# Comparing the predictive accuracy of life’s essential 8 and life’s crucial 9 scores for all-cause mortality in COPD patients among US adults: a prospective cohort study

## TL;DR

This study compares two health scores, Life’s Essential 8 and Life’s Crucial 9, to see which better predicts mortality in COPD patients.

## Contribution

The study introduces the new Life’s Crucial 9 score, which includes psychological health, and evaluates its predictive accuracy for COPD mortality.

## Key findings

- The highest LC9 score quartile was associated with significantly lower mortality risk (HR = 0.36).
- LC9 showed marginally higher predictive accuracy than LE8 in mortality risk assessment.
- Both scores were inversely associated with all-cause mortality in COPD patients.

## Abstract

Life’s Essential 8 (LE8) represents an established score for quantifying cardiovascular health (CVH). Life’s Crucial 9 (LC9) is a newly proposed metric that integrates psychological health with LE8. The prognostic significance of these scores concerning all-cause mortality risk in COPD patients remains unclear.

We analyzed data from NHANES 2005–2018 to examine the relationship between CVH (quantified by LC9 and LE8 scores) and all-cause mortality among adults with COPD. Cox proportional hazards regression was applied, and additional analyses were conducted to assess robustness.

Among 1,757 participants (380 deaths, 21.63%) over a 72-month median follow-up, the highest LC9 score quartile was associated with a significantly lower mortality risk when compared to the lowest quartile (HR = 0.36, 95% CI: 0.22–0.59). A similar inverse association was observed for the LE8 score. LC9 consistently demonstrated marginally higher predictive accuracy than LE8 across analyses.

Higher CVH levels defined by either LC9 or LE8 were strongly associated with reduced all-cause mortality in COPD patients. The slightly superior performance of LC9 highlights the added value of psychological health inclusion into cardiovascular health assessment to enhance mortality risk stratification and guide comprehensive COPD management.

The online version contains supplementary material available at 10.1186/s12889-026-26333-4.