Aging Fits the Disease Criteria of the International Classification of Diseases
Khaltourina Daria 1 , Matveyev Yuri 2 , Alekseev Aleksey , 3 , Cortese Franco 4 , Ioviţă Anca 5
1 International Longevity alliance, Federal Research Institute for Health Organization and Informatics of Ministry of
Health of the Russian Federation.
2 Moscow Regional Research and Clinical Institute, Council for Public Health and the Problems of Demography.
3 Scientific Center for Obstetrics, Gynecology and Perinatology, Moscow; Lomonosov Moscow State University;
Council for Public Health and the Problems of Demography.
4 Biogerontology Research Foundation.
5 International Longevity Alliance.
The International Classifications of Diseases (ICD) system is the international standard for clinical diagnosis, epidemiology and health management in developed nations, and adding a code to a disease not yet recognized by ICD effectively allows for drugs targeting that disease to be clinically evaluated and approved, and for insurance companies to provide coverage for therapies targeting that disease. As such, the classification of aging as a disease via ICD-11 is one of the largest prerequisites for the clinical evaluation and approval of healthspan-extending interventions from a regulatory standpoint. We applied the disease criteria followed by the WHO in classifying new diseases to biological aging, creating a proposal that sought to classify aging as a disease based upon clinical data supporting the existence of various presumed causal mechanisms of aging in human subjects, as well as clinical data demonstrating the efficacy of known therapeutic interventions capable of modifying these mechanisms. Our analysis aimed to identify and review only those hallmarks of aging supported by clinical data, and only those therapeutic interventions possessing clinical data, as a basis for classifying aging as a disease via ICD-11. The ICD-11 Joint Task force reviewed our proposal and included an extension code for “Ageing-related” into the “Temporality” section to the ICD-11 Beta Draft, as an adjunct code that can be added to any relevant condition present in the ICD system. While this does not amount to classifying aging as a disease in full, having the WHO adding an extension code for “age-related” for the first time is a step toward that goal. We hope that this will lead to greater focus on aging in global health policy and expand opportunities for drug and therapy developers, and establish a foundation upon which the classification of aging as a disease can be accomplished during the next round of ICD revision. Additionally, throughout the course of our analysis, we prepared a large ontological database on the pathophysiology of aging, identifying those major causal mechanisms of human aging that have clinical evidence to support their existence, their capacity to be modulated by genetic and environmental factors, and clinically supported interventions capable of modulating them, including inflammation, replicative cellular senescence, immune senescence, proteostasis failures, mitochondrial dysfunctions, fibrotic propensity, hormonal aging, body composition changes, etc.
1 International Longevity alliance, Federal Research Institute for Health Organization and Informatics of Ministry of
Health of the Russian Federation.
2 Moscow Regional Research and Clinical Institute, Council for Public Health and the Problems of Demography.
3 Scientific Center for Obstetrics, Gynecology and Perinatology, Moscow; Lomonosov Moscow State University;
Council for Public Health and the Problems of Demography.
4 Biogerontology Research Foundation.
5 International Longevity Alliance.
The International Classifications of Diseases (ICD) system is the international standard for clinical diagnosis, epidemiology and health management in developed nations, and adding a code to a disease not yet recognized by ICD effectively allows for drugs targeting that disease to be clinically evaluated and approved, and for insurance companies to provide coverage for therapies targeting that disease. As such, the classification of aging as a disease via ICD-11 is one of the largest prerequisites for the clinical evaluation and approval of healthspan-extending interventions from a regulatory standpoint. We applied the disease criteria followed by the WHO in classifying new diseases to biological aging, creating a proposal that sought to classify aging as a disease based upon clinical data supporting the existence of various presumed causal mechanisms of aging in human subjects, as well as clinical data demonstrating the efficacy of known therapeutic interventions capable of modifying these mechanisms. Our analysis aimed to identify and review only those hallmarks of aging supported by clinical data, and only those therapeutic interventions possessing clinical data, as a basis for classifying aging as a disease via ICD-11. The ICD-11 Joint Task force reviewed our proposal and included an extension code for “Ageing-related” into the “Temporality” section to the ICD-11 Beta Draft, as an adjunct code that can be added to any relevant condition present in the ICD system. While this does not amount to classifying aging as a disease in full, having the WHO adding an extension code for “age-related” for the first time is a step toward that goal. We hope that this will lead to greater focus on aging in global health policy and expand opportunities for drug and therapy developers, and establish a foundation upon which the classification of aging as a disease can be accomplished during the next round of ICD revision. Additionally, throughout the course of our analysis, we prepared a large ontological database on the pathophysiology of aging, identifying those major causal mechanisms of human aging that have clinical evidence to support their existence, their capacity to be modulated by genetic and environmental factors, and clinically supported interventions capable of modulating them, including inflammation, replicative cellular senescence, immune senescence, proteostasis failures, mitochondrial dysfunctions, fibrotic propensity, hormonal aging, body composition changes, etc.
