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Wang Q, Schmidt AF, Lennon LT, Papacosta O, Whincup PH, Wannamethee G. Association of Life's Simple 7 lifestyle metric with cardiometabolic disease-free life expectancy in older British men. COMMUNICATIONS MEDICINE 2024; 4:104. [PMID: 38834824 DOI: 10.1038/s43856-024-00534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Cardiometabolic diseases (CMD), including myocardial infarction, stroke, and type 2 diabetes, are leading causes of disability and mortality globally, particularly for people at an older age. The impact of adhering to the Life's Simple 7 (LS7) on the number of years an individual will live without CMD in older adults remains less studied. METHODS This study included a cohort of 2662 British men aged 60-79 years free of CMD at baseline from the British Regional Heart Study (BRHS). Each LS7 factor (BMI, blood pressure, blood glucose, total cholesterol, smoking, physical activity, and diet) was categorized as poor, intermediate, or ideal, and a composite LS7 adherence was determined by summing the number of LS7 ideal levels achieved. Flexible parametric Royston-Parmar proportional-hazards model was applied to estimate CMD-free life expectancy. RESULTS Here we show that compared to men with the lowest LS7 adherence [with 18.42 years (95% CI: 16.93, 19.90) of CMD-free life at age 60], men having an ideal LS7 adherence are estimated to gain an additional 4.37 years (95% CI: 2.95, 5.79) of CMD-free life. The CMD-free life gain benefits are consistent across social class groups of manual and non-manual workers. Among LS7 factors, achieving an ideal physical activity provides the largest CMD-free survival benefit: 4.84 years (95% CI: 3.37, 6.32) of additional CMD-free life compared with the physically inactive group. CONCLUSIONS Our study quantifies and highlights the benefits of adhering to the LS7 ideal levels for living a longer life without CMD in older adults.
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Affiliation(s)
- Qiaoye Wang
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK.
| | - Amand Floriaan Schmidt
- Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lucy T Lennon
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - Goya Wannamethee
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Sun Q, Hu Y, Yu C, Guo Y, Pei P, Yang L, Chen Y, Du H, Sun D, Pang Y, Burgess S, Sansome S, Ning F, Chen J, Chen Z, Li L, Lv J. Healthy lifestyle and life expectancy free of major chronic diseases at age 40 in China. Nat Hum Behav 2023; 7:1542-1550. [PMID: 37430072 PMCID: PMC7615116 DOI: 10.1038/s41562-023-01624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/27/2023] [Indexed: 07/12/2023]
Abstract
Whether a healthy lifestyle helps achieve gains in life expectancy (LE) free of major non-communicable diseases and its share of total LE in Chinese adults remains unknown. We considered five low-risk lifestyle factors: never smoking or quitting for reasons other than illness, no excessive alcohol use, being physically active, healthy eating habits and healthy body fat levels. Here we show that after a median follow-up of 11.1 years for 451,233 Chinese adults, the LE free of cardiovascular diseases, cancer and chronic respiratory diseases (95% confidence interval) at age 40 years for individuals with all five low-risk factors was on average 6.3 (5.1-7.5) years (men) and 4.2 (3.6-5.4) years (women) longer than those with 0-1 low-risk factors. Correspondingly, the proportion of disease-free LE to total LE increased from 73.1% to 76.3% for men and from 67.6% to 68.4% for women. Our findings suggest that promoting healthy lifestyles could be associated with gains in disease-free LE in the Chinese population.
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Kenny RA. Lifestyle and lifespan-opportunities for intervention. Age Ageing 2022; 51:6604742. [PMID: 35679194 DOI: 10.1093/ageing/afac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rose Anne Kenny
- Professor of Medical Gerontology, Trinity College Dublin Ireland
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Sakaniwa R, Noguchi M, Imano H, Shirai K, Tamakoshi A, Iso H. Impact of modifiable healthy lifestyle adoption on lifetime gain from middle to older age. Age Ageing 2022; 51:6572254. [PMID: 35543031 PMCID: PMC9092121 DOI: 10.1093/ageing/afac080] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE this study explored whether the modification of selected lifestyles is likely to increase life expectancy from middle age onwards, regardless of the presence of major comorbidities. METHODS we examined a prospective cohort of 20,373 men and 26,247 women aged 40-80 years. Eight modifiable lifestyle factors were assessed: consumption of fruit, fish and milk, walking and/or sports participation, body-mass index, smoking status, alcohol consumption and sleep duration. Modifiable healthy lifestyle factors scored one point each, for a maximum of eight points. The impact of modifiable healthy lifestyle adoption on lifetime gain during the ages of 40-102 years was analysed. FINDINGS during the median 21 years of follow-up, 8,966 individuals (3,683 men and 5,283 women) died. Life expectancy at 40 years (95% confidence intervals) for 7-8 health lifestyle points was 46.8 (45.6-48.1) and 51.3 (50.0-52.6) years for men and women, respectively. The potential impact of modifiable healthy lifestyle adoption on lifetime gain persisted over the age of 80 years or more, in individuals with ≥5 factors (P < 0.001), particularly older men. The benefits were more pronounced among patients with major comorbidities, such as cardiovascular disease, cancer, hypertension, diabetes, kidney disease and those with multimorbidity throughout all age categories. CONCLUSION adopting modifiable healthy lifestyles was associated with lifetime gain, even in individuals aged 80 years or more, regardless of the presence of any major comorbidities in each life stage since middle age. The findings imply the importance of improving the one's lifestyle for an increased lifespan, even among older patients and/or those with multimorbidity.
