AGE

, 36:9732 | Cite as

Multiple, but not traditional risk factors predict mortality in older people: the concord health and ageing in men project

  • Vasant Hirani
  • Vasi Naganathan
  • Fiona Blyth
  • David G. Le Couteur
  • Danijela Gnjidic
  • Fiona F. Stanaway
  • Markus J. Seibel
  • Louise M. Waite
  • David J. Handelsman
  • Robert G. Cumming
Article

Abstract

This study aims to identify the common risk factors for mortality in community-dwelling older men. A prospective population-based study was conducted with a median of 6.7 years of follow-up. Participants included 1705 men aged ≥70 years at baseline (2005–2007) living in the community in Sydney, Australia. Demographic information, lifestyle factors, health status, self-reported history of diseases, physical performance measures, blood pressure, height and weight, disability (activities of daily living (ADL) and instrumental ADLs, instrumental ADLs (IADLs)), cognitive status, depressive symptoms and blood analyte measures were considered. Cox regression analyses were conducted to model predictors of mortality. During follow-up, 461 men (27 %) died. Using Cox proportional hazards model, significant predictors of mortality included in the final model (p < 0.05) were older age, body mass index < 20 kg m2, high white cell count, anaemia, low albumin, current smoking, history of cancer, history of myocardial infarction, history of congestive heart failure, depressive symptoms and ADL and IADL disability and impaired chair stands. We found that overweight and obesity and/or being a lifelong non-drinker of alcohol were protective against mortality. Compared to men with less than or equal to one risk factor, the hazard ratio in men with three risk factors was 2.5; with four risk factors, it was 4.0; with five risk factors, it was 4.9; and for six or more risk factors, it was 11.4, respectively. We have identified common risk factors that predict mortality that may be useful in making clinical decisions among older people living in the community. Our findings suggest that, in primary care, screening and management of multiple risk factors are important to consider for extending survival, rather than simply considering individual risk factors in isolation. Some of the “traditional” risk factors for mortality in a younger population, including high blood pressure, hypercholesterolaemia, overweight and obesity and diabetes, were not independent predictors of mortality in this population of older men.

Keywords

Mortality Sociodemographic Economic and lifestyle factors Health conditions Physical function Disability 

Notes

Acknowledgements

The CHAMP study is funded by the National Health and Medical Research Council (project grant number 301916) and the Ageing and Alzheimer’s Institute. We thank all the staff working on CHAMP and the participants in the project. The lead author is funded by the ARC Centre of Excellence in Population Ageing Research (CEPAR).

Funding

The views expressed are those of the authors, not of the funders. Data analysis and interpretation were carried out by the authors independently of the funding sources based on the available data. The corresponding author had full access to the survey data and had final responsibility for the decision to submit for publication.

Conflicts of interest

The authors do not have any conflict of interest to declare.

Authors’ contributions

VH and RC designed and developed the study. VH conducted the data analyses and wrote the initial versions of the manuscript. RC edited the manuscript. All authors contributed to interpretation of the results, revised subsequent drafts, reviewed and approved the final version of the manuscript. RC and VH had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Sponsor’s role

The funding body played no role in the formulation of the design, methods, subject recruitment, data collection, analysis or preparation of this paper.

