ArticleThe journals of gerontology. Series A, Biological sciences and medical sciences2026
Utility of biological aging markers for mortality risk stratification in community-dwelling older adults: insights from the Mr. OS and Ms. OS (Hong Kong) cohort.
Article in The journals of gerontology. Series A, Biological sciences and medical sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStudies regarding the integration of various biological aging (BA) markers and their predictive values for long-term mortality risk remain limited, particularly in Asian older adults. We evaluated the associations of multiple BA markers with overall and cause-specific mortality over a 20-year period.
methodsData on 4000 older adults (mean age: 72.5 years) were obtained from the Mr. OS and Ms. OS cohort. BA was assessed by the frailty phenotype, clinical deficit-based frailty index (FI), biochemical-enhanced FI (eGFR, homocysteine, hsCRP, 25(OH)-D), and leukocyte telomere length. Mortality was ascertained by the Hong Kong Death Registry. Hazard ratios (HRs) were assessed using Cox and Fine-Gray models and predictive accuracy with Harrell's c-index.
resultsOver a median follow-up of 18.25 years, 2446 deaths occurred (CVD: 511, cancer: 644). For overall mortality, the HRs (95% CI) of pre-frail and frail groups were 1.24 (1.13-1.35) and 1.66 (1.39-1.98) compared to the fit. Each SD increase in the clinical or biochemical-enhanced FI was associated with 22% or 23% increased risk of overall mortality (p < .001). Longer telomere length reduced overall mortality risk (HR per SD: 0.93, 95% CI: 0.88-0.99). All BA markers except telomere length were significantly associated with CVD mortality. While all BA markers were not significantly associated with cancer mortality. Frailty-related markers showed added predictive values for both overall and cause-specific mortality, while telomere length was specifically predictive for CVD mortality (C-index improvements: 0.32%-7.90%).
conclusionsBiological aging is associated with overall and CVD-cause mortality in older Chinese and may support risk stratification and personalized interventions.
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