Abstract
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.
Generated Summary
This study investigated the combined impact of health behaviors on mortality in a large, prospective population study. The research, conducted in the EPIC-Norfolk cohort, examined the relationship between lifestyle factors and mortality in men and women aged 45-79 years. Participants were assessed for four health behaviors: non-smoking, not physically inactive, moderate alcohol intake, and adequate fruit and vegetable consumption. The study aimed to quantify the potential impact of these behaviors on overall mortality rates in a general community setting in the United Kingdom.
Key Findings & Statistics
- The study followed 20,244 men and women.
- Participants were followed for an average of 11 years.
- The study found 1,987 deaths during the follow-up period.
- Those with four health behaviors had an age-, sex-, body mass-, and social class-adjusted relative risk of 1.00.
- Those with three health behaviors had a relative risk of 1.39 (1.21-1.60).
- Those with two health behaviors had a relative risk of 1.95 (1.70-2.25).
- Those with one health behavior had a relative risk of 2.52 (2.13-3.00).
- Those with zero health behaviors had a relative risk of 4.04 (2.95-5.54).
- The p-value for the trend was less than 0.001 (p < 0.001).
- The mortality risk for those with four health behaviors compared to zero was equivalent to being 14 years younger in chronological age.
Other Important Findings
- The relationships between health behaviors and mortality were consistent across subgroups stratified by sex, age, body mass index, and social class.
- The trends were strongest for cardiovascular causes.
- The findings suggest that adopting multiple healthy behaviors has a significant protective effect against mortality.
Limitations Noted in the Document
- The study relies on self-reported data for some health behaviors, which may be subject to recall bias.
- The study’s findings may not be generalizable to populations outside of the UK.
- The study does not fully account for all potential confounding factors.
- The study is observational, so it cannot establish causality between health behaviors and mortality.
- The study period may not fully capture long-term health outcomes.
Conclusion
The study underscores the substantial impact of lifestyle factors on mortality, emphasizing the importance of adopting multiple healthy behaviors. The research indicates that individuals adhering to four key health behaviors – not smoking, being physically active, moderate alcohol consumption, and adequate fruit and vegetable intake – can significantly reduce their risk of mortality. The findings highlight a dose-response relationship, with greater adherence to healthy behaviors correlating with lower mortality rates. The study’s conclusions suggest that promoting multiple healthy lifestyle choices can have a substantial public health benefit. The study also underscores the importance of addressing health behaviors comprehensively within public health interventions and healthcare strategies. The four-fold difference in mortality observed between those with the healthiest and least healthy behaviors highlights the potential for significant improvements in overall health outcomes and longevity through lifestyle changes. The study’s conclusions emphasize that a focus on promoting multiple healthy behaviors can significantly improve population health outcomes.