Xiong-Fei Pan1,2,3, Yanping Li4, Oscar H Franco5, Jian-Min Yuan6,7, An Pan1,2,3, Woon-Puay Koh8,9. 1. Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 2. Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 3. State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 4. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 5. Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland. 6. UPMC Hillman Cancer Center, University of Pittsburgh, Pennsylvania. 7. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania. 8. Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore. 9. Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Abstract
BACKGROUND: To examine the impact of combined lifestyle factors on premature mortality and life expectancy in Chinese adults. METHODS: A total of 44,052 Chinese adults aged 45-74 years free of cardiovascular disease (CVD), cancer, and diabetes were followed from recruitment (1993-1998) to the end of 2016 in the Singapore Chinese Health Study. A composite score (0-5 scale) was calculated based on five baseline healthy lifestyle factors including healthy diet, nonsmoking status, light to moderate alcohol drinking, being physically active and optimal body mass index. Mortality cases were identified through linkage with the nationwide death registry. RESULTS: Adopting five healthy versus none was associated with a lower risk of all-cause and cause-specific mortality, and the hazard ratio (95% confidence interval [CI]) was 0.38 (0.29, 0.51) for all-cause mortality, 0.26 (0.13, 0.52) for CVD mortality, and 0.59 (0.37, 0.92) for cancer mortality. Nonadherence to 4-5 healthy lifestyle factors accounted for 34.9% (95% CI = 29.2, 40.2) in population attributable fraction for all-cause mortality, 35.1% (23.7, 44.9) for CVD mortality, and 18.0% (6.5, 28.0) for cancer mortality. Conversely, adherence to 4-5 healthy lifestyle factors versus none could achieve a gain of 8.1 years in women and 6.6 years in men for the life expectancy at 50 years. CONCLUSIONS: A healthier lifestyle is associated with a substantially reduced risk of mortality and a longer life expectancy in the Chinese population. Our findings highlight the necessity of coordinated actions targeting combined lifestyle factors in reducing the overall burden of diseases and premature deaths.
BACKGROUND: To examine the impact of combined lifestyle factors on premature mortality and life expectancy in Chinese adults. METHODS: A total of 44,052 Chinese adults aged 45-74 years free of cardiovascular disease (CVD), cancer, and diabetes were followed from recruitment (1993-1998) to the end of 2016 in the Singapore Chinese Health Study. A composite score (0-5 scale) was calculated based on five baseline healthy lifestyle factors including healthy diet, nonsmoking status, light to moderate alcohol drinking, being physically active and optimal body mass index. Mortality cases were identified through linkage with the nationwide death registry. RESULTS: Adopting five healthy versus none was associated with a lower risk of all-cause and cause-specific mortality, and the hazard ratio (95% confidence interval [CI]) was 0.38 (0.29, 0.51) for all-cause mortality, 0.26 (0.13, 0.52) for CVDmortality, and 0.59 (0.37, 0.92) for cancermortality. Nonadherence to 4-5 healthy lifestyle factors accounted for 34.9% (95% CI = 29.2, 40.2) in population attributable fraction for all-cause mortality, 35.1% (23.7, 44.9) for CVDmortality, and 18.0% (6.5, 28.0) for cancermortality. Conversely, adherence to 4-5 healthy lifestyle factors versus none could achieve a gain of 8.1 years in women and 6.6 years in men for the life expectancy at 50 years. CONCLUSIONS: A healthier lifestyle is associated with a substantially reduced risk of mortality and a longer life expectancy in the Chinese population. Our findings highlight the necessity of coordinated actions targeting combined lifestyle factors in reducing the overall burden of diseases and premature deaths.
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