Smoking, drinking, diet and physical activity-modifiable lifestyle risk factors and their associations with age to first chronic disease

Ryan Ng, Rinku Sutradhar, Zhan Yao, Walter P Wodchis, Laura C Rosella, Ryan Ng, Rinku Sutradhar, Zhan Yao, Walter P Wodchis, Laura C Rosella

Abstract

Background: This study examined the incidence of a person's first diagnosis of a selected chronic disease, and the relationships between modifiable lifestyle risk factors and age to first of six chronic diseases.

Methods: Ontario respondents from 2001 to 2010 of the Canadian Community Health Survey were followed up with administrative data until 2014 for congestive heart failure, chronic obstructive respiratory disease, diabetes, lung cancer, myocardial infarction and stroke. By sex, the cumulative incidence function of age to first chronic disease was calculated for the six chronic diseases individually and compositely. The associations between modifiable lifestyle risk factors (alcohol, body mass index, smoking, diet, physical inactivity) and age to first chronic disease were estimated using cause-specific Cox proportional hazards models and Fine-Gray competing risk models.

Results: Diabetes was the most common disease. By age 70.5 years (2015 world life expectancy), 50.9% of females and 58.1% of males had at least one disease and few had a death free of the selected diseases (3.4% females; 5.4% males). Of the lifestyle factors, heavy smoking had the strongest association with the risk of experiencing at least one chronic disease (cause-specific hazard ratio = 3.86; 95% confidence interval = 3.46, 4.31). The lifestyle factors were modelled for each disease separately, and the associations varied by chronic disease and sex.

Conclusions: We found that most individuals will have at least one of the six chronic diseases before dying. This study provides a novel approach using competing risk methods to examine the incidence of chronic diseases relative to the life course and how their incidences are associated with lifestyle behaviours.

Keywords: Alcohol; body mass index; chronic disease; competing risks; diet; life course; multimorbidity; physical activity; smoking.

© The Author(s) 2019. Published by Oxford University Press on behalf of the International Epidemiological Association.

Figures

Figure 1.
Figure 1.
Eligubilty criteria for the CCHS Cohort, ON, Canada, 2000–14.
Figure 2.
Figure 2.
Cumulative incidence function of age to first chronic disease with death as a competing risk, by sex.
Figure 3.
Figure 3.
Cumulative incidence function for age-to-first chronic disease among females (top) and males (bottom), by chronic disease. The individual chronic diseases are competing risks of one another, so the cumulative incidence shows the risk of a specific chronic disease without the presence of any other event (chronic disease or death). For example, ‘diabetes’ implies ‘diabetes without the presence of another chronic disease or death’.

