Causes of Death Associated With Prolonged TV Viewing: NIH-AARP Diet and Health Study

Abstract

Introduction: TV viewing is the most prevalent sedentary behavior and is associated with increased risk of cardiovascular disease and cancer mortality, but the association with other leading causes of death is unknown. This study examined the association between TV viewing and leading causes of death in the U.S.

Methods: A prospective cohort of 221,426 individuals (57% male) aged 50-71 years who were free of chronic disease at baseline (1995-1996), 93% white, with an average BMI of 26.7 (SD=4.4) kg/m(2) were included. Participants self-reported TV viewing at baseline and were followed until death or December 31, 2011. Hazard ratios (HRs) and 95% CIs for TV viewing and cause-specific mortality were estimated using Cox proportional hazards regression. Analyses were conducted in 2014-2015.

Results: After an average follow-up of 14.1 years, adjusted mortality risk for a 2-hour/day increase in TV viewing was significantly higher for the following causes of death (HR [95% CI]): cancer (1.07 [1.03, 1.11]); heart disease (1.23 [1.17, 1.29]); chronic obstructive pulmonary disease (1.28 [1.14, 1.43]); diabetes (1.56 [1.33, 1.83]); influenza/pneumonia (1.24 [1.02, 1.50]); Parkinson disease (1.35 [1.11, 1.65]); liver disease (1.33 [1.05, 1.67]); and suicide (1.43 [1.10, 1.85]. Mortality associations persisted in stratified analyses with important potential confounders, reducing causation concerns.

Conclusions: This study shows the breadth of mortality outcomes associated with prolonged TV viewing, and identifies novel associations for several leading causes of death. TV viewing is a prevalent discretionary behavior that may be a more important target for public health intervention than previously recognized.

Trial registration: ClinicalTrials.gov number, NCT00340015.

Figure 1

Association for a 2 h/day increase in TV viewing and the leading causes of death in the U.S.: NIH-AARP Diet and Health Study. Note: Values are HRs and 95% CI, fully adjusted for covariates in Model 2.

Figure 2

Associations for a 2 h/day increase in TV viewing for other causes of death by baseline characteristics: NIH-AARP Diet and Health Study. Note: Values are HRs and 95% CIs. Other causes of death included deaths due to COPD, diabetes, sepsis, hypertension, pneumonia and influenza, liver disease, kidney disease, suicide, accidents, Alzheimer disease and Parkinson disease. Models were fully adjusted for covariates in Model 2, unless they were the comparator of interest. Diet quality is based on HEI-2005, “low” included bottom two quintiles and “high” included top two quintiles.

Figure 3

Joint effects of MVPA and TV viewing on selected Mortality outcomes NIH-AARP Diet and Health Study. Note: Values are HRs and 95% CI. MVPA was categorized as active (≥4h/wk) or inactive is (<4h/wk). TV viewing was categorized as low (<2h/day), medium (3–4h/day), or high (≥5h/day). High active and low TV was set as referent group. Models were fully adjusted for covariates in Model 2.