The combined effect of smoking, excessive drinking, poor diet, and physical inactivity is “substantial” and significantly raises premature mortality from all causes, cardiovascular disease, and cancer, according to a U.K. prospective cohort study.
Compared with people who do not exhibit any of these poor lifestyle behaviors, those who exhibit all four are at threefold higher risk of dying prematurely from cardiovascular disease or cancer and at fourfold higher risk of dying prematurely from other causes, said Elisabeth Kvaavik, Ph.D., of the University of Oslo, and her associates.
The investigators assessed the combined influence of these health behaviors on 20-year mortality because almost all previous studies have examined only the individual effects. Since “poor lifestyle choices frequently coexist,” it is important to assess their combined impact on public health as well, they noted.
To do so, Dr. Kvaavik and her colleagues used data from a general survey of multiple health behaviors targeting the entire adult population of the United Kingdom. The survey began in 1984–1985. In this study, data for a subgroup of 4,886 men and women were assessed concerning self-reported smoking and alcohol drinking habits, leisure time exercise activities, and frequency of consuming fruits and vegetables.
During 20-year follow-up, there were 431 deaths from cardiovascular disease, 318 cancer deaths, and 331 deaths from other causes, for a total of 1,080 deaths.
Cumulative survival, adjusted for subject age at baseline and sex, was 96% for those who had none of the poor health behaviors measured, compared with 85% for those who had all four poor health behaviors. This rise in mortality risk was equivalent to an increase in chronological age of about 12 years, the researchers said (Arch. Intern. Med. 2010;170:711-8).
Compared with people who had no poor health behaviors, the risk of each cause of death rose as the number of poor health behaviors increased from one to four.
These findings suggest that “modest but achievable adjustments to lifestyle behaviors are likely to have a considerable impact at both the individual and population level,” Dr. Kvaavik and her associates wrote.
Disclosures: The U.K. survey was funded by the Health Promotion Research Trust. Dr. Kvaavik's study was supported by the Norwegian Research Council, the Medical Research Council (U.K.), Wellcome Trust, and the National Heart Foundation of Australia. No financial conflicts of interest were reported.