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Screening potential elderly preferred markers: exploratory analysis of Cardiovascular Health Study (CHS) data
1Swiss Re Life & Health, 1700 Magnavox Way, Fort Wayne, IN 46804, USA. kenneth_kraus@swissre.com
Insights
This study identified key medical factors for predicting mortality risk in older adults. Higher lung function, kidney function, hemoglobin, and albumin levels are linked to better survival, while family history of cardiovascular disease and low BMI indicate higher risk.
Area of Science:
- Gerontology
- Cardiovascular Health
- Epidemiology
Background:
- The elderly population is growing, increasing the need for precise mortality risk stratification in this demographic.
- The Cardiovascular Health Study (CHS) offers a unique dataset to examine cardiovascular risk factors and their association with mortality in individuals aged 65 and older.
- Accurate mortality risk assessment is crucial for market segments like life insurance.
Purpose of the Study:
- To identify medical factors that can improve mortality risk stratification in an elderly population, excluding those with pre-existing cardiovascular disease, diabetes, or major ECG abnormalities.
- To assess specific biomarkers and clinical measurements for their predictive value in mortality risk within a "standard" mortality population.
Main Methods:
- Utilized the Cardiovascular Health Study (CHS) public use data set for an exploratory analysis.
- Excluded participants with a history of cardiovascular disease, diabetes, or major electrocardiographic abnormalities to simulate a standard life insurance selection process.
- Employed Cox proportional hazards regression to analyze 10 medical risk factors for their association with mortality.
Main Results:
- Forced vital capacity >80% predicted, serum creatinine <1.5 mg/dL, hemoglobin >11 g/dL, and serum albumin >3.5 mg/L were significantly associated with favorable mortality (p=0.05).
- C-reactive protein <1 mg/L showed borderline significance (p=0.09) for favorable mortality.
- Family history of cardiovascular disease and low body mass index (BMI <26 kg/m2) were associated with unfavorable mortality.
Conclusions:
- Specific medical factors, including pulmonary function, renal function, hemoglobin, and albumin levels, can significantly stratify mortality risk in older adults without prevalent cardiovascular disease.
- Further research is needed to validate the predictive value of these identified medical factors in insured populations.
- The findings contribute to a better understanding of mortality predictors in the elderly, relevant for public health and insurance industries.
Abstract:
The Cardiovascular Health Study (CHS) analyzes risk factors for coronary heart disease and stroke in people age 65 and older. Since CHS is designed to comprehensively study cardiovascular risk factors in an elderly population, it provides a unique opportunity to study the association of risk factors with mortality, as well as morbidity risk. With the growth of the elderly as population and life insurance market segments, the need to more precisely stratify mortality within a standard risk group of the elderly has grown as well. This exploratory analysis assesses medical factors that could be used to improve mortality risk stratification within a "standard" mortality population, using the CHS public use data set. Participants with a personal history of cardiovascular disease, diabetes, or major electrocardiographic abnormalities were excluded from the analysis in order to mimic a standard life insurance selection process. Then, Cox proportional hazards regression was used to study 10 medical risk factors. This model suggested that forced vital capacity >80% predicted, serum creatinine <1.5 mg/dL (133 mcmol/L), hemoglobin >11 g/dL (110 g/L), and serum albumin >3.5 mg/L (35 mmol/ L) are significantly associated (p = 0.05) with favorable mortality. C-reactive protein <1 mg/L is associated with favorable mortality at borderline significance levels (p = 0.09). On the other hand, a family history of cardiovascular disease (MI and/or stroke) and low BMI (<26 kg/m2) are associated with unfavorable mortality in the analysis. Total to HDL cholesterol ratio of <6, presence of supine systolic blood pressure < or = 140 mmHg, and the presence of minor rest electrocardiographic findings were not statistically significant factors in the multivariate model. Further assessment of the predictive value of the "significant" medical factors identified is required in insured lives.
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