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

  • Zhuang, Zhenhuang1
  • Zhao, Yimin1
  • Huang, Ninghao1
  • Li, Yueying1
  • Wang, Wenxiu1
  • Song, Zimin1
  • Dong, Xue1
  • Xiao, Wendi1
  • Jia, Jinzhu2
  • Liu, Zhonghua3
  • Qi, Lu4, 5
  • Huang, Tao6, 7, 8
  • 1 Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China. , (China)
  • 2 Department of Biostatistics, School of Public Health, Peking University, Beijing, China. , (China)
  • 3 Department of Biostatistics, Columbia University, New York, NY, USA.
  • 4 Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. [email protected].
  • 5 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. [email protected].
  • 6 Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China. [email protected]. , (China)
  • 7 Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China. [email protected]. , (China)
  • 8 Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China. [email protected]. , (China)
Published Article
Publication Date
Feb 01, 2024
DOI: 10.1007/s11357-023-00891-6
PMID: 37526907


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. © 2023. The Author(s), under exclusive licence to American Aging Association.

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