Sir William Osler, the founder of Johns Hopkins Hospital and the father of modern medicine, said “Listen to your patient, he is telling you the diagnosis.” Over 100 years later, a new large-scale study shows that Osler knew what he was talking about. The research, which was published in Lancet Online on June 3, 2015, showed that answers to a brief questionnaire can be used to predict the risk of dying within 5 years for people aged 40 to 70 years in the United Kingdom.
The Swedish investigators wanted to develop and validate a prediction score of a 5-year mortality using only self-reported information. They set up a databank project called UK Biobank. Between 2006 and 2010, it collected 655 measurements, including blood samples, bone density, family history, dietary habits, smoking 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 Center 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 in men and women from any cause as well as six specific causes.
What were the strongest predictors?
The findings vindicated Osler’s exhortation. 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. 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. Imagine, just asking patients how they feel and how fast they walk speaks volumes about their risk of dying within the next 5 years!
Surprisingly, 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”.
Why is walking pace so important? Because it may reflect some serious health problem, such as obesity and type 2 diabetes, heart failure, liver and kidney dysfunction, incipient Parkinson’s disease, early Alzheimer’s disease, etc. When researchers examined only people who did not have any major diseases, smoking habits were the strongest predictors of death within 5 years.
Learning your Ubble Age
Intrigued? You, too, can answer the questionnaire and find out where are you going to be, in heaven or on earth, within the next five years (but remember this calculator is based on a UK population). You will also be introduced to the concept of “Ubble Age,” which is the age where the average risk in the population is most similar to your own estimated risk. For instance, you may be 70 years old but you exercise regularly, eat well, don’t smoke, avoid chronic stress in your life etc, and your Ubble Age may be 40. And vice versa, you may be a spry 40 years old, but if you abuse your body, your Ubble Age may be closer to 70. Sort of what we mean by physiological age and chronological age.
So in addition to our blood pressure, blood sugar, cholesterol level, we now have to worry about our Ubble age. And if you want to improve it, don’t smoke, eat well, exercise, and…walk faster!