{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T11:17:43Z","timestamp":1777893463315,"version":"3.51.4"},"reference-count":68,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Recognizing the pivotal role of circadian rhythm in the human aging process and its scalability through wearables, we introduce CosinorAge, a digital biomarker of aging developed from wearable-derived circadian rhythmicity from 80,000 midlife and older adults in the UK and US. A one-year increase in CosinorAge corresponded to 8\u201312% higher all-cause and cause-specific mortality risks and 3\u201314% increased prospective incidences of age-related diseases. CosinorAge also captured a non-linear decline in resilience and physical functioning, evidenced by an 8\u201333% reduction in self-rated health and a 3\u201323% decline in health-related quality of life score, adjusting for covariates and multiple testing. The associations were robust in sensitivity analyses and external validation using an independent cohort from a disparate geographical region using a different wearable device. Moreover, we illustrated a heterogeneous impact of circadian parameters associated with biological aging, with young (&lt;45 years) and fast agers experiencing a substantially delayed acrophase with a 25-minute difference in peak timing compared to slow agers, diminishing to a 7-minute difference in older adults (&gt;65 years). We demonstrated a significant enhancement in the predictive performance when integrating circadian rhythmicity in the estimation of biological aging over physical activity. Our findings underscore CosinorAge\u2019s potential as a scalable, economic, and digital solution for promoting healthy longevity, elucidating the critical and multifaceted circadian rhythmicity in aging processes. Consequently, our research contributes to advancing preventive measures in digital medicine.<\/jats:p>","DOI":"10.1038\/s41746-024-01111-x","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T13:05:38Z","timestamp":1717506338000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Circadian rhythm analysis using wearable-based accelerometry as a digital biomarker of aging and healthspan"],"prefix":"10.1038","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0226-7369","authenticated-orcid":false,"given":"Jinjoo","family":"Shim","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4842-1117","authenticated-orcid":false,"given":"Elgar","family":"Fleisch","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3905-2380","authenticated-orcid":false,"given":"Filipe","family":"Barata","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"key":"1111_CR1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/0531-5565(88)90025-3","volume":"23","author":"GT Baker","year":"1988","unstructured":"Baker, G. T. & Sprott, R. L. Biomarkers of aging. Exp. Gerontol. 23, 223\u2013239 (1988).","journal-title":"Exp. Gerontol."},{"key":"1111_CR2","doi-asserted-by":"publisher","DOI":"10.1186\/gb-2013-14-10-r115","volume":"14","author":"S Horvath","year":"2013","unstructured":"Horvath, S. DNA methylation age of human tissues and cell types. Genome Biol. 14, 3156 (2013).","journal-title":"Genome Biol."},{"key":"1111_CR3","doi-asserted-by":"publisher","first-page":"573","DOI":"10.18632\/aging.101414","volume":"10","author":"ME Levine","year":"2018","unstructured":"Levine, M. E. et al. An epigenetic biomarker of aging for lifespan and healthspan. Aging 10, 573\u2013591 (2018).","journal-title":"Aging"},{"key":"1111_CR4","doi-asserted-by":"publisher","first-page":"303","DOI":"10.18632\/aging.101684","volume":"11","author":"AT Lu","year":"2019","unstructured":"Lu, A. T. et al. DNA methylation GrimAge strongly predicts lifespan and healthspan. Aging (Albany NY) 11, 303\u2013327 (2019).","journal-title":"Aging (Albany NY)"},{"key":"1111_CR5","doi-asserted-by":"publisher","DOI":"10.1186\/s13059-019-1824-y","volume":"20","author":"CG Bell","year":"2019","unstructured":"Bell, C. G. et al. DNA methylation aging clocks: challenges and recommendations. Genome Biol. 20, 249 (2019).","journal-title":"Genome Biol."