Multi-cohort evidence linking edentulism to frailty among older adults.

To investigate the association between edentulism and frailty across nationally representative cohorts in China, the United Kingdom, and the United States. A harmonized analysis was conducted using longitudinal data from the CHARLS, ELSA, and HRS cohorts. This study examined the association between self-reported edentulism (exposure) and frailty (outcome), with adjustment for self-reported covariates including age, gender, lifestyle factors, and comorbidities. Multivariable linear and logistic regression models were applied to examine the associations of edentulism with the frailty index and frailty phenotype, respectively. To synthesize effect estimates across cohorts, fixed- and random-effects meta-analyses were conducted. Robustness was assessed through stratified analyses by age and gender, as well as through multiple imputation to address missing data. A total of 9,869 participants from CHARLS (female: 52.9%, mean age: 61.2 years), 5,083 from ELSA (female: 55.7%, mean age: 62.7 years), and 12,322 from HRS (female: 59.5%, mean age: 65.8 years) were included. Meta-analysis of the fully adjusted models across cohorts revealed that edentulous individuals exhibited significantly higher frailty index scores (pooled mean difference = 2.68; 95% confidence interval [CI]: 1.67-3.69) and increased odds of frailty status (pooled odds ratio = 1.38; 95% CI: 1.26-1.50) compared to dentate counterparts. These associations remained robust in stratified and sensitivity analyses. Edentulism is independently associated with frailty across aging populations. These findings underscore the clinical relevance of oral health in geriatric risk assessment and support the integration of dental evaluation into multidisciplinary strategies for frailty management.