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<p>Population aging is accelerating worldwide, with 16% projected to be aged ≥ 65&#xa0;years by 2050. A practical index reflecting overall aging status is needed for population-based research, as existing indices often require specialised or cognitive assessments. We developed a Physiological Healthy Aging Index (PHAI) using accessible biomarkers and evaluated its association with mortality in Korean adults. A total of 6398 participants aged ≥ 40&#xa0;years from the Korean Genome and Epidemiology Study (KoGES) Ansan-Ansung cohort followed up for an average duration of 16.5&#xa0;years (2001–2022). The PHAI, based on systolic blood pressure, fasting blood glucose, serum creatinine, forced vital capacity, and C-reactive protein levels, was scored 0–10, with higher scores indicating healthier aging. Mortality risks across quartiles were estimated using Cox proportional hazard models. Long-term changes were classified as accelerated (decreased scores), stable (unchanged scores), or resilient (increased scores). During 105,597 person-years, 934 deaths occurred (778 age-related, 353 cancer-related, and 184 cardiovascular-related). Higher PHAI quartiles were linked with significantly lower mortality risk versus Q1. Fully adjusted hazard ratios (95% CIs) for all-cause mortality were 0.82 (0.69–0.98) for Q2, 0.50 (0.42–0.60) for Q3, and 0.51 (0.41–0.63) for Q4 (<i>P</i> for trend &lt; 0.001). Similar associations were observed for age-related mortality (HR 0.51, 95% CI 0.40–0.64 for Q4 vs. Q1), cancer (HR 0.66, 95% CI 0.48–0.92), and cardiovascular mortality (HR 0.24, 95% CI 0.13–0.44). Resilient agers had much lower all-cause mortality than accelerated agers (HR 0.21, 95% CI 0.16–0.28), with stable agers also at reduced risk (HR 0.65, 95% CI 0.54–0.77). Higher scores also correlated with a lower cognitive impairment risk. The PHAI is a simple, robust predictor of mortality outcomes, supporting its use as a practical tool for assessing physiological aging in public health and clinical settings.</p> Graphical Abstract <p></p>

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A novel clinical biomarker-based Physiology Healthy Aging Index and risk of all-cause and cause-specific mortality: A 20-year prospective cohort study

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  • 发表日期：

    2025年12月6日

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  • Jieun Lyu,
  • Ji-Yun Hwang,
  • Joong-Yeon Lim,
  • Yoon Jung Park

摘要

Population aging is accelerating worldwide, with 16% projected to be aged ≥ 65 years by 2050. A practical index reflecting overall aging status is needed for population-based research, as existing indices often require specialised or cognitive assessments. We developed a Physiological Healthy Aging Index (PHAI) using accessible biomarkers and evaluated its association with mortality in Korean adults. A total of 6398 participants aged ≥ 40 years from the Korean Genome and Epidemiology Study (KoGES) Ansan-Ansung cohort followed up for an average duration of 16.5 years (2001–2022). The PHAI, based on systolic blood pressure, fasting blood glucose, serum creatinine, forced vital capacity, and C-reactive protein levels, was scored 0–10, with higher scores indicating healthier aging. Mortality risks across quartiles were estimated using Cox proportional hazard models. Long-term changes were classified as accelerated (decreased scores), stable (unchanged scores), or resilient (increased scores). During 105,597 person-years, 934 deaths occurred (778 age-related, 353 cancer-related, and 184 cardiovascular-related). Higher PHAI quartiles were linked with significantly lower mortality risk versus Q1. Fully adjusted hazard ratios (95% CIs) for all-cause mortality were 0.82 (0.69–0.98) for Q2, 0.50 (0.42–0.60) for Q3, and 0.51 (0.41–0.63) for Q4 (P for trend < 0.001). Similar associations were observed for age-related mortality (HR 0.51, 95% CI 0.40–0.64 for Q4 vs. Q1), cancer (HR 0.66, 95% CI 0.48–0.92), and cardiovascular mortality (HR 0.24, 95% CI 0.13–0.44). Resilient agers had much lower all-cause mortality than accelerated agers (HR 0.21, 95% CI 0.16–0.28), with stable agers also at reduced risk (HR 0.65, 95% CI 0.54–0.77). Higher scores also correlated with a lower cognitive impairment risk. The PHAI is a simple, robust predictor of mortality outcomes, supporting its use as a practical tool for assessing physiological aging in public health and clinical settings.

Graphical Abstract