Abstract
Background/ObjectivesPredictors of healthy aging have not been well-studied using longitudinal data with demographic, clinical, subclinical, and genetic information. The objective was to identify predictors of poor health outcome at 10 years of follow-up in the Multi-Ethnic Study of Atherosclerosis (MESA).DesignProspective cohort study.SettingPopulation-based sample from 6 U.S. communities.Participants4,355 participants In the MESA Study.MeasurementsPoor health outcome at 10 years of follow-up was defined as having died or having clinical cardiovascular disease, depression, cognitive impairment, chronic obstructive pulmonary disease, or cancer other than non-melanoma skin cancer. Absolute risk regression was used to estimate risk differences in the outcome adjusting for demographic variables, clinical and behavioral risk factors, subclinical cardiovascular disease, and ApoE genotype. Models were weighted to account for selective attrition.ResultsMean age at 10 years of follow-up was 69.5 years; 1,480 participants had a poor health outcome, 2,157 participants were in good health, and 718 were unknown. Older age, smoking, not taking a statin, hypertension, diabetes, and higher coronary calcium score were associated with higher probability of poor health outcome. After multivariable adjustment, participants in the lowest income and educational categories had 7 to 14% greater absolute risk of poor health outcome at 10 years of follow-up compared to those in the next highest categories of income or education (P = 0.002 for both). Those in the lowest categories of both income and education had 21% greater absolute risk of poor health outcome compared to those in the highest categories of both income and education.ConclusionsLow income and educational level predict poor health outcome at 10 years of follow-up in an aging cohort, independent of clinical and behavioral risk factors and subclinical cardiovascular disease.
Highlights
As life expectancy increases throughout the world, the numbers and proportion of the population living to older ages are increasing [1], reflecting both reduction in early life mortality and improvement in life expectancy for older people [2]
Older age, smoking, not taking a statin, hypertension, diabetes, and higher coronary calcium score were associated with higher probability of poor health outcome
Related work has focused on multi-morbidity [5] and the burden of disease in the elderly. One challenge in this field has been the lack of longitudinal data, which are important because of the potential in retrospective studies for bias arising from recall and from selective cohort truncation to reach the age of survivorship
Summary
As life expectancy increases throughout the world, the numbers and proportion of the population living to older ages are increasing [1], reflecting both reduction in early life mortality and improvement in life expectancy for older people [2]. Related work has focused on multi-morbidity [5] and the burden of disease in the elderly. One challenge in this field has been the lack of longitudinal data, which are important because of the potential in retrospective studies for bias arising from recall and from selective cohort truncation to reach the age of survivorship. Recent work by the US Burden of Disease Collaborators examining years of healthy life lost at the population level confirms the continued importance of ischemic heart disease and stroke as the first and third leading causes of years of life lost to premature mortality.
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