Deep Learning Chest X-Ray Age, Epigenetic Aging Clocks and Associations with Age-Related Subclinical Disease in the Project Baseline Health Study

Background Chronological age is an important component of medical risk scores and decision-making. However, there is considerable variability in how individuals age. We recently published an open-source deep learning model to assess biological age from chest radiographs (CXR-Age), which predicts all-cause and cardiovascular mortality better than chronological age. Here, we compare CXR-Age to two established epigenetic aging clocks (First generation—Horvath Age; Second generation—DNAm PhenoAge) to test which is more strongly associated with cardiopulmonary disease and frailty. Methods Our cohort consisted of 2,097 participants from the Project Baseline Health Study, a prospective cohort study of individuals from four US sites. We compared the association between the different aging clocks and measures of cardiopulmonary disease, frailty, and protein abundance collected at the participant’s first annual visit using linear regression models adjusted for common confounders. Results We found that CXR-Age was associated with coronary calcium, cardiovascular risk factors, worsening pulmonary function, increased frailty, and abundance in plasma of two proteins implicated in neuroinflammation and aging. Associations with DNAm PhenoAge were weaker for pulmonary function and all metrics in middle-age adults. We identified thirteen proteins that were associated with DNAm PhenoAge, one (CDH13) of which was also associated with CXR-Age. No associations were found with Horvath Age. Conclusion These results suggest that CXR-Age may serve as a better metric of cardiopulmonary aging than epigenetic aging clocks, especially in midlife adults.