},{"key":"1111_CR6","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1126\/science.aah4966","volume":"354","author":"K Man","year":"2016","unstructured":"Man, K., Loudon, A. & Chawla, A. Immunity around the clock. Science 354, 999\u20131003 (2016).","journal-title":"Science"},{"key":"1111_CR7","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1038\/nri3386","volume":"13","author":"C Scheiermann","year":"2013","unstructured":"Scheiermann, C., Kunisaki, Y. & Frenette, P. S. Circadian control of the immune system. Nat. Rev. Immunol. 13, 190\u2013198 (2013).","journal-title":"Nat. Rev. Immunol."},{"key":"1111_CR8","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.cell.2022.11.001","volume":"186","author":"C L\u00f3pez-Ot\u00edn","year":"2023","unstructured":"L\u00f3pez-Ot\u00edn, C., Blasco, M. A., Partridge, L., Serrano, M. & Kroemer, G. Hallmarks of aging: an expanding universe. Cell 186, 243\u2013278 (2023).","journal-title":"Cell"},{"key":"1111_CR9","first-page":"85","volume":"25","author":"MH Vitaterna","year":"2001","unstructured":"Vitaterna, M. H., Takahashi, J. S. & Turek, F. W. Overview of circadian rhythms. Alcohol Res. Health 25, 85\u201393 (2001).","journal-title":"Alcohol Res. Health"},{"key":"1111_CR10","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/S0140-6736(22)00877-7","volume":"400","author":"N Meyer","year":"2022","unstructured":"Meyer, N., Harvey, A. G., Lockley, S. W. & Dijk, D.-J. Circadian rhythms and disorders of the timing of sleep. Lancet 400, 1061\u20131078 (2022).","journal-title":"Lancet"},{"key":"1111_CR11","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1038\/s41591-018-0271-8","volume":"24","author":"S Masri","year":"2018","unstructured":"Masri, S. & Sassone-Corsi, P. The emerging link between cancer, metabolism, and circadian rhythms. Nat. Med. 24, 1795\u20131803 (2018).","journal-title":"Nat. Med."},{"key":"1111_CR12","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1038\/s41574-020-00427-4","volume":"16","author":"F Bishehsari","year":"2020","unstructured":"Bishehsari, F., Voigt, R. M. & Keshavarzian, A. Circadian rhythms and the gut microbiota: from the metabolic syndrome to cancer. Nat. Rev. Endocrinol. 16, 731\u2013739 (2020).","journal-title":"Nat. Rev. Endocrinol."},{"key":"1111_CR13","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1038\/s41583-018-0088-y","volume":"20","author":"RW Logan","year":"2019","unstructured":"Logan, R. W. & McClung, C. A. Rhythms of life: circadian disruption and brain disorders across the lifespan. Nat. Rev. Neurosci. 20, 49\u201365 (2019).","journal-title":"Nat. Rev. Neurosci."},{"key":"1111_CR14","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1007\/s40675-020-00170-2","volume":"6","author":"M de Feijter","year":"2020","unstructured":"de Feijter, M., Lysen, T. S. & Luik, A. I. 24-h activity rhythms and health in older adults. Curr. Sleep. Med. Rep. 6, 76\u201383 (2020).","journal-title":"Curr. Sleep. Med. Rep."},{"key":"1111_CR15","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1038\/nrendo.2014.78","volume":"10","author":"KL Gamble","year":"2014","unstructured":"Gamble, K. L., Berry, R., Frank, S. J. & Young, M. E. Circadian clock control of endocrine factors. Nat. Rev. Endocrinol. 10, 466\u2013475 (2014).","journal-title":"Nat. Rev. Endocrinol."