Abstract
Individual lifestyle risk factors have been associated with an increased risk of mortality. However, limited evidence is available on the combined association of lifestyle risk factors with mortality in non-Western populations. The analysis included 37,472 participants (aged ≥19 years) in the Korea National Health and Nutrition Examination Surveys (2007–2014) for whom the data were linked to death certificates/medical records through December 2016. A lifestyle risk score was created using five unhealthy behaviors: current smoking, high-risk alcohol drinking, unhealthy weight, physical inactivity, and insufficient/prolonged sleep. Cox proportional hazards models were used to estimate hazard ratio (HR) and 95% confidence interval (CI). During up to 9 years of follow-up, we documented 1,057 total deaths. Compared to individuals with zero lifestyle risk factor, those with 4–5 lifestyle risk factors had 2.01 times (HR = 2.01, 95% CI = 1.43–2.82) and 2.59 times (HR = 2.59, 95% CI = 1.24–5.40) higher risk of all-cause and cardiovascular mortality, respectively. However, higher lifestyle risk score was not significantly associated with cancer mortality (p-trend >0.05). In stratified analyses, the positive associations tended to be stronger in adults aged <65 years, unemployed, and those with lower levels of education. In conclusion, combined unhealthy lifestyle behaviors were associated with substantially increased risk of total and cardiovascular mortality in Korean adults.
Highlights
Individual lifestyle risk factors have been associated with an increased risk of mortality
Among 37,472 Korean men and women, having more unhealthy lifestyle risk factors was associated with considerably higher risk of mortality
We found no association between lifestyle risk factors and cancer mortality among
Summary
Individual lifestyle risk factors have been associated with an increased risk of mortality. A number of epidemiological studies have examined the combined association of major lifestyle factors including obesity, smoking, alcohol, and physical activity in relation to mortality. Limited data are available for non-Caucasians, especially Asians[16,19,20,21] including Koreans[10,12,18] whose lifestyle patterns are different from Western populations[22,23] These studies had relatively small sample size and restricted study population or did not consider emerging lifestyle factors such as insufficient or prolonged sleep. We used a large nationally representative cohort of Koreans to examine the combined association of 5 major lifestyle risk factors, including unhealthy weight, smoking, alcohol use, physical inactivity and insufficient/prolonged sleep, in relation to all-cause, cardiovascular and cancer mortality. We further explored different combinations of lifestyle risk factors in relation to mortality
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