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Affiliation(s)
- Ryoto Sakaniwa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Midori Noguchi
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
- Department of Public Health, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Akiko Tamakoshi
- Public Health, Department of Social Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido 060-8638, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Miao X, Chen J, Meng W, Wu Q, Wu Z, Ren L, Cai Y, Guo X, Zhang X, Meng Q. Association Between Living Risk and Healthy Life Years Lost Due to Multimorbidity: Observations From the China Health and Retirement Longitudinal Study. Front Med (Lausanne) 2022; 9:831544. [PMID: 35372432 PMCID: PMC8970175 DOI: 10.3389/fmed.2022.831544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background Multimorbidity has an effect on life expectancy, while its effect on healthy life years is unclear. This study aims to investigate the associations between healthy life years lost due to multimorbidity and living risk. Methods The participants of The China Health and Retirement Longitudinal Study (CHARLS) were assessed at four visits between 2011 (baseline) and 2018. At baseline, 13,949 individuals were administered surveys. A combined score based on seven health-related factors was calculated, and the participants were classified into 3 groups based on living risk. We used the adjusted Cox regression methods to examine the associations between living risk groups and multimorbidity. We estimated the healthy life years lost due to multimorbidity using the Sullivan method. Results A total of 9,091 adults aged 45 years or older (mean age of 59.55 ± 9.50 years with one disease, 52.60% women) were analyzed in the CHARLS. The probability of no multimorbidity over 7 years decreased from 0.9947 to 0.9697 in the low-risk group, whereas the probability of multimorbidity in low living risk was lower than that of high living risk, ranging from HR 1.253 (95% CI.992–1.581; P = 0.058) to 1.431 (1.05–1.949; P = 0.023) in sex, and ranging from HR 1.340 (95% CI 1.106–1.623; P = 0.003) to 2.002 (1.058–3.787; P = 0.033) in area. At 45 years, the healthy life years lost in men was <0.27 years compared to women in the low-risk group. Hypertension increased the risk of multimorbidity with an HR of 1.5 (95% CI 1.21–1.91; P < 0.001) in men. In urban areas, participants with diabetes had 3.2 times (95% CI 1.75–5.94, P < 0.001) higher risk of multimorbidity than participants without diabetes. Conclusions These findings indicate that a low-risk lifestyle could decrease the loss of healthy life years under multimorbidity. The probability of multimorbidity in women and in urban areas was high. Hypertension was correlated with the hazard risk of multimorbidity.
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Affiliation(s)
- Xinlei Miao
- School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jun Chen
- Center of Information Statistic, Health Information Center of Shaanxi Province, Xi'an, China
| | - Wen Meng
- Chinese Medical Doctor Association, Beijing, China
| | - Qiong Wu
- Center of Big Data Office, National Health Commission of the People's Republic of China, Beijing, China
| | - Zhiyuan Wu
- School of Public Health, Capital Medical University, Beijing, China
| | - Lin Ren
- Center of Information Statistic, Health Information Center of Shaanxi Province, Xi'an, China
| | - Yue Cai
- Center of Information Statistic, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiang Zhang
- Information Management Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- *Correspondence: Xiang Zhang
| | - Qun Meng
- Comprehensive Supervision Bureau, National Health Commission of the People's Republic of China, Beijing, China
- Qun Meng
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Hou Y, Xu C, Lu Q, Zhang Y, Cao Z, Li S, Yang H, Sun L, Cao X, Zhao Y, Wang Y. Associations of frailty with cardiovascular disease and life expectancy: A prospective cohort study. Arch Gerontol Geriatr 2022; 99:104598. [DOI: 10.1016/j.archger.2021.104598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/20/2022]
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Casagrande M, Forte G, Favieri F, Agostini F, Giovannoli J, Arcari L, Passaseo I, Semeraro R, Camastra G, Langher V, Pazzaglia M, Cacciotti L. The Broken Heart: The Role of Life Events in Takotsubo Syndrome. J Clin Med 2021; 10:4940. [PMID: 34768460 PMCID: PMC8585024 DOI: 10.3390/jcm10214940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 01/30/2023] Open
Abstract
The onset of Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is thought to be associated with some life events. This study focuses on clarifying life event characteristics and the role of triggers in the onset of TTS. Participants with TTS (n = 54) were compared to those with acute myocardial infarction (AMI; n = 52) and healthy individuals (n = 54). Using a modified version of the Interview for Recent Life Events, information about general life events perceived as stressful and triggers preceding the onset of a cardiac syndrome was collected. The assessment included the impact of these events as indicated by the participants and estimated by the interviewer; finally, the objective impact was considered. Although the number of events and the objective impact did not differ among the groups, patients with TTS reported a more negative perceived impact. Moreover, 61% of these patients objectively and subjectively reported a more stressful trigger before the onset of the disease (in the 24 h preceding the cardiac event) than those reported by patients with AMI. The dynamic between life events and individual responses could help differentiate TTS from other cardiovascular events, such as AMI. This study suggests that patients' perception of some life events (whether triggers or general life events) could represent a possible marker of TTS.
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Affiliation(s)
- Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Giuseppe Forte
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Agostini
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Jasmine Giovannoli
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
| | - Luca Arcari
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Ilaria Passaseo
- Divisione di Cardiologia, Policlinico Casilino, Via Casilina, 00169 Roma, Italy;
| | - Raffaella Semeraro
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Giovanni Camastra
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
| | - Viviana Langher
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Roma “Sapienza”, Via Degli Apuli 1, 00185 Roma, Italy;
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, Università di Roma “Sapienza”, Via dei Marsi 78, 00185 Roma, Italy; (G.F.); (F.F.); (F.A.); (J.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Luca Cacciotti
- UOC di Cardiologia, Ospedale M.G. Vannini, 00189 Roma, Italy; (L.A.); (R.S.); (G.C.); (L.C.)
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Dieteren CM, Faber T, van Exel J, Brouwer WBF, Mackenbach JP, Nusselder WJ. Mixed evidence for the compression of morbidity hypothesis for smoking elimination-a systematic literature review. Eur J Public Health 2021; 31:409-417. [PMID: 33338205 PMCID: PMC8071592 DOI: 10.1093/eurpub/ckaa235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is debate around the composition of life years gained from smoking elimination. The aim of this study was to conduct a systematic review of the literature to synthesize existing evidence on the effect of smoking status on health expectancy and to examine whether smoking elimination leads to compression of morbidity. METHODS Five databases were systematically searched for peer-reviewed articles. Studies that presented quantitative estimates of health expectancy for smokers and non-/never-smokers were eligible for inclusion. Studies were searched, selected and reviewed by two reviewers who extracted the relevant data and assessed the risk of bias of the included articles independently. RESULTS The search identified 2491 unique records, whereof 20 articles were eligible for inclusion (including 26 cohorts). The indicators used to measure health included disability/activity limitations (n=9), health-related quality of life (EQ-5D) (n=2), weighted disabilities (n=1), self-rated health (n=9), chronic diseases (n=6), cardiovascular diseases (n=4) and cognitive impairment (n=1). Available evidence showed consistently that non-/never-smokers experience more healthy life years throughout their lives than smokers. Findings were inconsistent on the effect of smoking on the absolute number of unhealthy life years. Findings concerning the time proportionally spent unhealthy were less heterogeneous: nearly all included articles reported that non-/never-smokers experience relatively less unhealthy life years (e.g. relative compression of morbidity). CONCLUSIONS Support for the relative compression of morbidity due to smoking elimination was evident. Further research is needed into the absolute compression of morbidity hypothesis since current evidence is mixed, and methodology of studies needs to be harmonized.
