Progress Towards a Midlife Risk Score for Decline in Women’s Physical Health and Function

Doctor sits with female patient, holding a clipboard and pen

Declines in health and function that are common in later life can begin in midlife. Some experts speculate midlife could be a window for interventions that would maintain long-term health-related quality of life.

Several studies, including the Study of Women’s Health Across the Nation (SWAN), have identified factors associated with declines in physical health and function. As reported in The Journals of Gerontology: Medical Sciences, these included older age, higher body mass index, reduced physical activity, tobacco use, and sleep problems.

Daniel H. Solomon, MD, MPH, chief of the Section of Clinical Sciences in the Division of Rheumatology, Inflammation and Immunity at Brigham and Women’s Hospital, and colleagues examined SWAN data to pinpoint risk factors that could be captured on the physical component summary (PCS) of the Short Form 36, a widely used measure of health-related quality of life. In JAMA Network Open, they identify several factors that might form the basis of a clinically useful risk score.


SWAN enrolled 3,302 women, ages 42 to 52, at seven sites across the U.S. The baseline visit occurred in 1996 or 1997, and the cohort was seen annually for up to 15 visits through 2016.

This analysis included 1,091 participants. About half identified as white (52%), 24% as Black, 12% as Chinese, and 12% as Japanese. The SWAN site enrolling Hispanic/Latina women was temporarily closed around the time of this study’s baseline, and those women had too few follow-up visits to be included.

The primary outcome was a clinically important change (defined here as ≥8 points) in the PCS between ages 55 and 65.

Change on the PCS

Over the 10-year study period:

  • 206 women (19%) reported a clinically important decline in the PCS
  • 791 women (72%) reported no clinically important change
  • 94 women (9%) reported a clinically important improvement

In multivariable analyses, variables associated with clinically important declines in PCS were:

  • Cardiovascular disease (OR, 2.06)
  • Clinically significant depressive symptoms (OR, 2.03)
  • Current smoking (OR, 1.93)
  • Less educational attainment (OR, 1.87)
  • Osteoarthritis (OR, 1.46)
  • Higher baseline PCS (OR, 1.08)
  • Greater BMI (OR, 1.07)

Progress Toward a Risk Score

These observational data don’t permit strong conclusions about targets for interventions. However, if the risk factors identified in this study are replicated in another cohort, then a risk score for clinically important declines in midlife women could be developed.

Some risk factors detected here are not easily modified (e.g., educational attainment), but others could be targeted for preventive or therapeutic interventions, including BMI, smoking and depressive symptoms. Moreover, other modifiable targets might be identified in future population-based studies.

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