},{"key":"1111_CR16","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1210\/er.2016-1083","volume":"37","author":"GDM Potter","year":"2016","unstructured":"Potter, G. D. M. et al. Circadian rhythm and sleep disruption: causes, metabolic consequences, and countermeasures. Endocr. Rev. 37, 584\u2013608 (2016).","journal-title":"Endocr. Rev."},{"key":"1111_CR17","doi-asserted-by":"publisher","unstructured":"Xu, Y. et al. Blunted rest-activity circadian rhythm is associated with increased rate of biological aging: an analysis of NHANES 2011\u20132014. J. Gerontol. A Biol. Sci. Med. Sci. 78, 407\u2013413. https:\/\/doi.org\/10.1093\/gerona\/glac199 (2022).","DOI":"10.1093\/gerona\/glac199"},{"key":"1111_CR18","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-36062-y","volume":"13","author":"J Shim","year":"2023","unstructured":"Shim, J., Fleisch, E. & Barata, F. Wearable-based accelerometer activity profile as digital biomarker of inflammation, biological age, and mortality using hierarchical clustering analysis in NHANES 2011\u20132014. Sci. Rep. 13, 9326 (2023).","journal-title":"Sci. Rep."},{"key":"1111_CR19","doi-asserted-by":"crossref","unstructured":"Leise, T. L. Chapter Five - Wavelet-Based Analysis of Circadian Behavioral Rhythms. in Methods in Enzymology (ed. Sehgal, A.) vol. 551 95\u2013119 (Academic Press, 2015).","DOI":"10.1016\/bs.mie.2014.10.011"},{"key":"1111_CR20","doi-asserted-by":"publisher","first-page":"100067","DOI":"10.1016\/j.crmeth.2021.100067","volume":"1","author":"MMH Shandhi","year":"2021","unstructured":"Shandhi, M. M. H., Wang, W. K. & Dunn, J. Taking the time for our bodies: how wearables can be used to assess circadian physiology. Cell Rep. Methods 1, 100067 (2021).","journal-title":"Cell Rep. Methods"},{"key":"1111_CR21","doi-asserted-by":"publisher","first-page":"2301","DOI":"10.1038\/s41591-022-02012-w","volume":"28","author":"H Master","year":"2022","unstructured":"Master, H. et al. Association of step counts over time with the risk of chronic disease in the All of Us Research Program. Nat. Med. 28, 2301\u20132308 (2022).","journal-title":"Nat. Med."},{"key":"1111_CR22","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-018-08259-7","volume":"10","author":"SE Jones","year":"2019","unstructured":"Jones, S. E. et al. Genome-wide association analyses of chronotype in 697,828 individuals provides insights into circadian rhythms. Nat. Commun. 10, 343 (2019).","journal-title":"Nat. Commun."},{"key":"1111_CR23","doi-asserted-by":"publisher","first-page":"e200","DOI":"10.1016\/S2666-7568(23)00056-9","volume":"4","author":"H Feng","year":"2023","unstructured":"Feng, H. et al. Association between accelerometer-measured amplitude of rest\u2013activity rhythm and future health risk: a prospective cohort study of the UK Biobank. Lancet Healthy Longev. 4, e200\u2013e210 (2023).","journal-title":"Lancet Healthy Longev."},{"key":"1111_CR24","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1093\/ije\/dyr112","volume":"40","author":"G Samitz","year":"2011","unstructured":"Samitz, G., Egger, M. & Zwahlen, M. Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies. Int. J. Epidemiol. 40, 1382\u20131400 (2011).","journal-title":"Int. J. Epidemiol."},{"key":"1111_CR25","doi-asserted-by":"publisher","first-page":"e1003757","DOI":"10.1371\/journal.pmed.1003757","volume":"18","author":"LAC Millard","year":"2021","unstructured":"Millard, L. A. C., Tilling, K., Gaunt, T. R., Carslake, D. & Lawlor, D. A. Association of physical activity intensity and bout length with mortality: an observational study of 79,503 UK Biobank participants. PLoS Med. 18, e1003757 (2021).","journal-title":"PLoS Med."