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The association of grip strength from midlife onwards with all-cause and cause-specific mortality over 17 years of follow-up in the Tromsø Study
  1. Bjørn Heine Strand1,2,3,4,
  2. Rachel Cooper5,
  3. Astrid Bergland6,
  4. Lone Jørgensen7,8,
  5. Henrik Schirmer9,10,
  6. Vegard Skirbekk1,
  7. Nina Emaus7
  1. 1Norwegian Institute of Public Health, Oslo, Norway
  2. 2Institute of Health and Society, University of Oslo, Oslo, Norway
  3. 3Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
  4. 4Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
  5. 5MRC Unit for Lifelong Health and Ageing, University College London (UCL), London, UK
  6. 6Oslo and Akershus University College, Oslo, Norway
  7. 7Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
  8. 8Department of Clinical Therapeutic Services, University Hospital of North Norway, Tromsø, Norway
  9. 9Department of Clinical Medicine, Faculty of Health sciences, The Arctic University of Norway, Tromsø, Norway
  10. 10Division of Cardiothoracic and Respiratory Medicine, University Hospital of North Norway, Tromsø, Norway
  1. Correspondence to Dr Bjørn Heine Strand, Department of Epidemiology, Norwegian Institute of Public Health, Marcus Thranes gt 6, Oslo 0473, Norway; heine{at}


Background Grip strength has consistently been found to predict all-cause mortality rates. However, few studies have examined cause-specific mortality or tested age differences in these associations.

Methods In 1994, grip strength was measured in the population-based Tromsø Study, covering the ages 50–80 years (N=6850). Grip strength was categorised into fifths, and as z-scores. In this cohort study, models with all-cause mortality and deaths from specific causes as the outcome were performed, stratified by sex and age using Cox regression, adjusting for lifestyle-related and health-related factors.

Results During 17 years of follow-up, 2338 participants died. A 1 SD reduction in grip strength was associated with HR=1.17 (95% CI 1.12 to 1.22) for all-cause mortality in a model adjusted for age, gender and body size. This association was similar across all age groups, in men and women, and robust to adjustment for a range of lifestyle-related and health-related factors. Results for deaths due to cardiovascular disease (CVD), respiratory diseases and external causes resembled those for all-cause mortality, while for cancer, the association was much weaker and not significant after adjustment for lifestyle-related and health-related factors.

Conclusions Weaker grip strength was associated with increased all-cause mortality rates, with similar effects on deaths due to CVD, respiratory disease and external causes, while a much weaker association was observed for cancer-related deaths. These associations were similar in both genders and across age groups, which supports the hypothesis that grip strength might be a biomarker of ageing over the lifespan.

  • Epidemiology of ageing

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Correction notice This article has been updated since it first published Online First. The units of grip strength have been edited.

  • Contributors BHS had the idea of the paper, and drafted it together with RC, AB, LJ, HS, VS and NE. BHS did all the statistical analyses. All authors have discussed the paper and seen and approved the final version.

  • Funding RC is supported by the UK Medical Research Council (Programme code MC_UU_12019/4).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Data Inspectorate, and written informed consent was obtained from the participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.