title: A comparison of methods for assessing mortality risk.
abstract: OBJECTIVE
  Concepts such as Allostatic Load, Framingham Risk Score, and Biological Age were developed to combine information from multiple measures into a single latent variable that can be used to quantify a person's biological state. Given these varying approaches, the goal of this article is to compare how well these three measures predict subsequent all-cause and disease-specific mortality within a large nationally representative U.S. sample.
  
  
  METHODS
  Our study population consisted of 9,942 adults, ages 30 and above from National Health and Nutrition Examination Survey III. Receiver Operating Characteristic curves and Cox Proportional Hazard models for the whole sample and for stratified age groups were used to compare how well Allostatic Load, Framingham Risk Score, and Biological Age predict ten-year all-cause and disease-specific mortality in the sample, for whom there were 1,076 deaths over 96,420 person years of exposure.
  
  
  RESULTS
  Overall, Biological Age predicted 10-year mortality more accurately than other measures for the full age range, as well as for participants ages 50 to 69 and 70+. Additionally, out of the three measures, Biological Age had the strongest association with all-cause and cancer mortality, while the Framingham Risk Score had the strongest association with CVD mortality.
  
  
  CONCLUSIONS
  Methods for quantifying biological risk provide important approaches to improving our understanding of the causes and consequences of changes in physiological function and dysregulation. Biological Age offers an alternative and, in some cases a more accurate summary approach to the traditionally used methods, such as Allostatic Load and Framingham Risk Score.
authors.affiliation: Davis School of Gerontology, University of Southern California, Los Angeles, California, 90089-0191.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Levine
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Crimmins
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D052636:Allostasis; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D014481:United States
references.citation: Exp Gerontol. 2005 May;40(5):438-49
references.pmid: 15919596
references.citation: J Gerontol A Biol Sci Med Sci. 2004 Jun;59(6):B560-7
references.pmid: 15215265
references.citation: J Gerontol A Biol Sci Med Sci. 2009 Feb;64(2):286-92
references.pmid: 19196637
references.citation: Arch Intern Med. 1997 Oct 27;157(19):2259-68
references.pmid: 9343003
references.citation: Exp Gerontol. 2006 Sep;41(9):862-70
references.pmid: 16908111
references.citation: J Gerontol A Biol Sci Med Sci. 2013 Jun;68(6):667-74
references.pmid: 23213031
references.citation: Exp Gerontol. 2010 Jan;45(1):2-4
references.pmid: 19651201
references.citation: Circulation. 1998 May 12;97(18):1837-47
references.pmid: 9603539
references.citation: Am Heart J. 1991 Jan;121(1 Pt 2):293-8
references.pmid: 1985385
references.citation: Psychosom Med. 2002 May-Jun;64(3):395-406
references.pmid: 12021414
references.citation: Mech Ageing Dev. 2006 Mar;127(3):240-8
references.pmid: 16318865
references.citation: Lancet. 1969 Dec 27;2(7635):1411-4
references.pmid: 4188291
references.citation: Circulation. 2007 Feb 20;115(7):928-35
references.pmid: 17309939
references.citation: Proc Natl Acad Sci U S A. 2001 Apr 10;98(8):4770-5
references.pmid: 11287659
references.citation: Soc Sci Med. 2008 Jan;66(1):72-87
references.pmid: 17920177
references.citation: Ann N Y Acad Sci. 2007 Apr;1100:1-13
references.pmid: 17460161
references.citation: Arch Intern Med. 1993 Sep 27;153(18):2093-101
references.pmid: 8379800
references.citation: Antioxid Redox Signal. 2003 Oct;5(5):557-61
references.pmid: 14580310
references.citation: JAMA. 2001 May 16;285(19):2486-97
references.pmid: 11368702
references.citation: Hypertension. 2007 Mar;49(3):432-8
references.pmid: 17242302
references.citation: J Clin Epidemiol. 2002 Jul;55(7):696-710
references.pmid: 12160918