References

  1. Andrews G, Cheok F, Carr S (1989) The Australian longitudinal study of ageing. Aust J Ageing 8:31–35CrossRefGoogle Scholar
  2. Australian Institute of Health and Welfare (AIHW) (2011) Measuring alcohol risk in the 2010 National Drug Strategy Household Survey: implementation of the 2009 Alcohol Guidelines. Drug statistics series no. 26. Cat. no. PHE 152, CanberraGoogle Scholar
  3. Cheng CK, Chan J, Cembrowski GS, van Assendelft OW (2004) Complete blood count reference interval diagrams derived from NHANES III: stratification by age, sex, and race. Lab Hematol 10(1):42–53PubMedCrossRefGoogle Scholar
  4. Cooper R, Kuh D, Hardy R, Mortality Review Group; FALCon and HALCyon Study Teams (2010) Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ 341:c4467PubMedCentralPubMedCrossRefGoogle Scholar
  5. Corti M-C, Guralnik JM, Salive ME, Sorkin JD (1994) Serum albumin level and physical disability as predictors of mortality in older persons. JAMA 272:1036–1042PubMedCrossRefGoogle Scholar
  6. Crimmins E, Vasunilashorn S, Kim JK, Alley D (2008) Biomarkers related to aging in human populations. Adv Clin Chem 46:161–216. http://dx.doi.org/ 10.1016/S0065-2423(08)00405-8
  7. Cuijpers P, Smit F (2002) Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 72:227–236PubMedCrossRefGoogle Scholar
  8. Cumming RG, Handelsman D, Seibel MJ et al (2008) Cohort profile: the concord health and ageing in men project (champ). Int J Epidemiol 38(2):374–378PubMedCrossRefGoogle Scholar
  9. Efron B, Tibshirani R (1993) An introduction to the bootstrap. Chapman and Hall, New YorkCrossRefGoogle Scholar
  10. Feldman HA, Johannes CB, Araujo AB et al (2001) Low dehydroepianrdrosterone and ischaemic heart disease in middle-aged men: prospective results from the Massachusetts Male Aging Study. Am J Epidemiol 153:79–89PubMedCrossRefGoogle Scholar
  11. Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434PubMedCrossRefGoogle Scholar
  12. Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198PubMedCrossRefGoogle Scholar
  13. Fried LP, Kronmal RA, Newman AB et al (1998) Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. JAMA 279(8):585–592PubMedCrossRefGoogle Scholar
  14. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156PubMedCrossRefGoogle Scholar
  15. Gellert C, Schöttker B, Brenner H (2012) Smoking and all-cause mortality in older people: systematic review and meta-analysis. Arch Intern Med 172(11):837–844. doi: 10.1001/archinternmed.2012.1397 PubMedCrossRefGoogle Scholar
  16. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Cumming RG et al (2012) High risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther 91:521–528PubMedCrossRefGoogle Scholar
  17. Green F, Ryan C (2009) An overview of chronic kidney disease in Australia, 2009. Cat. no. PHE 111. AIHW, Canberra. http://www.aihw.gov.au/publication-detail/?id=6442468245. Accessed 16 Oct. 2013
  18. Harrell FE (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, New YorkCrossRefGoogle Scholar
  19. Heart Foundation of Australia, (National Blood Pressure and Vascular Disease Advisory Committee) (2014). Guide to management of hypertension. 2008. Updated 2010. www.heartfoundation.org.au/SiteCollectionDocuments/HypertensionGuidelines2008to2010Update.pdf. Accessed 12 Mar.
  20. Hirani V, Naganathan V, Cumming RG et al (2013) Associations between frailty and serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations in older Australian men: the Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 68(9):1112–1121PubMedCrossRefGoogle Scholar
  21. Holahan CJ, Schutte KK, Brennan PL et al (2010) Late-life alcohol consumption and 20-year mortality. Alcohol Clin Exp Res 34(11):1961–1971PubMedCrossRefGoogle Scholar
  22. Holden CA, McLachlan RI, Pitts M et al (2005) Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men. Lancet 366:218–224PubMedCrossRefGoogle Scholar
  23. Isaks GI, Westendorp RGJ, Knook DL (1999) The definition of anemia in older persons. JAMA 281:1714–1717CrossRefGoogle Scholar
  24. Janssen I (2007) Morbidity and mortality risk associated with an overweight BMI in older men and women. Obesity 15(7):1827–1840PubMedCrossRefGoogle Scholar
  25. Janssen I, Katzmarzyk PT, Ross R (2005) Body mass index is inversely related to mortality in older people after adjustment for waist circumference. J Am Geriatr Soc 53(12):2112–2118PubMedCrossRefGoogle Scholar
  26. Jorm AF (1994) A short form of the informant questionnaire on cognitive decline in the elderly (IQCODE): development and cross-validation. Psychol Med 24:145–153PubMedCrossRefGoogle Scholar
  27. Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10:20–30PubMedCrossRefGoogle Scholar
  28. Kim KI, Lee J, Heo NJ et al (2013) Differential white blood cell count and all-cause mortality in the Korean elderly. Exp Gerontol 48(2):103–108. doi: 10.1016/j.exger.2012.11.016 PubMedCrossRefGoogle Scholar
  29. LaCroix AZ, Lang J, Scherr P et al (1991) Smoking and mortality among older men and women in three communities. N Engl J Med 324:1619–1625PubMedCrossRefGoogle Scholar
  30. Lee SJ, Lindquist K, Segal MR, Covinsky KE (2006) Development and validation of a prognostic index for 4-year mortality in older adults. JAMA 295(7):801–808PubMedCrossRefGoogle Scholar
  31. Levey AS, Coresh J, Greene T et al (2005) Expressing the MDRD equation for estimating GFR with IDMS traceable (gold standard ) serum creatinine values. J Am Soc Nephrol 16:69AGoogle Scholar
  32. Little R, Rubin D (2002) Statistical analysis with missing data, 2nd edn. Wiley, HobokenCrossRefGoogle Scholar
  33. Lord SR, Tiedemann A, Chapman K et al (2005) The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. J Am Geriatr Soc 53:1296–1304PubMedCrossRefGoogle Scholar
  34. Lubitz J, Cai L, Kramarow E, Lentzner H (2003) Health, life expectancy, and health care spending among the elderly. N Engl J Med 349(11):1048–1055PubMedCrossRefGoogle Scholar
  35. Newson RS, Witteman JC, Franco OH et al (2010) Predicting survival and morbidity-free survival to very old age. Age (Dordr) 32(4):521–534CrossRefGoogle Scholar
  36. Orwoll E, Blank JB, Barrett-Connor E et al (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26:569–585PubMedCrossRefGoogle Scholar
  37. Patel KV, Longo DL, Ershier WB et al (2009) Hemoglobin concentration and the risk of death in older adults: differences by race/ethnicity in the NHANES III follow-up. Br J Haematol 1445:514–523CrossRefGoogle Scholar
  38. Penninx BWJH, Pahor M, Woodman RC, Guralnik JM (2006) Anemia in old age is associated with increased mortality and hospitalization. J Gerontol 61A:474–479CrossRefGoogle Scholar
  39. Reid MC, Boutros NN, O’Connor PG, Cadariu A, Concato J (2002) The health-related effects of alcohol use in older persons: a systematic review. Subst Abus 23:149–164PubMedGoogle Scholar
  40. Reuben DB (2009) Medical care for the final years of life: “When you’re 83, it’s not going to be 20 years”. JAMA 302(24):2686–2694PubMedCentralPubMedCrossRefGoogle Scholar
  41. Ruggiero C, Metter EJ, Cherubini A et al (2007) White blood cell count and mortality in the Baltimore Longitudinal Study of Aging. J Am Coll Cardiol 49(18):1841–1850PubMedCentralPubMedCrossRefGoogle Scholar
  42. Sahyoun NR, Jacques PF, Dallal G et al (1996) Use of albumin as a predictor of mortality in community-dwelling and institutionalized elderly populations. J Clin Epidemiol 49(9):981–988PubMedCrossRefGoogle Scholar
  43. Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER (2009) Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey. J Gen Intern Med 24(10):1115–1122PubMedCentralPubMedCrossRefGoogle Scholar
  44. Seeman TE, Crimmins E, Huang MH et al (2004) Cumulative biological risk and socio‐economic differences in mortality: MacArthur Studies of Successful Aging. Soc Sci Med 58:1985–1997PubMedCrossRefGoogle Scholar
  45. Shiekh J, Yesavage J (1986) Geriatric depression scale: recent findings and development of a short version. In: Brink T (ed) Clinical gerontology: a guide to assessment and intervention. Howarth Press, New YorkGoogle Scholar
  46. Stineman MG, Xie D, Pan Q et al (2012) All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage. J Am Geriatr Soc 60(3):485–492PubMedCentralPubMedCrossRefGoogle Scholar
  47. Takata Y, Ansai T, Soh I et al (2010) Serum albumin levels as an independent predictor of 4-year mortality in a community-dwelling 80-year-old population. Aging Clin Exp Res 22(1):31–35PubMedCrossRefGoogle Scholar
  48. Tinetti ME, Fried TR, Boyd CM (2012) Designing health care for the most common chronic condition—multimorbidity. JAMA 307(23):2493–2494. doi: 10.1001/jama.2012.5265 PubMedCentralPubMedCrossRefGoogle Scholar
  49. Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233PubMedCrossRefGoogle Scholar
  50. Washburn RA, Smith KW, Jette AM, Janney CA (1993) The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162PubMedCrossRefGoogle Scholar
  51. Winter JE, Macinnis RJ, Wattanapenpaiboon N, Nowson CA (2014) BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr 99:875–890PubMedCrossRefGoogle Scholar
  52. World Health Organization (1968) Nutritional anemias: Report of a WHO Scientific Group. WHO Technical Reports Series 405. WHO, GenevaGoogle Scholar
  53. Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK (2012) Prognostic indices for older adults: a systematic review. JAMA 307(2):182–192PubMedCentralPubMedCrossRefGoogle Scholar
  54. Zakai NA, Katz R, Hirsch C et al (2005) A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort. The Cardiovascular Health Study. Arch Intern Med 165:2214–2220PubMedCrossRefGoogle Scholar

