Mayo Clinic Proceedings Publishes RGA-University of Leicester Research Article

Kishan Bakrania
Richard Russell

Black and white crosswolk photo showing people from the waist down with one pair of shoes in red

In Brief

RGA and the University of Leicester are actively collaborating on research to determine how traditional and non-traditional underwriting risk factors interact with one another to impact mortality. Insights from this research partnership have now been published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

Key takeaways

RGA and the University of Leicester joint research has been published by Mayo Clinic Proceedings: Innovations, Quality & Outcomes, a leading, peer-reviewed journal showcasing high-impact research that advances clinical practice, healthcare delivery, and patient outcomes.
In a study of more than 400,000 UK adults, supplementing and in some cases replacing conventional risk factors with measures such as grip strength and resting heart rate improved mortality risk assessment, with the largest gains seen in individuals with existing illness.
Walking pace emerged as the single strongest predictor of mortality risk, demonstrating that everyday indicators of functional health can be powerful substitutes for more complex clinical tests.
Continued analysis of more readily available health measures could meaningfully improve mortality risk assessment moving forward.

An analysis of more than 400,000 UK adults has found that basic, easy‑to‑collect measures of physical health can significantly improve predictions of mortality risk, especially among people already living with long-term health conditions.

The RGA-supported study was conducted by researchers at the University of Leicester with funding from the National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre (BRC), the MRC iCASE programme, and RGA. The research team analyzed data from 407,569 UK Biobank participants to determine whether five simple physical measures – walking pace, handgrip strength, resting heart rate, sleep duration, and leisure‑time physical activity – could enhance or even replace traditional clinical evidence such as blood pressure and cholesterol when assessing mortality risk.

Important note: UK Biobank data was only provided to the academic research team at the University of Leicester led by Professor Tom Yates. RGA does not have access to any of the UK Biobank data.

The paper’s abstract is re-printed below. To read the full study, visit Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

The Utility of Measures of Physical Behavior, Function, and Fitness as Predictors of Mortality

Authors

Yuhe Wang, MSc; Cameron Razieh, PhD; Alex V. Rowlands, PhD; Kishan Bakrania, PhD; Richard Russell, PhD; Kamlesh Khunti, PhD; Melanie J. Davies, MD; Francesco Zaccardi, PhD; and Thomas Yates, PhD

Objective

To assess whether simple measures of lifestyle and physical health improve mortality risk prediction in healthy adults and those living with health conditions when added to or substituted for traditional risk factors.

Patients and Methods

Data were from the UK Biobank (N=407,569; median age, 58 years; May 1, 2006 to September 30, 2022), stratified by sex and health status. The base model included the following: age, smoking status, body mass index, systolic blood pressure (SBP), total cholesterol-to-high-density lipoprotein cholesterol ratio (CHR), and material deprivation. Five simple physical measures (leisure time physical activity; sleep duration; resting heart rate; maximum handgrip strength; and walking pace [WP]) were added to or substituted for traditional risk factors (ie, SBP and CHR), both individually and combined. Model performance was assessed using the C-index and net reclassification index (NRI).

Results

Replacing both CHR and SBP with all physical measures improved C-index of 0.022 (95% CI, 0.018-0.026) and NRI by 9.6% (95% CI, 6.5%-12.8%) in women living with a health condition.
Corresponding values for men were as follows: C-index: 0.024 (95% CI, 0.020-0.027); NRI: 19.0% (95% CI, 16.6%-21.4%).
The improvement of C-index was smaller in healthy women (0.006; 95% CI, 0.004-0.007) and men (0.007; 95% CI, 0.006-0.009).
WP alone improved risk prediction and classification when replacing CHR and SBP in individuals with a health condition, with a C-index improvement of 0.015 (95% CI, 0.012-0.019) and an NRI of 11.0% (95% CI, 7.4%-14.6%) in women and 0.014 (95%
CI, 0.012-0.017) and 14.0% (95% CI, 11.5%-16.5%) in men, respectively.

Conclusion

Measures of lifestyle and physical health improve mortality prediction and classification and could be used as potential substitutes for traditional clinical factors, particularly in populations with prevalent illness. WP was the strongest individual predictor.

RGA life and health insurance experts are actively engaging with insurers to help determine emerging evidence sources for optimal risk assessment. Ready to join the conversation? Contact RGA.