Joint Association of Healthy Behaviors and Grip Strength With All-Cause Mortality Among European Middle-Aged and Older Adults: A 16-Year Cohort.

Abstract

Healthy behaviors and grip strength are individually associated with a lower mortality risk, but their combined effect remains unclear. The purpose of this study was to examine their joint association with all-cause mortality in European middle-aged and older adults. A 16-year prospective cohort study (2004-2020) was conducted using data from the Survey of Health, Ageing and Retirement in Europe, including 12,693 adults (aged ≥50 years). Healthy behaviors (smoking, alcohol consumption, physical activity, sleep) were self-reported. Grip strength was measured with a handheld dynamometer and categorized into age- and sex-specific groups. Cox proportional hazards models assessed the joint hazard ratio for all-cause mortality. Analysis was performed in 2025. Higher grip strength was associated with a reduced risk of all-cause mortality, regardless of smoking (hazard ratio=0.70, 95% CI=0.54, 0.90), alcohol consumption (hazard ratio=0.60, 95% CI=0.46, 0.77), low physical activity (moderate intensity: hazard ratio=0.51, 95% CI=0.36, 0.71; vigorous intensity: hazard ratio=0.55, 95% CI=0.45, 0.67), and sleeping trouble (hazard ratio=0.60, 95% CI=0.45, 0.79). For each healthy behavior, except not smoking, the joint protective effect on mortality was comparable with the individual effect of higher grip strength. The greatest survival benefits were observed in individuals who combined higher grip strength with healthy behaviors, with risk reductions ranging from 43% to 64%. Higher grip strength seems to be a protective factor against all-cause mortality, even in individuals not following healthy behaviors. Findings highlight the importance of public health strategies that promote both muscle strength and healthy behaviors to improve longevity.