Multi-organ aging quantified from routine chest CT predicts chronic disease risk and mortality
- 1The University of Texas MD Anderson Cancer Center
Abstract
Biological aging occurs heterogeneously across individuals and organs. However, current measures of biological age incompletely capture organ-specific differences in health and disease risk. Because chest CT visualizes multiple thoracic organs, it offers an opportunity to quantify structural aging across organ systems. Here, we developed MOSAIC-Age, a framework characterizing eight organ-specific aging clocks on chest CT. The clocks were developed and validated using 9,971 CT scans from CT-RATE and MIDRC, and subsequently locked and applied to two independent prospective cohorts with 35,293 participants from the National Lung Screening Trial and Genetic Epidemiology of COPD study. CT-derived biological age gaps (BAGs) were examined in relation to lifestyle and socioeconomic factors, prevalent comorbidities, incident chronic diseases, and all-cause and cause-specific mortality. Higher BAGs, indicating organs that appeared older on CT than expected for their chronological age, were broadly associated with adverse health characteristics, chronic disease burden, and increased mortality risk. Multiple disease outcomes were associated with aging across several organs, whereas in multivariable analyses including all eight organ-specific BAGs, the remaining associations were more organ specific. A greater number of markedly older-appearing organs and a faster pace of aging were each associated with higher mortality. Together, these findings demonstrate that routine chest CT captures both shared and organ-specific patterns of biological aging and establish CT-derived organ aging as a quantitative imaging biomarker for assessing multi-organ health and long-term disease risk.
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BibTeX
@misc{sato2026multiorgan,
title = {{Multi-organ aging quantified from routine chest CT predicts chronic disease risk and mortality}},
author = {J. Sato and M. Salehjahromi and A. Zafar and A. Muneer and X. Xu and E. Zhu and N. I. Vokes and T. Cascone and X. Le and M. Altan and E. E. Gardner and A. Sheshadri and E. J. Ostrin and A. A. Salahudeen and T. Li and M. Merad and A. A. Chaudhuri and D. E. Gerber and F. U. Kay and M. C. B. Godoy and B. W. Carter and G. S. Shroff and L. A. Byers and C. Chung and D. Jaffray and D. Rice and Z. Liao and J. Y. Chang and A. A. Vaporciyan and D. L. Gibbons and C. C. Wu and J. V. Heymach and J. Zhang and J. Wu},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.26.26361434},
url = {https://www.medrxiv.org/content/10.64898/2026.08.26.26361434v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Multi-organ aging quantified from routine chest CT predicts chronic disease risk and mortality
AU - J. Sato
AU - M. Salehjahromi
AU - A. Zafar
AU - A. Muneer
AU - X. Xu
AU - E. Zhu
AU - N. I. Vokes
AU - T. Cascone
AU - X. Le
AU - M. Altan
AU - E. E. Gardner
AU - A. Sheshadri
AU - E. J. Ostrin
AU - A. A. Salahudeen
AU - T. Li
AU - M. Merad
AU - A. A. Chaudhuri
AU - D. E. Gerber
AU - F. U. Kay
AU - M. C. B. Godoy
AU - B. W. Carter
AU - G. S. Shroff
AU - L. A. Byers
AU - C. Chung
AU - D. Jaffray
AU - D. Rice
AU - Z. Liao
AU - J. Y. Chang
AU - A. A. Vaporciyan
AU - D. L. Gibbons
AU - C. C. Wu
AU - J. V. Heymach
AU - J. Zhang
AU - J. Wu
PY - 2026
DA - 2026/08/26
PB - medRxiv
DO - 10.64898/2026.08.26.26361434
UR - https://www.medrxiv.org/content/10.64898/2026.08.26.26361434v1
AB - Biological aging occurs heterogeneously across individuals and organs. However, current measures of biological age incompletely capture organ-specific differences in health and disease risk. Because chest CT visualizes multiple thoracic organs, it offers an opportunity to quantify structural aging across organ systems. Here, we developed MOSAIC-Age, a framework characterizing eight organ-specific aging clocks on chest CT. The clocks were developed and validated using 9,971 CT scans from CT-RATE and MIDRC, and subsequently locked and applied to two independent prospective cohorts with 35,293 participants from the National Lung Screening Trial and Genetic Epidemiology of COPD study. CT-derived biological age gaps (BAGs) were examined in relation to lifestyle and socioeconomic factors, prevalent comorbidities, incident chronic diseases, and all-cause and cause-specific mortality. Higher BAGs, indicating organs that appeared older on CT than expected for their chronological age, were broadly associated with adverse health characteristics, chronic disease burden, and increased mortality risk. Multiple disease outcomes were associated with aging across several organs, whereas in multivariable analyses including all eight organ-specific BAGs, the remaining associations were more organ specific. A greater number of markedly older-appearing organs and a faster pace of aging were each associated with higher mortality. Together, these findings demonstrate that routine chest CT captures both shared and organ-specific patterns of biological aging and establish CT-derived organ aging as a quantitative imaging biomarker for assessing multi-organ health and long-term disease risk.
ER -