},{"key":"1111_CR26","first-page":"1486","volume":"76","author":"A Leroux","year":"2021","unstructured":"Leroux, A. et al. Quantifying the predictive performance of objectively measured physical activity on mortality in the UK Biobank. J. Gerontology: Ser. A 76, 1486\u20131494 (2021).","journal-title":"J. Gerontology: Ser. A"},{"key":"1111_CR27","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1038\/s41591-020-1012-3","volume":"26","author":"T Strain","year":"2020","unstructured":"Strain, T. et al. Wearable device measured physical activity and future health risk. Nat. Med. 26, 1385\u20131391 (2020).","journal-title":"Nat. Med."},{"key":"1111_CR28","doi-asserted-by":"publisher","first-page":"e0169649","DOI":"10.1371\/journal.pone.0169649","volume":"12","author":"A Doherty","year":"2017","unstructured":"Doherty, A. et al. Large scale population assessment of physical activity using wrist worn accelerometers: the UK Biobank study. PLOS ONE 12, e0169649 (2017).","journal-title":"PLOS ONE"},{"key":"1111_CR29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41746-023-00781-3","volume":"6","author":"L Yang","year":"2023","unstructured":"Yang, L. et al. Association of accelerometer-derived circadian abnormalities and genetic risk with incidence of atrial fibrillation. npj Digit. Med. 6, 1\u20138 (2023).","journal-title":"npj Digit. Med."},{"key":"1111_CR30","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2023.110262","volume":"197","author":"L Yang","year":"2023","unstructured":"Yang, L. et al. Association of circadian rest-activity rhythms with cardiovascular disease and mortality in type 2 diabetes. Diabetes Res. Clin. Pract. 197, 110262 (2023).","journal-title":"Diabetes Res. Clin. Pract."},{"key":"1111_CR31","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1001\/jamaneurol.2017.4719","volume":"75","author":"ES Musiek","year":"2018","unstructured":"Musiek, E. S. et al. Circadian rest-activity pattern changes in aging and preclinical Alzheimer disease. JAMA Neurol. 75, 582 (2018).","journal-title":"JAMA Neurol."},{"key":"1111_CR32","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1093\/brain\/awh129","volume":"127","author":"CF Hatfield","year":"2004","unstructured":"Hatfield, C. F., Herbert, J., van Someren, E. J. W., Hodges, J. R. & Hastings, M. H. Disrupted daily activity\/rest cycles in relation to daily cortisol rhythms of home-dwelling patients with early Alzheimer\u2019s dementia. Brain 127, 1061\u20131074 (2004).","journal-title":"Brain"},{"key":"1111_CR33","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1093\/sleep\/20.1.24","volume":"20","author":"S Ancoli-Israel","year":"1997","unstructured":"Ancoli-Israel, S. et al. Variations in circadian rhythms of activity, sleep, and light exposure related to dementia in nursing-home patients. Sleep 20, 18\u201323 (1997).","journal-title":"Sleep"},{"key":"1111_CR34","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1159\/000500141","volume":"65","author":"LA Gavrilov","year":"2019","unstructured":"Gavrilov, L. A. & Gavrilova, N. S. New trend in old-age mortality: Gompertzialization of mortality trajectory. Gerontology 65, 451\u2013457 (2019).","journal-title":"Gerontology"},{"key":"1111_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s42003-023-05102-8","volume":"6","author":"SA Rahman","year":"2023","unstructured":"Rahman, S. A. et al. Age-related changes in circadian regulation of the human plasma lipidome. Commun. Biol. 6, 1\u201314 (2023).","journal-title":"Commun. Biol."