Multinational evaluation of AnthropoAge as a measure of biological age in the USA, England, Mexico, Costa Rica, and China: a population-based longitudinal study.

We validated AnthropoAge, a biological age (BA) metric, for prediction of mortality and age-related outcomes using harmonized data from the US, England, Mexico, Costa Rica, and China. We estimated AnthropoAge and AnthropoAgeAccel as proxies of BA and age acceleration using body mass index and waist-to-height ratio. We compared mortality prediction of AnthropoAge vs. chronological age (CA) using Cox models and assessed its association with age-related outcomes with generalized estimating equations. Among 57,080 participants aged 50-94 years, AnthropoAgeAccel (c-statistic 0.806) improved mortality prediction of CA (0.803) and identified distinct aging trends for each country. Accelerated aging (AnthropoAgeAccel>0) increased mortality risk by ~37% independently of age and covariates, and predicted health deterioration, new deficits in activities of daily living, and age-related diseases. AnthropoAge is a robust BA metric with potential applications in identifying functional deficits, health decline, and mortality risk. However, it requires further validation and potential recalibration for broader applicability in underrepresented populations like Latin America.