Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study Background
There is overwhelming evidence that behavioural factors influence health, but their
combined impact on the general population is less well documented. We aimed to quantify the
potential combined impact of four health behaviours on mortality in men and women living in
the general community.
There is overwhelming evidence that behavioural factors influence health, but their
combined impact on the general population is less well documented. We aimed to quantify the
potential combined impact of four health behaviours on mortality in men and women living in
the general community.
Methods and Findings
We examined the prospective relationship between lifestyle and mortality in a prospective
population study of 20,244 men and women aged 45–79 y with no known cardiovascular
disease or cancer at baseline survey in 1993–1997, living in the general community in the
United Kingdom, and followed up to 2006. Participants scored one point for each health
behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a
week) and plasma vitamin C .50 mmol/l indicating fruit and vegetable intake of at least five
servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the
age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for allcause
mortality(1,987 deaths) for men and women who had three, two, one, and zero
compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52
(2.13–3.00), and 4.04 (2.95–5.54) p , 0.001 trend. The relationships were consistent in
subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths
within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with
four compared to zero health behaviours was equivalent to being 14 y younger in
chronological age.
Conclusions
Four health be haviours combined predict a 4-fold difference in total mortality in men and
women, with an estimated impact equivalent to 14 y in chronological age.
We examined the prospective relationship between lifestyle and mortality in a prospective
population study of 20,244 men and women aged 45–79 y with no known cardiovascular
disease or cancer at baseline survey in 1993–1997, living in the general community in the
United Kingdom, and followed up to 2006. Participants scored one point for each health
behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a
week) and plasma vitamin C .50 mmol/l indicating fruit and vegetable intake of at least five
servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the
age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for allcause
mortality(1,987 deaths) for men and women who had three, two, one, and zero
compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52
(2.13–3.00), and 4.04 (2.95–5.54) p , 0.001 trend. The relationships were consistent in
subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths
within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with
four compared to zero health behaviours was equivalent to being 14 y younger in
chronological age.
Conclusions
Four health be haviours combined predict a 4-fold difference in total mortality in men and
women, with an estimated impact equivalent to 14 y in chronological age.
