenditure","score":0.7110000252723694},{"id":"https://openalex.org/keywords/china-health-and-retirement-longitudinal-study","display_name":"China Health and Retirement Longitudinal Study","score":0.921999990940094}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.78329998254776},{"id":"https://openalex.org/C84393581","wikidata":"https://www.wikidata.org/wiki/Q82642","display_name":"Blood pressure","level":2,"score":0.6830999851226807},{"id":"https://openalex.org/C23131810","wikidata":"https://www.wikidata.org/wiki/Q818574","display_name":"Observational study","level":2,"score":0.6000000238418579},{"id":"https://openalex.org/C201903717","wikidata":"https://www.wikidata.org/wiki/Q1778788","display_name":"Cohort study","level":2,"score":0.4749000072479248},{"id":"https://openalex.org/C147077947","wikidata":"https://www.wikidata.org/wiki/Q1515895","display_name":"Socioeconomic status","level":3,"score":0.4726000130176544},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.4674000144004822},{"id":"https://openalex.org/C2777895361","wikidata":"https://www.wikidata.org/wiki/Q1758614","display_name":"Longitudinal study","level":2,"score":0.46619999408721924},{"id":"https://openalex.org/C72563966","wikidata":"https://www.wikidata.org/wiki/Q1303415","display_name":"Cohort","level":2,"score":0.4325999915599823},{"id":"https://openalex.org/C142853389","wikidata":"https://www.wikidata.org/wiki/Q744778","display_name":"Association (psychology)","level":2,"score":0.4083999991416931},{"id":"https://openalex.org/C2909041561","wikidata":"https://www.wikidata.org/wiki/Q25099514","display_name":"Frailty Index","level":2,"score":0.37540000677108765},{"id":"https://openalex.org/C188816634","wikidata":"https://www.wikidata.org/wiki/Q2113324","display_name":"Prospective cohort study","level":2,"score":0.35350000858306885},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.3427000045776367},{"id":"https://openalex.org/C2780221984","wikidata":"https://www.wikidata.org/wiki/Q131191","display_name":"Body mass index","level":2,"score":0.3352000117301941},{"id":"https://openalex.org/C179420905","wikidata":"https://www.wikidata.org/wiki/Q223871","display_name":"Mediation","level":2,"score":0.3255000114440918},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.3215000033378601},{"id":"https://openalex.org/C26831200","wikidata":"https://www.wikidata.org/wiki/Q16963953","display_name":"Marginal structural model","level":3,"score":0.295199990272522},{"id":"https://openalex.org/C54183767","wikidata":"https://www.wikidata.org/wiki/Q10384","display_name":"Geriatrics","level":2,"score":0.2897999882698059},{"id":"https://openalex.org/C133925201","wikidata":"https://www.wikidata.org/wiki/Q188419","display_name":"Life expectancy","level":3,"score":0.28290000557899475},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.2653000056743622},{"id":"https://openalex.org/C3020672099","wikidata":"https://www.wikidata.org/wiki/Q857354","display_name":"Longitudinal data","level":2,"score":0.2581000030040741},{"id":"https://openalex.org/C3018284874","wikidata":"https://www.wikidata.org/wiki/Q389735","display_name":"Cardiovascular health","level":3,"score":0.25380000472068787}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.1016/j.jnha.2026.101021","doi":"https://doi.org/10.1016/j.jnha.2026.101021","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jnha.2026.101021","pdf_url":"https://www.sciencedirect.com/science/article/pii/S127977072600254X/pdf","source":{"id":"https://openalex.org/S94854268","display_name":"The journal of nutrition health & aging","issn_l":"1279-7707","issn":["1279-7707","1760-4788"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","vabb-shw"],"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of nutrition, health and aging","raw_type":"journal-article"},{"id":"pmid:42950708","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42950708","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The