Would you like to know your risk of dying within the next five years? Or, if you have just been discharged from hospital, would you be interested to find out your chances of dying in the following year?
No, these questions are not the work of some fiendish new institute of thanatology but are the result of two separate research projects published in reputable medical journals on either side of the Atlantic in the past week. And despite their morbid focus they represent the kind of research of which I would like to see more.
The Swedish authors of a paper in the Lancet have developed a scoring system that predicts an individual's risk of dying within five years for people who are aged between 40 and 70 and living in Britain.
The score, which uses measures that can be obtained by simple questionnaires without any need for physical examination, could be used by individuals to improve awareness of their health status, and by doctors to identify high-risk individuals for further treatment, say the authors.
Individuals can calculate their personalised five-year mortality risk and what the study authors call an "Ubble age" – the age where the average mortality risk in the population is most similar to the estimated risk of the individual – by answering about a dozen questions, using the dedicated interactive website ubble.co.uk.
To calculate the score, Prof Erik Ingelsson and Dr Andrea Ganna, of the Karolinska Institutet in Stockholm, analysed data collected between 2006 and 2010 from nearly half a million adults aged between 40 and 70 from the UK Biobank. The data included self-reported information as well as physical measurements such as pulse and blood pressure.
There were some surprising results: self-reported walking pace turns out to be a stronger predictor of death risk in men and women than smoking habits and other lifestyle factors. Overall, the authors found that the variables that most accurately predicted death from all causes within five years were not the physical measures but those reported on the questionnaires.
One-year mortality risk
Meanwhile, Canadian and US researchers in the Canadian Medical Association Journal (CMAJ) have reported that the hospital-patient one-year mortality risk (HOMR) model can accurately predict one-year risk of death from any cause in the year after hospitalisation. It includes age, sex and living status (whether someone is living independently at home, or with home care, or in a nursing home), number of illnesses and severity of illness, as well as the number and type of admissions to hospital.
But are these scores of practical value? “An accurate assessment of risk of death, particularly if that risk is high, could motivate and inform discussions between patients and physicians regarding goals of care,” says Dr Carl van Walraven, a researcher at the University of Ottawa, who developed the HOMR tool. And according to Ubble score author Ganna, “the fact that the score can be measured online in a brief questionnaire, without any need for lab tests or physical examination, is an exciting development. We hope that our score might eventually enable doctors to quickly and easily identify their highest-risk patients.”
However, in a linked comment in the Lancet, doctors from the University of Cambridge wondered "whether this will help individuals improve self-awareness of their health status, however, or only lead to so-called cyberchondria".
I’d like to think the Ubble score will not be seen as a fatalistic determination but rather reinforce how a high score can be reduced by diet, increased physical activity and smoking cessation.
I like the interactive nature of the Ubble website, which is likely applicable to Irish people. And I’m particularly impressed that the authors developed the site with Sense About Science, a UK charity that that equips people to make sense of scientific and medical claims in public discussion. A poor public understanding of risk in healthcare continues to cause significant problems for patients and doctors.