Dear Editor,
Lian and Luo [1] examined the association between relative handgrip strength and cancer risk in older adults using harmonized multinational cohort data from HRS, ELSA, and SHARE. This work addresses an important question in aging research. However, because cancer diagnosis and mortality are both frequent and interrelated outcomes in older populations, several aspects of the analytic approach warrant further clarification.
In this setting, death may occur before cancer is diagnosed or recorded. Standard time‐to‐event analyses may therefore overestimate or misrepresent cancer risk if mortality is not explicitly handled as a competing event [2]. A competing‐risk framework would help determine whether the observed association remains consistent after accounting for the possibility that death precludes subsequent cancer ascertainment.
Reverse causation is another concern. Although the authors excluded participants with follow‐up shorter than 2.5 years, the preclinical interval differs substantially across cancer types [3]. Some cancers may influence muscle strength, weight, systemic inflammation, or general functional status several years before diagnosis. Sensitivity analyses excluding cancers diagnosed within the first 3 and 5 years of follow‐up would provide a stricter assessment of whether the association persists after reducing the influence of occult malignancy.
Finally, the description of follow‐up time appears to require clarification. The manuscript seems to define time as extending from the estimated diagnosis time or last participation year to baseline handgrip measurement, which could be read as a reversed temporal interval. A more explicit explanation of how follow‐up was calculated and whether cancer diagnosis timing was treated as interval‐censored [4], would improve reproducibility and help readers interpret the temporal structure of the analysis.
Author Contributions
Chung‐Chu Tung: writing – original draft. Hui‐Yuan Chen: writing – original draft. Renin Chang: conceptualization, writing – review and editing. Sun‐Lin Huang: conceptualization, writing – review and editing.
Funding
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Tung C.‐C., Chen H.‐Y., Chang R., and Huang S.‐L., “Methodological Considerations on Relative Handgrip Strength and Cancer Risk in Older Adults,” International Journal of Rheumatic Diseases 29, no. 9 (2026): e70812, 10.1111/1756-185x.70812.
First author: Chung‐Chu Tung.
Contributor Information
Renin Chang, Email: rhapsody1881@gmail.com.
Sun‐Lin Huang, Email: huangsunlin@gmail.com.
Data Availability Statement
The authors have nothing to report.
References
- 1. Lian Y. and Luo P., “Relative Handgrip Strength, Lifestyles, and Cancer Risk in Older Adults: A Multi‐Country Cohort Study,” QJM (2026). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. López‐Bueno R., Andersen L. L., Koyanagi A., et al., “Thresholds of Handgrip Strength for All‐Cause, Cancer, and Cardiovascular Mortality: A Systematic Review With Dose‐Response Meta‐Analysis,” Ageing Research Reviews 82 (2022): 101778. [DOI] [PubMed] [Google Scholar]
- 3. Nichols E. and Hayes‐Larson E., “Common Methodological Issues in Observational Epidemiological Studies of Older Adults,” BMJ Medicine 4, no. 1 (2025): e001332. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Eaton A. A. and Zabor E. C., “Analysis of Composite Endpoints With Component‐Wise Censoring in the Presence of Differential Visit Schedules,” Statistics in Medicine 41, no. 9 (2022): 1599–1612. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The authors have nothing to report.