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

Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
PLoS Medicine (Impact Factor: 14.43). 03/2008; 5(1):e12. DOI: 10.1371/journal.pmed.0050012
Source: PubMed Central


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.
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.
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.

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    • "c o m / p m e d r to job characteristics and lifestyle behaviours with researchers finding dissimilar associations between job characteristics and body mass index (BMI) (Kouvonen et al., 2005a; Block et al., 2009; Brunner et al., 2007; Ishizaki et al., 2004, 2008), leisure time physical activity (Lallukka et al., 2004, 2008; Tsutsumi et al., 2003; Chau et al., 2012), nicotine dependence (Tsutsumi et al., 2003; Lallukka et al., 2008; John et al., 2006; Radi et al., 2007) and alcohol intake (Kouvonen et al., 2005b; Hiro et al., 2007). These individual variations in responses can be reduced through investigating the co-occurrence of health behaviours where co-occurrence is understood as the bundling or clustering of health behaviours (Khaw et al., 2008). Such bundling may be explained by an underlying capacity suggested by the strength model of self-control (Hagger et al., 2010). "
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    09/2015; 2:812-817. DOI:10.1016/j.pmedr.2015.09.012
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    International Journal of Public Health 08/2015; DOI:10.1007/s00038-015-0731-6 · 2.70 Impact Factor
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    12/2014; 2(1):58. DOI:10.1186/s40359-014-0055-y
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