Biological Age Should Anchor Age-Related Disease Research

Chronological age is an inadequate proxy for the biological processes that drive disease risk, progression, and treatment response in older adults. This editorial advocates for a minimal standard in age-related disease research: the inclusion of one prespecified biological aging measure and one prespecified immune aging measure when biospecimens are available. Drawing on studies featured in this issue, we illustrate how biological and immune age account for heterogeneity across diverse domains, including cancer, neurodegeneration, vascular disease, immunosenescence, pain, and fibrosis. In the absence of aging readouts, biologically distinct states remain obscured, obscuring biological variation, weakening inference, and limiting translational relevance. We propose a practical framework for incorporating aging metrics into stratification, interpretation, and study design, with the goal of advancing both mechanistic insight and clinical application in aging biology.