Modifiable Risk Factors for Mortality Across Life Course: A Pooled Population-Based Cohort Study
1
Chinese PLA General Hospital, Institute of Geriatrics, Beijing, China
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
China's rapidly aging society has revealed a critical knowledge gap regarding life-course modifiable risk factors associated with mortality, particularly within its rapidly expanding oldest-old population.
METHODS:
This pooled population-based cohort study analyzed 11 potential modifiable risk factors across life course (30-49, 50-59, 60-79, 80-99, ≥100 years), leveraging data from the China Kadoorie Biobank (CKB), the China Hainan Centenarian Cohort Study (CHCCS), and the Guangzhou Biobank Cohort Study (GBCS). The modifiable risk factor score was calculated as the sum of the number of risk factors present. Cox proportional hazards regression models were conducted to assess the age-stratified associations in each cohort.
RESULTS:
During a mean follow-up of 10.53 years in CKB (enrolled 2004-2008), 3.79 years in CHCCS (enrolled 2014-2016), and 13.20 years in GBCS (enrolled 2003-2008), the mortality rates were 6.45, 169.52, and 12.72 per 1,000 person-years among 29,679, 1,794, and 29,572 participants, respectively. An overall modifiable risk factor score was associated with elevated mortality risk spanning from middle-aged adults to centenarians, with HR (95% CI) ranging from 1.11 (1.01-1.21) to 1.31 (1.21-1.36). Metabolic risk factors showed attenuated association with mortality across life course: from 1.43 (1.14-1.80) in middle-aged individuals to 1.07 (0.99-1.17) in centenarians. Diabetes and hypertension dominated this risk cluster, with hypertension-attributable mortality peaking at 16.2% (8.3-22.6%) in presenium before diminishing to residual levels (0.6% and 0.1%) in advanced longevity groups. Conversely, low educational attainment exhibited progressively increasing mortality impacts with advancing age (HR:1.55 [1.13-2.14] to 1.74 [1.01-3.01]; PAF:6.4%-30.8%). A similar trend was observed for physical inactivity, which contributed significantly to mortality in both middle-aged individuals and centenarians.
CONCLUSIONS:
Our life-course stratification reveals dynamic transitions in mortality risk, with metabolic burdens diminishing and socio-behavioral risks intensifying as longevity is achieved. These findings advocate for age-specific prevention strategies targeting dominant modifiable risk factors to optimize healthy aging trajectories.
China's rapidly aging society has revealed a critical knowledge gap regarding life-course modifiable risk factors associated with mortality, particularly within its rapidly expanding oldest-old population.
METHODS:
This pooled population-based cohort study analyzed 11 potential modifiable risk factors across life course (30-49, 50-59, 60-79, 80-99, ≥100 years), leveraging data from the China Kadoorie Biobank (CKB), the China Hainan Centenarian Cohort Study (CHCCS), and the Guangzhou Biobank Cohort Study (GBCS). The modifiable risk factor score was calculated as the sum of the number of risk factors present. Cox proportional hazards regression models were conducted to assess the age-stratified associations in each cohort.
RESULTS:
During a mean follow-up of 10.53 years in CKB (enrolled 2004-2008), 3.79 years in CHCCS (enrolled 2014-2016), and 13.20 years in GBCS (enrolled 2003-2008), the mortality rates were 6.45, 169.52, and 12.72 per 1,000 person-years among 29,679, 1,794, and 29,572 participants, respectively. An overall modifiable risk factor score was associated with elevated mortality risk spanning from middle-aged adults to centenarians, with HR (95% CI) ranging from 1.11 (1.01-1.21) to 1.31 (1.21-1.36). Metabolic risk factors showed attenuated association with mortality across life course: from 1.43 (1.14-1.80) in middle-aged individuals to 1.07 (0.99-1.17) in centenarians. Diabetes and hypertension dominated this risk cluster, with hypertension-attributable mortality peaking at 16.2% (8.3-22.6%) in presenium before diminishing to residual levels (0.6% and 0.1%) in advanced longevity groups. Conversely, low educational attainment exhibited progressively increasing mortality impacts with advancing age (HR:1.55 [1.13-2.14] to 1.74 [1.01-3.01]; PAF:6.4%-30.8%). A similar trend was observed for physical inactivity, which contributed significantly to mortality in both middle-aged individuals and centenarians.
CONCLUSIONS:
Our life-course stratification reveals dynamic transitions in mortality risk, with metabolic burdens diminishing and socio-behavioral risks intensifying as longevity is achieved. These findings advocate for age-specific prevention strategies targeting dominant modifiable risk factors to optimize healthy aging trajectories.
| eISSN: | 2654-1459 |
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