The proposal of the International Longevity Alliance to classify aging as a disease in ICD-11 has been partially implemented by the World Health Organisation

The International Longevity Alliance welcomes the World Health Organization inclusion of aging-related conditions in the 11th version of the International Classification of Diseases.

77 conditions that should be classified as ageing-related disease

1. Ageing
1.1. Frailty (instead of ICD1MG2A Old age)
2. Ageing-related low-grade inflammation (“Inflamm-aging”)
3. Ageing-related impairment of oxygen metabolism (hypoxia and oxidative stress)
4. Ageing-related replicative cellular senescence 
5. Ageing-related dystrophies of blood and blood-forming organs
5.1. Ageing-related fat dystrophy and atrophy of bone marrow
5.2. Ageing-related pro-thrombotic blood changes
6. Ageing-related immune deficiency (ICD11 4A20+XT9T)
6.1. Ageing-related deterioration of T-cell immunity
7. Ageing-related endocrine, nutritional and metabolic diseases
7.1. Ageing-related body composition pathological changes
7.2. Menopause-related metabolic impairment
7.3. Testicular hypofunction in aged men (ICD11 5A81.1+XT9T
7.4. Benign prostate hyperplasia (ICD11 2F34)
7.5. Ageing-related pro-fibrotic metabolic changes
7.6. Ageing-related insulin resistance (ICD11 5A44XT9T)
7.7. Ageing-related accumulation of advanced glycation end products (AGEs)
7.8. Ageing-related amyloidosis (ICD11 5D00+XT9T)
7.9. Ageing-related amylin accumulation in β-cells
7.10. Ageing-related cerebral accumulation of phosphorylated tau-proteins
7.11. Ageing-related cerebral accumulation of neuromelanin
8. Ageing-related mental disorders
8.1. Ageing-related cognitive decline
8.2. Dementia due to Alzheimer’s disease (ICD11 6D80)
8.3. Vascular dementia (ICD11 6D81)
9. Ageing-related dystrophies of the nervous system
9.1. Ageing-related impairment of neurogenesis
9.2. Ageing-related loss of neural circuits
9.3. Ageing-related degradation of dendritic morphology
9.4. Ageing-related neuronal damage from dysregulated glia cells
9.5. Ageing-related neuroinflammation
9.6. Ageing-related thinning of the cortex
9.7. Ageing-related decrease in hippocampus volume
9.8. Ageing-related accumulation of neurofibrillary tangles
9.9. Ageing-related neuron cell loss
9.10. Ageing-related decrease in white matter integrity (ICD11 8A45+XT9T)
9.11. Ageing-related decline in dopamine synthesis and processing (5C59.00+XT9T)
9.12. Ageing-related decrease in the levels of serotonin receptors and transporters
9.13. Ageing-related pineal gland calcification
9.14. Ageing-related decreased in melatonin synthesis
9.15. Ageing-related decline in olfactory acuity
10. Ageing-related dystrophies of the eye and adnexa
10.1. Ageing-related degeneration of macula and posterior pole
10.2. Ageing-related decrease in the pupil size (LA11.62+XT9T)
10.3. Ageing-related posterior vitreous detachment (ICD11 9B81)
10.4. Ageing-related nuclear sclerosis (ICD11 9B10.0Y)
10.5. Ageing-related reduction in quality and quantity of the meibum production
11. Ageing-related dystrophies of the ear and mastoid process
12. Ageing-related dystrophies of the circulatory system
12.1. Ageing-related heart remodeling
12.2. Ageing-related blood vessels remodeling
12.3. Ageing-related blood vessel calcification
12.4. Ageing-related blood pressure increase
13. Ageing-related dystrophies of the respiratory system
13.1. Ageing-related lung atrophy (ICD11 CB7Z)
13.2. Idiopathic pulmonary fibrosis (ICD11 CB03.4)
13.3. Ageing-related alveolar surface reduction 13.4. Ageing-related upper respiratory system dystrophy
14. Ageing-related dystrophies of the digestive system
14.1. Ageing-related fatty liver changes, not classified elsewhere (ICD11 DB92.Z+XT9T)
14.2. Ageing-related chronic passive congestion of the liver (ICD 11 DB98.8)
14.3. Ageing-related gastrointestinal tract dystrophy
15. Ageing-related dystrophies of the skin 
15.1. Ageing-related skin dystrophy and atrophy (ICD11 EE40.31)
15.2. Ageing-related male pattern hair loss (ICD11 ED70.0)
15.3. Ageing-related hair discoloration (ICD11 ED73.Y+XT9T)
16. Ageing-related dystrophies of the musculoskeletal system and connective tissue
16.1. Ageing-related bone mass decline (ICD11 FB83+XT9T)
16.2. Ageing-related osteoporosis (ICD11 FB83.1)
16.3. Ageing-related osteomalacia (ICD11 FB83.2Z+XT9T)
16.4. Ageing-related mitochondrial myopathies (ICD11 8C73+XT9T)
17. Ageing-related dystrophies of the genitourinary system
17.1. Ageing-related hypertensive renal disease (ICD11 BA02)
17.2. Renal senescent dystrophy and atrophy (ICD11 MF54.Y+XT9T)
17.3. Ageing-related progressive bladder hyperactivity (MF50.0+XT9T)
18. Ageing-related conditions related to sexual health
18.1. Ageing-related reduction in sexual desire (HA00+XT9T)
18.2. Ageing-related erectile dysfunction (ICD11 HA01.12+XT9T)
18.3. Postmenopausal atrophic vaginitis (ICD11-GA30.2)

