title: Effect of health protective factors on health deficit accumulation and mortality risk in older adults in the Beijing Longitudinal Study of Aging.
abstract: OBJECTIVE
  To evaluate transitions in health status and risk of death in older adults in relation to baseline health deficits and protective factors.
  
  
  METHODS
  Prospective cohort study with reassessments at 5, 8, and 15 years.
  
  
  METHODS
  Secondary analysis of data from the Beijing Longitudinal Study on Aging.
  
  
  METHODS
  Urban and rural community-dwelling people aged 55 and older at baseline (n = 3,275), followed from 1992 to 2007, during which time 51% died.
  
  
  METHODS
  Health status was quantified using the deficit accumulation-based frailty index (FI), constructed from 30 intrinsic health measures. A protection index was constructed using 14 extrinsic items (e.g., exercise, education). The probabilities of health changes, including death, were evaluated using a multistate transition model.
  
  
  RESULTS
  Women had more health deficits (mean baseline FI 0.13 ± 0.11) than did men (mean baseline FI 0.11 ± 0.10). Although health declined on average (mean FIs increased), improvement and stability were common. Baseline health significantly affected health transitions and survival over various follow-up durations (odds ratio (OR) = 1.27, 95% confidence interval (CI) = 1.17-1.37 for men; OR = 1.24, 95% CI = 1.16-1.33 for women for each increment of deficits). Each protective factor reduced the risk of health decline and the risk of death in men and women by 13% to 25%.
  
  
  CONCLUSIONS
  Deficit accumulation-based transition modeling demonstrates persisting effects of baseline health status on age-related health outcomes. Some mitigation by protective factors can be demonstrated, suggesting that improving physical and social conditions might be beneficial.
authors.affiliation: Department of Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: Chunxiu
authors.initials: C
authors.lastname: Wang
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Song
authors.forename: Arnold
authors.initials: A
authors.lastname: Mitnitski
authors.forename: Xianghua
authors.initials: X
authors.lastname: Fang
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tang
authors.forename: Pulin
authors.initials: P
authors.lastname: Yu
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000368:Aged; D000375:Aging; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D012737:Sex Factors; D016019:Survival Analysis; D015996:Survival Rate / Q000639:trends; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: aging; frailty; frailty index; health transitions; protection index