ArticleBioengineering (Basel, Switzerland)2026
Association of the Frailty-to-Estimated Cardiorespiratory Fitness Ratio with Prevalent Stroke in Middle-Aged and Older Adults: A Cross-Sectional NHANES Study.
Article in Bioengineering (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Stroke remains a major cause of disability worldwide, and population-level indicators that integrate multidimensional vulnerability with physiological reserve may provide useful perspectives for characterizing cerebrovascular health in aging populations. This cross-sectional study examined the association between the Frailty-to-estimated Cardiorespiratory Fitness Ratio (FCR) and self-reported prevalent stroke among middle-aged and older adults using NHANES 2011-2014 data. FCR was calculated as a 23-item modified Frailty Index divided by estimated cardiorespiratory fitness, providing an interpretable load-to-reserve measure that linked accumulated health deficits with estimated cardiorespiratory reserve. The final analytical sample included 3511 participants aged 45 years or older. Survey-weighted logistic regression models, sensitivity analyses, exploratory subgroup analyses, and spline models were used to evaluate the association. The weighted prevalence of self-reported prevalent stroke increased across FCR quartiles, from 2.2% in Q1 to 12.9% in Q4. In the conventional clinical adjustment model, participants in the highest FCR quartile had greater odds of self-reported prevalent stroke than those in the lowest quartile (OR = 6.13, 95% CI: 2.97-12.66; p<0.001), with similar findings in the overlap-aware model (OR = 6.31, 95% CI: 3.07-12.97; p<0.001). Log-transformed FCR was also consistently associated with greater odds of self-reported prevalent stroke across adjustment models, and spline analysis suggested a generally increasing association. These findings support FCR, particularly when modeled using quartiles or log-transformed values, as an interpretable integrative load-to-reserve construct associated with self-reported prevalent stroke, and suggest its potential relevance for population-based characterization of cerebrovascular health in aging adults.
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