{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:08:42Z","timestamp":1762189722419,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003392","name":"Natural Science Foundation of Fujian Province","doi-asserted-by":"publisher","award":["2023J05043"],"award-info":[{"award-number":["2023J05043"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Social Science Foundation of Fujian Province","award":["FJ2023BF078"],"award-info":[{"award-number":["FJ2023BF078"]}]},{"name":"Educational Research Project for Young and Middle-aged Teachers in Fujian Province","award":["JAT220103"],"award-info":[{"award-number":["JAT220103"]}]},{"name":"Soft Science Research Project on Health and Wellness in Fujian Province","award":["2024RKA011"],"award-info":[{"award-number":["2024RKA011"]}]},{"name":"Start-up Fund for High-level Talents of Fujian Medical University","award":["XRCZX2022006"],"award-info":[{"award-number":["XRCZX2022006"]}]},{"DOI":"10.13039\/501100006636","name":"Swedish Research Council for Health, Working Life and Welfare","doi-asserted-by":"publisher","award":["2019\u201301120 and 2020\u201300313"],"award-info":[{"award-number":["2019\u201301120 and 2020\u201300313"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2023-02601"],"award-info":[{"award-number":["2023-02601"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Few studies have simultaneously examined how blood biomarkers for inflammation, metabolic, and cardiovascular function are associated with disability incidence. This study aimed to comprehensively examine these associations. Methods: We used data from adults aged 50 and older in the Health and Retirement Study (n = 9250) and the China Health and Retirement Longitudinal Study (n = 6844), with biennial follow-up over a 4-year period. We defined abnormal biomarker values using standard clinical cut-off points for three biological systems. Disability burden was quantified as the cumulative number of impairments in basic and instrumental activities of daily living. Multivariate linear mixed-effects models were used to analyze the associations. Results: At baseline, 42% of participants had abnormal biomarker values in at least one system, 28% in two systems, and 7% in all three. A dose\u2013response relationship was observed between the rate of disability accumulation and the number of systems with abnormal biomarker values. Compared to individuals with normal values across all systems, those with abnormalities in two systems had a significantly faster annual increase in disability burden (\u03b2 = 0.06, 95% CI: 0.02\u20130.09), while those with abnormalities in all three systems exhibited an even steeper increase (\u03b2 = 0.1, 95% CI: 0.05\u20130.16). Conclusions: The presence of abnormal levels in any two or all three of the systems significantly accelerated the rate of disability accumulation over a 4-year period. These findings highlight the importance of integrated biomarker monitoring for early identification of individuals at risk and inform the development of targeted preventive strategies.<\/jats:p>","DOI":"10.3390\/jcdd12110429","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T16:18:42Z","timestamp":1762186722000},"page":"429","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Abnormal Blood Biomarkers and Cumulative Disability Burden in Middle-Aged and Older Adults: Evidence from Two Nationally Representative Surveys in the United States and China"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1962-9488","authenticated-orcid":false,"given":"Raoping","family":"Tu","sequence":"first","affiliation":[{"name":"School of Health Management, Fujian Medical University, Fuzhou 350122, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin-Jing","family":"Pei","sequence":"additional","affiliation":[{"name":"Division of Psychobiology and Epidemiology, Department of Psychology, Stockholm University, SE-114 19 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Wolthon","sequence":"additional","affiliation":[{"name":"Division of Psychobiology and Epidemiology, Department of Psychology, Stockholm University, SE-114 19 Stockholm, Sweden"},{"name":"Department of Comparative Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueping","family":"Li","sequence":"additional","affiliation":[{"name":"Fujian Medical University Library, Fuzhou 350122, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Psychobiology and Epidemiology, Department of Psychology, Stockholm University, SE-114 19 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/1475-9276-11-52","article-title":"Social determinants of sex differences in disability among older adults: A multi-country decomposition analysis using the World Health Survey","volume":"11","author":"Hosseinpoor","year":"2012","journal-title":"Int. J. Equity Health"},{"key":"ref_2","first-page":"77","article-title":"C-reactive protein is associated with disability independently of vascular events: The Northern Manhattan