journal of nutrition, health & aging","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:dce0a46a5a94481aaf7911dbffe31e5e","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/dce0a46a5a94481aaf7911dbffe31e5e","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"The Journal of Nutrition, Health and Aging, Vol 30, Iss 12, Pp 101021- (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1016/j.jnha.2026.101021","doi":"https://doi.org/10.1016/j.jnha.2026.101021","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jnha.2026.101021","pdf_url":"https://www.sciencedirect.com/science/article/pii/S127977072600254X/pdf","source":{"id":"https://openalex.org/S94854268","display_name":"The journal of nutrition health & aging","issn_l":"1279-7707","issn":["1279-7707","1760-4788"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-c","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-100","vabb-shw"],"host_organization":"https://openalex.org/P4310319900","host_organization_name":"Springer Science+Business Media","host_organization_lineage":["https://openalex.org/P4310319900","https://openalex.org/P4310319965"],"host_organization_lineage_names":["Springer Science+Business Media","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of nutrition, health and aging","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":1.0,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[{"id":"https://openalex.org/F4320330493","display_name":"Sichuan Provincial Key Laboratory of Development and Regeneration","ror":null}],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7224359682.pdf","grobid_xml":"https://content.openalex.org/works/W7224359682.grobid-xml"},"referenced_works_count":65,"referenced_works":["https://openalex.org/W1933768036","https://openalex.org/W1972450621","https://openalex.org/W2105092978","https://openalex.org/W2128573775","https://openalex.org/W2142002753","https://openalex.org/W2339076625","https://openalex.org/W2372962096","https://openalex.org/W2587455374","https://openalex.org/W2624934302","https://openalex.org/W2744831402","https://openalex.org/W2760473724","https://openalex.org/W2767618030","https://openalex.org/W2801549787","https://openalex.org/W2803561464","https://openalex.org/W2884611136","https://openalex.org/W2892396086","https://openalex.org/W2898401647","https://openalex.org/W2932248400","https://openalex.org/W2979794911","https://openalex.org/W3010304920","https://openalex.org/W3012502670","https://openalex.org/W3014816167","https://openalex.org/W3017984820","https://openalex.org/W3110280394","https://openalex.org/W3118585852","https://openalex.org/W3147857812","https://openalex.org/W3150642647","https://openalex.org/W3200854382","https://openalex.org/W3206576542","https://openalex.org/W4210249960","https://openalex.org/W4210844155","https://openalex.org/W4210995410","https://openalex.org/W4226031284","https://openalex.org/W4292056313","https://openalex.org/W4308463484","https://openalex.org/W4317433198","https://openalex.org/W4318755521","https://openalex.org/W4319456373","https://openalex.org/W4323568601","https://openalex.org/W4379769310","https://openalex.org/W4383897028","https://openalex.org/W4386535033","https://openalex.org/W4388828720","https://openalex.org/W4389050443","https://openalex.org/W4389224588","https://openalex.org/W4391022636","https://openalex.org/W4392612893","https://openalex.org/W4392932092","https://openalex.org/W4398252378","https://openalex.org/W4399167365","https://openalex.org/W4400211653","https://openalex.org/W4401349525","https://openalex.org/W4403552437","https://openalex.org/W4405701242","https://openalex.org/W4406835895","https://openalex.org/W4408659082","https://openalex.org/W4409280338","https://openalex.org/W4410877695","https://openalex.org/W4411163567","https://openalex.org/W4412394110","https://openalex.org/W4412492069","