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The McCance Brain Care Score and Mortality: Evidence From a Large-Scale Population-Based Cohort
Zhiqiang Xu1, Xiaoxiao Wang2, Nan Li2
1Department of Neurology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Objectives:
This study aimed to examine the relationship between the McCance Brain Care Score (BCS) and mortality in the general population.
Methods:
We conducted a prospective, population-based cohort study using data from the UK Biobank. Participants with complete data enabling calculation of BCS and full mortality information were included. For the longitudinal component, participants without follow-up BCS data were excluded. Mortality information was obtained via the National Health Service (NHS) Information Centre (England and Wales) and the NHS Central Register Scotland, with follow-up through December 31, 2022.
Results:
A total of 331,894 participants were included (mean age 56.46 ± 8.07 years; 54.2% women; 91.8% White). Over a median follow-up of 13.83 years (IQR 13.11-14.55), 27,446 deaths (8.27%) occurred. Higher baseline BCS was significantly associated with lower all-cause mortality. As a continuous variable, each 1-point increase in BCS corresponded to a 6% lower risk of death (fully adjusted HR = 0.94; 95% CI 0.94-0.95; p < 0.001). When analyzed in 5-point increments, participants with BCS 5-10, 10-15, and ≥ 15 had 40%, 53%, and 55% lower mortality risks, respectively, compared with the reference group (BCS < 5) (all p < 0.001; p for trend < 0.001). Cause-specific analyses revealed inverse associations between BCS and death from malignant neoplasm (HR = 0.95; 95% CI 0.94-0.95), heart disease (HR = 0.90; 95% CI 0.89-0.92), cerebrovascular disease (HR = 0.96; 95% CI 0.94-0.98), respiratory disease (HR = 0.92; 95% CI 0.90-0.94), and diabetes (HR = 0.90; 95% CI 0.84-0.96) (all p ≤ 0.001). In longitudinal analyses of 7114 participants with repeated BCS measurements over a median 4.52 years, persistently high BCS was associated with a 50% lower mortality risk compared with persistently low BCS (HR = 0.50; 95% CI 0.29-0.87).
Interpretation:
These findings suggest that BCS is a practical tool reflecting healthy lifestyle behaviors and clinical measures, aiding early identification of individuals at high risk of mortality and showing promise in health management. Further studies are needed to explore its mechanisms and confirm causality.