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Affiliation(s)
- Charlotte M Dieteren
- Department of Health Economics, Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Timor Faber
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Job van Exel
- Department of Health Economics, Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Werner B F Brouwer
- Department of Health Economics, Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Cuthbertson CC, Nichols HB, Tan X, Kucharska-Newton A, Heiss G, Joshu CE, Platz EA, Evenson KR. Associations of Leisure-Time Physical Activity and Television Viewing with Life Expectancy Cancer-Free at Age 50: The ARIC Study. Cancer Epidemiol Biomarkers Prev 2020; 29:2617-2625. [PMID: 32978174 PMCID: PMC7710595 DOI: 10.1158/1055-9965.epi-20-0870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/29/2020] [Accepted: 09/22/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Physical activity has been associated with longer chronic disease-free life expectancy, but specific cancer types have not been investigated. We examined whether leisure-time moderate-to-vigorous physical activity (LTPA) and television (TV) viewing were associated with life expectancy cancer-free. METHODS We included 14,508 participants without a cancer history from the Atherosclerosis Risk in Communities (ARIC) study. We used multistate survival models to separately examine associations of LTPA (no LTPA, RESULTS Compared with no LTPA, participants who engaged in LTPA ≥median had a greater life expectancy cancer-free from colorectal [men-2.2 years (95% confidence interval (CI), 1.7-2.7), women-2.3 years (95% CI, 1.7-2.8)], lung [men-2.1 years (95% CI, 1.5-2.6), women-2.1 years (95% CI, 1.6-2.7)], prostate [1.5 years (95% CI, 0.8-2.2)], and postmenopausal breast cancer [2.4 years (95% CI, 1.4-3.3)]. Compared with watching TV often/very often, participants who seldom/never watched TV had a greater colorectal, lung, and postmenopausal breast cancer-free life expectancy of ∼1 year. CONCLUSIONS Participating in LTPA was associated with longer life expectancy cancer-free from colorectal, lung, prostate, and postmenopausal breast cancer. Viewing less TV was associated with more years lived cancer-free from colorectal, lung, and postmenopausal breast cancer. IMPACT Increasing physical activity and reducing TV viewing may extend the number of years lived cancer-free.
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Affiliation(s)
- Carmen C Cuthbertson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xianming Tan
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Muchira JM, Gona PN, Mogos MF, Stuart-Shor E, Leveille SG, Piano MR, Hayman LL. Parental cardiovascular health predicts time to onset of cardiovascular disease in offspring. Eur J Prev Cardiol 2020; 29:883-891. [PMID: 33624039 DOI: 10.1093/eurjpc/zwaa072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/18/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) risk factors are transmitted from parents to children. We prospectively examined the association between parental cardiovascular health (CVH) and time to onset of CVD in the offspring. METHODS AND RESULTS The study consisted of a total of 5967 offspring-mother-father trios derived from the Framingham Heart Study. Cardiovascular health score was defined using the seven American Heart Association's CVH metrics attained at ideal levels: poor (0-2), intermediate (3-4), and ideal CVH (5-7). Multivariable-adjusted Cox proportional hazards regression models, Kaplan-Meier plots, and Irwin's restricted mean were used to examine the association and sex-specific differences between parental CVH and offspring's CVD-free survival. In a total of 71 974 person-years of follow-up among the offspring, 718 incident CVD events occurred. The overall CVD incidence rate was 10 per 1000 person-years [95% confidence interval (CI) 9.3-10.7]. Offspring of mothers with ideal CVH lived 9 more years free of CVD than offspring of mothers with poor CVH (P < 0.001). Maternal poor CVH was associated with twice as high hazard of early onset of CVD compared with maternal ideal CVH (adjusted Hazard Ratio 2.09, 95% CI 1.50-2.92). No statistically significant association was observed in the hazards of CVD-free survival by paternal CVH categories. CONCLUSIONS We found that offspring of parents with ideal CVH had a greater CVD-free survival. Maternal CVH was a more robust predictor of offspring's CVD-free survival than paternal CVH, underscoring the need for clinical and policy interventions that involve mothers to break the intergenerational cycle of CVD-related morbidity and mortality.
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Affiliation(s)
- James M Muchira
- Center for Research Development and Scholarship, Vanderbilt University, School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA.,College of Nursing and Health Sciences, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA 02125, USA
| | - Philimon N Gona
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA 02125, USA
| | - Mulubrhan F Mogos
- Center for Research Development and Scholarship, Vanderbilt University, School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Eileen Stuart-Shor
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA 02125, USA.,Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA 02125, USA.,Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.,Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Mariann R Piano
- Center for Research Development and Scholarship, Vanderbilt University, School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Laura L Hayman
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 William T Morrissey Blvd, Boston, MA 02125, USA.,Division of Preventive & Behavioral Medicine, Department of Population & Quantitative Health Sciences, UMass Medical School, 368 Plantation Street, Worcester, MA 01605, USA
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11
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Behavioural risk factors and healthy life expectancy: evidence from two longitudinal studies of ageing in England and the US. Sci Rep 2020; 10:6955. [PMID: 32332825 PMCID: PMC7181761 DOI: 10.1038/s41598-020-63843-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/07/2020] [Indexed: 01/19/2023] Open
Abstract
We examined whether the co-occurrence of four behavioural risk factors (alcohol consumption, smoking, physical inactivity and obesity) is associated with disability-free and chronic disease-free life expectancy similarly in two longitudinal studies of ageing in England and the United States. Data were from 17,351 individuals aged 50+ from the US Health and Retirement Study (HRS) and, 10,388 from the English Longitudinal Study of Ageing (ELSA), from 2002 to 2013. Disability-free life expectancy was estimated using repeat measures of limitations with instrumental activities and activities of daily living and, chronic disease-free life expectancy was based on chronic health conditions. Multistate life table models were used to estimate sex-specific health expectancy at the ages of 50, 60 and 70. In both countries and at all ages, there was a clear gradient towards shorter health expectancy with increasing number of behavioural risk factors. Compared to people with 2+ behavioural risk factors, in both countries, those with no behavioural risk factors could expect to live up to 11 years longer without disability and, up to 12 years longer without chronic conditions. Individual and co-occurring behavioural risk factors were strongly associated with shorter healthy life expectancy in both countries, attesting to the robustness of the contribution of lifestyle factors on health expectancy.
