Impact of Combined Lifestyle Factors on All-Cause and Cause-Specific Mortality and Life Expectancy in Chinese: The Singapore Chinese Health Study

Abstract Background To examine the impact of combined lifestyle factors on premature mortality and life expectancy in Chinese adults. Methods A total of 44,052 Chinese adults aged 45–74 years free of cardiovascular disease (CVD), cancer, and diabetes were followed from recruitment (1993–1998) to the end of 2016 in the Singapore Chinese Health Study. A composite score (0–5 scale) was calculated based on five baseline healthy lifestyle factors including healthy diet, nonsmoking status, light to moderate alcohol drinking, being physically active and optimal body mass index. Mortality cases were identified through linkage with the nationwide death registry. Results Adopting five healthy versus none was associated with a lower risk of all-cause and cause-specific mortality, and the hazard ratio (95% confidence interval [CI]) was 0.38 (0.29, 0.51) for all-cause mortality, 0.26 (0.13, 0.52) for CVD mortality, and 0.59 (0.37, 0.92) for cancer mortality. Nonadherence to 4–5 healthy lifestyle factors accounted for 34.9% (95% CI = 29.2, 40.2) in population attributable fraction for all-cause mortality, 35.1% (23.7, 44.9) for CVD mortality, and 18.0% (6.5, 28.0) for cancer mortality. Conversely, adherence to 4–5 healthy lifestyle factors versus none could achieve a gain of 8.1 years in women and 6.6 years in men for the life expectancy at 50 years. Conclusions A healthier lifestyle is associated with a substantially reduced risk of mortality and a longer life expectancy in the Chinese population. Our findings highlight the necessity of coordinated actions targeting combined lifestyle factors in reducing the overall burden of diseases and premature deaths.

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Association Between Combined Lifestyle Factors and Healthy Ageing in Chinese Adults: The Singapore Chinese Health Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab033 ◽

2021 ◽

Author(s):

Yan-Feng Zhou ◽

Xing-Yue Song ◽

Xiong-Fei Pan ◽

Lei Feng ◽

Nan Luo ◽

...

Keyword(s):

Healthy Lifestyle ◽

Population Attributable Risk ◽

Lifestyle Factors ◽

Healthy Eating Index ◽

Healthy Ageing ◽

Health Study ◽

Moderate Activity ◽

Chinese Adults ◽

Singapore Chinese

Abstract Background The aim of the study was to examine the relations of individual lifestyle factors and its composite score with healthy ageing among Chinese adults. Method We included 14 159 participants aged 45–74 years at baseline from the Singapore Chinese Health Study, a population-based prospective cohort. A protective lifestyle score (0–5 scale) was calculated at baseline (1993–1998) and updated at the second follow-up visit (2006–2010) on the basis of optimal body mass index (18.5–22.9 kg/m2), healthy diet (upper 40% of the Alternative Healthy Eating Index score), being physically active (≥2 h/wk of moderate activity or ≥0.5 h/wk of strenuous activity), nonsmoking (never smoking), and low-to-moderate alcohol drinking (>0 to ≤14 drinks/wk for men and >0 to ≤7 drinks/wk for women). Healthy ageing was assessed at the third follow-up visit (2014–2016) and was defined as absence of specific chronic diseases, absence of cognitive impairment and limitations in instrumental activities of daily living, good mental and overall self-perceived health, good physical functioning, and no function-limiting pain. Results About 20.0% (2834) of the participants met the criteria of healthy ageing after a median follow-up of 20 years. Each 1-point increase in the protective lifestyle score computed at baseline and second follow-up visits was associated with higher likelihood of healthy ageing by 25% (95% CI: 20%–30%) and 24% (18%–29%), respectively. The population-attributable risk percent of adherence to 4–5 protective lifestyle factors was 34.3% (95% CI: 25.3%–42.3%) at baseline and 31.3% (23.0%–38.7%) at second follow-up visits for healthy ageing. In addition, positive increase in lifestyle scores from baseline to second follow-up visits was also significantly associated with a higher likelihood of healthy ageing with an odds ratio of 1.18 (95% CI: 1.12%–1.24%) for each increment in protective lifestyle score. Conclusions Our findings confirmed that adopting healthy lifestyle factors, even after midlife, was associated with healthy ageing at old age.

