Bojing Liu, PhD *; Zhehui Luo, PhD *; Jayant M. Pinto, MD; Eric J. Shiroma, ScD; Gregory J. Tranah, PhD; Karin Wirdefeldt, MD, PhD; Fang Fang, MD, PhD; Tamara B. Harris, MD, MSc; Honglei Chen, MD, PhD
Disclaimer: Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the National Institutes of Health or the Department of Defense.
Acknowledgment: The authors thank Drs. Arvid Sjölander and Johan Steen for the valuable input and discussion in the statistical analysis.
Financial Support: By the Intramural Research Program of the National Institutes of Health (National Institute on Aging) and by contracts N01AG62101, N01AG62103, and N01AG62106 from the National Institute on Aging. Dr. Fang is supported by a Senior Researcher Award and a Strategic Research Area in Epidemiology Award from Karolinska Institutet. Dr. Chen is supported by start-up fund GE100455 from Michigan State University, grant PF-IMP-1825 from the Parkinson's Foundation, and award W81XWH-17-1-0536 from the Office of the Assistant Secretary of Defense for Health Affairs through the Parkinson's Research Program.
Disclosures: Dr. Pinto reports grants from the National Institute on Aging and National Institute of Allergy and Infectious Diseases of the National Institutes of Health during the conduct of the study and personal fees from Stallergenes and Optinose outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0775.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol and statistical code: See the Supplement. Data set: Not available.
Corresponding Author: Honglei Chen, MD, PhD, Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road, East Lansing, MI 48824; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Liu, Wirdefeldt, and Fang: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, 171 65 Solna, Stockholm, Sweden.
Dr. Luo: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road, West Fee Hall, Room B601, East Lansing, MI 48824.
Dr. Pinto: Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, 5841 South Maryland Avenue, Chicago, IL 60637.
Drs. Shiroma and Harris: Laboratory of Epidemiology and Population Science, Intramural Research Program of the National Institutes of Health, National Institute on Aging, Building 31, Room 5C27, 31 Center Drive, MSC 2292, Bethesda, MD 20892.
Dr. Tranah: California Pacific Medical Center Research Institute, Box 0560, 550 16th Street, 2nd Floor, San Francisco, CA 94159.
Dr. Chen: Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road, West Fee Hall, Room B645, East Lansing, MI 48824.
Author Contributions: Conception and design: B. Liu, Z. Luo, F. Fang, H. Chen.
Analysis and interpretation of the data: B. Liu, Z. Luo, J.M. Pinto, E.J. Shiroma, G.J. Tranah, F. Fang, T.B. Harris, H. Chen.
Drafting of the article: B. Liu, Z. Luo, H. Chen.
Critical revision of the article for important intellectual content: B. Liu, Z. Luo, J.M. Pinto, E.J. Shiroma, G.J. Tranah, K. Wirdefeldt, F. Fang, T.B. Harris, H. Chen.
Final approval of the article: B. Liu, Z. Luo, J.M. Pinto, E.J. Shiroma, G.J. Tranah, K. Wirdefeldt, F. Fang, T.B. Harris, H. Chen.
Provision of study materials or patients: T.B. Harris.
Statistical expertise: B. Liu, Z. Luo, F. Fang, H. Chen.
Obtaining of funding: T.B. Harris, H. Chen.
Administrative, technical, or logistic support: B. Liu, E.J. Shiroma, K. Wirdefeldt, T.B. Harris, H. Chen.
Collection and assembly of data: B. Liu, H. Chen, T.B. Harris.
Poor olfaction is common among older adults and has been linked to higher mortality. However, most studies have had a relatively short follow-up and have not explored potential explanations.
To assess poor olfaction in relation to mortality in older adults and to investigate potential explanations.
Community-based prospective cohort study.
2 U.S. communities.
2289 adults aged 71 to 82 years at baseline (37.7% black persons and 51.9% women).
Brief Smell Identification Test in 1999 or 2000 (baseline) and all-cause and cause-specific mortality at 3, 5, 10, and 13 years after baseline.
During follow-up, 1211 participants died by year 13. Compared with participants with good olfaction, those with poor olfaction had a 46% higher cumulative risk for death at year 10 (risk ratio, 1.46 [95% CI, 1.27 to 1.67]) and a 30% higher risk at year 13 (risk ratio, 1.30 [CI, 1.18 to 1.42]). Similar associations were found in men and women and in white and black persons. However, the association was evident among participants who reported excellent to good health at baseline (for example, 10-year mortality risk ratio, 1.62 [CI, 1.37 to 1.90]) but not among those who reported fair to poor health (10-year mortality risk ratio, 1.06 [CI, 0.82 to 1.37]). In analyses of cause-specific mortality, poor olfaction was associated with higher mortality from neurodegenerative and cardiovascular diseases. Mediation analyses showed that neurodegenerative diseases explained 22% and weight loss explained 6% of the higher 10-year mortality among participants with poor olfaction.
No data were collected on change in olfaction and its relationship to mortality.
Poor olfaction is associated with higher long-term mortality among older adults, particularly those with excellent to good health at baseline. Neurodegenerative diseases and weight loss explain only part of the increased mortality.
National Institutes of Health and Michigan State University.
Liu B, Luo Z, Pinto JM, Shiroma EJ, Tranah GJ, Wirdefeldt K, et al. Relationship Between Poor Olfaction and Mortality Among Community-Dwelling Older Adults: A Cohort Study. Ann Intern Med. [Epub ahead of print 30 April 2019]170:673–681. doi: 10.7326/M18-0775
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Published: Ann Intern Med. 2019;170(10):673-681.
Published at www.annals.org on 30 April 2019
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