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12
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Li Y, Schoufour J, Wang DD, Dhana K, Pan A, Liu X, Song M, Liu G, Shin HJ, Sun Q, Al-Shaar L, Wang M, Rimm EB, Hertzmark E, Stampfer MJ, Willett WC, Franco OH, Hu FB. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 2020; 368:l6669. [PMID: 31915124 PMCID: PMC7190036 DOI: 10.1136/bmj.l6669] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.
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Affiliation(s)
- Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Josje Schoufour
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- Faculty of Sports and Nutrition, ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Dong D Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Klodian Dhana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoran Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Gang Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hyun Joon Shin
- Division of General Internal Medicine, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laila Al-Shaar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Timmermans EJ, Hoogendijk EO, Broese van Groenou MI, Comijs HC, van Schoor NM, Thomése FCF, Visser M, Deeg DJH, Huisman M. Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands. Eur J Public Health 2019; 29:1096-1102. [PMID: 31008512 PMCID: PMC6896978 DOI: 10.1093/eurpub/ckz065] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Monitoring of trends in functioning of older adults provides indispensable information for health care policy. This study examined trends in multiple indicators of functioning among Dutch older adults across a period of 20 years. METHODS Data from the Longitudinal Aging Study Amsterdam were used. We included 10 870 observations of 3803 respondents aged 64-84 years across seven waves (1992-12) and 931 observations of 603 respondents aged 85-94 years across four waves (2001-12). At each wave, 8 indicators of functioning were measured: multimorbidity, severe functional limitations, depression, anxiety, cognitive impairment, physical inactivity, loneliness and social isolation. In addition, a sum score (range: 0-8) of these indicators was calculated, with a score of ≥5 indicating 'multiple problems.' Trends in functioning over time were assessed using Generalized Estimating Equation analyses. RESULTS In the 64-84-years-olds, the prevalence of multimorbidity increased over time [OR(year) = 1.06, 95% CI = 1.05-1.06], whereas the prevalence of the other indicators decreased [i.e. cognitive impairment, physical inactivity (in women) and loneliness (in women)] or remained stable [i.e. severe functional limitations, depression, anxiety, physical inactivity (in men), loneliness (in men) and social isolation]. In the 85-94-year-olds, the prevalence of severe functional limitations increased over time [OR(year) = 1.08, 95% CI = 1.02-1.13], whereas the prevalence of the other indicators remained stable. In both age groups, the prevalence of 'multiple problems' remained stable. CONCLUSION Unfavorable trends were observed in multimorbidity among 64-84-years-olds and in severe functional limitations among 85-94-year-olds. Favorable trends were found in cognitive impairment, physical inactivity (in women) and loneliness (in women) among 64-84-years-olds.
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Affiliation(s)
- Erik J Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | | | - Hannie C Comijs
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Fleur C F Thomése
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Cuthbertson CC, Tan X, Heiss G, Kucharska‐Newton A, Nichols HB, Kubota Y, Evenson KR. Associations of Leisure-Time Physical Activity and Television Viewing With Life Expectancy Free of Nonfatal Cardiovascular Disease: The ARIC Study. J Am Heart Assoc 2019; 8:e012657. [PMID: 31495291 PMCID: PMC6818021 DOI: 10.1161/jaha.119.012657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Background High levels of physical activity have been associated with longer life expectancy free of cardiovascular disease (CVD), but specific types of CVD and sedentary behavior have not been examined. We examined associations of leisure-time moderate-to-vigorous physical activity (LTPA) and television viewing with life expectancy free of 3 types of CVD. Methods and Results We included 13 534 participants from the ARIC (Atherosclerosis Risk in Communities) cohort. We used multistate survival models to estimate associations of LTPA in the past year (no LTPA, less than the median, equal to or greater than the median) and television viewing (often or very often, sometimes, seldom or rarely) with life expectancy at age 50 free of nonfatal coronary heart disease (CHD), stroke, and heart failure (HF). Over 27 years of follow-up, 4519 participants developed one of the 3 nonfatal CVDs and 5475 deaths occurred. Compared with participants who engaged in no LTPA, participants who engaged in LTPA equal to or greater than the median had longer life expectancy free of nonfatal CHD (men: 1.5 years [95% CI, 1.0-2.0]; women: 1.6 years [95% CI, 1.1-2.2]), stroke (men: 1.8 years [95% CI, 1.2-2.3]; women: 1.8 years [95% CI, 1.3-2.3]), and HF (men: 1.6 years [95% CI, 1.1-2.1]; women: 1.7 years [95% CI, 1.2-2.2]). Compared with viewing more television, watching less television was associated with longer life expectancy free of CHD, stroke, and HF (≈0.8 year). Conclusions Higher levels of LTPA and less television viewing were associated with longer life expectancy free of CHD, stroke, and HF. Engaging in LTPA and watching less television may increase the number of years lived free of CHD, stroke, and HF.
