Researchers identify factors at midlife linked with 10-year declines in women's physical health

Among 55-year-old women, factors such as higher body mass index, smoking, osteoarthritis, depressive symptoms and more were associated with clinically important declines in physical health 10 years later.

Imagine going to the doctor’s office at age 55 and, after measuring a set of health variables, the physician predicted your health trajectory for 10 years into the future. Investigators from Brigham and Women’s Hospital studied easily obtained variables among women at midlife, variables included health status measures, lab measurements and imaging assessments, to determine which factors were associated with clinically important declines in physical health later in life. In a study published in JAMA Network Open, the team identified factors that could potentially be used to determine who may be at increased risk of physical health decline later in life.

“Age 55 to 65 may be a critical decade,” said corresponding author Daniel H. Solomon, MD, MPH, of the Division of Rheumatology, Inflammation, and Immunity. “A person’s health and factors during this period may set them on a path for their later adult years. The good news is that a large proportion of women at midlife are very stable and will not go on to experience declines. But, being able to identify women at higher risk could help lead to interventions targeted to them.”

Solomon and colleagues conducted their cohort study using data from the Study of Women’s Health Across the Nation (SWAN), a multicenter, multiethnic and multiracial longitudinal study that followed women from 1996 through 2016. The main outcome the researchers assessed was a decline in participants’ physical component summary score (PCS), a composite measure of a person’s physical health. The team looked for clinically important changes in PCS, comparing women’s scores at age 55 to their score 10 years later.

The researchers found that about 20 percent of the women they studied experienced clinically important declines in their physical health. At age 55, some of the factors significantly associated with these declines include:

• Baseline physical health and function (women with higher PCS at age 55 were less likely to experience a decline)
• Higher body mass index
• Lower educational attainment
• Current smoking
• Co-morbidities (diabetes, hypertension, cardiovascular disease, osteoarthritis and osteoporosis were associated with declines in PCS)
• Clinically significant depressive symptoms

While the study cohort was diverse and representative, the study’s size — 1,091 women — was relatively small and the findings will require validation. The researchers are working to determine how to apply their results in clinical practice, including the development of a risk score that clinicians and patients could use to determine the likelihood of future declines in health status.

As a clinician and epidemiologist, I often think about the window of opportunity at midlife, when people are vital, engaged and resilient. If we can identify risk factors and determine who is at risk, we may be able to find interventions that can stave off health declines and help put people on a better health trajectory.”

Daniel H. Solomon, MD, MPH, Corresponding Author, Division of Rheumatology, Inflammation, and Immunity

Disclosures: Solomon reports receiving grants from Amgen, AbbVie and Moderna (paid to his institution); personal fees from UpToDate and Arthritis & Rheumatology; and serving the board of directors for Childhood Arthritis and Rheumatology Research Alliance and on an advisory committee for the Food and Drug Administration outside of this work. Additional disclosures from other authors can be found in the published paper.

Funding: The Study of Women’s Health Across the Nation (SWAN) has grant support from the NIH, Department of Health and Human Services (through the National Institute on Aging [NIA]), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women’s Health (ORWH) (grants No. U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, and U19AG063720).

Paper cited: Solomon DH et al. “Factors Associated with 10-Year Declines in Physical Health Among Women During Midlife” JAMA Network Open DOI: 10.1001/jamanetworkopen.2021.42773