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

• Published in: BMC medicine 2016-06, Vol.14 (1), p.87-87, Article 87
• Main Authors: Muller, David C, Murphy, Neil, Johansson, Mattias, Ferrari, Pietro, Tsilidis, Konstantinos K, Boutron-Ruault, Marie-Christine, Clavel, Francoise, Dartois, Laureen, Li, Kuanrong, Kaaks, Rudolf, Weikert, Cornelia, Bergmann, Manuela, Boeing, Heiner, Tjønneland, Anne, Overvad, Kim, Redondo, M Luisa, Agudo, Antonio, Molina-Portillo, Elena, Altzibar, Jone M, Cirera, Lluís, Ardanaz, Eva, Khaw, Kay-Tee, Wareham, Nicholas J, Key, Timothy J, Travis, Ruth C, Bamia, Christina, Orfanos, Philippos, Trichopoulou, Antonia, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Vineis, Paolo, Panico, Salvatore, Bueno-de-Mesquita, H Bas, Verschuren, W M Monique, Struijk, Ellen A, Peeters, Petra H, Engström, Gunnar, Melander, Olle, Sund, Malin, Weiderpass, Elisabete, Skeie, Guri, Lund, Eiliv, Norat, Teresa, Gunter, Marc, Riboli, Elio, Brennan, Paul
• Format: Article
• Language: English
• Subjects: Absolute risk; Adult; Aged; Alcohol Drinking - adverse effects; Alcohol Drinking - mortality; Alcohol use; Attributable fraction; Blood pressure; Body mass index; Cholesterol; Clinical Medicine; Cohort analysis; Cohort Studies; Community medicine, Social medicine: 801; Diet; Europe - epidemiology; Exercise; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Health Sciences; Health sciences: 800; Helsefag: 800; Humans; Hypertension; Hypertension - complications; Hypertension - mortality; Hälsovetenskap; Klinisk medicin; Life Expectancy; Male; Medical and Health Sciences; Medical disciplines: 700; Medicin och hälsovetenskap; Medisinske Fag: 700; Middle age; Middle Aged; Modifiable risk factors; Mortality; Mortality, Premature; Motor Activity; Nutrition research; Obesity - complications; Obesity - mortality; Premature death; Prospective Studies; Public Health, Global Health, Social Medicine and Epidemiology; Questionnaires; Risk Factors; Samfunnsmedisin, sosialmedisin: 801; Smoking - adverse effects; Smoking - mortality; VDP
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-016-0630-6

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. 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. 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. 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.