In June 2018 the World Health Organization released the new International Classification of Diseases (ICD-11). The previous version, ICD-10, was released in 1983 and ICD-11 shall similarly be a standard for years to come. With ICD-11, ICD now includes an extension code “Ageing-Related” (XT9T) for ageing-related diseases, implying the recognition of aging as a major disease risk factor by the World Health Organization.

A step forward to treat ageing-related conditions

This “ageing-related” extension is the result of a proposal by the International Longevity Alliance (ILA), the Biogerontology Research Foundation (BGRF) and the Council for Public Health and the Problems of Demography, submitted through the ICD-11 Maintenance PlatformThe new code “Ageing-related” can be added to any other relevant condition listed in the ICD-11. It can also be used in the formation of newly recognized conditions, such as “Ageing-related primary immunodeficiency”, “Ageing-related lung atrophy”, etc. Some of these conditions are already incorporated into ICD-11, while others can be created in the future as permanent codes, as needed. A list of 77 ageing-related conditions is showed on the right side of this page, they should now be proposed to the World Health Organization and used in pharmaceutical developments and medical practice. 

The International Classification of Diseases is essential for the registration of new drugs and therapies, and the absence of aging and the lack of aging-related conditions in the previous round of ICD revision (ICD-10) was a major barrier for the development of life and healthspan-extending interventions. ICD-10 had a code called “Senility”, now replaced by “Old age” in ICD-11, but it was not concrete enough to be used.
The new code “Ageing-related” can be added to any other condition listed in the ICD-11, and can also be used in the formation of newly recognized conditions, such as “Ageing-related primary immunodeficiency”, “Ageing-related lung atrophy”, etc. Some of these conditions are already incorporated into ICD-11, while others can be created in the future as permanent codes, as needed. This can create new opportunities for the development and registration of innovative anti-aging biomedical technologies.

