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Linear association between grip strength and all-cause mortality among the elderly: results from the SHARE study



Grip strength had become a potential tool for clinical assessments, while the predictive value of the grip strength of community-based populations had some limitations.


To identify the shapes of the association between grip strength and all-cause mortality in the Survey of Health, Ageing and Retirement in Europe (SHARE) cohort.


Based on the SHARE cohort, 13,231 subjects aged 65 years and older were included in this study. Cox models with penalized splines (P-splines) were employed to characterize the shapes of the association between grip strength and all-cause mortality with the adjustment of covariates including sociodemographic characteristics, health characteristics, behavioral habits, and illness status. Then grip strength was analyzed as a categorical variable in quintile to examine the impact of low grip strength on all-cause mortality.


Inversely linear associations were found between grip strength and mortality both in males and females after adjustment for covariates. The hazard ratios (HRs) and their 95% confidence intervals (CIs) for each 5 kg decrease in grip strength to all-cause mortality were 1.11 (1.06–1.18) in males and 1.17 (1.08–1.28) in females. In comparison with subjects in the fifth quintile, the adjusted HRs and 95% CIs of all-cause mortality in the first quintile was 2.39 (1.79–3.19) in males and 1.84 (1.34–2.51) in females. Which were statistically significant in the second quintile compared with the fifth quintile [Males: 2.06 (1.56, 2.74), Females: 1.83 (1.35, 2.48)].


Grip strength is inversely linear association with all-cause mortality and the low grip strength at the first and second quintile are a robust predictor of all-cause mortality.

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Availability of data and material

Data are available in a public, open access repository.

Code availability

All analyses were completed using R software version 3.5.0 and the core code was simPH package.


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Data used in this study were from SHARE Waves 4, 5, 6 (DOIs: 10.6103/SHARE.w4.700, 10.6103/SHARE.w5.700, 10.6103/SHARE.w6.700), see Börsch-Supan et al. (2013) for methodological details (1). The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001–00360), FP6 (SHARE-I3: RII-CT-2006–062193, COMPARE: CIT5-CT-2005–028857, SHARELIFE: CIT4-CT-2006–028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N°227822, SHARE M4: GA N°261982) and Horizon 2020 (SHARE-DEV3: GA N°676536, SERISS: GA N°654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553–01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged(see


This work was supported by the National Natural Science Foundation of China (Grant number 81202277); the Key Research Project for Colleges and Universities in Henan Province (Grant number 16A330003); Cultivating grand for youth key teacher in Higher Education Institutions of Henan province (Grant number 2017GGJS012); the Natural Science Foundation of Henan Province (Grant number 182300410303).

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YC and ZP contributed to the study design, data analysis and drafted and edited the manuscript. JW and YG contributed to the study design and reviewed/edited the manuscript. LL and ZG contributed to interpretation, all authors read and approved the final manuscript.

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Correspondence to Zhiguang Ping.

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Ethical approvals for wave 4 and the continuation of the project were reviewed and approved by the Ethics Council of the Max Planck Society.

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Cai, Y., Liu, L., Wang, J. et al. Linear association between grip strength and all-cause mortality among the elderly: results from the SHARE study. Aging Clin Exp Res 33, 933–941 (2021).

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  • Grip strength
  • All-cause mortality
  • Gender
  • Older adults