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Affiliation(s)
| | - Xianming Tan
- Department of BiostatisticsUniversity of North Carolina at Chapel HillNC
| | - Gerardo Heiss
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
| | | | - Hazel B. Nichols
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
| | - Yasuhiko Kubota
- Osaka Center for Cancer and Cardiovascular Disease PreventionOsakaJapan
| | - Kelly R. Evenson
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
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16
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Nyberg ST, Batty GD, Pentti J, Virtanen M, Alfredsson L, Fransson EI, Goldberg M, Heikkilä K, Jokela M, Knutsson A, Koskenvuo M, Lallukka T, Leineweber C, Lindbohm JV, Madsen IEH, Magnusson Hanson LL, Nordin M, Oksanen T, Pietiläinen O, Rahkonen O, Rugulies R, Shipley MJ, Stenholm S, Suominen S, Theorell T, Vahtera J, Westerholm PJM, Westerlund H, Zins M, Hamer M, Singh-Manoux A, Bell JA, Ferrie JE, Kivimäki M. Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study. Lancet Public Health 2018; 3:e490-e497. [PMID: 30177479 PMCID: PMC6178874 DOI: 10.1016/s2468-2667(18)30139-7] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight. METHODS We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991-2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18·5 kg/m2), overweight (≥25 kg/m2 to <30 kg/m2), and obesity (class I [mild] ≥30 kg/m2 to <35 kg/m2; class II-III [severe] ≥35 kg/m2) compared with normal weight (≥18·5 kg/m2 to <25 kg/m2) were estimated. FINDINGS Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0·4%) were underweight, 21 468 (45·6%) normal weight, 20 738 (44·0%) overweight, 3982 (8·4%) class I obese, and 728 (1·5%) class II-III obese. The corresponding numbers among the 73 054 women were 1493 (2·0%), 44 760 (61·3%), 19 553 (26·8%), 5670 (7·8%), and 1578 (2·2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11·5 years [range 6·3-18·6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29·3 (95% CI 28·8-29·8) in normal-weight men and 29·4 (28·7-30·0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1·8 (95% CI -1·3 to 4·9) for underweight, 1·1 (0·7 to 1·5) for overweight, 3·9 (2·9 to 4·9) for class I obese, and 8·5 (7·1 to 9·8) for class II-III obese. The corresponding estimates for women were 0·0 (-1·4 to 1·4) for underweight, 1·1 (0·6 to 1·5) for overweight, 2·7 (1·5 to 3·9) for class I obese, and 7·3 (6·1 to 8·6) for class II-III obese. The loss of disease-free years associated with class II-III obesity varied between 7·1 and 10·0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit. INTERPRETATION Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy. FUNDING NordForsk, UK Medical Research Council, US National Institute on Aging, Academy of Finland, Helsinki Institute of Life Science, and Cancer Research UK.
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Affiliation(s)
- Solja T Nyberg
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jaana Pentti
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Marianna Virtanen
- Finnish Institute of Occupational Health, Helsinki, Finland; Institute of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Stress Research Institute, University of Stockholm, Stockholm, Sweden
| | - Lars Alfredsson
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eleonor I Fransson
- Stress Research Institute, University of Stockholm, Stockholm, Sweden; School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marcel Goldberg
- Paris Descartes University, Paris, France; Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Katriina Heikkilä
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons, London, UK
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anders Knutsson
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Markku Koskenvuo
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Joni V Lindbohm
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ida E H Madsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Maria Nordin
- Stress Research Institute, University of Stockholm, Stockholm, Sweden; Department of Psychology, Umeå University, Umeå, Sweden
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Olli Pietiläinen
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Public Health and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; University of Skövde, School of Health and Education, Skövde, Sweden
| | - Töres Theorell
- Stress Research Institute, University of Stockholm, Stockholm, Sweden
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Hugo Westerlund
- Stress Research Institute, University of Stockholm, Stockholm, Sweden
| | - Marie Zins
- Paris Descartes University, Paris, France; Inserm UMS 011, Population-Based Epidemiological Cohorts Unit, Villejuif, France
| | - Mark Hamer
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK; Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Joshua A Bell
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jane E Ferrie
- Department of Epidemiology and Public Health, University College London, London, UK; Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Mika Kivimäki
- Clinicum, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK
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Leskinen T, Stenholm S, Aalto V, Head J, Kivimäki M, Vahtera J. Physical activity level as a predictor of healthy and chronic disease-free life expectancy between ages 50 and 75. Age Ageing 2018; 47:423-429. [PMID: 29546375 DOI: 10.1093/ageing/afy016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 02/05/2018] [Indexed: 12/14/2022] Open
Abstract
Background physical activity promotes healthy aging. However, little is known about the relationship between physical activity levels and healthy and chronic disease-free life expectancy (LE). The study aim was to examine healthy and chronic disease-free LE between ages 50 and 75 and across various levels of physical activity by sex and different occupational statuses. Methods overall, 34,379 women (mean age 53.2 (SD 2.9) years) and 8,381 men (53.6 (SD 3.2) years) from the Finnish Public Sector study were categorized into five physical activity levels (inactive to vigorously active) according to self-reported physical activity and into three occupational statuses at the first observation point. Partial LE between ages 50 and 75 based on discrete-time multistate life table models was defined using two health indicators: healthy LE based on self-rated health and chronic disease-free LE based on chronic diseases. The average follow-up time for health indicators was 6.8 (SD 5.2) years. Results a clear dose-response relationship between higher physical activity levels and increased healthy and chronic disease-free LE in men and women, and within occupational statuses was found. On average, vigorously active men and women lived 6.3 years longer in good health and 2.9 years longer without chronic diseases between ages 50 and 75 compared to inactive individuals. The difference in years in good health between vigorously active and inactive individuals was the largest in individuals with low occupation status (6.7 years). Conclusion higher levels of physical activity increase healthy and chronic disease-free years similarly in men and women, but more among persons with low than with high occupational status.
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Affiliation(s)
- Tuija Leskinen
- Department of Public Health, University of Turku and Turku University Hospital, Turku Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku Finland
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Turku, Finland
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Turku, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku Finland
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Mytton OT, Tainio M, Ogilvie D, Panter J, Cobiac L, Woodcock J. The modelled impact of increases in physical activity: the effect of both increased survival and reduced incidence of disease. Eur J Epidemiol 2017; 32:235-250. [PMID: 28258521 PMCID: PMC5380706 DOI: 10.1007/s10654-017-0235-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/20/2017] [Indexed: 12/21/2022]
Abstract
Physical activity can affect ‘need’ for healthcare both by reducing the incidence rate of some diseases and by increasing longevity (increasing the time lived at older ages when disease incidence is higher). However, it is common to consider only the first effect, which may overestimate any reduction in need for healthcare. We developed a hybrid micro-simulation lifetable model, which made allowance for both changes in longevity and risk of disease incidence, to estimate the effects of increases in physical activity (all adults meeting guidelines) on measures of healthcare need for diseases for which physical activity is protective. These were compared with estimates made using comparative risk assessment (CRA) methods, which assumed that longevity was fixed. Using the lifetable model, life expectancy increased by 95 days (95% uncertainty intervals: 68–126 days). Estimates of the healthcare need tended to decrease, but the magnitude of the decreases were noticeably smaller than those estimated using CRA methods (e.g. dementia: change in person-years, −0.6%, 95% uncertainty interval −3.7% to +1.6%; change in incident cases, −0.4%, −3.6% to +1.9%; change in person-years (CRA methods), −4.0%, −7.4% to −1.6%). The pattern of results persisted under different scenarios and sensitivity analyses. For most diseases for which physical activity is protective, increases in physical activity are associated with decreases in indices of healthcare need. However, disease onset may be delayed or time lived with disease may increase, such that the decreases in need may be relatively small and less than is sometimes expected.
