What Matters Most for Predicting Survival? A Multinational Population-Based Cohort Study

Abstract

Despite myriad efforts among social scientists, epidemiologists, and clinicians to identify variables with strong linkages to mortality, few researchers have evaluated statistically the relative strength of a comprehensive set of predictors of survival. Here, we determine the strongest predictors of five-year mortality in four national, prospective studies of older adults. We analyze nationally representative surveys of older adults in four countries with similar levels of life expectancy: England (n = 6113, ages 52+), the US (n = 2023, ages 50+), Costa Rica (n = 2694, ages 60+), and Taiwan (n = 1032, ages 53+). Each survey includes a broad set of demographic, social, health, and biological variables that have been shown previously to predict mortality. We rank 57 predictors, 25 of which are available in all four countries, net of age and sex. We use the area under the receiver operating characteristic curve and assess robustness with additional discrimination measures. We demonstrate consistent findings across four countries with different cultural traditions, levels of economic development, and epidemiological transitions. Self-reported measures of instrumental activities of daily living limitations, mobility limitations, and overall self-assessed health are among the top predictors in all four samples. C-reactive protein, additional inflammatory markers, homocysteine, serum albumin, three performance assessments (gait speed, grip strength, and chair stands), and exercise frequency also discriminate well between decedents and survivors when these measures are available. We identify several promising candidates that could improve mortality prediction for both population-based and clinical populations. Better prognostic tools are likely to provide researchers with new insights into the behavioral and biological pathways that underlie social stratification in health and may allow physicians to have more informed discussions with patients about end-of-life treatment and priorities.

Cancer Screening of Older Adults in Israel According to Life Expectancy: Cross Sectional Study

“…Furthermore, our sensitivity analyses supported our conclusions and minimize the possibility that these proxy substitutions markedly influenced the overall study findings. The factors used to assess LE in this index have been found to be predictive of mortality in multiple studies, suggesting that individuals in our population with functional and mobility limitations and comorbidities have a shorter LE than those without these conditions …”

“…The factors used to assess LE in this index have been found to be predictive of mortality in multiple studies, suggesting that individuals in our population with functional and mobility limitations and comorbidities have a shorter LE than those without these conditions. 22,23 We did not have data on whether the tests were conducted for screening or diagnostic purposes, but it is recommended to use FOBT only for screening, and it is unlikely to be used for diagnostic purposes. A previous study that was able to distinguish between diagnostic and screening mammograms found that only approximately 15% of all mammograms were diagnostic.…”

Medical foster home is less costly than traditional nursing home care

“…Additional bias may be introduced by unobserved covariates that influenced the Veteran's decision to reside in MFH or CNH. For example, functional status is highly correlated with survival and was not included in this analysis because of limited availability . However, we have included multiple measures of illness severity to capture clinical differences between the groups of Veterans utilizing MFH and CNH.…”

“…For example, functional status is highly correlated with survival and was not included in this analysis because of limited availability. [43][44][45] However, we have included multiple measures of illness severity to capture clinical differences between the groups of Veterans utilizing MFH and CNH. Because these measures are highly correlated with functional status, we expect that functional status would also be similar across the two groups.…”

Predicting Mortality up to 14 Years Among Community‐Dwelling Adults Aged 65 and Older

“…However, our index also includes whether older adults need help with household chores, past cigarette use, perceived health, and hospitalizations in the past year. In a recent review of the top predictors of 5‐year mortality in four countries, age, sex, limitations in instrumental activities of daily living, mobility, and perceived health were all found to be top predictors and all of these variables are in our index . While there have been no direct comparisons of the performance of our index with other methods for estimating older adults prognosis; Pollack et al found that there was 84.9% agreement in categorization of Medicare beneficiaries as having <50% chance of survival in 9–10 years when our index, the Lee index, and a method for estimating life expectancy that uses US life table data while accounting for individuals' comorbidity were compared.…”