Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study

By Kay-Tee Khaw, Nick Wareham, S. Bingham, A. Welch, R. Luben, N. Day. PLoS Medicine, 2008

892 citations recorded by the source corpus.

Background There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community. Methods and Findings We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45–79 y with no known cardiovascular disease or cancer at baseline survey in 1993–1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52 (2.13–3.00), and 4.04 (2.95–5.54) p < 0.001 trend. The relationships were consistent in subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with four compared to zero health behaviours was equivalent to being 14 y younger in chronological age. Conclusions Four health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age.

Subfields: Health, Public Health, Environmental and Occupational Health

View Paper: https://www.semanticscholar.org/paper/1c07e335d58005eeefb7b3c86c3ff6dc9718d665

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Citations in the corpus

Loneliness, social isolation, and behavioral and biological health indicators in older adults. (2011, background): “Being physically active and nonsmoking are both associated with improved health, cognitive function, and reduced mortality in older adults (Etgen et al., 2010; Haveman-Nies et al., 2002; Khaw et al., 2008; Lee et al., 2010).”
The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. (2012, methodology): “The meta-analysis including 15 studies (Byun et al., 2010; Ford et al., 2009, 2011;Gopinath et al., 2010;Hamer et al., 2011; Iversen et al., 2010; Khaw et al., 2008; Knoops et al., 2004; Kvaavik et al., 2010; McCullough et al., 2011; Nechuta et al., 2010; Tamakoshi et al., 2009; Tsubono et Table 1…”
Association of socioeconomic position with health behaviors and mortality. (2010, methodology): “LIFESTYLE AND HEALTH-RELATED behaviors are recognized as major determinants of morbidity and mortality worldwide.(1-3) Concurrently, there is evidence to suggest that the socioeconomic differences in morbidity and mortality have increased.”
Sleep duration and mortality: a systematic review and meta‐analysis (2009, result): “…sleep showed a relatively small increase in all-cause mortality (RR: 1.10) compared with estimates reported for the known mortality risk factors such as obesity [RR: 1.27; (McGee, 2005)], cigarette smoking [RR: 1.78; (Khaw et al., 2008)], and physical inactivity [RR: 1.49; (Nocon et al., 2008)].”
Happy People Live Longer: Subjective Well-Being Contributes to Health and Longevity (2011, result): “Kvaavik et al. estimated that those with all four positive health behaviors would live 12 years longer than those who were low on all four, an estimate similar to the 14 year estimate from Khaw et al. (2008).”