I know. The
mirror on the wall in Snow White determined who was the fairest of them all, not who was more likely to die over the next 10 years. But I find myself telling my patients repeatedly that my crystal ball is in the shop getting prepared, since I really have no way to predict mortality, or do I? In a
research letter published earlier this week in JAMA, the authors developed a
risk calculator that was reasonably accurate in predicting mortality over the next 10 years. The score was developed based upon 3 distinct geographic locations (11,701 participants in the West, Central & East) and then validated in a fourth one (8,009 participants in the South)
12 items comprised the risk calculator, including age, gender, tobacco use, body mass index, diabetes, non-skin cancer, chronic lung disease, heart failure, difficulty breathing, difficulty managing finances, difficulty walking several blocks, and/or difficulty pushing/pulling large objects. Depending upon your answer, you might gain 0, 1 or 2 points. The lowest sum was zero while the greatest was 26. It turns out that those without any points (zero score) had a 3% mortality over the next decade while those with scores >14 had a 95% chance of not making to the next decade.
All of the risk factors should not be a surprise to any of you who've been following my posts. However, you may raise an eyebrow when you find out that you actually score a point if you're "normal" BMI rather than overweight or obese. But let's not forget that
just 2 months ago, a review article was published in this very same JAMA concluding that
overweight BMI was associated w/6% lower all-cause mortality compared to normal BMI.
So aside from that anomaly, it's pretty clear that lowest mortality is associated with younger women who don't smoke, don't have diabetes/cancer/lung disease/heart disease or any functional limitations. Well, while we can't do anything about our age & gender, that still leaves 10 risk factors under our control. In other words,
we are the master of our fate.
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