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American Journal of Epidemiology Advance Access originally published online on January 15, 2009
American Journal of Epidemiology 2009 169(6):769-779; doi:10.1093/aje/kwn389
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American Journal of Epidemiology Published by the Johns Hopkins Bloomberg School of Public Health 2009.

PRACTICE OF EPIDEMIOLOGY

Improving Mortality Prediction Using Biosocial Surveys

Noreen Goldman, Dana A. Glei, Yu-Hsuan Lin and Maxine Weinstein

Correspondence to Dr. Noreen Goldman, Office of Population Research, Princeton University, 243 Wallace Hall, Princeton, NJ 08544-2091 (e-mail: ngoldman{at}princeton.edu).

Received for publication July 15, 2008. Accepted for publication November 12, 2008.

The authors used data from a nationally representative survey of 933 adults aged 54 years or older (mean age = 66.2 years; standard deviation, 8.0) in Taiwan to explore whether mortality prediction at older ages is improved by the use of 3 clusters of biomarkers: 1) standard cardiovascular and metabolic risk factors; 2) markers of disease progression; and 3) nonclinical (neuroendocrine and immune) markers. They also evaluated the extent to which these biomarkers account for the female advantage in survival. Estimates from logistic regression models of the probability of dying between 2000 and 2006 (162 deaths; mean length of follow-up = 5.8 years) showed that inclusion of each of the 3 sets of markers significantly (P = 0.024, P = 0.002, and P = 0.003, respectively) improved discriminatory power in comparison with a base model that adjusted for demographic characteristics, smoking, and baseline health status. The set of disease progression markers and the set of nonclinical markers each provided more discriminatory power than standard risk factors. Most of the excess male mortality resulted from the men being more likely than women to smoke, but each of 3 markers related to disease progression or inflammation (albumin, neutrophils, and interleukin-6) explained more than 10% of excess male mortality.

biological markers; mortality; risk factors; sex factors; Taiwan

Abbreviations: AUC, area under the receiver operating characteristic curve; OR, odds ratio; SEBAS, Social Environment and Biomarkers of Aging Study


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