Nwanaji-Enwerem Jamaji C, Khodasevich Dennis, Gladish Nicole, Shen Hanyang, Bozack Anne K, Daredia Saher, Needham Belinda L, Rehkopf David H, Cardenas Andres
Department of Emergency Medicine, Center for Health Justice, and Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, HUP, Ground Ravdin, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA.
Clin Epigenetics. 2025 May 14;17(1):80. doi: 10.1186/s13148-025-01887-z.
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.
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.
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.
健康状况与医疗保健的可及性和利用率密切相关。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，但在医疗保健可及性和利用率背景下探索这些关系的研究仍然有限。为了填补这一空白，我们分析了来自1999 - 2000年和2001 - 2002年国家健康与营养检查调查（NHANES）的2343名美国成年人代表性样本中的横断面关联。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率与七种表观遗传衰老生物标志物之间的关系：汉纳姆年龄（HannumAge）、霍瓦特年龄（HorvathAge）、皮肤血液年龄（SkinBloodAge）、表型年龄（PhenoAge）、格里姆年龄2（GrimAge2）、DNA甲基化端粒长度（DNAm Telomere Length，DNAmTL）和达尼丁多组学加速衰老指标（DunedinPoAm）。
在调整了实际年龄、人口统计学、生活方式因素和健康保险后，自评健康状况为良好 - 优秀的参与者比健康状况为差 - 一般的参与者表型年龄低1.58岁（95%置信区间 - 2.54， - 0.62，P = 0.006），格里姆年龄2低1.16岁（95%置信区间 - 1.80， - 0.53，P = 0.004）。报告有常规医疗保健场所的参与者比没有常规医疗保健场所的参与者格里姆年龄2更低（β = - 1.44岁，95%置信区间 - 2.66， - 0.22，P = 0.03）。前一年就诊≥10次的参与者比就诊<10次的参与者DNAmTL更短（β = - 0.05千碱基，95%置信区间 - 0.09， - 0.01，P = 0.02）。在对估计的白细胞比例进行额外调整后，前一年有过夜住院经历的参与者比未住院的个体DNAmTL更短（β = - 0.05千碱基，95%置信区间 - 0.08， - 0.01，P = 0.02）。
我们的研究结果强化了先前将更好的健康状况与更低的表观遗传衰老联系起来的报告，并提供了表观遗传衰老与医疗保健可及性和利用率指标之间关联的新证据。如果这些发现得到验证，表明表观遗传衰老生物标志物可能有助于研究疾病过程以及评估与可及性和利用率相关的健康结果。