The achievement of the community 

The proposal was developed by Daria Khaltourina (ILA), Anca Ioviţă (ILA), Franco Cortese (Biogerontology Research Foundation), Yury Matveyev (CPHD) and Aleksey Alekseev (CPHD). The working group also benefited from previous groundwork and calls to classify aging as a disease by Alex Zhavoronkov and Bhupinder Bhullar and by Sven Bulterijs, Raphaella S. Hull, Victor Björk, and Avi Roy. The authors would like to thank Alex Zhavoronkov who facilitated professional discussions on aging being classified as a disease and other experts who shared their insights during the proposal development, including Aubrey de Grey, Chief Science Officer of SENS Research Foundation, ILA Board members Edouard Debonneuil and Paul Spiegel, as well as Valeria Pride, the co-author of the Human Aging Diagram, and Viktor Zykov, the CEO of CPHD for his support of the project.

The working group collected clinical (human) data on the mechanisms of aging, diagnostic methods and anti-aging interventions with a systematic and evidence-based medicine approach. It advocated inclusion of aging per se into the ICD as a disease, as it seems to fit the WHO criteria of diseases.

A first step that requires further achievements

“It is very encouraging to see the World Health Organization being responsive to the idea of aging being a major public health problem”, says Daria Khaltourina, the leader of the Working group. “However, we plan to continue advocating the WHO, governments, and the biomedical community to truly treat biological aging as a disease, a condition subject to prevention and treatment, and to publish our extensive review which suggests that aging can be treated as a disease”.

The proposal, “Adding Aging to the ICD”, was presented at the Undoing Aging 2018 in Berlin.

“While the addition of an extension code for ‘aging-related’ via ICD-11 does not amount to classifying aging as a disease as such, it is a step in the right direction, and our hope is that this achievement will open doors to getting the World Health Organization to recognize aging as a pathological process with identifiable and quantifiable clinical indications, which can be intervened upon so as to enable human healthspan extension, compression of morbidity and prevention of age-related disease, during subsequent ICD revision processes” said Franco Cortese, a co-author of the proposal.

Does it lead pharma to undertake research and pharmaceutical developments against processes of aging and ageing-related diseases?” asks Edouard Debonneuil. “A financial incentive must be created to drive the move from fundamental biology of aging to solutions for human health. A DEBATE with regulators such as the FDA in the USA, the EMA in Europe, the PMDA in Japan and others to align the force of large pharmaceutical companies with societal needs”. A possibillity, for people accointed with biomedical aging and clinical trial or medical use of ICD codes, is to register on the ICD-11 platform and then to comment where adequate. Recent comments can be read here and some persons at the World Health Organisation read them and interact where adequate.


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About the International Longevity Alliance:

The International Longevity Alliance promotes the social struggle against the deteriorative aging process and for healthy and productive longevity for all, through scientific research, technological development, medical treatment, public health and education measures, and social activism. Advocacy Groups within the International Longevity Alliance have been initiated in more than 60 countries. The ILA has a record of advocating longevity policies internationally, including the promotion of provisions on aging research and longevity to the WHO Global Strategy and Action Plan on Aging and Health (“WHO has listened” and details).

About the Biogerontology Research Foundation:

The Biogerontology Research Foundation is a UK non-profit research foundation and public policy center seeking to fill a gap within the research community, whereby the current scientific understanding of the ageing process is not yet being sufficiently exploited to produce effective medical interventions. The BGRF funds and conducts research which, building on the body of knowledge about how ageing happens, aims to develop biotechnological interventions to remediate the molecular and cellular deficits which accumulate with age and which underlie the ill-health of old age. Addressing ageing damage at this most fundamental level will provide an important opportunity to produce the effective, lasting treatments for the diseases and disabilities of ageing, required to improve quality of life in the elderly. The BGRF seeks to use the entire scope of modern biotechnology to attack the changes that take place in the course of ageing, and to address not just the symptoms of age-related diseases but also the mechanisms of those diseases.

About the Council for Public Health and the Problems of Demography:

The Council for Public Health and Demography (CPHD) is a Russia-based NGO member of the International Longevity Alliance. The CPHD’s goals are to facilitate realization of the right of all people to the highest standard of health and to contribute to solving demographic problems, as well as activity coordination in these fields.

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