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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    • "There were gender differences for other risk factors of CVD observed in this study. Males with MetS had worse smoking habits than females, while females with MetS had lower physical activity levels and higher BMIs than males, which has also been observed previously in Korea and the UK[14,42]. Therefore, gender-specific programs designed to change health behaviors and prevent CVD events should be developed. There are a number of potential limitations to this study. "
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    ABSTRACT: Background: Gender is thought to be an important factor in metabolic syndrome and its outcomes. Despite a number of studies that have demonstrated differences in metabolism and its components that are dependent on gender, limited information about gender differences on the characteristics of metabolic syndrome and its components is available regarding the Korean old adult population. This study aimed to identify gender differences in characteristics of the metabolic syndrome and other risk factors for cardiovascular disease. Methods: Secondary analysis of data from a nationwide cross-sectional survey for health examination at the time of transitioning from midlife to old age was performed. Multiple logistic regression models were used to estimate adjusted odds ratios and 95 % confidence intervals for gender differences among the Korean 66-year-old population with metabolic syndrome. Results: Gender differences in metabolic syndrome components that contributed to the diagnosis of metabolic syndrome were identified. In males, the most common component was high blood sugar levels (87.5 %), followed by elevated triglyceride levels (83.5 %) and high blood pressure (83.1 %). In females, the most commonly identified component was elevated triglyceride levels (79.0 %), followed by high blood sugar levels (78.6 %) and high blood pressure (78.5 %). Gender differences for other risk factors for cardiovascular disease, including family history, health habits, and body mass index were observed. Conclusions: Gender-specific public health policies and management strategies to prevent cardiovascular disease among the older adult population should be developed for Koreans undergoing the physiological transition to old age.
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    • "Clustering is important because the co-occurrence of multiple health-compromising behaviours is associated * Correspondence: 2 Research Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK Full list of author information is available at the end of the article with increased risk of chronic diseases including certain cancers and cardiovascular diseases[16]. The increased risk is the result of accumulation and synergistic adverse effects of behaviours on health[17]. Moreover, behavioural patterns in adulthood are primarily shaped during the adolescence period[18]. "

    Full-text · Dataset · Jan 2016
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    • "Ill health in later life is heavily influenced by behaviours across the life course, which in turn are influenced by a variety of wider contextual social, economic, and organisational factors[1,2]. People who adopt healthy behaviours are more likely to age successfully and have improved quality of life345. As they age, those people now in mid-life have a greater risk of development of disease and frailty than younger people in the next decades678. "
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    ABSTRACT: Background: With an ageing population, there is an increasing societal impact of ill health in later life. People who adopt healthy behaviours are more likely to age successfully. To engage people in health promotion initiatives in mid-life, a good understanding is needed of why people do not undertake healthy behaviours or engage in unhealthy ones. Methods: Searches were conducted to identify systematic reviews and qualitative or longitudinal cohort studies that reported mid-life barriers and facilitators to health behaviour. Mid-life ranged from 40 to 64 years, but younger adults in disadvantaged or minority groups were also eligible to reflect potential earlier disease onset. Two reviewers independently conducted reference screening and study inclusion. Included studies were assessed for quality. Barriers and facilitators were identified and synthesised into broader themes to allow comparisons across behavioural risks. Findings: From 16,426 titles reviewed, 28 qualitative studies, 11 longitudinal cohort studies and 46 systematic reviews were included. Evidence was found relating to uptake and maintenance of physical activity, diet and eating behaviours, smoking, alcohol, eye care, and other health promoting behaviours and grouped into six themes: health and quality of life, sociocultural factors, the physical environment, access, psychological factors, evidence relating to health inequalities. Most of the available evidence was from developed countries. Barriers that recur across different health behaviours include lack of time (due to family, household and occupational responsibilities), access issues (to transport, facilities and resources), financial costs, entrenched attitudes and behaviours, restrictions in the physical environment, low socioeconomic status, lack of knowledge. Facilitators include a focus on enjoyment, health benefits including healthy ageing, social support, clear messages, and integration of behaviours into lifestyle. Specific issues relating to population and culture were identified relating to health inequalities. Conclusions: The barriers and facilitators identified can inform the design of tailored interventions for people in mid-life.
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