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Cited by 927Cardiovascular Health and Risk FactorsHealth and Lifestyle StudiesNutritional Studies and Diet

The DOI matches its Crossref record; 42 of the 43 references it cites were found in a registry or an index.

Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population

Open access
Li, Yanping, Pan, An, Wang, Dong D., Liu, Xiaoran, Dhana, Klodian, Franco, Oscar H., Kaptoge, Stephen, Di Angelantonio, Emanuele, Stampfer, Meir, Willett, Walter C., Hu, Frank B.·2018·Circulation
DOI 10.1161/circulationaha.117.032047PMC PMC6207481
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Abstract

Background: Americans have a shorter life expectancy compared with residents of almost all other high-income countries. We aim to estimate the impact of lifestyle factors on premature mortality and life expectancy in the US population. Methods: Using data from the Nurses’ Health Study (1980–2014; n=78 865) and the Health Professionals Follow-up Study (1986–2014, n=44 354), we defined 5 low-risk lifestyle factors as never smoking, body mass index of 18.5 to 24.9 kg/m 2 , ≥30 min/d of moderate to vigorous physical activity, moderate alcohol intake, and a high diet quality score (upper 40%), and estimated hazard ratios for the association of total lifestyle score (0–5 scale) with mortality. We used data from the NHANES (National Health and Nutrition Examination Surveys; 2013–2014) to estimate the distribution of the lifestyle score and the US Centers for Disease Control and Prevention WONDER database to derive the age-specific death rates of Americans. We applied the life table method to estimate life expectancy by levels of the lifestyle score. Results: During up to 34 years of follow-up, we documented 42 167 deaths. The multivariable-adjusted hazard ratios for mortality in adults with 5 compared with zero low-risk factors were 0.26 (95% confidence interval [CI], 0.22–0.31) for all-cause mortality, 0.35 (95% CI, 0.27–0.45) for cancer mortality, and 0.18 (95% CI, 0.12–0.26) for cardiovascular disease mortality. The population-attributable risk of nonadherence to 5 low-risk factors was 60.7% (95% CI, 53.6–66.7) for all-cause mortality, 51.7% (95% CI, 37.1–62.9) for cancer mortality, and 71.7% (95% CI, 58.1–81.0) for cardiovascular disease mortality. We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3–29.8) for women and 25.5 years (95% CI, 24.7–26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3–44.9) for women and 37.6 years (95% CI, 35.8–39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8–16.2) longer among female Americans with 5 low-risk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1–14.2). Conclusions: Adopting a healthy lifestyle could substantially reduce premature mortality and prolong life expectancy in US adults.

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Research works printed but not linked: 3

  1. Institute of Medicine and National Research Council. Woolf, SH, Aron, L, eds. US Health in International Perspective: Shorter Lives, Poorer Health. Washington, DC: National Academies Press (US); 2013.
  2. Department of Health and Human Services, Public Health Service. Ten Leading Causes of Death in the United States. Atlanta, GA: Bureau of State Services; 1980.
  3. Braveman, P, Egerter, S. Overcoming Obstacles to Health: Report From the Robert Wood Johnson Foundation to the Commission to Build a Healthier America. Washington, DC: Robert Wood Johnson Foundation; 2008.

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Metadata

Authors
Li, Y., Pan, A., Wang, D. D., Liu, X., Dhana, K., Franco, O. H., Kaptoge, S., Di Angelantonio, E., Stampfer, M., Willett, W. C., & Hu, F. B.
Affiliations
  • Departments of Nutrition (Y.L., D.D.W., X.L., K.D., M.S., W.C.W., F.B.H.)
  • Harvard University (US)
  • Erasmus MC (NL)
  • University of Cambridge (GB)
  • Department of Public Health and Primary Care University of Cambridge, United Kingdom (S.K., E.D.A.).
  • Brigham and Women's Hospital (US)
Corresponding author
  • Li, Yanping
  • Pan, An
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-07-24
Volume
138
Issue
4
Pages
345-355
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.117.032047
PMC
PMC6207481
OpenAlex
W2802410718
Cited by
927
References
43
Citations by year
2026: 107 · 2025: 130 · 2024: 129 · 2023: 136 · 2022: 145 · 2021: 119 · 2020: 76 · 2019: 53 · 2018: 29
FWCI
52.32
Type
journal article
Language
en
Update notices
correction (2018-07-23)
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Apollo (University of Cambridge) (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Apollo
Funders
  • National Institute for Health and Care Research (NF-SI-0617-10113, NF-SI-0512-10165)
  • British Heart Foundation (RG/13/13/30194)
  • Centers for Disease Control and Prevention
  • Medical Research Council (MR/L003120/1)
  • National Heart, Lung, and Blood Institute (R01HL060712, R01HL035464, R01HL034594, R01HL088521)
  • National Cancer Institute (P01CA087969, UM1CA186107, UM1CA167552)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health and Lifestyle Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
healthy lifestyle factors, life expectancy, premature mortality, all-cause mortality, cancer mortality, cardiovascular mortality, physical activity, alcohol consumption, diet quality, lifestyle score, population attributable risk, sex differences, life table method, NHANES, United States population, mortality projections, health equity
MeSH terms
Healthy Lifestyle, Diet, Healthy, Non-Smokers, Adult, Aged, Aged, 80 and over, Alcohol Drinking, Cause of Death, Female, Health Personnel, Health Status, Humans, Life Expectancy, Male, Middle Aged, Nurses, Nutrition Surveys, Risk Factors, Time Factors, United States, Exercise, Body Mass Index, Databases, Factual, Risk Reduction Behavior, Protective Factors

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