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Adherence to a healthy lifestyle and all-cause and cause-specific mortality in Chinese adults: a 10-year prospective study of 0.5 million people

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-019-0860-z ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 6

Author(s):

Nanbo Zhu ◽

◽

Canqing Yu ◽

Yu Guo ◽

Zheng Bian ◽

...

Keyword(s):

Heart Disease ◽

Cox Regression ◽

Lifestyle Modification ◽

Healthy Lifestyle ◽

Lifestyle Factors ◽

Chinese Adults ◽

Linear Relationships ◽

Hazard Ratios ◽

All Cause Mortality ◽

Specific Mortality

Abstract Background Adherence to a healthy lifestyle is associated with substantially lower risks of mortality from all causes, cardiovascular diseases, and cancer in white populations. However, little is known about the health benefits among non-white populations. Also, no previous studies have focused on respiratory disease mortality in both white and non-white populations. We assessed the relationships between a combination of healthy lifestyle factors and multiple death outcomes in Chinese adults. Methods This study included 487,198 adults aged 30–79 years from the China Kadoorie Biobank without heart disease, stroke, and cancer at study enrolment. We defined five healthy lifestyle factors as never smoking or smoking cessation not due to illness; non-daily drinking or moderate alcohol drinking; median or higher level of physical activity; a diet rich in vegetables, fruits, legumes and fish, and limited in red meat; a body mass index of 18.5 to 27.9 kg/m2 and a waist circumference < 90 cm (men)/85 cm (women). Cox regression was used to produce adjusted hazard ratios (HRs) relating these healthy lifestyle factors to all-cause and cause-specific mortality. Results During a median follow-up of 10.2 years (IQR 9.2–11.1), we documented 37,845 deaths. After multivariable adjustment, the number of healthy lifestyle factors exhibited almost inverse linear relationships with the risks of all-cause and cause-specific mortality. Compared with participants without any healthy factors, the hazard ratio of participants with five healthy factors was 0.32 [95% confidence interval (CI): 0.28, 0.37] for all-cause mortality. The corresponding HRs in specific cause of death were 0.42 (95% CI: 0.26, 0.67) for ischaemic heart disease, 0.21 (95% CI: 0.09, 0.49) for ischaemic stroke, 0.37 (95% CI: 0.22, 0.60) for haemorrhage stroke, 0.36 (95% CI: 0.29, 0.45) for cancer, 0.26 (95% CI: 0.14, 0.48) for respiratory diseases, and 0.29 (95% CI: 0.22, 0.39) for other causes. Theoretically, 38.5% (95% CI: 33.0, 43.8%) of all-cause mortality was attributable to nonadherence to a healthy lifestyle, and the proportions of preventable deaths through lifestyle modification ranged from 26.9 to 47.9% for cause-specific mortality. Conclusions Adherence to a healthy lifestyle was associated with substantially lower risks of all-cause, cardiovascular, respiratory, and cancer mortality in Chinese adults. Promotion of a healthy lifestyle may considerably reduce the burden of non-communicable diseases in China.

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Abstract MP35: Physical Activity Before and After Cancer Diagnosis and Total and Cause-Specific Mortality

Circulation ◽

10.1161/circ.137.suppl_1.mp35 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Paulette D Chandler ◽

Deirdre Tobias ◽

Jule E Buring ◽

I-Min Lee ◽

Daniel Chasman ◽

...

