Ubble-Bubble, toil and trouble…

The UK Biobank, which is running a long-term observational study on nearly half a million middle-aged and elderly people in the UK, has produced a cross between an online game and a fortune teller.

It’s at www.ubble.co.uk and it asks you a series of innocuous questions: how old are you (only works for people who are 40+), how fast you walk, how you rate your own health, did you ever smoke, and so on. Then you press the button, and it gives you two pieces of information:

  1. Your chance of dying in the next five years and
  2. The average age of people who have the same chance of dying (which they call your ‘Ubble Age’.

I did the test – and had to lie about my age because I’m not forty yet – and it came out that (if I had actually been forty) I would have had a 0.2% chance of dying within the next five years. My ‘Ubble Age’ is 27.

This doesn’t mean that Ubble thinks I’m actually 27, or that I, personally, have a 0.2% chance of dying within 5 years. What it means is that

  • the average 27-year-old has a 0.2% chance of dying within 5 years and
  • If you had a crowd of 1000 27-year-olds, and you had a party this year, when you tried to have a reunion party in five years’ time, two of them wouldn’t be able to attend because they’d be dead.

A journalist in the Guardian has sneered at the test, because it’s easy to change the outcome: all you have to do, for example, say that you rate your health as ‘good’ instead of ‘fair’, and you get a better outcome. Also, the journalist who did the test got an ‘Ubble Age’ of 54 instead of her real age of 40. She concluded that she “would rather concentrate on living”, thus demonstrating that she has completely missed the point.

The point of Ubble is not to tell you when you are going to die, so you know whether to either make a will or borrow lots of money from people you don’t like.

The point of the Ubble test is to give people a chance to evaluate their own health, and what that means.

If a person’s ‘Ubble Age’ is older than their physical age, then that tells the  person something – it means that something about them or the way they’re living gives them a greater chance of dying than the average person their age. Maybe that’s due to factors outside their control, like having a past diagnosis of cancer, which is the greatest predictor of dying-in-five-years for women, apparently. On the other hand, maybe it’s because they smoke, or because they’re generally unfit. These things can be changed.

Playing with the questions gives you some interesting points: if I tell the quiz that I’m a current smoker, then my risk of death immediately doubles (to 0.4%), and my Ubble Age climbs 10 years, to 37.

If I stopped smoking (making me a ‘past smoker’), my risk of dying goes back to 0.2%, and my Ubble Age falls to 29 (not quite as good as being a never-smoker, but still a lot better than being a current smoker).

So I can use the quiz to estimate what effect making simple changes in my lifestyle would have on my health, and therefore my chance of dying. Of course, I still might get run over by a bus tomorrow, and even smokers sometimes live into their 90s, but that’s not the point. The point is giving myself the best chance of living until I’m 102.

Another point the journalist missed is that lying to the quiz isn’t a useful thing to do, unless you’re doing it to see what the results would be if you made a lifestyle change. The results don’t go anywhere: you’re only doing it for your own interest. So why lie?

The journalist also complained about the inaccuracy of people’s own self-made “health ratings”, saying that people often mis-estimate their own health. Well, that’s his/her opinion. The statistics, apparently, say differently – especially in the case of men. In looking at the questionnaires completed by nearly half a million people, the researchers found that self-reported health status (e.g. poor, fair, good, excellent) was the best predictor of future mortality for men. So whether all those people were lying or deluded or not, the results they put on the study questionnaires were gold (or maybe the reason self-reported health status isn’t the top predictor for women is that women – like the journalist – are more likely to be lying or deluded about their health, rather than that factor being taken over by a more powerful one: past cancer diagnosis).

The major point to take away from this is that Ubble is an exercise in statistics. On a personal level, it’s most useful for figuring out whether you’re likely to die earlier or later than other people your age – and thus, what your general health is like. If you come out as likely to die earlier (i.e., you get an older Ubble Age), then maybe you should think about making some lifestyle changes.

But for healthcare professionals, it’s far more exciting. The more data we have on people, as they grow older and die, the more we can predict where we need to direct resources for healthcare.

For instance, we know we can test Prostate Specific Antigen (PSA) in men, and we could potentially screen for prostate cancer. The trouble is, at the moment, the tests throw up a lot of false positives: where men get a result that says “Yep, you’re going to get prostate cancer”, and then they never do. So you end up with a lot of testing and following-up and worry, all for nothing. But with more data, we could pull all the factors together, and make screening more specific. Maybe it should go something like “If you get a high PSA result and you smoke and you rate your health as fair or below then you should be followed up.”

That’s the sort of thing that the UK Biobank might be able to tell us, as they get more data and evaluate it.

An even more interesting thing is that when they were evaluating the data, the researchers found that doing the questionnaire was a better predictor of when people were going to die than any physical tests (like blood tests). Which would you rather have – a short questionnaire, or a blood test?

So, in short, researchers have not yet discovered how to predict the future – but they may have started to do something nearly as good: help everyone figure out what lifestyle changes could have the biggest impact on their health, and help professionals figure out how to use our health resources best.

There’s a good article on Medscape here.


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