Development and Validation of a New Simple Functional Score in the Older Chinese Population

Xingqi Cao; Chen Chen; Liu He; Zhoutao Zheng; Jingyun Zhang; Emiel O Hoogendijk; Xiaoting Liu; Shujuan Li; Xiaofeng Wang; Yimin Zhu; Zuyun Liu

doi:10.3389/fpubh.2022.813323

Development and Validation of a New Simple Functional Score in the Older Chinese Population

Front Public Health. 2022 Feb 24:10:813323. doi: 10.3389/fpubh.2022.813323. eCollection 2022.

Authors

Xingqi Cao¹, Chen Chen², Liu He¹, Zhoutao Zheng¹, Jingyun Zhang¹, Emiel O Hoogendijk³, Xiaoting Liu⁴, Shujuan Li⁵, Xiaofeng Wang⁶, Yimin Zhu⁷, Zuyun Liu¹

Affiliations

¹ Center for Clinical Big Data and Analytics of the Second Affiliated Hospital and Department of Big Data in Health Science School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
² National Center for Acquired Immunodeficiency Syndrome/Sexually Transmitted Disease (AIDS/STD) Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
³ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, Netherlands.
⁴ School of Public Affairs, Zhejiang University, Hangzhou, China.
⁵ Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
⁶ National Clinical Research Center for Aging and Medicine, Huashan Hospital, and Human Phenome Institute, Fudan University, Shanghai, China.
⁷ Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.

Abstract

Background: Existing aging metrics incorporating cognitive and physical function are often not feasible for application in research and clinical practice. Therefore, this study aimed to develop and validate a new simple functional score based on self-reported cognitive and physical function in the older Chinese population.

Methods: The development sample included 3,929 older adults aged 60-95 years from the China Health and Retirement Longitudinal Study (CHARLS). The validation sample included 1,345 older adults aged 60-87 years from the Rugao Longitudinal Aging study (RLAS). Logistic regression models and receiver operating characteristic curves were used to examine the associations of the new functional score with all-cause mortality risk.

Results: Six items were selected to construct the new functional score in CHARLS. This functional score was associated with all-cause mortality risk, with an adjusted odds ratio of 1.10 (95% confidence interval = 1.07, 1.13). This functional score presented additional predictive utility beyond age and sex, as demonstrated by the significantly increased C-statistic, integrated discrimination improvement (IDI), and continuous net reclassification improvement (NRI) (all P < 0.001). Furthermore, this functional score was further validated in RLAS, such that adding the new functional score to a model of age and sex improved all-cause mortality risk discrimination (IDI = 0.036, P < 0.001; NRI = 0.485, P < 0.001). To facilitate the quick screening of the older population with deteriorations in cognitive and physical function, we introduced a publicly available online tool designed for this new functional score.

Conclusions: A new functional score based on six self-reported items was developed and validated in the older Chinese population, and was demonstrated to be a simple and practical tool to assess functional deterioration, showing good feasibility, and performance.

Keywords: Chinese; aging; cognitive function; mortality; physical function.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aging*
Asian People*
China / epidemiology
Humans
Longitudinal Studies
ROC Curve