Keyword(s):

Physical Activity ◽

Cancer Diagnosis ◽

Cancer Mortality ◽

Total Mortality ◽

Health Study ◽

Specific Mortality ◽

Before And After ◽

After Cancer ◽

Cvd Mortality

Background: Given the increased prevalence of cancer survivors in the United States, it is imperative to define risk factors for potential reductions in total and cause-specific mortality. Physical activity (PA) represents a promising target for intervention. Design: We prospectively evaluated PA from questionnaires before and after cancer diagnosis with total and cause-specific mortality among 13,297 subjects diagnosed with invasive cancer combined from the Physicians’ Health Study (PHS) (n=6328), Physicians’ Health Study II (PHS II) (n=912), and Women's Health Study (WHS) (n=6057). WHS and PHS participants were free of baseline cancer; PHS II participants reported no active cancer at baseline. We ascertained PA before and after an incident cancer diagnosis based on reports on repeated follow-up questionnaires. Death was ascertained by medical records and death certificates. Cox regression estimated combined hazard ratios (HRs) of mortality by PA adjusted for age, randomized treatments, BMI, and other lifestyle/demographic factors. We evaluated the interaction between PA before and after cancer diagnosis by comparing PA ≤1 versus ≥2 times/wk. Results: The mean follow-up after cancer diagnosis was 8.0, 7.5, and 5.2 y for WHS, PHS, and PHS II, respectively, during which there were 5623 deaths (WHS, 2164; PHS, 3269; PHS II; 190). Higher PA before cancer diagnosis was associated with significantly lower mortality. Compared with PA ≤ once/wk, the HRs (95% CIs) associated with PA 2-4 and >4 times/wk were 0.87 (0.82-0.93) and 0.88 (0.82-0.94) for total mortality; 0.77 (0.63-0.95) and 0.79 (0.62-0.997) for CVD mortality, and 0.90 (0.83-0.98) and 0.90 (0.83-0.98) for cancer mortality. Higher PA after cancer diagnosis was associated with significantly lower total and cancer mortality and non-significantly lower CVD mortality, with HRs (95% CIs) of 0.65 (0.58-0.72) and 0.66 (0.59-0.73) for total mortality; 0.78 (0.59-1.03) and 0.82 (0.61-1.10) for CVD mortality, and 0.66 (0.57-0.77) and 0.64 (0.55-0.74) for cancer mortality. There was a significant interaction of PA before and after cancer diagnosis for total (p int =0.02) and cancer (p int =0.007) mortality, but not CVD mortality (p int =0.38). Conclusions: Greater PA both before and after cancer diagnosis were significantly associated with lower total and cancer mortality. Higher PA before cancer diagnosis was also associated with lower CVD mortality. PA may be an important target for lower mortality after cancer diagnosis.

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Leukocyte telomere length, cancer incidence and all‐cause mortality among Chinese adults: Singapore Chinese Health Study

International Journal of Cancer ◽

10.1002/ijc.33211 ◽

2020 ◽

Vol 148 (2) ◽

pp. 352-362

Author(s):

Hamed Samavat ◽

Hung N. Luu ◽

Kenneth B. Beckman ◽

Aizhen Jin ◽

Renwei Wang ◽

...

Keyword(s):

Telomere Length ◽

Cancer Incidence ◽

Health Study ◽

Leukocyte Telomere Length ◽

Chinese Adults ◽

All Cause Mortality ◽

Singapore Chinese

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Long working hours and mortality in Central and Eastern Europe: the HAPIEE study

European Journal of Public Health ◽

10.1093/eurpub/ckz185.365 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Pikhart ◽

Q Liu ◽

A Pajak ◽

S Malyutina ◽

R Kubinova ◽

...

Keyword(s):

Eastern Europe ◽

Cancer Mortality ◽

Central And Eastern Europe ◽

Working Hours ◽

Long Working Hours ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Specific Mortality ◽

