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. 2016 Jun 14:14:87.
doi: 10.1186/s12916-016-0630-6.

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

David C Muller  1 , Neil Murphy  2 , Mattias Johansson  1 , Pietro Ferrari  1 , Konstantinos K Tsilidis  3   4 , Marie-Christine Boutron-Ruault  5   6   7 , Francoise Clavel  6   7   8 , Laureen Dartois  6   7   8 , Kuanrong Li  9 , Rudolf Kaaks  9 , Cornelia Weikert  10 , Manuela Bergmann  10 , Heiner Boeing  10 , Anne Tjønneland  11 , Kim Overvad  12 , M Luisa Redondo  13 , Antonio Agudo  14 , Elena Molina-Portillo  15   16 , Jone M Altzibar  16   17 , Lluís Cirera  16   18   19 , Eva Ardanaz  16   20   21 , Kay-Tee Khaw  22 , Nicholas J Wareham  23 , Timothy J Key  24 , Ruth C Travis  24 , Christina Bamia  25   26 , Philippos Orfanos  25   26 , Antonia Trichopoulou  25   26 , Domenico Palli  27 , Valeria Pala  28 , Rosario Tumino  29 , Paolo Vineis  2   30 , Salvatore Panico  31 , H Bas Bueno-de-Mesquita  2   32   33   34 , W M Monique Verschuren  32   35 , Ellen A Struijk  35 , Petra H Peeters  2   35 , Gunnar Engström  36 , Olle Melander  37 , Malin Sund  38 , Elisabete Weiderpass  39   40   41   42 , Guri Skeie  39   43 , Eiliv Lund  39   43 , Teresa Norat  2 , Marc Gunter  2 , Elio Riboli  2 , Paul Brennan  44
Affiliations

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

David C Muller et al. BMC Med. .

Abstract

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.

Keywords: Absolute risk; Attributable fraction; Modifiable risk factors; Mortality; Premature death.

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Figures

Fig. 1
Fig. 1
Model-based survival curves by smoking status and other individual factors. “Healthy” participants are those with a body mass index (BMI) of 22–25 who are moderately active, have normal blood pressure, eat a healthy diet, and drink one to two drinks per day. “Unhealthy” participants are those with a BMI of 30–35 who are inactive, hypertensive, eat an unhealthy diet, and consume more than two drinks per day
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