Study","volume":"46","author":"Dhamoon","year":"2017","journal-title":"Age Ageing"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1161\/HYPERTENSIONAHA.107.097667","article-title":"Association between concurrent and remote blood pressure and disability in older adults","volume":"50","author":"Hajjar","year":"2007","journal-title":"Hypertension"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1093\/gerona\/glaa043","article-title":"Patterns of cardiovascular risk factors in old age and survival and health status at 90","volume":"75","author":"Odden","year":"2020","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1093\/gerona\/gls123","article-title":"Association of a Modified Physiologic Index with mortality and incident disability: The Health, Aging, and Body Composition study","volume":"67","author":"Sanders","year":"2012","journal-title":"J. Gerontol. Ser. A Biomed. Sci. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1111\/jgs.15390","article-title":"Index of healthy aging in Chinese older adults: China health and retirement longitudinal study","volume":"66","author":"Wu","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1161\/CIRCOUTCOMES.115.002519","article-title":"Optimal levels of all major cardiovascular risk factors in younger age and functional disability in older age: The Chicago Heart Association Detection Project in Industry 2016, 32-year follow-up health survey","volume":"9","author":"Vu","year":"2016","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1159\/000510696","article-title":"Allostatic Load and Its Impact on Health: A Systematic Review","volume":"90","author":"Guidi","year":"2021","journal-title":"Psychother. Psychosom."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.neubiorev.2009.10.002","article-title":"Allostatic load biomarkers of chronic stress and impact on health and cognition","volume":"35","author":"Juster","year":"2010","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1007\/s12603-019-1251-5","article-title":"Allostatic Load as a Biological Substrate to Intrinsic Capacity: A Secondary Analysis of CRELES","volume":"23","year":"2019","journal-title":"J. Nutr. Health Aging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"104006","DOI":"10.1016\/j.archger.2019.104006","article-title":"Allostatic load and stress biomarkers in a sample of community-dwelling older adults","volume":"87","author":"Freire","year":"2020","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.exger.2005.03.002","article-title":"A comparative analysis of measurement approaches for physiological dysregulation in an older population","volume":"40","author":"Seplaki","year":"2005","journal-title":"Exp. Gerontol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1353\/dem.2006.0009","article-title":"Measurement of cumulative physiological dysregulation in an older population","volume":"43","author":"Seplaki","year":"2006","journal-title":"Demography"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"105829","DOI":"10.1016\/j.jamda.2025.105829","article-title":"Comprehensiveness vs Efficiency: A Cross-Sectional Analysis of the Association Between Allostatic Load and the Frailty Index Using the CLSA","volume":"26","author":"Duignan","year":"2025","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"104961","DOI":"10.1016\/j.archger.2023.104961","article-title":"Allostatic load and physical performance in older adults: Findings from the International Mobility in Aging Study (IMIAS)","volume":"109","author":"Germano","year":"2023","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"14158","DOI":"10.1073\/pnas.0606215103","article-title":"Combinations of biomarkers predictive of later life mortality","volume":"103","author":"Gruenewald","year":"2006","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1111\/j.1532-5415.2009.02389.x","article-title":"Allostatic load and frailty in older adults","volume":"57","author":"Gruenewald","year":"2009","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e3517","DOI":"10.1002\/smi.3517","article-title":"Does allostatic load in 50\u201389-year-olds predict the development of frailty? Evidence from a national longitudinal study over 12 years","volume":"41","author":"Arkesteijn","year":"2025","journal-title":"Stress Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/PSY.0000000000001013","article-title":"Examination of the Allostatic Load Construct and Its Longitudinal Association with Health Outcomes in the Boston Puerto Rican Health Study","volume":"84","author":"McClain","year":"2022","journal-title":"Psychosom. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/s10522-017-9677-9","article-title":"Multidimensional predictors of physical frailty in older people: Identifying how and for whom they exert their effects","volume":"18","author":"Ding","year":"2017","journal-title":"Biogerontology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1602\/neurorx.1.2.182","article-title":"Biomarkers potential uses and limitations","volume":"1","author":"Mayeux","year":"2004","journal-title":"NeuroRx"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Crimmins, E., Faul, J., Kim, J.K., Guyer, H., Langa, K., Ofstedal, M.B., Sonnega, A., Wallace, R., and Weir, D. (2013). Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study, Survey Research Center University of Michigan.","DOI":"10.7826\/ISR-UM.06.585031.001.05.0018.2009"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/ije\/dys203","article-title":"Cohort profile: The China health and retirement longitudinal study (CHARLS)","volume":"43","author":"Zhao","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1161\/01.CIR.0000052939.59093.45","article-title":"Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association","volume":"107","author":"Pearson","year":"2003","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke statistics\u20142022 update: A report from the American Heart Association","volume":"145","author":"Tsao","year":"2022","journal-title":"Circulation"},{"key":"ref_26","unstructured":"Crimmins, E., Faul, J., Kim, J.K., and Weir, D.J.A.A. (2015). Documentation of Biomarkers in the 2010 and 2012 Health and Retirement Study, Survey Research Center, University of Michigan."},{"key":"ref_27","unstructured":"(2025, February 11). CHARLS Blood Sample Users\u2019 Guide. Available online: https:\/\/charls.pku.edu.cn\/wenjian\/xuejianshujuyonghushiyongshouce.pdf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1080\/19485565.2014.901885","article-title":"Validation of blood-based assays using dried blood spots for use in large population studies","volume":"60","author":"Crimmins","year":"2014","journal-title":"Biodemogr Soc. Biol."},{"key":"ref_29","first-page":"S46","article-title":"Combining activities of daily living with instrumental activities of daily living to measure functional disability","volume":"53","author":"Spector","year":"1998","journal-title":"J. Gerontol. Ser. B Psychol. Sci. Soc. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1007\/s12144-014-9281-y","article-title":"Validation of the eight-item center for epidemiologic studies depression scale (CES-D) among older adults","volume":"34","author":"Karim","year":"2015","journal-title":"Curr. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0749-3797(18)30622-6","article-title":"Screening for Depression in Well Older Adults: Evaluation of a Short Form of the CES-D","volume":"10","author":"Andresen","year":"1994","journal-title":"Am. J. Prev. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1146\/annurev-publhealth-031816-044628","article-title":"The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach","volume":"39","author":"Zajacova","year":"2018","journal-title":"Annu. Rev. Public. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100367","DOI":"10.1016\/j.jnha.2024.100367","article-title":"Association of allostatic load with functional disability in the China Health and Retirement Longitudinal Study","volume":"28","author":"Zhao","year":"2024","journal-title":"J. Nutr. Health Aging"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e2449855","DOI":"10.1001\/jamanetworkopen.2024.49855","article-title":"Allostatic Load, Educational Attainment, and Risk of Cancer Mortality Among US Men","volume":"7","author":"Li","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Crimmins, E.M., Zhang, Y.S., Kim, J.K., Frochen, S., Kang, H., Shim, H., Ailshire, J., Potter, A., Cofferen, J., and Faul, J. (2020). Dried blood spots: Effects of less than optimal collection, shipping time, heat, and humidity. Am. J. Hum. Biol., 32.","DOI":"10.1002\/ajhb.23390"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e007462","DOI":"10.1161\/JAHA.117.007462","article-title":"Comparison of Prevalence, Awareness, Treatment, and Control of Cardiovascular Risk Factors in China and the United States","volume":"7","author":"Lu","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_37","unstructured":"Read, S., and Grundy, E. (2025, March 12). Allostatic Load\u2014A Challenge to Measure Multisystem Physiological Dysregulation. Available online: https:\/\/eprints.ncrm.ac.uk\/id\/eprint\/2879\/1\/NCRM_workingpaper_0412.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1093\/ageing\/afm105","article-title":"HDL-cholesterol and physical performance: Results from the ageing and longevity study in the sirente geographic area (ilSIRENTE Study)","volume":"36","author":"Landi","year":"2007","journal-title":"Age Ageing"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/11\/429\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T16:48:09Z","timestamp":1762188489000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/11\/429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":38,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcdd12110429"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12110429","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}