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

BACKGROUND: 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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907105/
https://www.ncbi.nlm.nih.gov/pubmed/27296932
http://dx.doi.org/10.1186/s12916-016-0630-6
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author 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
author_facet 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
author_sort Muller, David C.
collection PubMed
description BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-016-0630-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-49071052016-06-15 Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study 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 BMC Med Research Article BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12916-016-0630-6) contains supplementary material, which is available to authorized users. BioMed Central 2016-06-14 /pmc/articles/PMC4907105/ /pubmed/27296932 http://dx.doi.org/10.1186/s12916-016-0630-6 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
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
Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study
title Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study
title_full Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study
title_fullStr Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study
title_full_unstemmed Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study
title_short Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study
title_sort modifiable causes of premature death in middle-age in western europe: results from the epic cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907105/
https://www.ncbi.nlm.nih.gov/pubmed/27296932
http://dx.doi.org/10.1186/s12916-016-0630-6
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