The combined impact of adherence to five lifestyle factors on all-cause, cancer and cardiovascular mortality: a prospective cohort study among Danish men and women

Abstract

Individual lifestyle factors have been associated with lifestyle diseases and premature mortality by an accumulating body of evidence. The impact of a combination of lifestyle factors on mortality has been investigated in several studies, but few have applied a simple index taking national guidelines into account. The objective of the present prospective cohort study was to investigate the combined impact of adherence to five lifestyle factors (smoking, alcohol intake, physical activity, waist circumference and diet) on all-cause, cancer and cardiovascular mortality based on international and national health recommendations. A Cox proportional hazards model was used to estimate hazard ratios (HR) with 95 % CI. During a median follow-up of 14 years, 3941 men and 2827 women died. Among men, adherence to one additional health recommendation was associated with an adjusted HR of 0·73 (95 % CI 0·71, 0·75) for all-cause mortality, 0·74 (95 % CI 0·71, 0·78) for cancer mortality and 0·70 (95 % CI 0·65, 0·75) for cardiovascular mortality. Among women, the corresponding HR was 0·72 (95 % CI 0·70, 0·75) for all-cause mortality, 0·76 (95 % CI 0·73, 0·80) for cancer mortality and 0·63 (95 % CI 0·57, 0·70) for cardiovascular mortality. In the present study, adherence to merely one additional health recommendation had a protective effect on mortality risk, indicating a huge potential in enhancing healthy lifestyle behaviours of the population. Key words: Lifestyle factors: Mortality: Public health: RecommendationsTo improve public health and implement targeted efforts, it is necessary to acquire knowledge about health risk factors and quantify their influence on public health. The simplest and most objective measure of a population's health status is overall mortality. Tobacco smoking (1 -3) , alcohol consumption (4,5) , physical inactivity (6 -8) , adiposity (9,10) and an unhealthy diet (11 -17) are all modifiable lifestyle factors that by an accumulating body of evidence have been associated with a higher risk of developing lifestyle diseases and premature mortality. Among the leading causes of death worldwide are cancers and CVD (18) . Although these diseases are highly preventable, approximately 60 % of all deaths are attributed to cancers and CVD in Denmark (19) . Multiple lifestyle behaviours coexist and may interact, and the underlying causes of death are probably multicausal of nature. Thus, studying the combined impact of lifestyle factors instead of their individual impact on health outcomes is highly relevant. Public health recommendations for the most important risk factors have been developed by many organisations and countries (20 -22) . Applying a simple lifestyle index based on international and national lifestyle recommendations is useful for decision-makers and political governments and for counselling purposes, and may motivate subjects to change their lifestyle in a healthier direction -particularly if the message is simple.Recently, the combined impact of healthy lifestyle behaviours on all-cau...

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