Mortality Analysis ◽

Cvd Mortality

Abstract Background Long working hours are common in countries of Central and Eastern Europe (CEE). A wide range of epidemiological studies have showed that long working hours had an adverse effect on health but the evidence mostly comes from Western Europe, East Asia and North America. This study aimed to assess the relationship between long working hours and the risk of mortality in employed people in three Eastern European countries. Methods Participants, aged 45-69 years at baseline, were from the Health, Alcohol and Psychosocial Indicators in Eastern Europe (HAPIEE) cohort study conducted in Russia, Poland and the Czech Republic. Baseline survey included a structured questionnaire and examination in the clinic during 2002-2005. Working hours were assessed by a self-reported questionnaire at baseline. Participants have been followed-up for all-cause mortality and cause-specific mortality for an average of 11 years. Impact of long working hours on mortality was analysed by Cox proportional hazards regression. In all-cause mortality analysis, a total of 10878 men and women were included, and 10399 participants were included in cause-specific mortality analysis. Results During the follow-up, there were 1187 deaths from all causes, 288 from CVD, and 251 from cancer. Those who worked 61 hours or more in a week showed higher risk of mortality compared to those working 36-45 hours per week: HR 1.32 (95%CI 1.01 to 1.74) for all-cause mortality and 1.73 (95% CI 1.03-2.93) for CVD mortality. There was no significant increase in risk of cancer mortality associated with working long hours. There was no significant association between working 46-60 hours a week and risk of mortality, including all-cause mortality and cause-specific mortality. Conclusions The risk of all-cause and CVD mortality in three CEE was significantly higher among employees working extensive hours. These findings suggest that more attention should be paid to shortening working hours for those who work extensively. Key messages Long working hours increase risk of all cause and CVD mortality. Cancer mortality is not related to long working hours.

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Association Between Initiation, Intensity, and Cessation of Smoking and Mortality Risk in Patients With Cardiovascular Disease: A Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.728217 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiang-lin Wang ◽

Wen-jun Yin ◽

Ling-yun Zhou ◽

Ya-feng Wang ◽

Xiao-cong Zuo

Keyword(s):

Cardiovascular Disease ◽

Smoking Cessation ◽

Cohort Study ◽

Cancer Mortality ◽

Smoking Initiation ◽

Smoking Intensity ◽

All Cause Mortality ◽

Specific Mortality ◽

Former Smokers ◽

Cvd Mortality

Objectives: To examine the effect of smoking status, smoking intensity, duration of smoking cessation and age of smoking initiation on the risk of all-cause and cause-specific mortality among cardiovascular disease (CVD) patients.Design: A population-based prospective cohort study.Setting: The National Health Interview Survey (NHIS) in the U.S. that were linked to the National Death Index (NDI).Participants: 66,190 CVD participants ≥ 18 years of age who were interviewed between 1997 and 2013 in the NHIS linked to the NDI through December 31, 2015.Outcome Measures: The primary outcome was all-cause mortality and the secondary outcome was cause-specific mortality including CVD mortality and cancer mortality.Results: During the mean follow-up of 8.1 years, we documented 22,518 deaths (including 6,473 CVD deaths and 4,050 cancer deaths). In the overall CVD population, former and current smokers had higher risk of all-cause (Former smokers: hazard ratios (HRs), 1.26; 95% confidence interval (CI), 1.21–1.31, P < 0.001; Current smokers: HRs, 1.96; 95%CI, 1.86–2.07, P < 0.001), CVD (Former smokers: HRs, 1.12; 95%CI, 1.05–1.21, P = 0.001; Current smokers: HRs, 1.80; 95%CI, 1.64–1.97, P < 0.001) and cancer mortality (Former smokers: HRs, 1.49; 95%CI, 1.35–1.64, P < 0.001; Current smokers: HRs, 2.78; 95%CI, 2.49–3.09, P < 0.001) than never smokers. Furthermore, similar results were observed when the study subjects were stratified according to the type of CVD. Among current smokers, the risk for cancer mortality increased as the daily number of cigarettes increased, regardless of the specific type of CVD. However, the association of the risk for all-cause and CVD mortality with smoking intensity did not present a dose-response relationship. In participants with angina pectoris or stroke, smoking intensity was inversely associated with deaths from CVD. In addition, the risk for all-cause, CVD and cancer mortality declined as years of smoking cessation increased. Finally, the relative risk of all-cause mortality was not significantly different in individuals with a younger age of smoking initiation.Conclusions: CVD patients who are smokers have an increased risk of all-cause, CVD and cancer mortality, and the risk decreases significantly after quitting smoking. These data further provide strong evidence that supports the recommendation to quit smoking for the prevention of premature deaths among individuals with CVD.

