The Brits have come up with an interesting on-line calculator which enables people between ages 40 and 70 to estimate their risk of dying within the coming five years. The calculator relies on a massive database looking at 500,000 people living in Britain to assess what factors tend to foretell or forestall mortality. For men, the strongest predictive factor is self-reported health. For women, the strongest factor is a prior cancer diagnosis. Out of hundreds of potential risk factors, 13 for men and 11 for women turned out to have the most significance.

The calculator, as well as an interesting interactive graph showing the predictive power of multiple possible risk factors, can be found at Ubble, whose website is www.ubble.co.uk. If you click on the link, you will probably first do a risk calculation on yourself. Of course that is what I did. (By the way, when you get to the question about a Blue badge, that refers to a disabled parking placard in Britain.)

Presumably the risk calculator might prove useful in assessing longevity prospects for one’s patients, ages 40 to 70. The problem, of course, is that for any individual, the risk calculator may be way off. We certainly do want any patient to assume that because the Ubble calculator says they have a 33% risk of dying in the next five years that their chance of being alive in five years is definitively two in three. But the risk calculator does help understand what are the most significant factors contributing to mortality for people in the 40-70 year old age group.

While probably more intellectually stimulating than practically useful, the calculator highlights the importance of physicians thinking ahead for each patient we see. Physicians are notoriously inaccurate in their predictions of lifespan, even among patients with cancer and those who are terminally ill. Predicting longevity for any individual person will always require equal measures of art and science. But we do need to think about each patient’s probable lifespan. It can be clinically useful to have an educated assessment that a person’s death in the next five years would not be surprising. Physicians can help our patients, and their families, prepare. We can redouble our efforts to make sure that our patients with narrowing horizons have given thought to their wishes for end-of-life care and given voice to their preferences by filling out their Advance Directives.

Richard Fleming, MD