Abstract
BackgroundLife expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death.MethodsWe analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models.ResultsWe identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31–32 %) and 14 % (95 % CI, 12–16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8–12 %) and high blood pressure (9 %; 95 % CI, 7–11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55–59 %), being 35 % (95 % CI, 32–37 %) among never smokers and 74 % (95 % CI, 73–75 %) among current smokers.ConclusionsWhile smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0630-6) contains supplementary material, which is available to authorized users.
Highlights
Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years
In summary, we used individual level data from a large European prospective cohort study to estimate the relative contributions of various factors to premature mortality both on the population level and the individual level
Our results indicate that it is of public health importance to persist and extend the fight against smoking as well as to promote healthy behaviour, including better diet, avoidance of overweight/obesity, physical activity, and blood pressure and blood lipid control with the aim of minimising premature mortality
Summary
Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. Life expectancy in all countries of Western Europe has increased substantially over recent decades, primarily due to important decreases in mortality rates for death in middle age [1]. Other important factors are thought to include high cholesterol, high fasting plasma glucose, ambient air pollution, and occupational risks [3, 4]. While this initiative has resulted in extremely important information, and is the only option for most populations, it has a number of limitations such as the inclusion of data of variable quality from many different sources, and the inability to adjust comprehensively and consistently for other mortality risk factors that may confound the observed relationships. The GBD modelling approach is usually not able to provide estimates of absolute risk and attributable fractions for important subgroups, e.g. for smokers and non-smokers separately, or for sets of risk factors combined
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