},{"key":"1111_CR36","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-022-01364-3","volume":"19","author":"K Suorsa","year":"2022","unstructured":"Suorsa, K. et al. Changes in the 24-h movement behaviors during the transition to retirement: compositional data analysis. Int. J. Behav. Nutr. Phys. Act. 19, 121 (2022).","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"1111_CR37","doi-asserted-by":"publisher","DOI":"10.1186\/s12966-016-0375-9","volume":"13","author":"S Stenholm","year":"2016","unstructured":"Stenholm, S. et al. Changes in physical activity during transition to retirement: a cohort study. Int. J. Behav. Nutr. Phys. Act. 13, 51 (2016).","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"1111_CR38","doi-asserted-by":"publisher","first-page":"e0138098","DOI":"10.1371\/journal.pone.0138098","volume":"10","author":"T Aledavood","year":"2015","unstructured":"Aledavood, T. et al. Daily rhythms in mobile telephone communication. PLOS ONE 10, e0138098 (2015).","journal-title":"PLOS ONE"},{"key":"1111_CR39","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-77795-4","volume":"10","author":"T Aubourg","year":"2020","unstructured":"Aubourg, T., Demongeot, J. & Vuillerme, N. Novel statistical approach for assessing the persistence of the circadian rhythms of social activity from telephone call detail records in older adults. Sci. Rep. 10, 21464 (2020).","journal-title":"Sci. Rep."},{"key":"1111_CR40","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1111\/cpf.12337","volume":"37","author":"O Dieu","year":"2017","unstructured":"Dieu, O. et al. Physical activity using wrist-worn accelerometers: comparison of dominant and non-dominant wrist. Clin. Physiol. Funct. Imaging 37, 525\u2013529 (2017).","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"1111_CR41","doi-asserted-by":"publisher","first-page":"e1001779","DOI":"10.1371\/journal.pmed.1001779","volume":"12","author":"C Sudlow","year":"2015","unstructured":"Sudlow, C. et al. UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLOS Med. 12, e1001779 (2015).","journal-title":"PLOS Med."},{"key":"1111_CR42","unstructured":"NHANES - About the National Health and Nutrition Examination Survey. https:\/\/www.cdc.gov\/nchs\/nhanes\/about_nhanes.htm (2022)."},{"key":"1111_CR43","doi-asserted-by":"publisher","first-page":"5499","DOI":"10.1002\/sim.3069","volume":"26","author":"IR K\u00f6nig","year":"2007","unstructured":"K\u00f6nig, I. R. et al. Practical experiences on the necessity of external validation. Stat. Med. 26, 5499\u20135511 (2007).","journal-title":"Stat. Med."},{"key":"1111_CR44","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.jclinepi.2015.04.005","volume":"69","author":"EW Steyerberg","year":"2016","unstructured":"Steyerberg, E. W. & Harrell, F. E. Prediction models need appropriate internal, internal\u2013external, and external validation. J. Clin. Epidemiol. 69, 245\u2013247 (2016).","journal-title":"J. Clin. Epidemiol."},{"key":"1111_CR45","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1016\/S0895-4356(03)00207-5","volume":"56","author":"SE Bleeker","year":"2003","unstructured":"Bleeker, S. E. et al. External validation is necessary in prediction research: a clinical example. J. Clin. Epidemiol. 56, 826\u2013832 (2003).","journal-title":"J. Clin. Epidemiol."},{"key":"1111_CR46","unstructured":"National Center for Health Statistics. (2013-2014). NHANES 2013-2014 Data Documentation, Codebook, and Frequencies: Physical Activity Monitor (PAXMIN_H). Retrieved from. https:\/\/wwwn.cdc.gov\/Nchs\/Nhanes\/2013-2014\/PAXMIN_H.htm."},{"key":"1111_CR47","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-11848-8","volume":"12","author":"S Su","year":"2022","unstructured":"Su, S., Li, X., Xu, Y., McCall, W. V. & Wang, X. Epidemiology of accelerometer-based sleep parameters in US school-aged children and adults: NHANES 2011\u20132014. Sci. Rep. 12, 7680 (2022).","journal-title":"Sci. Rep."},{"key":"1111_CR48","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1016\/j.mex.2016.05.006","volume":"3","author":"C Blume","year":"2016","unstructured":"Blume, C., Santhi, N. & Schabus, M. \u2018nparACT\u2019 package for R: a free software tool for the non-parametric analysis of actigraphy data. MethodsX 3, 430\u2013435 (2016).","journal-title":"MethodsX"},{"key":"1111_CR49","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1007\/s12561-019-09236-4","volume":"11","author":"J Di","year":"2019","unstructured":"Di, J. et al. Joint and individual representation of domains of physical activity, sleep, and circadian rhythmicity. Stat. Biosci. 