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. 2022 Mar 10;22(1):478.
doi: 10.1186/s12889-022-12849-y.

Comparison of mortality hazard ratios associated with health behaviours in Canada and the United States: a population-based linked health survey study

Stacey Fisher  1   2   3 , Carol Bennett  1   2 , Deirdre Hennessy  4 , Philippe Finès  4 , Mahsa Jessri  1   2   4 , Anan Bader Eddeen  1   2 , John Frank  5 , Tony Robertson  6 , Monica Taljaard  1   3 , Laura C Rosella  2   7 , Claudia Sanmartin  4 , Prabhat Jha  7   8 , Alastair Leyland  9 , Douglas G Manuel  10   11   12   13   14
Affiliations

Comparison of mortality hazard ratios associated with health behaviours in Canada and the United States: a population-based linked health survey study

Stacey Fisher et al. BMC Public Health. .

Abstract

Background: Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications.

Methods: The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history.

Results: A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a 'healthy profile' was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada.

Conclusion: Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development.

Keywords: Health behaviours; Health surveillance; National health surveys; Population health.

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Conflict of interest statement

The authors have declared no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of the United States and Canadian mortality hazard ratios associated with health behaviours for age 45 (A) males and (B) females
Fig. 2
Fig. 2
Comparison of the United States and Canadian mortality hazard ratios associated with health behaviours for age 70 (A) males and (B) females
See this image and copyright information in PMC

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