https://openalex.org/W4413750090","https://openalex.org/W4414692043","https://openalex.org/W7125100264","https://openalex.org/W7128382153"],"related_works":["https://openalex.org/W4392612893","https://openalex.org/W7220939041","https://openalex.org/W3200854382","https://openalex.org/W7163073737","https://openalex.org/W4221063988","https://openalex.org/W4304014489","https://openalex.org/W4282934404","https://openalex.org/W2114295394","https://openalex.org/W4394690363","https://openalex.org/W2921630119"],"abstract_inverted_index":{"BACKGROUND:":[0],"Routine":[1],"hypertension":[2],"management":[3,249],"primarily":[4],"targets":[5],"acute":[6],"cardiovascular":[7,248],"events,":[8],"frequently":[9],"overlooking":[10],"progressive":[11],"physiological":[12],"decline":[13],"(frailty)":[14],"and":[15,29,46,58,113,125,162,178,195,225,237,240,252],"its":[16],"economic":[17],"implications.":[18],"This":[19],"study":[20],"aimed":[21],"to":[22,106,233,241],"identify":[23],"systolic":[24],"blood":[25,221],"pressure":[26,222],"(SBP)":[27],"trajectories":[28,119],"evaluate":[30],"the":[31,55,85,103,130,133,156,159,176,205,235],"mediating":[32],"role":[33],"of":[34,102],"frailty":[35,152,245],"in":[36,92,164,188,223],"their":[37],"association":[38,157],"with":[39,129,139,209],"catastrophic":[40],"health":[41,219],"expenditure":[42,99],"(CHE)":[43],"among":[44],"middle-aged":[45,224],"older":[47,226],"adults.":[48,227],"METHODS:":[49],"We":[50],"analyzed":[51],"3996":[52],"participants":[53],"from":[54],"China":[56],"Health":[57],"Retirement":[59],"Longitudinal":[60],"Study":[61],"(CHARLS).":[62],"Group-based":[63],"trajectory":[64,135,161,208],"modeling":[65],"identified":[66],"SBP":[67,118,207],"evolution":[68],"patterns":[69],"(2011-2015).":[70],"The":[71,87],"2015":[72,141],"Frailty":[73,199],"Index":[74],"(FI),":[75],"based":[76],"on":[77],"a":[78],"27-item":[79],"deficit":[80],"accumulation":[81],"model,":[82],"served":[83],"as":[84,95],"mediator.":[86],"primary":[88],"outcome":[89],"was":[90,136,153],"CHE":[91,163,193],"2018,":[93],"defined":[94],"annual":[96],"household":[97,211],"healthcare":[98],"exceeding":[100],"40%":[101],"household's":[104],"capacity":[105],"pay.":[107],"Mediation":[108],"analysis":[109],"quantified":[110],"total,":[111],"direct,":[112],"indirect":[114,149],"effects.":[115],"RESULTS:":[116],"Three":[117],"emerged:":[120],"\"Low-stable\"":[121],"(50.0%),":[122],"\"Moderate-increasing\"":[123],"(41.3%),":[124],"\"High-decreasing\"":[126],"(8.7%).":[127],"Compared":[128],"Low-stable":[131],"group,":[132],"High-decreasing":[134,160,206],"significantly":[137],"associated":[138],"higher":[140],"FI":[142],"scores":[143],"(\u03b2=0.029,":[144],"P<0.001).":[145],"A":[146],"statistically":[147,183],"significant":[148],"effect":[150],"through":[151],"observed":[154],"for":[155],"between":[158],"2018":[165],"(ACME":[166],"=":[167],"0.0084,":[168],"95%":[169],"CI:":[170],"0.0031-0.0100,":[171],"P":[172],"<":[173],"0.001),":[174],"although":[175],"direct":[177],"total":[179],"effects":[180],"were":[181,186],"not":[182],"significant.":[184],"Findings":[185],"similar":[187],"sensitivity":[189],"analyses":[190],"using":[191],"alternative":[192],"definitions":[194],"BMI":[196],"trajectories.":[197],"CONCLUSIONS:":[198],"may":[200],"be":[201],"one":[202],"pathway":[203],"linking":[204],"subsequent":[210],"CHE.":[212],"These":[213],"observational":[214],"findings":[215],"support":[216],"considering":[217],"functional":[218],"alongside":[220],"Further":[228],"prospective":[229],"studies":[230],"are":[231],"needed":[232],"clarify":[234],"temporal":[236],"causal":[238],"relationships":[239],"assess":[242],"whether":[243],"incorporating":[244],"assessments":[246],"into":[247],"improves":[250],"clinical":[251],"socioeconomic":[253],"outcomes.":[254]},"counts_by_year":[],"updated_date":"2026-11-02T09:45:03.842371","created_date":"2026-10-30T00:00:00"}