Copyright information

© American Aging Association 2014

Authors and Affiliations

  • Vasant Hirani
    • 1
    • 2
    • 3
  • Vasi Naganathan
    • 1
  • Fiona Blyth
    • 1
  • David G. Le Couteur
    • 6
  • Danijela Gnjidic
    • 1
    • 7
  • Fiona F. Stanaway
    • 2
  • Markus J. Seibel
    • 4
  • Louise M. Waite
    • 1
  • David J. Handelsman
    • 5
  • Robert G. Cumming
    • 1
    • 2
    • 3
  1. 1.Centre for Education and Research on Ageing, Concord HospitalUniversity of SydneySydneyAustralia
  2. 2.School of Public HealthUniversity of SydneySydneyAustralia
  3. 3.The ARC Centre of Excellence in Population Ageing ResearchUniversity of SydneySydneyAustralia
  4. 4.Bone Research Program, ANZAC Research Institute, and Department of Endocrinology & Metabolism, Concord HospitalThe University of SydneySydneyAustralia
  5. 5.Department of Andrology, Concord Hospital & ANZAC Research InstituteUniversity of SydneySydneyAustralia
  6. 6.ANZAC Research Institute & Charles Perkins CentreUniversity of SydneySydneyAustralia
  7. 7.Faculty of Pharmacy, Pharmacy and Bank BuildingUniversity of SydneySydneyAustralia

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