11, 371\u2013402 (2019).","journal-title":"Stat. Biosci."},{"key":"1111_CR50","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4682-11-16","volume":"11","author":"G Cornelissen","year":"2014","unstructured":"Cornelissen, G. Cosinor-based rhythmometry. Theor. Biol. Med. Model 11, 16 (2014).","journal-title":"Theor. Biol. Med. Model"},{"key":"1111_CR51","first-page":"305","volume":"6","author":"W Nelson","year":"1979","unstructured":"Nelson, W., Tong, Y. L., Lee, J. K. & Halberg, F. Methods for cosinor-rhythmometry. Chronobiologia 6, 305\u2013323 (1979).","journal-title":"Chronobiologia"},{"key":"1111_CR52","doi-asserted-by":"publisher","first-page":"3339","DOI":"10.1016\/j.lfs.2003.05.007","volume":"73","author":"B Selmaoui","year":"2003","unstructured":"Selmaoui, B. & Touitou, Y. Reproducibility of the circadian rhythms of serum cortisol and melatonin in healthy subjects: a study of three different 24-h cycles over six weeks. Life Sci. 73, 3339\u20133349 (2003).","journal-title":"Life Sci."},{"key":"1111_CR53","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41526-020-00129-1","volume":"7","author":"S Mendt","year":"2021","unstructured":"Mendt, S. et al. Regular exercise counteracts circadian shifts in core body temperature during long-duration bed rest. npj Microgravity 7, 1\u20136 (2021).","journal-title":"npj Microgravity"},{"key":"1111_CR54","first-page":"397","volume":"9","author":"C Bingham","year":"1982","unstructured":"Bingham, C., Arbogast, B., Guillaume, G. C., Lee, J. K. & Halberg, F. Inferential statistical methods for estimating and comparing cosinor parameters. Chronobiologia 9, 397\u2013439 (1982).","journal-title":"Chronobiologia"},{"key":"1111_CR55","unstructured":"Centers for Disease Control and Prevention (CDC). The National Health and Nutrition Examination Survey Tutorials. 2020. https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/tutorials\/default.aspx."},{"key":"1111_CR56","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1002\/hec.3564","volume":"27","author":"NJ Devlin","year":"2018","unstructured":"Devlin, N. J., Shah, K. K., Feng, Y., Mulhern, B. & van Hout, B. Valuing health-related quality of life: An EQ-5D-5L value set for England. Health Econ. 27, 7\u201322 (2018).","journal-title":"Health Econ."},{"key":"1111_CR57","first-page":"138","volume":"10","author":"P Sakharkar","year":"2022","unstructured":"Sakharkar, P. & Ansari, N. Application of exploratory factor analysis and item response theory to validate NHANES ADL scale in patients reporting rheumatoid arthritis. Pharm. (Basel) 10, 138 (2022).","journal-title":"Pharm. (Basel)"},{"key":"1111_CR58","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1093\/gerona\/glx144","volume":"73","author":"JM Murabito","year":"2018","unstructured":"Murabito, J. M. et al. Measures of biologic age in a community sample predict mortality and age-related disease: the Framingham Offspring study. J. Gerontol. A Biol. Sci. Med. Sci. 73, 757\u2013762 (2018).","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"1111_CR59","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.51507","volume":"9","author":"X Li","year":"2020","unstructured":"Li, X. et al. Longitudinal trajectories, correlations and mortality associations of nine biological ages across 20-years follow-up. eLife 9, e51507 (2020).","journal-title":"eLife"},{"key":"1111_CR60","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.mad.2005.10.004","volume":"127","author":"P Klemera","year":"2006","unstructured":"Klemera, P. & Doubal, S. A new approach to the concept and computation of biological age. Mech. Ageing Dev. 127, 240\u2013248 (2006).","journal-title":"Mech. Ageing Dev."