Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis
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OBJECTIVE: To compare established associations between risk factors and mortality in UK Biobank, a study with an exceptionally low rate of response to its baseline survey, against those from representative studies that have conventional response rates. DESIGN: Prospective cohort study alongside individual participant meta-analysis of other cohort studies. SETTING: United Kingdom. PARTICIPANTS: Analytical sample of 499 701 people (response rate 5.5%) in analyses in UK Biobank; pooled data from the Health Surveys for England (HSE) and the Scottish Health Surveys (SHS), including 18 studies and 89 895 people (mean response rate 68%). Both study populations were linked to the same nationwide mortality registries, and the baseline age range was aligned at 40-69 years. MAIN OUTCOME MEASURE: Death from cardiovascular disease, selected malignancies, and suicide. To quantify the difference between hazard ratios in the two studies, a ratio of the hazard ratios was used with HSE-SHS as the referent. RESULTS: Risk factor levels and mortality rates were typically more favourable in UK Biobank participants relative to the HSE-SHS consortium. For the associations between risk factors and mortality endpoints, however, close agreement was seen between studies. Based on 14 288 deaths during an average of 7.0 years of follow-up in UK Biobank and 7861 deaths over 10 years of mortality surveillance in HSE-SHS, for cardiovascular disease mortality, for instance, the age and sex adjusted hazard ratio for ever having smoked cigarettes (versus never) was 2.04 (95% confidence interval 1.87 to 2.24) in UK Biobank and 1.99 (1.78 to 2.23) in HSE-SHS, yielding a ratio of hazard ratios close to unity (1.02, 0.88 to 1.19). The overall pattern of agreement between studies was essentially unchanged when results were compared separately by sex and when baseline years and censoring dates were aligned. CONCLUSION: Despite a very low response rate, risk factor associations in the UK Biobank seem to be generalisable.
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A previous analysis revealed that the exposure-outcome associations of the UK Biobank are comparable to observations from other more representative samples.
“A previous analysis, however, revealed that the exposure-outcome associations of the UK Biobank are comparable to observations from other more representative samples.43”
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- Authors
- Batty, G. D., Gale, C. R., Kivimäki, M., Deary, I. J., & Bell, S.
- Affiliations
- Oregon State University (US)
- University of Edinburgh (GB)
- University of Cambridge (GB)
- Corresponding author
- Batty, G David
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-02-12
- Volume
- 368
- Pages
- m131
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC7190071
- OpenAlex
- W3006266257
- Cited by
- 635
- References
- 59
- Citations by year
- 2026: 64 · 2025: 108 · 2024: 102 · 2023: 101 · 2022: 109 · 2021: 103 · 2020: 47
- FWCI
- 56.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- BMJ (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- National Institute for Health and Care Research (NIHR BTRU‐2014‐10024, 311492, BTRU-2014–10024, R024227)
- British Heart Foundation (R024227, RG/13/13/30194, 311492)
- University of Cambridge
- Academy of Finland (311492, R024227)
- Cambridge University Hospitals
- NordForsk (R024227, 311492)
- National Institutes of Health (R024227)
- Medical Research Council (RG/13/13/30194, MR/R024227, MR/P023444/1, MR/S011676/1, 1R56AG052519-01, R024227, MR/L003120/1, MR/K026992/1, MC_PC_17228, 311492, MC_PC_12028, MR/L003120, MRC_MC_UU_12011/2)
- NIHR Cambridge Biomedical Research Centre
- National Institute on Aging (R56AG052519, R01AG056477, R01AG052519)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Keywords
- UK Biobank, generalizability, risk factor association, mortality, cardiovascular mortality, cancer mortality, suicide, smoking, Scottish Health Survey
- MeSH terms
- Cause of Death, United Kingdom, Health Surveys, Humans, Prospective Studies, Proportional Hazards Models, Biological Specimen Banks
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