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Association of Walnut Consumption with Total and Cause-Specific Mortality and Life Expectancy in U.S. Adults

Nutrients ◽

10.3390/nu13082699 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2699

Author(s):

Xiaoran Liu ◽

Marta Guasch-Ferré ◽

Deirdre K. Tobias ◽

Yanping Li

Keyword(s):

Life Expectancy ◽

Cox Regression ◽

Total Mortality ◽

Health Study ◽

Hazard Ratios ◽

Estimate Life Expectancy ◽

Specific Mortality ◽

Elder Adults ◽

Cvd Mortality

Walnut consumption is associated with health benefits. We aimed to (1) examine the association between walnut consumption and mortality and (2) estimate life expectancy in relation to walnut consumption in U.S. adults. We included 67,014 women of the Nurses’ Health Study (1998–2018) and 26,326 men of the Health Professionals Follow-up Study (1998–2018) who were free of cancer, heart disease, and stroke at baseline. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During up to 20 years of follow-up, we documented 30,263 deaths. The hazard ratios for total mortality across categories of walnut intake (servings/week), as compared to non-consumers, were 0.95 (95% confidence interval (CI), 0.91, 0.98) for <1 serving/week, 0.94 (95% CI, 0.89, 0.99) for 1 serving/week, 0.87 (95% CI, 0.82, 0.93) for 2–4 servings/week, and 0.86 (95% CI, 0.79, 0.93) for >=5 servings/week (p for trend <0.0001). A greater life expectancy at age 60 (1.30 years in women and 1.26 years in men) was observed among those who consumed walnuts more than 5 servings/week compared to non-consumers. Higher walnut consumption was associated with a lower risk of total and CVD mortality and a greater gained life expectancy among U.S. elder adults.

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Abstract 3484: Dietary Patterns And The Risk Of Mortality From All-causes, Cardiovascular Disease, And Cancer In Women

Circulation ◽

10.1161/circ.116.suppl_16.ii_789 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Christin Heidemann ◽

Matthias B Schulze ◽

Oscar H Franco ◽

Rob M van Dam ◽

Christos S Mantzoros ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Dietary Patterns ◽

Cancer Mortality ◽

Cox Proportional Hazards ◽

Health Study ◽

Processed Meat ◽

All Cause Mortality ◽

Specific Mortality ◽

The Impact

Background: Few studies have investigated the impact of dietary patterns that reflect existing eating habits on the risk of all-cause or cause-specific mortality. Objective: To prospectively examine the relation between major dietary patterns and the risk of all-cause and cause-specific mortality among women of the Nurses’ Health Study. Methods: The participants included 72,113 women aged 35 to 55 years without a history of cancer, myocardial infarction, angina, coronary artery surgery, stroke, or diabetes at baseline. Dietary patterns were derived by factor analysis using information from five repeated, validated food frequency questionnaires that were administrated at baseline and every 2 to 4 years during the follow-up period (1984–2002). Cox proportional hazards regression was used to adjust for covariates including age, cigarette smoking, physical activity, body mass index, and further suspected risk factors. Results: Two major dietary patterns were identified. High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high western pattern scores represented high intakes of red meat, processed meat, refined grains, french fries, condiments, and sweets and desserts. During 18 years of follow-up (633,516 person-years), we ascertained 6,011 deaths, including 3,139 cancer deaths and 1,154 cardiovascular deaths. After adjustment for potential confounders, the prudent diet was inversely associated with all-cause mortality (relative risk [RR] = 0.83 for highest versus lowest quintile, 95% confidence interval [CI] = 0.76 – 0.90, p for trend < 0.0001) and cardiovascular mortality (RR = 0.72, 95% CI = 0.60 – 0.87, p for trend = 0.0007), but not with cancer mortality (RR = 0.99, 95% CI = 0.88 –1.11, p for trend = 0.87). The western pattern was directly associated with all-cause mortality (RR = 1.21, 95% CI = 1.11–1.32, p for trend < 0.0001), cardiovascular mortality (RR = 1.22, 95% CI = 1.00 –1.48, p for trend = 0.01), and cancer mortality (RR = 1.15, 95% CI = 1.02–1.29, p for trend = 0.004). Conclusions: These data provide evidence that a high prudent pattern score and a low western pattern score may reduce the risk of total and cause-specific mortality.

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