The impact of key modifiable risk factors on leading chronic conditions

Abstract

We studied associations between 7 cardiovascular disease (CVD) risk factors (RFs) and 9 chronic conditions and estimated population-attributable risk. Data (N = 358,218) were from the 2017 Behavioral Risk Factor Surveillance System. Outcomes included asthma, arthritis, chronic obstructive pulmonary disease (COPD), cognitive impairment, CVD, and kidney disease. Risk factors (RF) were obesity, ever smoking, sedentary lifestyle, and inadequate fruit and vegetable consumption, while hypertension, high cholesterol, and diabetes were considered in both categories. Stata was used to study associations in both unadjusted and adjusted analysis. Population-attributable risk was estimated in Excel using adjusted odds ratios (AORs) and compared results using all RFs versus only those where causality was confirmed by other studies. RF prevalence rates ranged from 10.8% (95% CI 10.6, 11.0) for diabetes to 84.1% (83.8, 84.3) for inadequate fruit and vegetable consumption. Almost all adults (95.2%) reported ≥1 RF. Highest total PARs for RFs with confirmed causality were for obesity and ever smoking, and for hypertension when all RFs were considered. Total PARs for the 9 outcomes averaged 37.2-41.5% when results were limited to RFs with confirmed causality. Although the number of risk factors for which causality had been confirmed ranged from 1 to 6, all 9 outcomes showed linear dose response gradients with added risk factors. While all 7 RFs appeared important to address, targeting smoking and obesity with programs that have shown previous success offers the greatest potential for reducing burden for these 9 chronic diseases.

Keywords: Arthritis; Asthma; Behavioral risk factor surveillance system; COPD; Cardiovascular disease; Chronic disease; Cognitive dysfunction; Health risk behaviors; Risk factors; attributable-risk.