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Affiliation(s)
- Oliver T Mytton
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Marko Tainio
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Systems Research Institute, Polish Academy of Sciences, Newelska 6, 01-447, Warsaw, Poland
| | - David Ogilvie
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Jenna Panter
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Linda Cobiac
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, Carlton, VIC, 3053, Australia
| | - James Woodcock
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study. Int J Obes (Lond) 2017; 41:769-775. [PMID: 28138135 PMCID: PMC5418561 DOI: 10.1038/ijo.2017.29] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 01/02/2017] [Accepted: 01/20/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies. METHODS Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5-24.9 kg m-2) to obesity class II (⩾35 kg m-2). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category. RESULTS The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts. CONCLUSIONS Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.
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Dhana K, Koolhaas CM, Berghout MA, Peeters A, Ikram MA, Tiemeier H, Hofman A, Nusselder W, Franco OH. Physical activity types and life expectancy with and without cardiovascular disease: the Rotterdam Study. J Public Health (Oxf) 2016; 39:e209-e218. [DOI: 10.1093/pubmed/fdw110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/01/2016] [Indexed: 11/12/2022] Open
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Lhachimi SK, Nusselder WJ, Smit HA, Baili P, Bennett K, Fernández E, Kulik MC, Lobstein T, Pomerleau J, Boshuizen HC, Mackenbach JP. Potential health gains and health losses in eleven EU countries attainable through feasible prevalences of the life-style related risk factors alcohol, BMI, and smoking: a quantitative health impact assessment. BMC Public Health 2016; 16:734. [PMID: 27495151 PMCID: PMC4975898 DOI: 10.1186/s12889-016-3299-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 07/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models. METHODS For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the "worst practice", "best practice", and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported. RESULTS Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases). CONCLUSION Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior.
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Affiliation(s)
- Stefan K. Lhachimi
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Research Group for Evidence Based Public Health, Institute for Public Health and Nursing, University Bremen & Leibniz Institute for Epidemiology and Prevention Research, Bremen, Germany
- Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Public Health, Heinrich Heine University, Duesseldorf, Germany
| | - Wilma J. Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Paolo Baili
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity Centre for health sciences, St James’s Hospital, Dublin, Ireland
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat Barcelona, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Margarete C. Kulik
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Tim Lobstein
- IASO -the International Association for the Study of Obesity, IOTF -the International Obesity TaskForce, London, UK
| | - Joceline Pomerleau
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
| | - Hendriek C. Boshuizen
- Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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O'Doherty MG, Cairns K, O'Neill V, Lamrock F, Jørgensen T, Brenner H, Schöttker B, Wilsgaard T, Siganos G, Kuulasmaa K, Boffetta P, Trichopoulou A, Kee F. Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES). Eur J Epidemiol 2016; 31:455-68. [PMID: 26781655 PMCID: PMC4901087 DOI: 10.1007/s10654-015-0112-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/13/2015] [Indexed: 12/26/2022]
Abstract
Seldom have studies taken account of changes in lifestyle habits in the elderly, or investigated their impact on disease-free life expectancy (LE) and LE with cardiovascular disease (CVD). Using data on subjects aged 50+ years from three European cohorts (RCPH, ESTHER and Tromsø), we used multi-state Markov models to calculate the independent and joint effects of smoking, physical activity, obesity and alcohol consumption on LE with and without CVD. Men and women aged 50 years who have a favourable lifestyle (overweight but not obese, light/moderate drinker, non-smoker and participates in vigorous physical activity) lived between 7.4 (in Tromsø men) and 15.7 (in ESTHER women) years longer than those with an unfavourable lifestyle (overweight but not obese, light/moderate drinker, smoker and does not participate in physical activity). The greater part of the extra life years was in terms of “disease-free” years, though a healthy lifestyle was also associated with extra years lived after a CVD event. There are sizeable benefits to LE without CVD and also for survival after CVD onset when people favour a lifestyle characterized by salutary behaviours. Remaining a non-smoker yielded the greatest extra years in overall LE, when compared to the effects of routinely taking physical activity, being overweight but not obese, and drinking in moderation. The majority of the overall LE benefit is in disease free years. Therefore, it is important for policy makers and the public to know that prevention through maintaining a favourable lifestyle is “never too late”.
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Affiliation(s)
- Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Karen Cairns
- Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Vikki O'Neill
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK
| | - Felicity Lamrock
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.,Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Tom Wilsgaard
- Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway
| | - Galatios Siganos
- Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway
| | - Kari Kuulasmaa
- Department of Health, National Institute for Health and Welfare (THL), 00271, Helsinki, Finland
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, 10029, USA.,Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos str., 115 27, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos str., 115 27, Athens, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Mikras Asias 75 st, 115 27, Athens, Greece
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK
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23
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Kobza J, Geremek M. Exploring the Life Expectancy Increase in Poland in the Context of CVD Mortality Fall: The Risk Assessment Bottom-Up Approach, From Health Outcome to Policies. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2015; 52:0046958015613091. [PMID: 26546595 PMCID: PMC5813646 DOI: 10.1177/0046958015613091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Life expectancy at birth is considered the best mortality-based summary indicator of the health status of the population and is useful for measuring long-term health changes. The objective of this article was to present the concept of the bottom-up policy risk assessment approach, developed to identify challenges involved in analyzing risk factor reduction policies and in assessing how the related health indicators have changed over time. This article focuses on the reasons of the significant life expectancy prolongation in Poland over the past 2 decades, thus includes policy context. The methodology details a bottom-up risk assessment approach, a chain of relations between the health outcome, risk factors, and health policy, based on Risk Assessment From Policy to Impact Dimension project guidance. A decline in cardiovascular disease mortality was a key factor that followed life expectancy prolongation. Among basic factors, tobacco and alcohol consumption, diet, physical activity, and new treatment technologies were identified. Poor health outcomes of the Polish population at the beginning of 1990s highlighted the need of the implementation of various health promotion programs, legal acts, and more effective public health policies. Evidence-based public health policy needs translating scientific research into policy and practice. The bottom-up case study template can be one of the focal tools in this process. Accountability for the health impact of policies and programs and legitimization of the decisions of policy makers has become one of the key questions nowadays in European countries' decision-making process and in EU public health strategy.
