Among 9,583 American adults followed for a median of 6.75 years, the group with the lowest grip strength died at hazard ratios of 2.20 for men and 2.52 for women, according to a 2024 analysis of national health survey data. The measurement behind those numbers is a few squeezes of a handheld device, and the researchers wanted to know which version of the squeeze predicts death best.
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The work comes from Lirong Chai, Dongfeng Zhang and Junning Fan of Qingdao University in China, who published it in Scientific Reports on Nov. 25, 2024. They found that grip strength tracked mortality in every form they tested, with the strongest signal in the weakest fifth of participants. Several caveats in the paper matter just as much as the top-line ratio.
Hand dynamometers and 9,583 NHANES participants
The Scientific Reports paper is a secondary analysis of the National Health and Nutrition Examination Survey for 2011 through 2014, which supplied 9,583 adults aged 20 and older. The survey releases its data in two-year cycles, and the 2013-2014 cycle page shows how the data and documentation are organized by component, from examinations to laboratory results. The Centers for Disease Control and Prevention’s National Center for Health Statistics runs NHANES, which measures health and nutrition through interviews, mobile exam center visits and laboratory tests, and which draws about 5,000 participants a year through a scientific random selection process.
Grip strength was recorded with a Takei dynamometer. In the survey’s own protocol, documented in the NHANES 2011-2012 muscle strength file, a trained examiner demonstrates the test, adjusts the grip size to the participant’s hand and runs a practice trial. Each hand is then tested three times, alternating hands, with a 60-second rest between measurements on the same hand.
The authors compared five ways of summarizing those readings: the average of the best reading from each hand, the maximum of six readings, and three versions scaled to body mass index, height squared or weight. They also tested three definitions of low grip strength, one of which uses the sarcopenia cutoffs of under 26 kilograms for men and under 16 kilograms for women.
Hazard ratios of 2.20 for men and 2.52 for women
Deaths were identified through the National Death Index, a database of more than 115 million death records dating back to 1979 that the National Center for Health Statistics processes for researchers. Follow-up ran through Dec. 31, 2019 and captured 805 deaths. The ratios in the fully adjusted models account for age, race, education, marital status, income, smoking, alcohol use, regular exercise and chronic diseases including hypertension, diabetes, cardiovascular disease and cancer.
The lowest-20-percent group had the highest risk, with a hazard ratio of 2.20 in men and 2.52 in women. A hazard ratio of 2.20 means that, at any point during follow-up, men in that group were dying at a rate 2.2 times that of the comparison group, after the adjustments. Across the whole range of strength, each 5 kilogram drop in the average grip reading carried a ratio of 1.36 in men and 1.49 in women.
As a predictive tool the measure performed modestly. The simple average grip reading and a version scaled to height squared had the highest area under the curve, 0.714, and a C-index of 0.860, followed closely by the maximum reading at 0.712. The authors concluded that plain absolute measures worked best, better than the body-size-adjusted ratios that some clinicians favor.
Limits that keep this from being a home test
The paper lists its own limitations. The design is cross-sectional with respect to grip, so changes in strength over time could not be assessed. All-cause mortality includes deaths from causes unrelated to muscle strength, such as accidents, and residual confounding is possible. In a sensitivity analysis that adjusted for cognitive function among participants 65 and older, the effect sizes weakened or disappeared, which suggests part of the grip signal reflects overall brain and body health rather than muscle alone.
Results also differed by sex for one definition. Low grip strength by the reference-based definition was associated with a hazard ratio of 1.91 in men, but the association was not significant in fully adjusted women, and the sex interaction was significant at P = 0.013. That is why the 2.52 figure for women comes from the lowest-20-percent definition rather than from the reference cutoff.
The paper’s closing message is cautious. The authors suggest that maintaining adequate handgrip strength may reduce mortality risk. A single survey cannot show that strengthening the hands lengthens life, only that weak grip marks adults who were more likely to die within the follow-up window. Grip strength may simply be a convenient marker of general physical condition, which is a common reading of results like these. Because NHANES participants were sampled to represent the national population, the findings speak to American adults broadly, yet they come from one snapshot of grip taken at the start and a death count that ended in 2019. Readers curious about their own number should treat it as a conversation starter with a clinician, not a verdict.
This article was produced with the assistance of AI and reviewed by Morning Overview editors prior to publication.
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