},{"key":"1111_CR61","doi-asserted-by":"publisher","first-page":"2795","DOI":"10.1007\/s11357-021-00480-5","volume":"43","author":"D Kwon","year":"2021","unstructured":"Kwon, D. & Belsky, D. W. A toolkit for quantification of biological age from blood chemistry and organ function test data: BioAge. GeroScience 43, 2795\u20132808 (2021).","journal-title":"GeroScience"},{"key":"1111_CR62","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/j.0006-341X.2005.030814.x","volume":"61","author":"PJ Heagerty","year":"2005","unstructured":"Heagerty, P. J. & Zheng, Y. Survival model predictive accuracy and ROC curves. Biometrics 61, 92\u2013105 (2005).","journal-title":"Biometrics"},{"key":"1111_CR63","doi-asserted-by":"publisher","unstructured":"Comparing the predictive powers of survival models using Harrell\u2019s C or Somers\u2019 D. Stata J. https:\/\/doi.org\/10.22004\/ag.econ.159022 (2010).","DOI":"10.22004\/ag.econ.159022"},{"key":"1111_CR64","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1002\/sim.4154","volume":"30","author":"H Uno","year":"2011","unstructured":"Uno, H., Cai, T., Pencina, M. J., D\u2019Agostino, R. B. & Wei, L. J. On the C-statistics for evaluating overall adequacy of risk prediction procedures with censored survival data. Stat. Med. 30, 1105\u20131117 (2011).","journal-title":"Stat. Med."},{"key":"1111_CR65","doi-asserted-by":"publisher","first-page":"2538","DOI":"10.1016\/j.csda.2007.09.003","volume":"52","author":"H Liang","year":"2008","unstructured":"Liang, H. & Zou, G. Improved AIC selection strategy for survival analysis. Comput Stat. Data Anal. 52, 2538\u20132548 (2008).","journal-title":"Comput Stat. Data Anal."},{"key":"1111_CR66","doi-asserted-by":"publisher","first-page":"e044575","DOI":"10.1002\/alz.044575","volume":"16","author":"L Gao","year":"2020","unstructured":"Gao, L. et al. Sleep disturbance and incident Alzheimer\u2019s disease: a UK Biobank study of 502,538 middle-aged to older participants. Alzheimer\u2019s Dement. 16, e044575 (2020).","journal-title":"Alzheimer\u2019s Dement."},{"key":"1111_CR67","doi-asserted-by":"publisher","first-page":"e13392","DOI":"10.1111\/jsr.13392","volume":"30","author":"M von Schantz","year":"2021","unstructured":"von Schantz, M., Ong, J. C. & Knutson, K. L. Associations between sleep disturbances, diabetes and mortality in the UK Biobank cohort: a prospective population-based study. J. Sleep. Res. 30, e13392 (2021).","journal-title":"J. Sleep. Res."},{"key":"1111_CR68","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1136\/bjsports-2021-104050","volume":"56","author":"R Walmsley","year":"2021","unstructured":"Walmsley, R. et al. Reallocation of time between device-measured movement behaviours and risk of incident cardiovascular disease. Br. J. Sports Med. 56, 1008\u20131017 (2021).","journal-title":"Br. J. Sports Med."}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01111-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01111-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01111-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T14:14:30Z","timestamp":1717510470000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-024-01111-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,4]]},"references-count":68,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1111"],"URL":"https:\/\/doi.org\/10.1038\/s41746-024-01111-x","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3740073\/v1","asserted-by":"object"}]},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,4]]},"assertion":[{"value":"11 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"146"}}