What Shapes Unhealthy Aging Trajectories in Midlife?

TOPLINE:

Factors such as low socioeconomic status, the presence of chronic conditions, and the lack of consistent insurance coverage were associated with unhealthy or less healthy aging trajectories in midlife. Individuals in unhealthy aging trajectories had increased hospitalizations, higher out-of-pocket costs, and higher mortality after the age of 65 years.

METHODOLOGY:

• Researchers used longitudinal survey data from a nationally representative biennial study to identify predictors of unhealthy aging among middle-aged adults and assess their potential consequences on healthcare utilization, costs, and mortality.
• They included 12,333 US adults aged 51-64 years (48.1% men; 73% non-Hispanic White individuals) interviewed between 1998 and 2018.
• Participants’ health and functional statuses were determined using self-reported health status and the number of limitations in both activities of daily living and instrumental activities of daily living.
• Latent class growth analysis was used to classify trajectories of health status and assign participants into one of the four classesin decreasing order of baseline health and increasing order of limitations: Healthy agers (n = 1505), less healthy agers (n = 4626), unhealthy agers with low baseline (n = 4196), and persistently ill (n = 2006); the analysis allowed the examination of underlying heterogeneity and nonlinear trajectories.
• Predictors included sociodemographic characteristics, clinical conditions, lifestyle factors, and healthcare variables, such as insurance coverage and doctor visits during ages 50-64 years, and cost-related nonadherence to medication.

TAKEAWAY:

• Significant predictors of persistently ill and unhealthy aging with low baseline trajectories included male sex (odds ratio [OR], 1.90; P < .001 and OR, 1.39; P = .005, respectively), non-Hispanic Black race (OR, 2.19 and 1.82, respectively; P = .009 for both), Hispanic ethnicity (OR, 4.33; P = .001 and OR, 3.47; P < .001, respectively), and low socioeconomic status (P < .05 for all).
• Clinical factors such as smoking and body mass index (BMI) > 25 were significantly associated with greater odds of persistently ill, unhealthy, or less healthy aging trajectories, with BMI showing a dose-response association and individuals with a BMI ≥ 35 having the highest odds for these trajectories. Many chronic diseases, except for lung conditions, also showed a significant association with unhealthy or less healthy aging trajectories.
• Continuous insurance coverage between the ages of 50 and 64 years was associated with lower odds of unhealthy aging (OR, 0.76; P = .01) or less healthy aging (OR, 0.73; P = .007) trajectories, whereas regular doctor visits were linked to greater odds of persistently ill (OR, 1.68; P = .005), unhealthy aging (OR, 1.29; P = .04), or less healthy aging (OR, 1.35; P = .01) trajectories, possibly because poor health necessitated more care.
• Compared with healthy aging, persistently ill, unhealthy, or less healthy aging trajectories were associated with increased hospitalizations within 2 years (P < .001 for all), higher out-of-pocket costs (P < .05 for all), and higher mortality risk (P < .001 for all) after the age of 65 years.

IN PRACTICE:

“In addition to addressing clinical risks, interventions to promote healthy aging should focus on addressing healthcare factors such as consistency of health insurance and socioeconomic factors such as structural racism and discrimination in opportunities that promote health,” the authors wrote.

SOURCE:

This study was led by Renuka Tipirneni, MD, MSc, of the Department of Internal Medicine at the University of Michigan in Ann Arbor, Michigan. It was published online on March 6, 2025, in the Journal of General Internal Medicine.

LIMITATIONS: 

The competing risks for mortality in midlife may have confounded the identification of health trajectories and their predictors. Additionally, sample attrition might have affected the findings.

DISCLOSURES:

This study was supported by the National Institute on Aging of the National Institutes of Health. Three authors disclosed receiving grants from various organizations, with one of them also reporting receiving consulting fees. One author reported employment and stock options with Amgen.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.