Abstract
For facilitating risk communication in clinical management, such a ratio-based measure becomes easier to understand if expressed as a loss of life expectancy. The cohort, consisting of 543,410 adults in Taiwan, was recruited between 1994 and 2008. Health risks included lifestyle, biomarkers, and chronic diseases. A total of 18,747 deaths were identified. The Chiang’s life table method was used to estimate a loss of life expectancy. We used Cox regression to calculate hazard ratios (HRs) for health risks. The increased mortality from cardio-metabolic risks such as high cholesterol (HR=1.10), hypertension (HR=1.48) or diabetes (HR=2.02) can be converted into a loss of 1.0, 4.4, and 8.9 years in life expectancy, respectively. The top 20 of the 30 risks were associated with a loss of 4 to 10 years of life expectancy, with 70% of the cohort having at least two such risk factors. Smoking, drinking, and physical inactivity each had 5-7 years loss. Individuals with diabetes or an elevated white count had a loss of 7-10 years, while prolonged sitting, the most prevalent risk factor, had a loss of 2-4 years. Those with diabetes (8.9 years) and proteinuria (9.1 years) present at the same time showed a loss of 16.2 years, a number close to the sum of each risk. Health risks, expressed as life expectancy loss, could facilitate risk communication. The paradigm shift in expressing risk intensity can help set public health priorities scientifically to promote a focus on the most important ones in primary care.
Highlights
Much of our efforts in primary care are to identify health risks and to reduce their health impact
Life expectancy, derived from collapsing age-specific mortality, is an absolute risk with implications well understood to most people
Life expectancy has not been extensively used in cohort studies, and its potential has not been fully recognized, mainly because its calculation requires a large cohort with an extended follow-up time yielding stable results with a sufficient number of deaths in each age group [4,5,6,7,8]
Summary
Much of our efforts in primary care are to identify health risks and to reduce their health impact. A ratio-based measure, is difficult for the public to understand, and cannot be directly compared with other relative risks, or with different reference www.aging-us.com groups. Prolonging one’s life is an overarching goal of the public health community [3] Overcoming the loss of life expectancy, on the other hand, is a clinical goal shared by everyone. Loss of life expectancy in years can be a universal yardstick across different disciplines in clinical practice, reflecting the severity of a given risk. Life expectancy has not been extensively used in cohort studies, and its potential has not been fully recognized, mainly because its calculation requires a large cohort with an extended follow-up time yielding stable results with a sufficient number of deaths in each age group [4,5,6,7,8]
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