Questionnaire Predicts Risk for Death Within 5 Years

Marcia Frellick

June 04, 2015

Answers to a brief questionnaire can predict risk of dying within 5 years for people aged 40 to 70 years in the United Kingdom, according to a new large-scale study published online June 4 in the Lancet.

Andrea Ganna, PhD, from the Karolinska Institutet in Stockholm and Uppsala University in Sweden, and Erik Ingelsson, MD, also from Uppsala University, set up a databank project called UK Biobank. Between 2006 and 2010, it collected 655 measurements, including blood samples, bone density, family history, and so on, from 498,103 UK volunteers aged 40 to 70 years.

The researchers followed the volunteers until February 2014. For those who died, a cause of death was assigned using information from the Health & Social Care Information Centre and National Health Service Central Register. The authors used a statistical survival model to assess the probability that specific demographic, lifestyle, and health measurements could predict death from any cause and six specific causes in men and women separately.

"This is the first study of its kind which is based on a very large study sample, and is not limited to specific populations, single types of risk, or requiring laboratory testing," Dr Ingelsson said in a journal news release.

Questionnaires Beat Physical Tests

The authors found that the variables that most accurately predicted death from all causes within 5 years were not the physical measures, but those reported on the questionnaires.

For example, asking people to rate their overall health and to describe their usual walking pace were two of the strongest predictors in both men and women for different causes of death.

Some findings differed by sex. Self-reported health (C-index including age, 0.74; 95% confidence interval [CI], 0.73 - 0.75]) was the strongest predictor of all-cause mortality in men, and a previous cancer diagnosis (C-index including age, 0.73; 95% CI, 0.72 - 0.74) was the strongest predictor of all-cause mortality in women.

Walking pace was a stronger predictor than smoking habits and other lifestyle measurements in predicting death. Men aged 40 to 52 years who said their walking pace was "slow" had a 3.7 times increased risk for death within 5 years than those who answered "steady average pace."

When researchers examined only people who did not have any major diseases, smoking habits were the strongest predictors of death within 5 years.

Dr Ganna and Dr Ingelsson conclude: "The prediction score we have developed accurately predicts 5 year all-cause mortality and can be used by individuals to improve health awareness, and by health professionals and organisations to identify high-risk individuals and guide public policy."

The authors say it is likely the prediction would work similarly in countries comparable to the United Kingdom in demographic and socioeconomic factors, provision of healthcare, and lifestyle and risk factors, although only studies in each country could present that evidence.

Comment Writers Question Value

In an accompanying comment, Simon G. Thompson, DSc, director of research in biostatistics in the Department of Public Health and Primary Care at the University of Cambridge, United Kingdom, and Peter Willeit, MD, PhD, a chronic disease epidemiologist with the department, say the study's large size offers both advantages and disadvantages.

Because so many factors were investigated, "some of the stronger associations are likely to be exaggerated," they write.

"This study reinforces our evidence that increases in physical activity, smoking cessation, and having a healthy diet can increase longevity," the authors say. "However, the challenge lies in how these changes can be achieved, rather than in removing any uncertainty in scientific understanding."

They add that 5-year risk for death is easier to predict than long-term morbidity or quality of life, "which are more important to individuals and to society."

They note, however, that the accompanying website is intriguing in helping people to determine their "Ubble age" (the age where the average risk in the population is most similar to the estimated risk of the individual), and they say Biobank is beginning to show its true potential.

UK Biobank is available to researchers whose application is approved. So far, more than 1800 scientists have registered to study a wide range of diseases.

This project has funding from the Knut and Alice Wallenberg Foundation and the Swedish Research Council. The authors have disclosed no relevant financial relationships.

Lancet. Published online June 4, 2015. Article full text, Comment full text

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