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Associations of healthy aging index and all-cause and cause-specific mortality: a prospective cohort study of UK Biobank participants

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Abstract

The healthy aging index (HAI) has been recently developed as a surrogate measure of biological age. However, to what extent the HAI is associated with all-cause and cause-specific mortality and whether this association differs in younger and older adults remains unknown. We aimed to quantify the association between the HAI and mortality in a population of UK adults. In the prospective cohort study, data are obtained from the UK Biobank. Five HAI components (systolic blood pressure, reaction time, cystatin C, serum glucose, forced vital capacity) were scored 0 (healthiest), 1, and 2 (unhealthiest) according to sex-specific tertiles or clinically relevant cut-points and summed to construct the HAI (range 0–10). Cox proportional hazard regression models were used to estimate the associations of the HAI with the risk of all-cause and cause-specific mortality. 387,794 middle-aged and older participants were followed up for a median of 8.9 years (IQR 8.3–9.5). A total of 14,112 all-cause deaths were documented. After adjustments, each 1-point increase in the HAI was related to a higher risk of all-cause mortality (hazards ratio [HR], 1.17; 95%CI, 1.15–1.18). Such association was stronger among adults younger than 60 years (1.19, 1.17–1.21) than that among those 60 years and older (1.15, 1.14–1.17) (P interaction < 0.001). For each unit increment of the HAI, the multivariate-adjusted HRs for risk of death were 1.28 (1.25–1.31) for cardiovascular diseases, 1.09 (1.07–1.10) for cancer, 1.36 (1.29–1.44) for digestive disease, 1.42 (1.35–1.48) for respiratory disease, 1.42 (1.33–1.51) for infectious diseases, and 1.15 (1.09–1.21) for neurodegenerative disease, respectively. Our findings indicate that the HAI is positively associated with all-cause and cause-specific mortality independent of chronological age. Our results further underscore the importance of effective early-life interventions to slow aging and prevent premature death.

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Data availability

UKB data are available in a public, open-access repository. This research has been conducted using the UKB Resource under Application Number 44430. The UKB data are available on application to the UK Biobank (http://www.ukbiobank.ac.uk/).

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Funding

The study was supported by grants from the National Key R&D Program of China (2020YFC2003401), the National Natural Science Foundation of China (82173499), and the High-Performance Computing Platform of Peking University. The funders had no role in the study design, data collection, data analysis and interpretation, writing of the report, or the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China

    Zhenhuang Zhuang, Yimin Zhao, Ninghao Huang, Yueying Li, Wenxiu Wang, Zimin Song, Xue Dong, Wendi Xiao & Tao Huang

  2. Department of Biostatistics, School of Public Health, Peking University, Beijing, China

    Jinzhu Jia

  3. Department of Biostatistics, Columbia University, New York, NY, USA

    Zhonghua Liu

  4. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA

    Lu Qi

  5. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Lu Qi

  6. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China

    Tao Huang

  7. Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China

    Tao Huang

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  1. Zhenhuang Zhuang
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  2. Yimin Zhao
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  3. Ninghao Huang
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  4. Yueying Li
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  10. Zhonghua Liu
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  11. Lu Qi
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  12. Tao Huang
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Contributions

T. H. and L. Q. designed the research. Z. Z. and T. H. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Z. Z. wrote the paper and performed the data analysis. All authors contributed to the statistical analysis, critically reviewed the manuscript during the writing process, and approved the final version to be published. Z. Z. and T. H. are the guarantors for the study.

Corresponding authors

Correspondence to Lu Qi or Tao Huang.

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Ethics approval

The UKB study was approved by the National Information Governance Board for Health and Social Care in England and Wales, the Community Health Index Advisory Group in Scotland, and the North West Multicenter Research Ethics Committee. All participants gave written informed consent. This UKB study was also approved by the Ethical Committee of Peking University (Beijing, China).

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The authors declare no competing interests.

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Zhuang, Z., Zhao, Y., Huang, N. et al. Associations of healthy aging index and all-cause and cause-specific mortality: a prospective cohort study of UK Biobank participants. GeroScience 46, 1241–1257 (2024). https://doi.org/10.1007/s11357-023-00891-6

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