Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States
- 1Rush University Medical Center
Abstract
ImportanceThe ASPREE randomized trial found no overall benefit of low-dose aspirin for disability-free survival among older adults. However, individual estimates in pre-specified subgroups indicated potential benefit among racial and ethnic minoritized participants in the United States (US).
ObjectiveTo evaluate whether the effect of low-dose aspirin vs placebo on disability-free survival differed across US Black and Hispanic ASPREE participants using individualized treatment-effect estimation.
Design, Setting, and ParticipantsPost hoc clinical trial analysis of ASPREE, a randomized, double-blind, placebo-controlled clinical trial of daily low-dose aspirin vs placebo. This analysis included US ASPREE participants who self-identified as non-Hispanic Black or Hispanic, were aged 65 years or older, and had complete baseline predictor and outcome data.
InterventionsRandomization to daily 100-mg aspirin or placebo.
Main Outcomes and MeasuresThe primary outcome was loss of disability-free survival, defined as death, persistent physical disability, or dementia. Individualized treatment effects were estimated post hoc using a Random Survival Forest X-learner. Heterogeneity was evaluated on the relative scale with Cox proportional hazards models and on the absolute scale with 5-year risk differences.
ResultsAmong 2411 US ASPREE participants, 1270 were included in the Black and Hispanic analytic cohort (897 non-Hispanic Black and 373 Hispanic participants; mean age, 71.8 years). Aspirin was associated with lower risk of disability-free survival loss compared with placebo (hazard ratio [HR], 0.65; 95% CI, 0.45-0.93). In model-derived tertiles, aspirin was associated with lower risk in the greatest predicted-benefit group (HR, 0.36; 95% CI, 0.19-0.71; 5-year absolute risk difference [ARD], -11.1 percentage points; 95% CI, -22.0 to -0.1) but not in the lowest predicted-benefit group (HR, 1.26; 95% CI, 0.70-2.27; ARD, +3.9 percentage points; 95% CI, -5.9 to 13.6).
Conclusions and RelevanceIn these analyses of US Black and Hispanic ASPREE participants, aspirin effects on disability-free survival appear to be heterogeneous, with benefit concentrated in a subset of participants. Because these findings are from post-hoc models, they should be externally validated before being incorporated into clinical decision-making.
Trial RegistrationClinicalTrials.gov Identifier: NCT01038583; https://clinicaltrials.gov/study/NCT01038583
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BibTeX
@misc{tzimas2026aspirin,
title = {{Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States}},
author = {G. Tzimas and J. C. Vanghelof and A. Mohammed and D. S. Raicu and L. Du and M. E. Ernst and E. T. Warner and A. T. Chan and J. Ryan and S. E. Espinoza and A. Murray and K. Sheets and R. B. Tchoua and R. C. Shah},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.24.26361036},
url = {https://www.medrxiv.org/content/10.64898/2026.08.24.26361036v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States
AU - G. Tzimas
AU - J. C. Vanghelof
AU - A. Mohammed
AU - D. S. Raicu
AU - L. Du
AU - M. E. Ernst
AU - E. T. Warner
AU - A. T. Chan
AU - J. Ryan
AU - S. E. Espinoza
AU - A. Murray
AU - K. Sheets
AU - R. B. Tchoua
AU - R. C. Shah
PY - 2026
DA - 2026/08/24
PB - medRxiv
DO - 10.64898/2026.08.24.26361036
UR - https://www.medrxiv.org/content/10.64898/2026.08.24.26361036v1
AB - ImportanceThe ASPREE randomized trial found no overall benefit of low-dose aspirin for disability-free survival among older adults. However, individual estimates in pre-specified subgroups indicated potential benefit among racial and ethnic minoritized participants in the United States (US). ObjectiveTo evaluate whether the effect of low-dose aspirin vs placebo on disability-free survival differed across US Black and Hispanic ASPREE participants using individualized treatment-effect estimation. Design, Setting, and ParticipantsPost hoc clinical trial analysis of ASPREE, a randomized, double-blind, placebo-controlled clinical trial of daily low-dose aspirin vs placebo. This analysis included US ASPREE participants who self-identified as non-Hispanic Black or Hispanic, were aged 65 years or older, and had complete baseline predictor and outcome data. InterventionsRandomization to daily 100-mg aspirin or placebo. Main Outcomes and MeasuresThe primary outcome was loss of disability-free survival, defined as death, persistent physical disability, or dementia. Individualized treatment effects were estimated post hoc using a Random Survival Forest X-learner. Heterogeneity was evaluated on the relative scale with Cox proportional hazards models and on the absolute scale with 5-year risk differences. ResultsAmong 2411 US ASPREE participants, 1270 were included in the Black and Hispanic analytic cohort (897 non-Hispanic Black and 373 Hispanic participants; mean age, 71.8 years). Aspirin was associated with lower risk of disability-free survival loss compared with placebo (hazard ratio [HR], 0.65; 95% CI, 0.45-0.93). In model-derived tertiles, aspirin was associated with lower risk in the greatest predicted-benefit group (HR, 0.36; 95% CI, 0.19-0.71; 5-year absolute risk difference [ARD], -11.1 percentage points; 95% CI, -22.0 to -0.1) but not in the lowest predicted-benefit group (HR, 1.26; 95% CI, 0.70-2.27; ARD, +3.9 percentage points; 95% CI, -5.9 to 13.6). Conclusions and RelevanceIn these analyses of US Black and Hispanic ASPREE participants, aspirin effects on disability-free survival appear to be heterogeneous, with benefit concentrated in a subset of participants. Because these findings are from post-hoc models, they should be externally validated before being incorporated into clinical decision-making. Trial RegistrationClinicalTrials.gov Identifier: NCT01038583; https://clinicaltrials.gov/study/NCT01038583
ER -