Abstract
Background: The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established, while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinal individual data. Objective: We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy and lifetime health care expenditure in Taiwan. Methods: Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with and without healthy lifestyle factors. Results: A total of 19,893 participants aged ≥30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%; P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore, individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none. Conclusions: Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on the overall health and economic burden.
Generated Summary
This research article presents a nationwide cohort study that examines the impact of healthy lifestyle factors on life expectancy (LE) and lifetime health care expenditure in Taiwan. The study utilized data from the Taiwan National Health Interview Survey (NHIS) cohort and employed a rolling extrapolation algorithm to estimate the LE and health care expenditure of study populations with and without healthy lifestyle factors. The study defined and analyzed five healthy lifestyle behaviors: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. The research aimed to determine the individual and combined effects of these factors on both LE and health care expenditure. The study design included over 19,000 participants aged 30 and older and followed them for a median period of 15.6 years. The methodology involved using a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting (IPTW) to estimate the LE and lifetime health care expenditure. This approach allowed the researchers to account for potential confounders and provide a more comprehensive understanding of how healthy lifestyle factors influence overall health and economic burden.
Key Findings & Statistics
- A total of 19,893 participants aged ≥30 years (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years.
- The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively.
- Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49).
- Significant increases in life expectancy were found for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01).
- Nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03).
- Individuals maintaining optimal body weight experienced a significant reduction in annual health care expenditure (-18.36%; 95% CI -29.66% to -8.57%; P=.01).
- Participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62).
- Individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none.
- Per capita estimated lifetime health care expenditures were US $60,395 for smokers and US $58,821 for nonsmokers.
- Individuals with nonoptimal body weight had a significantly higher per capita estimated lifetime health care expenditure compared with those with optimal body weight (US $62,474 vs US $53,336, respectively).
- The combination of nonsmoking and sufficient fruit and vegetable intake exhibited a higher life years gain (5.49, 95% CI-4.21 to 12.17).
- The amalgamation of nonsmoking, moderate alcohol consumption, sufficient fruit and vegetable intake, and maintaining an optimal body weight was deemed optimal (life years gain: 9.91, 95% CI 5.51-14.07).
- Individuals with 4 and 5 healthy lifestyle behaviors have a life span increase of 6.58 (95% CI 1.13-10.76) and 7.13 (95% CI 1.33-11.11) years, respectively, compared with LE (29.19 years) for individuals who do not adhere to more than one healthy lifestyle behavior.
- The percentage change in annual health care expenditure was calculated as the difference in per capita annual health care expenditure between populations with and without healthy lifestyle factors divided by the annual average health care expenditure per capita for the overall population.
- The study found that never-smokers had a significant reduction in the percentage change in annual health care expenditure compared with current or former smokers (-9.78%; 95% CI -46.53% to -1.45%).
- Individuals with optimal body weight had notably lower average annual health care expenditures compared with those with nonoptimal body weight, with an 18.36% reduction of annual health care expenditures per capita (95% CI 8.57%-29.66%).
- Individuals who adopted 2, 3, 4, or 5 healthy lifestyle factors demonstrated a dose-response reduction in the percentage change in annual health care expenditure per capita by 16.01%, 18.90%, 18.61%, and 28.12%, respectively, in comparison to those who adopted 0 or only 1 healthy lifestyle factor.
Other Important Findings
- Each individual healthy lifestyle factor was significantly associated with all-cause mortality.
- The risk of mortality decreased with increasing adherence to healthy lifestyle behaviors.
- Individuals adhering to all 5 healthy lifestyle behaviors exhibited a hazard ratio of 0.37 (95% CI 0.27-0.49) for all-cause mortality, compared with those with 0 healthy factors, after adjusting for potential confounding factors.
- The study found that participants with mean ages of 48.8 years who did not smoke had a life gain of 2.31 (95% CI 0.04-5.13) additional years.
- Not drinking excessively was marginally associated with an additional gain in life years by 1.62 (95% CI -0.15 to 4.59) years.
- Sufficient physical activity was associated with an additional 1.85 (95% CI 0.25-4.34) life years gain.
- Sufficient fruit and vegetable intake was associated with a life gain of 3.25 (95% CI 1.29-6.81) years.
- Having an optimal weight was associated with a nonsignificant increment in life years (0.72 years; 95% CI -1.21 to 2.14).
- Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults.
Limitations Noted in the Document
- All analyzed lifestyle factors were assessed at baseline; therefore, lifestyle changes over time were not accounted for because no repeated measurement data were available.
- The lifestyle factors data were self-reported, which may have led to misclassification.
- Although the statistical models were adjusted for a wide range of potential confounders, the likelihood of residual and unmeasured confounding effects cannot be ruled out.
- The proportion of individuals with an unhealthy lifestyle may be underestimated because individuals with poor health may be less likely to participate in surveys or may even die before participating.
- The study did not account for other healthy lifestyle factors that may independently affect LE, including dietary intake frequency information, sleep quality, and stress levels.
- Lifetime health care expenditures were estimated based on reimbursement data from Taiwan’s NHIRD, not accounting for out-of-pocket expenses or costs associated with a loss of productivity.
Conclusion
This nationwide cohort study in Taiwan demonstrates a clear association between adopting a healthy lifestyle and improved life expectancy, along with a reduction in health care expenditure. The study’s findings highlight the significant benefits of adhering to key lifestyle factors, including nonsmoking, maintaining a healthy weight, consuming sufficient fruits and vegetables, engaging in regular physical activity, and limiting alcohol consumption. The results indicate a dose-response relationship, where the more healthy behaviors an individual adopts, the greater the gains in life expectancy and the lower the health care costs. The study’s use of a rolling extrapolation algorithm and IPTW enhances the reliability and validity of the estimates, enabling a robust assessment of the impact of lifestyle factors. The findings suggest that individuals who adopted all five healthy lifestyle behaviors had a life gain of 7.13 years, and a reduction in health care expenditure of 28.12% compared to those who adopted none. Furthermore, it underscores the importance of promoting healthy behaviors in Taiwan, given the country’s lower life expectancy compared to other high-income nations in the region. The study emphasizes that the impact of the lifestyle factors on LE and health care expenditure did not exert equal effects. Moreover, the study’s findings have practical implications for public health strategies. They suggest the need for primary prevention initiatives that focus on encouraging healthy lifestyle behaviors. By prioritizing interventions that promote healthy habits and mitigate risk factors, health outcomes can be improved, and health care costs can be minimized. The study’s conclusions indicate that these findings can be used to inform policymakers, healthcare professionals, and the public about the importance of adopting a healthy lifestyle for both improved health outcomes and reduced economic burden. Further research is needed to refine exposure assessment methods and comprehensively explore the impact of alcohol consumption on LE and health care costs and investigate the effects of various combinations of healthy lifestyle factors on LE and lifetime health expenditures across various combinations of healthy lifestyle factors. In addition, there could be notable diversity in the effects on LE and lifetime health expenditures across various combinations of healthy lifestyle factors. The combination of nonsmoking and adequate fruit and vegetable consumption stands out as the most crucial factors associated with increased LE while maintaining an optimal body weight emerges as pivotal for reducing lifetime health expenditures.