Informative frailty indices from binarized biomarkers

Abstract

Frailty indices (FIs) based on continuous valued health data, such as obtained from blood and urine tests, have been shown to be predictive of adverse health outcomes. However, creating FIs from such biomarker data requires a binarization treatment that is difficult to standardize across studies. In this work, we explore a "quantile" methodology for the generic treatment of biomarker data that allows us to construct an FI without preexisting medical knowledge (i.e. risk thresholds) of the included biomarkers. We show that our quantile approach performs as well as, or even slightly better than, established methods for the National Health and Nutrition Examination Survey and the Canadian Study of Health and Aging data sets. Furthermore, we show that our approach is robust to cohort effects within studies as compared to other data-based methods. The success of our binarization approaches provides insight into the robustness of the FI as a health measure, and the upper limits of the FI observed in various data sets, and also highlights general difficulties in obtaining absolute scales for comparing FIs between studies.

Keywords: Binarization; Biomarkers; Dichotomization; Frailty index; Quantiles.