Jamaji C Nwanaji-Enwerem, Dennis Khodasevich, Nicole Gladish, Hanyang Shen, Anne K Bozack, Saher Daredia, Belinda L Needham, David H Rehkopf, Andres Cardenas
{"title":"在美国成年人的代表性样本中，表观遗传衰老与自评健康、获得护理和医疗保健利用的关系","authors":"Jamaji C Nwanaji-Enwerem, Dennis Khodasevich, Nicole Gladish, Hanyang Shen, Anne K Bozack, Saher Daredia, Belinda L Needham, David H Rehkopf, Andres Cardenas","doi":"10.1186/s13148-025-01887-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Health status is closely linked to both healthcare access and utilization. While previous research has identified associations between health status and DNA methylation-based biomarkers of aging (epigenetic aging), studies exploring these relationships in the context of healthcare access and utilization remain limited. To address this gap, we analyzed cross-sectional associations in a representative sample of 2,343 U.S. adults from the 1999-2000 and 2001-2002 cycles of the National Health and Nutrition Examination Survey (NHANES). Our study examined the relationships of self-rated health status, healthcare access, and healthcare utilization with seven epigenetic aging biomarkers: HannumAge, HorvathAge, SkinBloodAge, PhenoAge, GrimAge2, DNAm Telomere Length (DNAmTL), and DunedinPoAm.</p><p><strong>Results: </strong>After adjusting for chronological age, demographics, lifestyle factors, and health insurance, participants with good-excellent self-rated health had a 1.58-year lower PhenoAge (95% CI - 2.54, - 0.62 P = 0.006) and a 1.16-year lower GrimAge2 (95% CI - 1.80, - 0.53, P = 0.004) than participants with poor-fair health. Participants who reported having a routine place where they received healthcare had a lower GrimAge2 (β = - 1.44-years, 95% CI - 2.66, - 0.22, P = 0.03) than participants without a routine healthcare location. Participants with ≥ 10 healthcare visits in the prior year had a shorter DNAmTL (β = - 0.05-kb, 95% CI - 0.09, - 0.01, P = 0.02) than participants with < 10 visits. After including additional adjustments for estimated leukocyte proportions, participants who were hospitalized overnight in the prior year had a shorter DNAmTL (β = - 0.05-kb, 95% CI - 0.08, - 0.01, P = 0.02) than non-hospitalized individuals.</p><p><strong>Conclusions: </strong>Our findings reinforce previous reports linking better health status to lower epigenetic aging and provide new evidence of associations of epigenetic aging with measures of healthcare access and utilization. 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While previous research has identified associations between health status and DNA methylation-based biomarkers of aging (epigenetic aging), studies exploring these relationships in the context of healthcare access and utilization remain limited. To address this gap, we analyzed cross-sectional associations in a representative sample of 2,343 U.S. adults from the 1999-2000 and 2001-2002 cycles of the National Health and Nutrition Examination Survey (NHANES). Our study examined the relationships of self-rated health status, healthcare access, and healthcare utilization with seven epigenetic aging biomarkers: HannumAge, HorvathAge, SkinBloodAge, PhenoAge, GrimAge2, DNAm Telomere Length (DNAmTL), and DunedinPoAm.</p><p><strong>Results: </strong>After adjusting for chronological age, demographics, lifestyle factors, and health insurance, participants with good-excellent self-rated health had a 1.58-year lower PhenoAge (95% CI - 2.54, - 0.62 P = 0.006) and a 1.16-year lower GrimAge2 (95% CI - 1.80, - 0.53, P = 0.004) than participants with poor-fair health. Participants who reported having a routine place where they received healthcare had a lower GrimAge2 (β = - 1.44-years, 95% CI - 2.66, - 0.22, P = 0.03) than participants without a routine healthcare location. Participants with ≥ 10 healthcare visits in the prior year had a shorter DNAmTL (β = - 0.05-kb, 95% CI - 0.09, - 0.01, P = 0.02) than participants with < 10 visits. 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引用次数: 0
