Frailty burden and symptomatic BPH/LUTS in aging men: evidence from two nationally representative population-based studies.

Authors

Guanwei Wu, Jianghua Wang, Jiewu Shi, Yingqing Liu, Jie Zheng, Xuefeng Jiang, Jiawei Wang, Lijun Pan, Lingsong Tao

Published in

World journal of urology. Volume 44. Issue 1. Jul 11, 2026. Epub Jul 11, 2026.

Abstract

The frailty index (FI) is a well-established marker of biological aging and a widely validated predictor of adverse health outcomes in older adults. However, its association with symptomatic benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) has not been well defined in nationally representative populations. This study aimed to evaluate the association between FI levels and symptomatic BPH/LUTS in men using two large population-based studies.
We analyzed men from the China Health and Retirement Longitudinal Study (CHARLS) and the US National Health and Nutrition Examination Survey (NHANES). Cohort-specific FIs were constructed following the Rockwood-Mitnitski deficit-accumulation approach. Symptomatic BPH/LUTS was operationalized using cohort-specific questionnaire and medication data and included bothersome LUTS with or without physician-diagnosed BPH, depending on data availability in each cohort. Multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for associations of log-transformed FI (continuous) and FI tertiles with BPH/LUTS. Restricted cubic splines (RCS) were used to assess graded associations and potential nonlinearity, and prespecified subgroup analyses with interaction tests evaluated effect modification. As a supplementary analysis, cohort-specific machine-learning models were internally validated for risk stratification, with SHAP used for model interpretation.
The analysis included 8,781 men in CHARLS, of whom 1,043 met criteria for BPH/LUTS (11.9%), and 2,539 men in NHANES, with 559 classified as BPH/LUTS (22.0%). Higher log(FI) was associated with higher odds of BPH/LUTS after full adjustment (CHARLS: OR 1.91, 95% CI 1.71-2.13; NHANES: OR 1.47, 95% CI 1.25-1.73). FI tertiles showed graded associations (Model 3; Q3 vs Q1: CHARLS OR 2.91, 95% CI 2.39-3.56; NHANES OR 1.77, 95% CI 1.32-2.37; both P for trend < 0.001). RCS models indicated significant overall associations without evidence of nonlinearity (CHARLS P for nonlinearity = 0.171; NHANES P for nonlinearity = 0.791). Effect modification was observed for drinking status in CHARLS and for age and smoking status in NHANES (all P for interaction ≤ 0.005). Exploratory machine-learning models showed good internal discrimination (CHARLS CatBoost AUC 0.947; NHANES XGBoost AUC 0.925), but these findings require cautious interpretation because external validation was not performed.
Higher FI levels were associated with a higher prevalence of broadly defined symptomatic BPH/LUTS in two nationally representative populations. Given the cross-sectional design, these findings should be interpreted as associations only, and longitudinal studies are needed to clarify the temporal and causal relationships between frailty burden and BPH/LUTS.

PMID:
42435056
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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