Handgrip strength asymmetry is associated with mortality risk: Systematic review and meta-analysis

Handgrip strength (HGS) is a key indicator of muscle function and is associated with adverse outcomes including all-cause mortality and cardiovascular disease (CVD). Conventional single-hand assessment mainly reflects the absolute level of muscle strength, while handgrip strength asymmetry (HGSA) represents the relative balance and bilateral coordination of neuromuscular function, which provides independent and supplementary prognostic information beyond single-hand measurement. As a novel assessment dimension, the associations between HGSA and mortality remain unclear, with inconsistent evidence reported in the literature.

To evaluate the association between HGSA and all-cause mortality and CVD mortality, investigate combined effects and heterogeneity, and provide evidence for health risk assessment.

Five databases were searched from inception to January 2026. Two researchers independently screened the literature, extracted data, and assessed risk of bias. Meta-analyses, subgroup, sensitivity, and publication bias analyses were performed using Stata 17.0.

Nine cohort studies (900,253 participants) were included. HGSA was associated with increased all-cause mortality (HR=1.12, 95% CI:1.07∼1.17) and CVD mortality (HR=1.29, 95% CI:1.03∼1.62). When combined with low HGS, all-cause mortality risk was further increased by 39% (HR=1.39, 95% CI:1.17∼1.65), showing a significantly stronger predictive effect than HGSA alone. Associations were stable across subgroups; sensitivity analysis confirmed robustness, with no significant publication bias.

HGSA is an independent, qualitative biomarker of mortality risk that outperforms single-hand assessment in detecting subclinical functional impairment. It offers incremental prognostic value and, when combined with low HGS, enables more accurate risk stratification. HGSA represents a promising indicator for population-level health risk assessment.