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Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population
Open accessAbstract
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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“During up to 34 years of follow-up, the most physically active cohorts of men and women demonstrated 7- to 8-year gains in life expectancy!”
From Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations (2022) · cites this paper as [12]
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“More and more research has proven that maintaining a healthy lifestyle, such as adequate nutrition,321 moderate exercise,322 and good mental state323 can effectively delay aging.”
From Inflammation and aging: signaling pathways and intervention therapies (2023) · cites this paper as [322]
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“People with obesity are at increased risk for a variety of medical disorders including hypertension, dyslipidemia, type 2 diabetes mellitus, cardiovascular disease (CVD), and several cancers [4–6]”
From Mediterranean Diet and Obesity-related Disorders: What is the Evidence? (2022) · cites this paper as [4]
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“Fair Innings,” Women, and Longevity Science
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Shurtz, L., Sanders, G. D., Datoc, A. E., Kronenberger, O. R., Thakkar, V. J., Bunt, S. C., Didehbani, N., Schaffert, J., LoBue, C., & Cullum, C. M. (2026) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2026.2699847
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Tynkkynen, N. P., Joensuu, L., Herranen, P., Kaprio, J. A., Törmäkangas, T., & Sillanpää, E. (2026) · GeroScience · doi:10.1007/s11357-026-02422-5
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Self-citationLu, Q., Koemel, N. A., Biswas, R. K., Bian, W., Wiley, J. F., Pase, M. P., Drummond, S. P. A., Olivier, P. L., Allman-Farinelli, M. A., Cistulli, P. A., et al. (2026) · medRxiv · doi:10.64898/2026.07.23.26358753
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
- Published
- 2018-07-24
- Volume
- 138
- Issue
- 4
- Pages
- 345-355
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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