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Meta-Analysis
. 2020 Feb 12:368:m131.
doi: 10.1136/bmj.m131.

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

G David Batty  1   2 , Catharine R Gale  3   4 , Mika Kivimäki  5 , Ian J Deary  4 , Steven Bell  6   7   8
Affiliations
Meta-Analysis

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

G David Batty et al. BMJ. .

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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; the authors have published papers using data from the studies featured in this manuscript (these counts are not mutually exclusive, such that selected publications involve more than one author from the present group and more than one of the datasets: GDB (8 UK Biobank; 38 HSE/SHS), CRG (28; 2), MK (4; 13), IJD (30; 0), and SB (9; 9)); IJD was responsible for the design of some of the cognitive function tests in the revised battery used in the imaging sessions in UK Biobank and is also a study participant; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
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 2
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 3
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
See this image and copyright information in PMC

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