Research Article: A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: A cohort study

Date Published: December 31, 2018

Publisher: Public Library of Science

Author(s): Zuyun Liu, Pei-Lun Kuo, Steve Horvath, Eileen Crimmins, Luigi Ferrucci, Morgan Levine, Sanjay Basu

Abstract: BackgroundA person’s rate of aging has important implications for his/her risk of death and disease; thus, quantifying aging using observable characteristics has important applications for clinical, basic, and observational research. Based on routine clinical chemistry biomarkers, we previously developed a novel aging measure, Phenotypic Age, representing the expected age within the population that corresponds to a person’s estimated mortality risk. The aim of this study was to assess its applicability for differentiating risk for a variety of health outcomes within diverse subpopulations that include healthy and unhealthy groups, distinct age groups, and persons with various race/ethnic, socioeconomic, and health behavior characteristics.Methods and findingsPhenotypic Age was calculated based on a linear combination of chronological age and 9 multi-system clinical chemistry biomarkers in accordance with our previously established method. We also estimated Phenotypic Age Acceleration (PhenoAgeAccel), which represents Phenotypic Age after accounting for chronological age (i.e., whether a person appears older [positive value] or younger [negative value] than expected, physiologically). All analyses were conducted using NHANES IV (1999–2010, an independent sample from that originally used to develop the measure). Our analytic sample consisted of 11,432 adults aged 20–84 years and 185 oldest-old adults top-coded at age 85 years. We observed a total of 1,012 deaths, ascertained over 12.6 years of follow-up (based on National Death Index data through December 31, 2011). Proportional hazard models and receiver operating characteristic curves were used to evaluate all-cause and cause-specific mortality predictions. Overall, participants with more diseases had older Phenotypic Age. For instance, among young adults, those with 1 disease were 0.2 years older phenotypically than disease-free persons, and those with 2 or 3 diseases were about 0.6 years older phenotypically. After adjusting for chronological age and sex, Phenotypic Age was significantly associated with all-cause mortality and cause-specific mortality (with the exception of cerebrovascular disease mortality). Results for all-cause mortality were robust to stratifications by age, race/ethnicity, education, disease count, and health behaviors. Further, Phenotypic Age was associated with mortality among seemingly healthy participants—defined as those who reported being disease-free and who had normal BMI—as well as among oldest-old adults, even after adjustment for disease prevalence. The main limitation of this study was the lack of longitudinal data on Phenotypic Age and disease incidence.ConclusionsIn a nationally representative US adult population, Phenotypic Age was associated with mortality even after adjusting for chronological age. Overall, this association was robust across different stratifications, particularly by age, disease count, health behaviors, and cause of death. We also observed a strong association between Phenotypic Age and the disease count an individual had. These findings suggest that this new aging measure may serve as a useful tool to facilitate identification of at-risk individuals and evaluation of the efficacy of interventions, and may also facilitate investigation into potential biological mechanisms of aging. Nevertheless, further evaluation in other cohorts is needed.

Partial Text: Rapid population aging represents a major public health burden, as aging is one of the leading risk factors for most major chronic diseases [1,2]. As a result, preventive strategies and interventions that promote healthy aging are critical. While everyone ages, the rate at which aging occurs is heterogeneous, and between-person variations in the pace of aging manifest as differences in susceptibility to death and disease. Thus, differentiating aging in individuals of the same chronological age, particularly in early life, will facilitate secondary and tertiary prevention through earlier identification of high-risk individuals or groups. However, a key issue remains in how to measure aging. Further, to be applicable to the clinical setting, such assessment should be easy to conduct using existing instruments, must do a better job at capturing risk stratification than current tools, and should be able to differentiate risk prior to manifestation of disease or disability.

The basic characteristics of the study participants are shown in S1 Table. The mean age of the 11,432 adults was 45.5 years, and about half of the sample were women (50.8%). Young (20–39 years) and middle aged (40–64 years) adults accounted for 40% and 45%, respectively. Three-quarters of participants self-identified as non-Hispanic white, about 11% were non-Hispanic black, and 13% were Hispanic. One-quarter of participants had a college degree, about 30% had some college education, one-quarter had a HS education, and about 19% had not graduated from HS or received a GED. Half of the sample were never smokers, while the other half were approximately equal parts former and current smokers. Approximately 15% had binge drinking tendencies over the past year. Finally, proportions of normal BMI, overweight, and obese were each about one-third.

In a nationally representative US adult population, we showed that our new measure of aging—Phenotypic Age—was highly predictive of mortality even after adjusting for chronological age. Overall, we found that the mortality prediction of this measure is valid across different stratifications, particularly by age, disease count, health behaviors, and cause of death. For instance, Phenotypic Age is strongly associated with all-cause mortality in multiple age groups, including young adults, middle aged adults, and older adults. Moreover, the effect sizes seem to decrease with age, which may suggest that in younger groups, when the risk of death is low, variations in physiological status—as captured by PhenoAgeAccel—may play a bigger role in who lives longer. Conversely, in older adults, for whom the risk of death increases, mortality may be more stochastic. Nevertheless, we were able to determine that this measure was not just capturing an end-of-life or critically ill status, given that it remained predictive of mortality after excluding participants who had not survived for at least 5 years after baseline.



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