摘要
背景：健康状况与医疗保健的获取和利用密切相关。虽然先前的研究已经确定了健康状况与基于DNA甲基化的衰老生物标志物（表观遗传衰老）之间的关联，但在医疗保健获取和利用的背景下探索这些关系的研究仍然有限。为了解决这一差距，我们分析了1999-2000年和2001-2002年国家健康与营养检查调查（NHANES）周期中2343名美国成年人的代表性样本的横断面关联。我们的研究考察了自评健康状况、医疗保健可及性和医疗保健利用与七个表观遗传衰老生物标志物的关系：HannumAge、HorvathAge、SkinBloodAge、PhenoAge、GrimAge2、DNAm端粒长度（DNAmTL）和DunedinPoAm。结果：在调整了实际年龄、人口统计、生活方式因素和健康保险后，自我评价健康状况良好的参与者比健康状况不佳的参与者的表型年龄低1.58年（95% CI - 2.54, - 0.62 P = 0.006）， GrimAge2低1.16年（95% CI - 1.80, - 0.53, P = 0.004）。与没有常规医疗地点的参与者相比，报告有常规医疗地点的参与者grimag2较低（β = - 1.44年，95% CI - 2.66, - 0.22, P = 0.03）。结论：我们的研究结果加强了先前有关良好健康状况与较低表观遗传衰老之间联系的报道，并为表观遗传衰老与医疗保健获取和利用之间的关联提供了新的证据。如果得到验证，这些发现表明表观遗传衰老生物标志物可能有助于研究疾病过程和评估与获取和利用相关的健康结果。
Associations of epigenetic aging with self-rated health, access to care, and healthcare utilization in a representative sample of United States adults.
Background: Health status is closely linked to both healthcare access and utilization. While previous research has identified associations between health status and DNA methylation-based biomarkers of aging (epigenetic aging), studies exploring these relationships in the context of healthcare access and utilization remain limited. To address this gap, we analyzed cross-sectional associations in a representative sample of 2,343 U.S. adults from the 1999-2000 and 2001-2002 cycles of the National Health and Nutrition Examination Survey (NHANES). Our study examined the relationships of self-rated health status, healthcare access, and healthcare utilization with seven epigenetic aging biomarkers: HannumAge, HorvathAge, SkinBloodAge, PhenoAge, GrimAge2, DNAm Telomere Length (DNAmTL), and DunedinPoAm.
Results: After adjusting for chronological age, demographics, lifestyle factors, and health insurance, participants with good-excellent self-rated health had a 1.58-year lower PhenoAge (95% CI - 2.54, - 0.62 P = 0.006) and a 1.16-year lower GrimAge2 (95% CI - 1.80, - 0.53, P = 0.004) than participants with poor-fair health. Participants who reported having a routine place where they received healthcare had a lower GrimAge2 (β = - 1.44-years, 95% CI - 2.66, - 0.22, P = 0.03) than participants without a routine healthcare location. Participants with ≥ 10 healthcare visits in the prior year had a shorter DNAmTL (β = - 0.05-kb, 95% CI - 0.09, - 0.01, P = 0.02) than participants with < 10 visits. After including additional adjustments for estimated leukocyte proportions, participants who were hospitalized overnight in the prior year had a shorter DNAmTL (β = - 0.05-kb, 95% CI - 0.08, - 0.01, P = 0.02) than non-hospitalized individuals.
Conclusions: Our findings reinforce previous reports linking better health status to lower epigenetic aging and provide new evidence of associations of epigenetic aging with measures of healthcare access and utilization. If validated, these findings suggest that epigenetic aging biomarkers may be useful in studying disease processes and assessing health outcomes related to access and utilization.
期刊介绍：
Clinical Epigenetics, the official journal of the Clinical Epigenetics Society, is an open access, peer-reviewed journal that encompasses all aspects of epigenetic principles and mechanisms in relation to human disease, diagnosis and therapy. Clinical trials and research in disease model organisms are particularly welcome.
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