Combined Unhealthy Behaviors Associated With 4-Fold Increased Risk for Death

Emma Hitt, PhD

April 26, 2010

April 26, 2010 — Smoking, lack of physical activity, poor diet, and alcohol consumption, when their effect is considered collectively, appear to be associated with a substantially increased risk for death, according to a new study.

Elisabeth Kvaavik, PhD, from the University of Oslo, Norway, and colleagues note that most studies evaluate these risk factors as independent entities, but "to fully understand the public health impact of these behaviors, it is necessary to examine both their individual and combined impact on health outcomes," they write in the April 26 issue of the Archives of Internal Medicine.

The researchers interviewed 4886 individuals in the United Kingdom who were at least 18 years of age in 1984 to 1985. Participants were allocated a health behavior score, with 1 point assigned for each of 4 poor behaviors:

  • smoking;

  • fruits and vegetables consumed less than 3 times daily;

  • less than 2 hours of physical activity per week; and

  • weekly consumption of excessive alcohol (>14 units [1 unit equals 8 g] of alcohol for women and >21 units for men). 

In addition, risk increased with an increasing number of poor risk behaviors. Compared with those with no risk behaviors, the adjusted hazard ratios for total mortality associated with 1, 2, 3, and 4 poor health behaviors were 1.85 (95% confidence interval [CI], 1.28 – 2.68), 2.23 (95% CI, 1.55 –3.20), 2.76 (95% CI, 1.91 – 3.99), and 3.49 (95% CI, 2.31 – 5.26), respectively (P value for trend < .001).

During 20 years of follow-up, 1080 participants died:

  • 431 from cardiovascular disease;

  • 318 from cancer; and

  • 331 from other causes.

Individuals with all 4 behaviors had about 3 times the risk of dying from cardiovascular disease or cancer, 4 times the risk of dying from other causes, and an overall death risk equivalent to being 12 years older than those with none of these behaviors.

"Modest but achievable adjustments to lifestyle behaviors are likely to have a considerable impact at both the individual and population level,” the study authors write. “Developing more efficacious methods by which to promote healthy diets and lifestyles across the population should be an important priority of public health policy."

The Health and Lifestyle Survey was funded by The Health Promotion Research Trust. The study authors have disclosed no relevant financial relationships.

Arch Intern Med. 2010;170:711-718.


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