Evidence map›Paper›PMID 42237291›Full record

ArticleInternational journal for equity in health2026

Frailty among older adults in Germany: regional variation across NAKO study centers.

Maximilian König, Stefan Rach, Rafael Mikolajczyk, Ben Schöttker, Ute Mons, Manuel Amthor, Henry Völzke, Claudia Meinke-Franze, Volker Harth, Nadia Obi and 14 more

Abstract read
In one paragraph

Article in International journal for equity in health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Maximilian KönigDepartment of Internal Medicine D - Geriatrics, Universitätsmedizin Greifswald, Greifswald, Germany. maximilian.koenig@med.uni-greifswald.de.
Stefan RachDepartment of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
Rafael MikolajczykInstitute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Ben SchöttkerDivision of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Ute MonsDivision of Primary Cancer Prevention, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Manuel AmthorDepartment of Internal Medicine D - Geriatrics, Universitätsmedizin Greifswald, Greifswald, Germany.
Henry VölzkeDepartment of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany.
Claudia Meinke-FranzeDepartment of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany.
Volker HarthInstitute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Nadia ObiInstitute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Matthias B SchulzeDepartment of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
Barbara ThorandInstitute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
Karin Halina GreiserDivision of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Michael LeitzmannInstitute for Epidemiology and Preventive Medicine, University Medicine Regensburg, Regensburg, Germany.
Anne HerrmannInstitute for Epidemiology and Preventive Medicine, University Medicine Regensburg, Regensburg, Germany.
Wolfgang LiebInstitute of Epidemiology, Christian-Albrechts-University of Kiel and University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
Jasmin KiekertInstitute for Epidemiology and Prevention, Universitätsklinikum Freiburg, Freiburg, Germany.
Thomas KeilInstitute of Social Medicine, Epidemiology, and Health Economics, Charité- Universitätsmedizin Berlin, Berlin, Germany.
Lilian KristInstitute of Social Medicine, Epidemiology, and Health Economics, Charité- Universitätsmedizin Berlin, Berlin, Germany.
Börge SchmidtInstitute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
Jana-Kristin HeiseDepartment of Epidemiology, Helmholtz-Center for Infection Research (HZI), Braunschweig, Germany.
Katharina NimptschMolecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.
Tobias PischonMolecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany.
Till IttermannDepartment of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFrailty is a geriatric syndrome associated with increased morbidity, disability, and mortality. While its prevalence has been studied extensively in individual cohorts and patient populations, national prevalence data are scarce and regional variations within Germany remain largely unexplored. This study examined the frequency of frailty and its regional variation across the 18 NAKO (German National Cohort) study centers using a uniform frailty index.

methodsWe analysed baseline data collected between 2014 and 2019 from 39,248 participants aged 61-75 years enrolled in the NAKO study, a large population-based cohort recruited across 18 study centers in Germany. Frailty was measured using a 40-item Frailty Index (FI), with FI ≥ 0.25 indicating frailty. Regional variations in frailty were first examined using crude frequencies and subsequently analysed with logistic regression, adjusting for key confounders, including age, sex, and sociodemographic and socioeconomic factors, to account for compositional differences across centers.

resultsThe crude frequency of frailty in the total sample was 7.7% (95% CI: 7.5-8.0), while 34.1% were prefrail. Frailty frequencies showed a nearly twofold spread (5.4%-10.2%) across study sites, being highest in Essen, Düsseldorf, Regensburg, Saarbrücken, and Berlin, and lowest in Freiburg, Münster, and northern German centers. Higher age, lower socioeconomic status and weaker social networks were all independently associated with frailty status. However, while these compositional factors contributed to the variability observed across centers, they did not fully account for it.

conclusionNotable regional differences in frailty are evident across NAKO study centers in Germany, even after accounting for population composition (age, sex, and socioeconomic factors). This residual heterogeneity suggests that contextual factors - such as regional healthcare access, environmental exposures, or structural policies - contribute to frailty development beyond individual risk factors.

Indexed as

Frail ElderlyFrailtyAgedCohort StudiesFemaleGeriatric AssessmentGermanyHumansMaleMiddle AgedPrevalenceSocioeconomic FactorsFrailtyOlder adultsPrevalenceRegionalSpatial

Identifiers

PMID42237291
PMCPMC13231660

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.