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Modifiable causes of premature death in middle-age in Western Europe : Results from the EPIC cohort study

Muller, David C.; Murphy, Neil; Johansson, Mattias; Ferrari, Pietro; Tsilidis, Konstantinos K.; Boutron-Ruault, Marie Christine; Clavel, Francoise; Dartois, Laureen; Li, Kuanrong and Kaaks, Rudolf, et al. (2016) In BMC Medicine 14(1).
Abstract

Background: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death. Methods: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models. Results: We identified 11,930 deaths which... (More)

Background: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death. Methods: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models. Results: We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31-32 %) and 14 % (95 % CI, 12-16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8-12 %) and high blood pressure (9 %; 95 % CI, 7-11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55-59 %), being 35 % (95 % CI, 32-37 %) among never smokers and 74 % (95 % CI, 73-75 %) among current smokers. Conclusions: While smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed.

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Absolute risk, Attributable fraction, Modifiable risk factors, Mortality, Premature death
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BMC Medicine
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14
issue
1
publisher
BioMed Central
external identifiers
  • scopus:84976875301
  • wos:000378046400001
ISSN
1741-7015
DOI
10.1186/s12916-016-0630-6
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English
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yes
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a90c8aac-2585-448c-87a8-f2a4557dd60d
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2016-07-20 09:54:10
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2017-10-16 12:48:19
@article{a90c8aac-2585-448c-87a8-f2a4557dd60d,
  abstract     = {<p>Background: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death. Methods: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models. Results: We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31-32 %) and 14 % (95 % CI, 12-16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8-12 %) and high blood pressure (9 %; 95 % CI, 7-11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55-59 %), being 35 % (95 % CI, 32-37 %) among never smokers and 74 % (95 % CI, 73-75 %) among current smokers. Conclusions: While smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed.</p>},
  articleno    = {87},
  author       = {Muller, David C. and Murphy, Neil and Johansson, Mattias and Ferrari, Pietro and Tsilidis, Konstantinos K. and Boutron-Ruault, Marie Christine and Clavel, Francoise and Dartois, Laureen and Li, Kuanrong and Kaaks, Rudolf and Weikert, Cornelia and Bergmann, Manuela and Boeing, Heiner and Tjønneland, Anne and Overvad, Kim and Redondo, M. Luisa and Agudo, Antonio and Molina-Portillo, Elena and Altzibar, Jone M. and Cirera, Lluís and Ardanaz, Eva and Khaw, Kay Tee and Wareham, Nicholas J. and Key, Timothy J. and Travis, Ruth C. and Bamia, Christina and Orfanos, Philippos and Trichopoulou, Antonia and Palli, Domenico and Pala, Valeria and Tumino, Rosario and Vineis, Paolo and Panico, Salvatore and Bueno-de-Mesquita, H. Bas and Verschuren, W. M Monique and Struijk, Ellen A. and Peeters, Petra H. and Engström, Gunnar and Melander, Olle and Sund, Malin and Weiderpass, Elisabete and Skeie, Guri and Lund, Eiliv and Norat, Teresa and Gunter, Marc and Riboli, Elio and Brennan, Paul},
  issn         = {1741-7015},
  keyword      = {Absolute risk,Attributable fraction,Modifiable risk factors,Mortality,Premature death},
  language     = {eng},
  month        = {06},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {BMC Medicine},
  title        = {Modifiable causes of premature death in middle-age in Western Europe : Results from the EPIC cohort study},
  url          = {http://dx.doi.org/10.1186/s12916-016-0630-6},
  volume       = {14},
  year         = {2016},
}