Estimation of biological age and age-related outcomes with easily accessible parameters in Chinese.

Biological aging exhibits significant heterogeneity across individuals, and a precise evaluation at scale is urgently needed. Here, we developed a PCAge, based on common clinical, physiological, and laboratory indices routinely collected in primary healthcare, in the CHARLS. PCAge demonstrated strong correlations with chronological age (r = 0.86-0.88, P < 0.001) and robust performance in the prediction of mortality (C-index = 0.798) over a 10-year follow-up. Biologically older individuals (PCAge > chronological age) suffered from substantially higher risk of age-related diseases, including cardiovascular disease (HR = 1.30, P < 0.001), heart disease (HR = 1.35, P = 0.003), stroke (HR = 2.38, P < 0.001), hypertension (HR = 1.28, P = 0.007), and diabetes (HR = 1.51, P < 0.001). Furthermore, the generalizability of PCAge was validated in the South China Cohort (SCC, n = 68,920). Biologically older individuals were more likely to have hypertension, diabetes, cardiovascular disease, and respiratory diseases. Being female (proportion ratios [PR] = 1.94, P < 0.001), lower education attainment (PR = 1.18, P < 0.001), higher income (PR = 1.47, P < 0.001), and unfavorable lifestyles (PR = 1.41, P < 0.001) were associated with a higher probability of having accelerated aging. PCAge identified aging trajectories up to a decade before clinical disease onset, offering a cost-effective tool for population-level aging surveillance. Our findings underscore the potential of PCAge as a highly accessible tool for the evaluation of aging status, especially in resource-limited areas.