Abstract
BackgroundLifestyle risk behaviors are responsible for a large proportion of disease burden worldwide. Behavioral risk factors, such as smoking, poor diet, and physical inactivity, tend to cluster within populations and may have synergistic effects on health. As evidence continues to accumulate on emerging lifestyle risk factors, such as prolonged sitting and unhealthy sleep patterns, incorporating these new risk factors will provide clinically relevant information on combinations of lifestyle risk factors.Methods and FindingsUsing data from a large Australian cohort of middle-aged and older adults, this is the first study to our knowledge to examine a lifestyle risk index incorporating sedentary behavior and sleep in relation to all-cause mortality. Baseline data (February 2006– April 2009) were linked to mortality registration data until June 15, 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting, and unhealthy (short/long) sleep duration were measured by questionnaires and summed into an index score. Cox proportional hazards analysis was used with the index score and each unique risk combination as exposure variables, adjusted for socio-demographic characteristics.During 6 y of follow-up of 231,048 participants for 1,409,591 person-years, 15,635 deaths were registered. Of all participants, 31.2%, 36.9%, 21.4%, and 10.6% reported 0, 1, 2, and 3+ risk factors, respectively. There was a strong relationship between the lifestyle risk index score and all-cause mortality. The index score had good predictive validity (c index = 0.763), and the partial population attributable risk was 31.3%. Out of all 96 possible risk combinations, the 30 most commonly occurring combinations accounted for more than 90% of the participants. Among those, combinations involving physical inactivity, prolonged sitting, and/or long sleep duration and combinations involving smoking and high alcohol intake had the strongest associations with all-cause mortality. Limitations of the study include self-reported and under-specified measures, dichotomized risk scores, lack of long-term patterns of lifestyle behaviors, and lack of cause-specific mortality data.ConclusionsAdherence to healthy lifestyle behaviors could reduce the risk for death from all causes. Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors.
Highlights
Noncommunicable disease is the leading cause of death worldwide [1]
Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors
Mounting evidence has implicated lifestyle risk behaviors, such as smoking [6], alcohol use [7], physical inactivity [8], and poor diet [9], in adverse health outcomes. As these common risk behaviors are often associated with multiple disease outcomes and tend to cluster within populations [10], understanding the combined effects of these risk factors on disease burden could be informative for policy making and resource allocation in the context of primary prevention [11]
Summary
Noncommunicable disease is the leading cause of death worldwide [1]. Many noncommunicable diseases, such as cardiovascular disease, some cancers, and diabetes, can be largely attributed to modifiable lifestyle risk factors [2]. Mounting evidence has implicated lifestyle risk behaviors, such as smoking [6], alcohol use [7], physical inactivity [8], and poor diet [9], in adverse health outcomes As these common risk behaviors are often associated with multiple disease outcomes and tend to cluster within populations [10], understanding the combined effects of these risk factors on disease burden could be informative for policy making and resource allocation in the context of primary prevention [11]. The most common NCDs are cardiovascular diseases (conditions that affect the heart and the circulation), cancers, diabetes, and chronic respiratory diseases (long-term diseases that affect the lungs and airways) These NCDs can be largely attributed to modifiable lifestyle risk factors such as smoking, harmful use of alcohol, physical inactivity, and having an unhealthy diet (one with low fruit and vegetable intake and high saturated fat and salt intake). They identify the most commonly occurring combinations of health risk behaviors and quantify the risk for all-cause mortality for each combination of risk behaviors
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