Effect of health protective factors on health deficit accumulation and mortality risk in older adults in the Beijing longitudinal study of aging

Objectives: To evaluate transitions in health status and risk of death in older adults in relation to baseline health deficits and protective factors. Design: Prospective cohort study with reassessments at 5, 8, and 15 years. Setting: Secondary analysis of data from the Beijing Longitudinal Study on Aging. Participants: 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. Measurements: 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%. Conclusion: 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.