Abstract
Backgroundwe aimed to develop and validate a population-representative 10-year mortality risk index for older adults in England.Methodsdata were from 10,798 men and women aged 50 years and older in the population-based English Longitudinal Study of Ageing in 2002/03, randomly split into development (n = 5,377) and validation cohorts (n = 5,421). Participants were asked about their sociodemographics, health behaviours, comorbidities, and functional status in the home-based interviews. Variables that were independently associated with all-cause mortality through March 2013 in the development cohort were weighted relative to one another to develop risk point scores for the index that was calibrated in the validation cohort.Resultsthe validated 10-year mortality risk index assigns points for: increasing age (50–59 years: 0 points; 60–64: 1 point; 65–69: 3 points; 70–74: 5 points; 75–79: 7 points; 80–84: 9 points; ≥85: 12 points), male (2 points), no vigorous physical activity (1 point), smoking (2 points), having a diagnosis of cancer (1 point), chronic lung disease (2 points) or heart failure (4 points), and having difficulty preparing a hot meal (2 points), pushing or pulling large objects (1 point) or walking 100 yards (1 point). In the full study cohort, 10-year mortality rates increased from 1.7% (11/664) in those with 0 points to 95% (189/199) among those with ≥16 points.Conclusionthis highly predictive 10-item mortality risk index is valid in the English population aged 50 years and older. It uses simple information that is often available in research studies and patient reports, and does not require biomarker data to predict mortality.
Highlights
As the age structures of global populations shift upwards, the ability to predict mortality risk for older adults becomes increasingly valuable in clinical, research and policy settings
The fewest number of points achievable on the index is 0, corresponding to a woman aged 50–59 years who engages in some vigorous physical activity, does not smoke, has no diagnosis of cancer, chronic lung disease, or heart failure, and who has no difficulty preparing meals, pushing or pulling large objects or walking 100 yards
This new mortality risk index is similar to frailty indices that predict mortality such as the Frailty Phenotype or the Frailty Index [12,13,14]; yet, it includes additional mortality-specific risk factors, is validated for use in the older English population and harmonised with an existing mortality risk index for the older American population
Summary
As the age structures of global populations shift upwards, the ability to predict mortality risk for older adults becomes increasingly valuable in clinical, research and policy settings. Mortality risk could be adjusted in observational and randomised studies, examined in relation to exposures or treatments, or compared across sociodemographic groups to assess social inequalities. For these uses to be achievable, an appropriate mortality risk index for older adults should include information that is readily accessible through physician–patient discussion and regularly collected in epidemiological studies. Such an index would be valuable in instances when biomarker data are not readily available
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