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Affiliation(s)
- Joanna Kobza
- Public Health Department, Medical University of Silesia, Bytom, Poland
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24
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Heiwe S, Jacobson SH. Exercise Training in Adults With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2014; 64:383-93. [DOI: 10.1053/j.ajkd.2014.03.020] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 03/18/2014] [Indexed: 01/23/2023]
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25
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Prinsloo EAM, Joubert G, Mohale M, Nyindi N, Matu N, Ntechane L, Struwig MC. The prevalence and perception of obesity and its association with the lifestyle of women at the Mangaung University Community Partnership Project healthcare centre, Bloemfontein. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2011.10874116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- EAM Prinsloo
- Department of Family Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Abu Dahbi, Al Ain, United Arab Emirates
| | - G Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - M Mohale
- School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - N Nyindi
- School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - N Matu
- School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - L Ntechane
- School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - MC Struwig
- Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein
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Abstract
The ageing of European populations presents health, long-term care, and welfare systems with new challenges. Although reports of ageing as a fundamental threat to the welfare state seem exaggerated, societies have to embrace various policy options to improve the robustness of health, long-term care, and welfare systems in Europe and to help people to stay healthy and active in old age. These policy options include prevention and health promotion, better self-care, increased coordination of care, improved management of hospital admissions and discharges, improved systems of long-term care, and new work and pension arrangements. Ageing of the health workforce is another challenge, and policies will need to be pursued that meet the particular needs of older workers (ie, those aged 50 years or older) while recruiting young practitioners.
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Affiliation(s)
- Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK.
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Sabia S, Singh-Manoux A, Hagger-Johnson G, Cambois E, Brunner EJ, Kivimaki M. Influence of individual and combined healthy behaviours on successful aging. CMAJ 2012; 184:1985-92. [PMID: 23091184 DOI: 10.1503/cmaj.121080] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Increases in life expectancy make it important to remain healthy for as long as possible. Our objective was to examine the extent to which healthy behaviours in midlife, separately and in combination, predict successful aging. METHODS We used a prospective cohort design involving 5100 men and women aged 42-63 years. Participants were free of cancer, coronary artery disease and stroke when their health behaviours were assessed in 1991-1994 as part of the Whitehall II study. We defined healthy behaviours as never smoking, moderate alcohol consumption, physical activity (≥ 2.5 h/wk moderate physical activity or ≥ 1 h/wk vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes). RESULTS At the end of follow-up, 549 participants had died and 953 qualified as aging successfully. Compared with participants who engaged in no healthy behaviours, participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging (95% confidence interval [CI] 2.1-5.1). The association with successful aging was linear, with the odds ratio (OR) per increment of healthy behaviour being 1.3 (95% CI 1.2-1.4; population-attributable risk for 1-4 v. 0 healthy behaviours 47%). When missing data were considered in the analysis, the results were similar to those of our main analysis. INTERPRETATION Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. We did not investigate the mechanisms underlying these associations, but we saw clear evidence of the importance of healthy behaviours for successful aging.
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Affiliation(s)
- Séverine Sabia
- Department of Epidemiology and Public Health, University College London, London, UK.
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28
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Charansonney O. [Physical activity and aging: opposing physiologic effects]. Ann Cardiol Angeiol (Paris) 2012; 61:365-9. [PMID: 22985596 DOI: 10.1016/j.ancard.2012.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 08/07/2012] [Indexed: 01/23/2023]
Abstract
The benefits of physical activity in preventing premature mortality have been established by a large set of epidemiological studies. These benefits have been shown both in middle-aged and elderly individuals. Furthermore, the reduction of acute events such as myocardial infarction observed with higher levels of physical activity together with the increase in disease-free life expectancy among the most active individuals supports physical activity's antiaging effect. This review highlights two models supporting this effect. The first model describes the path to frailty and the second explains that immobilization is a stressor which triggers stress-responses responsible for many chronic diseases. Aging reduces the physiological reserve and can lead to frailty when this reserve cannot allow an appropriate adaptation of the aging body to environmental challenges. The components of this physiological reserve can easily be measured by cardiorespiratory testing. Among them are heart rate reserve and VO(2)max, the maximal body oxygen consumption. The opposite effects of exercise training and aging on the physiological reserve are detailed. Sedentary lifestyle accelerates the effects of aging in susceptible individuals. Sedentary lifestyle induces mechanisms which lead to risk factors of chronic diseases and, eventually, to premature death. These inappropriate mechanisms and their consequences constitute the sedentary lifestyle syndrome.
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Affiliation(s)
- O Charansonney
- Service de cardiologie, centre médical de Bligny, 91640 Briis sous Forges, France.
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29
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Does physical activity increase life expectancy? A review of the literature. J Aging Res 2012; 2012:243958. [PMID: 22811911 PMCID: PMC3395188 DOI: 10.1155/2012/243958] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 03/19/2012] [Accepted: 04/13/2012] [Indexed: 01/23/2023] Open
Abstract
Physical activity reduces many major mortality risk factors including arterial hypertension, diabetes mellitus type 2, dyslipidemia, coronary heart disease, stroke, and cancer. All-cause mortality is decreased by about 30% to 35% in physically active as compared to inactive subjects. The purpose of this paper was to synthesize the literature on life expectancy in relation to physical activity. A systematic PubMed search on life expectancy in physically active and inactive individuals was performed. In addition, articles comparing life expectancy of athletes compared to that of nonathletes were reviewed. Results of 13 studies describing eight different cohorts suggest that regular physical activity is associated with an increase of life expectancy by 0.4 to 6.9 years. Eleven studies included confounding risk factors for mortality and revealed an increase in life expectancy by 0.4 to 4.2 years with regular physical activity. Eleven case control studies on life expectancy in former athletes revealed consistently greater life expectancy in aerobic endurance athletes but inconsistent results for other athletes. None of these studies considered confounding risk factors for mortality. In conclusion, while regular physical activity increases life expectancy, it remains unclear if high-intensity sports activities further increase life expectancy.
