The exposome of healthy and accelerated aging across 40 countries

Protective and risk factors can drive healthy or accelerated aging, with distinct environments modulating their effects. The impact of the exposome-the combined physical and social exposures experienced throughout life-on accelerated aging remains unknown. We assessed delayed and accelerated aging in 161,981 participants from 40 countries (45.09% female; mean age, 67.06; s.d., 9.85) by measuring biobehavioral age gaps (BBAGs), defined as the difference between estimated age from protective and risk factors and chronological age, in cross-sectional and longitudinal designs. BBAGs predicted chronological age, followed by regional and exposomal factor analyses, linked to accelerated aging. Europe led in healthy aging, while Egypt and South Africa showed the greatest acceleration; Asia and Latin America fell in between (Cliff's delta (δd) = 0.15-0.52; all P < 0.0001). Accelerated aging was more evident in eastern and southern Europe; globally, it was also associated with lower income (δd = 0.48-0.56, P < 1 × 10^-15). Exposomal factors of accelerated aging include physical (air quality), social (socioeconomic and gender inequality, migration) and sociopolitical (representation, party freedom, suffrage, elections and democracy) determinants (all Cohen's d (d) > 0.37, P < 0.0001). BBAGs predicted future functional (r (Pearson correlation) = -0.33, P < 1 × 10^-15, d = 0.70) and cognitive declines (r = -0.22, P < 1 × 10^-15, d = 0.44), and larger BBAGs (P < 0.0001, d = 1.55). Healthy and accelerated aging are influenced by physical, social and sociopolitical exposomes, with considerable disparities across nations.