Impact of Healthy Lifestyle Factors on Life Expectancy and Lifetime Health Care Expenditure: Nationwide Cohort Study

• Published in: JMIR public health and surveillance Vol. 10; p. e57045
• Main Authors: Lo, Wei-Cheng, Hu, Tsuey-Hwa, Shih, Cheng-Yu, Lin, Hsien-Ho, Hwang, Jing-Shiang
• Format: Journal Article
• Language: English
• Published: Canada JMIR Publications 17.07.2024
• Subjects: Adult; Aged; Alcohol; Algorithms; Body weight; Chronic illnesses; Cohort analysis; Cohort Studies; Costs; Disease; Exercise; Female; Fruits; GDP; Gross Domestic Product; Health behavior; Health care; Health care expenditures; Health care policy; Health Expenditures - statistics & numerical data; Health Surveys; Healthy Lifestyle; Humans; Interviews; Leisure; Life Expectancy; Lifestyles; Male; Metabolism; Middle Aged; Mortality risk; National health insurance; Obesity; Original Paper; Overweight; Questionnaires; Risk factors; Smoking; Sociodemographics; Taiwan - epidemiology; Vegetables; Womens health; Taiwan; United States > US; life expectancy; rolling extrapolation algorithm; nonsmoking; healthy lifestyle factors; moderate alcohol consumption; fruit and vegetable intake; nationwide cohort study; lifetime health care expenditure; optimal body weight; physical activity
• ISSN: 2369-2960; 2369-2960
• DOI: 10.2196/57045

The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established, while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinal individual data. We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy and lifetime health care expenditure in Taiwan. Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with and without healthy lifestyle factors. A total of 19,893 participants aged ≥30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%; P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore, individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none. Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on the overall health and economic burden.