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Abstract
Although the increased lifespan of our populations illustrates the success of modern medicine, the risk of developing many diseases increases exponentially with old age. Caloric restriction is known to retard ageing and delay functional decline as well as the onset of disease in most organisms. Studies have implicated the sirtuins (SIRT1-SIRT7) as mediators of key effects of caloric restriction during ageing. Two unrelated molecules that have been shown to increase SIRT1 activity in some settings, resveratrol and SRT1720, are excellent protectors against metabolic stress in mammals, making SIRT1 a potentially appealing target for therapeutic interventions. This Review covers the current status and controversies surrounding the potential of sirtuins as novel pharmacological targets, with a focus on SIRT1.
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Abstract
PURPOSE OF REVIEW Prolonged sitting (sedentary behavior) has deleterious cardiovascular and metabolic correlates; however, little is known about the associations of too much sitting with all-cause and cardiovascular mortality risk. In addition to the adverse effects of total sitting time, the manner in which it is accumulated has also been postulated to be important for cardiovascular health. RECENT FINDINGS We describe recent evidence from several research papers published in the last 12-18 months, showing deleterious relationships of sedentary behavior with mortality outcomes. We also explore emerging findings on breaking up sedentary time and its potential beneficial impact on cardiovascular health. SUMMARY Consistent independent associations have been observed between sitting time/sedentary behaviors and elevated all-cause and cardiovascular disease mortality risk. Generally, these associations have persisted following adjustment for physical activity. Furthermore, total sedentary time (measured objectively via accelerometer) is detrimentally associated with several cardiovascular risk factors, whereas breaking up sedentary time (independent of total sedentary time and moderate-to-vigorous intensity activity) is beneficially associated. This evidence provides further support to the importance of avoiding prolonged, uninterrupted periods of sitting time for cardiovascular health. However, further evidence from intervention trials is required to establish the causal pathways.
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Affiliation(s)
- David W Dunstan
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Abstract
This article discusses various theories of aging and their relative plausibility related to the human aging process. Structural and physiologic changes of aging are discussed in detail by organ system. Each of the organ systems is discussed when applicable to the various theories of aging. Normal versus abnormal aging is discussed in the context of specific aging processes, with atypical presentations of disease and general links to life expectancy. Life expectancy and lifespan are discussed in the context of advances in medical science and the potential ultimate link to human life span.
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Affiliation(s)
- Charles A Cefalu
- Department of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70113, USA.
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Majer IM, Nusselder WJ, Mackenbach JP, Kunst AE. Life expectancy and life expectancy with disability of normal weight, overweight, and obese smokers and nonsmokers in Europe. Obesity (Silver Spring) 2011; 19:1451-9. [PMID: 21415846 DOI: 10.1038/oby.2011.46] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of this study was to estimate life expectancy (LE) and LE with disability (LwD) among normal weight, overweight, and obese smokers and nonsmokers in Western Europe. Data from four waves (1998-2001) of the European Community Household Panel (ECHP) were used; a standardized multipurpose annual longitudinal survey. Self-reported health and socioeconomic information was collected repeatedly using uniform questionnaires for 66,331 individuals in nine countries. Health status was measured in terms of disability in daily activities. Multistate Markov (MSM) models were applied to obtain hazard ratios (HRs) and age-specific transition rates according to BMI and smoking status. Multistate life tables were computed using the predicted transition probabilities to estimate LE and LwD. Significant associations were observed between disability incidence and BMI (HR = 1.15 for overweight, HR = 1.64 for obese, compared to normal weight). The risk of mortality was negatively associated with overweight status among disabled (HR = 0.77). Overweight people had higher LE than people with normal-weight and obesity. Among women, overweight and obese nonsmokers expect 3.6 and 6.1 more years of LwD than normal weight persons, respectively. In contrast, daily smokers expect lower LE but a similar LwD. The same patterns were observed among people with high education and those with low education. To conclude, daily smoking is associated with mortality more than with disability, whereas obesity is associated with disability more than with mortality. The findings suggest that further tobacco control would contribute to increasing LE, while tackling the obesity epidemic is necessary to prevent an expansion of disability.
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Affiliation(s)
- Istvan M Majer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Franklin BA, Brinks J, Fowler A. Physical Activity, Weight Loss, and Cardiac Rehabilitation to Reduce Recurrent Cardiovascular Events. CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0176-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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35
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Yach D. From Framingham to the Framework Convention on Tobacco Control. Prog Cardiovasc Dis 2010; 53:52-4. [PMID: 20620426 DOI: 10.1016/j.pcad.2010.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Klijs B, Nusselder WJ, Mackenbach JP. [Compression of morbidity: a promising approach to alleviate the societal consequences of population ageing?]. Tijdschr Gerontol Geriatr 2010; 40:228-36. [PMID: 20073271 DOI: 10.1007/bf03088516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is an urgent need for strategies that alleviate the societal consequences of population ageing. A possible strategy is aiming for compression of morbidity. Some of the initial conditions for a compression of morbidity have been invalidated. This is, the life expectancy has shown a much stronger increase than was expected and the modal age at death has exceeded the age of 85. Additionally, trend studies have found no consistent evidence for a compression of morbidity. At the department of Public Health, we aim at identifying entry-points for a compression. For example, an analysis was performed on potential contributions of changes in exposure to life style factors (smoking, hypertension, physical inactivity and overweight/obesity) to compression of cardiovascular disease, using multi-state life tables with data from the Framingham Heart Study. It was shown that smoking and physical inactivity increased the incidence of cardiovascular disease, as well as mortality with and without cardiovascular disease. Hypertension and overweight mainly increased the incidence of cardiovascular disease and were associated with a shorter lifespan and more years with cardiovascular disease. Interventions on the latter risk factors will therefore increase the life expectancy, but will also result in a compression of morbidity. For policymakers and researchers it is important to find a mix of interventions that lead to a comparable overall effect.
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Affiliation(s)
- B Klijs
- Afdeling Maatschappelijke Gezondheidszorg, Erasmus MC, Rotterdam.
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