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Cited by 637Cardiovascular Health and Risk FactorsStatistical Methods in EpidemiologySurvey Methodology and Nonresponse

The DOI matches its Crossref record; 58 of the 59 references it cites were found in a registry or an index.

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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Batty, G David, Gale, Catharine R, Kivimäki, Mika, Deary, Ian J, Bell, Steven·2020·BMJ
DOI 10.1136/bmj.m131PMC PMC7190071
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Abstract

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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Fig 1 Association of baseline demographic and behavioural characteristics with cardiovascular disease mortality in UK Biobank and Health Survey for England/Scottish Health Surveys (HSE-SHS) cohort studies. Hazard ratios are adjusted for age and sex, with the exception of individual effects for age and sex which are mutually adjusted. Squares indicate hazard ratios and error bars denote 95% CI for relation of each characteristic with risk of death outcome. Ratio of hazard ratios (RHR) summarises between study differences (HSE-SHS is reference group) for effect estimates for each outcome
Fig 1 Association of baseline demographic and behavioural characteristics with cardiovascular disease mortality in UK Biobank and Health Survey for England/Scottish Health Surveys (HSE-SHS) cohort studies. Hazard ratios are adjusted for age and sex, with the exception of individual effects for age and sex which are mutually adjusted. Squares indicate hazard ratios and error bars denote 95% CI for relation of each characteristic with risk of death outcome. Ratio of hazard ratios (RHR) summarises between study differences (HSE-SHS is reference group) for effect estimates for each outcomeCC BY · PubMed Central
Fig 2 Association of baseline biomedical characteristics with cardiovascular disease (CVD) mortality in UK Biobank and Health Survey for England/Scottish Health Surveys (HSE-SHS) cohort studies. Hazard ratios are adjusted for age and sex. Squares indicate hazard ratios and error bars denote 95% CI for relation of each characteristic with risk of death outcome. Ratio of hazard ratios (RHR) summarises between study differences (HSE-SHS is reference group) for effect estimates for each outcome. Distributions of glycated haemoglobin (HbA1c), C reactive protein, and high density lipoprotein (HDL) cholesterol were skewed, so they were log2 transformed and effect estimates reflect doubling for each biomarker. Elevated waist:hip ratio was denoted by ≥0.90 for men and ≥0.85 for women; obesity was indicated by body mass index ≥30. FEV1=forced expiratory volume in one second
Fig 2 Association of baseline biomedical characteristics with cardiovascular disease (CVD) mortality in UK Biobank and Health Survey for England/Scottish Health Surveys (HSE-SHS) cohort studies. Hazard ratios are adjusted for age and sex. Squares indicate hazard ratios and error bars denote 95% CI for relation of each characteristic with risk of death outcome. Ratio of hazard ratios (RHR) summarises between study differences (HSE-SHS is reference group) for effect estimates for each outcome. Distributions of glycated haemoglobin (HbA1c), C reactive protein, and high density lipoprotein (HDL) cholesterol were skewed, so they were log2 transformed and effect estimates reflect doubling for each biomarker. Elevated waist:hip ratio was denoted by ≥0.90 for men and ≥0.85 for women; obesity was indicated by body mass index ≥30. FEV1=forced expiratory volume in one secondCC BY · PubMed Central
Fig 3 Association of selected baseline characteristics with cause specific mortality in UK Biobank and Health Survey for England/Scottish Health Surveys (HSE-SHS) cohort studies. Hazard ratios are adjusted for age and sex. Squares indicate hazard ratios and error bars denote 95% CI for relation of each characteristic with risk of death outcome. Ratio of hazard ratios (RHR) summarises between study differences (HSE-SHS is reference group) for effect estimates for each outcome
Fig 3 Association of selected baseline characteristics with cause specific mortality in UK Biobank and Health Survey for England/Scottish Health Surveys (HSE-SHS) cohort studies. Hazard ratios are adjusted for age and sex. Squares indicate hazard ratios and error bars denote 95% CI for relation of each characteristic with risk of death outcome. Ratio of hazard ratios (RHR) summarises between study differences (HSE-SHS is reference group) for effect estimates for each outcomeCC BY · PubMed Central

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Research works printed but not linked: 3

  1. World Health Organization, 2008, Waist circumference and waist-hip ratio - Report of a WHO Expert Consultation, Geneva, 8-11 December 2008.
  2. World Health Organization, 1995, Physical status: the use and interpretation of anthropometry: report of a WHO expert committee. Who Tech. Rep. Ser.
  3. Bolling, 1994, The Dinamap 8100 Calibration Study.

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Metadata

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
ORCID
Venue
BMJ
Publisher
BMJ
Published
2020-02-12
Volume
368
Pages
m131
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj.m131
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
Licence
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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