The relationship between handgrip strength and mortality among Korean adults

Handgrip strength is associated with all-cause mortality, but evidence from nationally representative Asian adult populations remains limited.

This study analyzed data from 27,679 adults aged ≥19 years who participated in the Korea National Health and Nutrition Examination Survey from 2014 to 2018 and were linked to Cause of Death Statistics from Statistics Korea through 2022. Handgrip strength was categorized into sex-specific quartiles. Cox proportional hazards models assessed the association between handgrip strength and all-cause mortality after covariate adjustment. Sex-stratified and sensitivity analyses, including lagged analyses and time-varying coefficient models, were conducted.

During a mean follow-up of 75.6 months, 1,237 deaths occurred. All-cause mortality decreased markedly across increasing handgrip strength quartiles, from 9.2% in quartile 1 (Q1) to 0.6% in Q4. In the fully adjusted model, Q1 was associated with significantly higher mortality risk than Q4 (hazard ratio [HR], 2.9; 95% confidence interval [CI], 2.1 to 3.9). Sex-stratified analyses showed a stronger association in men (Q1 vs. Q4: HR, 3.4; 95% CI, 2.2 to 5.3) than in women (HR, 2.3; 95% CI, 1.5 to 3.5), although the interaction was not statistically significant (p=0.219). Age-stratified sensitivity analyses confirmed the inverse association in younger adults aged <65 years and older adults aged ≥65 years.

Lower handgrip strength was independently associated with higher all-cause mortality among Korean adults, and this association persisted after comprehensive covariate adjustment. These findings support the use of handgrip strength as a simple predictor of long-term mortality risk across the adult lifespan in an Asian population.