Impact of Individual and Combined Lifestyle Factors on Mortality in China: A Cohort Study

• Published in: American journal of preventive medicine Vol. 59; no. 3; pp. 461 - 468
• Main Authors: Wu, Meng-yin, Wang, Jian-bing, Zhu, Yao, Lu, Jie-ming, Li, Die, Yu, Zhe-bin, Shen, Peng, Jiang, Dan-jie, Lin, Hong-bo, Chen, Kun
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.09.2020; Elsevier Science Ltd
• Subjects: Cohort analysis; Disease management; Disease prevention; Epidemiology; Lifestyles; Mortality; Public health; China
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2020.01.029

Although numerous studies have suggested that lifestyle-related factors are associated with chronic diseases and preventable deaths, limited evidence is available for the Chinese population. This study established a prospective cohort of >360,000 residents on the basis of the Yinzhou Health Information System in China during 2004–2017 and calculated the combined effects of lifestyle-related factors, including BMI, smoking, alcohol consumption, and physical activity, using a points system. A Cox regression model estimated the combined effects of lifestyle-related factors on total mortality, and a competing risk model estimated the combined effects on cancer and cardiovascular disease mortality. All data analyses were conducted in 2018‒2019. During 3,755,879 person-years of follow-up, 11,791 deaths were identified, including 4,983 from cancer and 3,143 from cardiovascular disease. Having a standard BMI, never smoking, never drinking, and engaging in physical activity more than 4 times per week had protective effects on total mortality. Overall, the risk of total and cause-specific mortality increased with the increment of risk score. Compared with subjects in the lowest quartile, the risk of total and cause-specific mortality peaked among individuals in the fourth quartile (total mortality: hazard ratio=1.87, 95% CI=1.77, 1.98; cancer mortality: hazard ratio=2.05, 95% CI=1.87, 2.25; cardiovascular disease mortality: hazard ratio=1.51, 95% CI=1.35, 1.68). Sensitivity analyses excluding individuals with follow-up <3 years did not materially change the results. The combined effects of lifestyle-related factors, including BMI, smoking, alcohol drinking, and physical activity, are associated with total, cancer, and cardiovascular disease mortality among the Chinese population.