Abstract
BackgroundBehaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death.MethodsA predictive algorithm for 5 y risk of death—the Mortality Population Risk Tool (MPoRT)—was developed and validated using the 2001 to 2008 Canadian Community Health Surveys. There were approximately 1 million person-years of follow-up and 9,900 deaths in the development and validation datasets. After validation, MPoRT was used to predict future mortality and estimate the burden of smoking, alcohol, physical inactivity, and poor diet in the presence of sociodemographic and other risk factors using the 2010 national survey (approximately 90,000 respondents). Canadian period life tables were generated using predicted risk of death from MPoRT. The burden of behavioural risk factors attributable to life expectancy was estimated using hazard ratios from the MPoRT risk model.FindingsThe MPoRT 5 y mortality risk algorithms were discriminating (C-statistic: males 0.874 [95% CI: 0.867–0.881]; females 0.875 [0.868–0.882]) and well calibrated in all 58 predefined subgroups. Discrimination was maintained or improved in the validation cohorts. For the 2010 Canadian population, unhealthy behaviour attributable life expectancy lost was 6.0 years for both men and women (for men 95% CI: 5.8 to 6.3 for women 5.8 to 6.2). The Canadian life expectancy associated with health behaviour recommendations was 17.9 years (95% CI: 17.7 to 18.1) greater for people with the most favourable risk profile compared to those with the least favourable risk profile (88.2 years versus 70.3 years). Smoking, by itself, was associated with 32% to 39% of the difference in life expectancy across social groups (by education achieved or neighbourhood deprivation).ConclusionsMultivariable predictive algorithms such as MPoRT can be used to assess health burdens for sociodemographic groups or for small changes in population exposure to risks, thereby addressing some limitations of more commonly used measurement approaches. Unhealthy behaviours have a substantial collective burden on the life expectancy of the Canadian population.
Highlights
Unhealthy behaviours, including smoking, poor diet, physical inactivity, and unhealthy alcohol consumption, are leading risk factors for premature mortality worldwide [1,2,3]
The most commonly used method—aggregated data approach, used in the Global Burden of Disease study and first described by Levin—starts with disease-specific mortality and indirectly attributes underlying risks to a fraction of deaths according to separately measured estimates of the association between the exposures and disease [2,4,5]
We propose a method to estimate mortality attributable to unhealthy behaviour using risk algorithms that directly incorporate a variety of baseline characteristics and risk factors
Summary
Unhealthy behaviours, including smoking, poor diet, physical inactivity, and unhealthy alcohol consumption, are leading risk factors for premature mortality worldwide [1,2,3]. The most commonly used method—aggregated data approach, used in the Global Burden of Disease study and first described by Levin—starts with disease-specific mortality and indirectly attributes underlying risks to a fraction of deaths according to separately measured estimates of the association between the exposures and disease [2,4,5]. Respondents are followed until death, with attribution of unhealthy behaviours estimated directly from a multivariable regression model. Behaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death
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