Risk Factors for 5-Year Mortality in Older Adults: The Cardiovascular Health Study

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ContextMultiple factors contribute to mortality in older adults, but the extent to which subclinical disease and other factors contribute independently to mortality risk is not known.ObjectiveTo determine the disease, functional, and personal characteristics that jointly predict mortality in community-dwelling men and women aged 65 years or older.DesignProspective population-based cohort study with 5 years of follow-up and a validation cohort of African Americans with 4.25-year follow-up.SettingFour US communities.ParticipantsA total of 5201 and 685 men and women aged 65 years or older in the original and African American cohorts, respectively.Main Outcome MeasuresFive-year mortality.ResultsIn the main cohort, 646 deaths (12%) occurred within 5 years. Using Cox proportional hazards models, 20 characteristics (of 78 assessed) were each significantly (P<.05) and independently associated with mortality: increasing age, male sex, income less than $50 000 per year, low weight, lack of moderate or vigorous exercise, smoking for more than 50 pack-years, high brachial (>169 mm Hg) and low tibial (7.2 mmol/L [130 mg/dL]), low albumin level (or= to 106 micromoles/L [1.2 mg/dL]), low forced vital capacity (ConclusionsObjective measures of subclinical disease and disease severity were independent and joint predictors of 5-year mortality in older adults, along with male sex, relative poverty, physical activity, smoking, indicators of frailty, and disability. Except for history of congestive heart failure, objective, quantitative measures of disease were better predictors of mortality than was clinical history of disease.JAMA.1998;279:585-592

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