References

    1. World Health Organization. Global Status Report on Noncommunicable Diseases 2014. Geneva: WHO, 2014.
    1. Public Health Agency of Canada. How Healthy Are Canadians: A Trend Analysis of Canadians From a Healthy Living and Chronic Disease Perspective. Ottawa: PHAC, 2016.
    1. Busse R, Blumel M, Scheller-Kreinsen D, Zentner A.. Tackling Chronic Disease in Europe: Strategies, Interventions, and Challenges. Geneva: WHO, 2010.
    1. Bauer UE, Briss PA, Goodman RA, Bowman BA.. Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. Lancet 2014;384:45–52.
    1. Fortin M, Pinho G, Gignac J, Almirall J, Lapointe L, Dionne J.. Randomized controlled trials: do they have external validity for patients with multiple comorbidities? Ann Fam Med 2006;4:104–8.
    1. Parekh AK, Barton MB.. The challenge of multiple comorbidity for the US Health Care System. JAMA 2010;303:1303–4.
    1. Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M.. Multimorbidity’s many challenges. BMJ 2007;334:1016–7.
    1. Betancourt MT, Roberts KC, Bennett T-L, Driscoll ER, Jayaraman G, Monitoring PL.. Chronic diseases in Canada: the Chronic Disease Indicator Framework. Chronic Dis Inj Can 2014;34(Suppl 1):1–30.
    1. Beaglehole R, Bonita R, Horton R. et al. Priority actions for the non-communicable disease crisis. Lancet 2011;377:1438–47.
    1. Kearns K, Dee A, Fitzgerald AP, Doherty E, Perry IJ.. Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level. BMC Public Health 2014;14:1–10.
    1. Gaziano TA, Galea G, Reddy KS.. Scaling up interventions for chronic disease prevention: the evidence. Lancet 2007;370:1939–46.
    1. Brownson RC, Haire-Joshu D, Luke DA.. Shaping the context of health: a review of environmental and policy approaches in the prevention of chronic diseases. Annu Rev Public Health 2006;27:341–70.
    1. Bunnell R, O’Neil D, Soler R. et al. Fifty communities putting prevention to work: accelerating chronic disease prevention through policy, systems and environmental change. J Community Health 2012;37:1081–90.
    1. Béland YC. Canadian community health survey - methodological overview. Health Rep 2002;13:9–14.
    1. McLaughlin JR, Kreiger N, Marrett LD, Holowaty EJ.. Cancer incidence registration and trends in Ontario. Eur J Cancer 1991;27:1520–4.
    1. Schultz SE, Rothwell DM, Chen Z, Tu K.. Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records. Chronic Dis Inj Can 2013;33:160–6.
    1. Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, To T.. Identifying individuals with physician diagnosed COPD in health administrative databases. COPD 2009;6:388–94.
    1. Hux JE, Ivis F, Flintoft V, Bica A.. Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 2002;25:512–6.
    1. Austin PC, Daly PA, Tu JV.. A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario. Am Heart J 2002;144:290–6.
    1. Tu K, Wang M, Young J. et al. Validity of administrative data for identifying patients who have had a stroke or transient ischemic attack using EMRALD as a reference standard. Can J Cardiol 2013;29:1388–94.
    1. Shields M, Gorber SC, Janssen I, Tremblay MS.. Bias in self-reported estimates of obesity in Canadian health surveys: an update on correction equations for adults. Health Rep 2011;22:35–45.
    1. Korn EL, Graubard BI, Midthune D.. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol 1997;145:72–80.
    1. Hosmer DW, Lemeshow S, May S.. Applied Survival Analysis. 2nd edn Hoboken, NJ: Wiley, 2008.
    1. Therneau TM, Grambsch PM.. Modeling Survival Data: Extending the Cox Model. 1st edn New York, NY: Springer; 2000.
    1. Hu FB. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care 2011;34:1249–57.
    1. Mosca L, Barrett-Connor E, Kass Wenger N.. Sex/gender differences in cardiovascular disease prevention: What a difference a decade makes. Circulation 2011;124:2145–54.
    1. Postma DS, Bush A, Van Den Berge M.. Risk factors and early origins of chronic obstructive pulmonary disease. Lancet 2015;385:899–909.
    1. Irigaray P, Newby JA, Clapp R. et al. Lifestyle-related factors and environmental agents causing cancer: An overview. Biomed Pharmacother 2007;61:640–58.
    1. Marisol B, Brenda B, Geneviève G. et al. At-a-glance - The 2017 Canadian Chronic Disease Indicators. Health Promot Chronic Dis Prev Canada 2017;37:248–51.
    1. Austin PC, Fine JP.. Practical recommendations for reporting Fine-Gray model analyses for competing risk data. Stat Med 2017;36:4391–400.
    1. International Agency for Research on Cancer. Personal Habits and Indoor Combustions. Volume 100 E. A Review of Human Carcinogens. IARC Monogr Eval Carcinog Risks to Humans [Internet] 2012. (11 February 2019, date last accessed).
    1. International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention: Weight Control and Physical Activity Vol. 6. Lyon, France: IARC Press, 2002.
    1. International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention: Fruits and Vegetables Vol. 8. Lyon, France: IARC Press, 2003.
    1. International Agency for Research on Cancer. Personal Habits and Indoor Combustions Volume 100 E. Consumption of Alcoholic Beverages 2011. (11 February 2019, date last accessed).
    1. International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention: Absensce of Excess Body Fatness Vol. 16. Lyon, France: IARC Press, 2018.
    1. United Nations, Department of Economic and Social Affairs. World Population Prospects: The 2015 Revision New York, NY; UNO, 2015.
    1. Rosella L, Kornas K, Huang A, Bornbaum C, Henry D, Wodchis WP.. Accumulation of chronic conditions at the time of death increased in Ontario from 1994 to 2013. Health Aff 2018;37:1–9.
    1. Pefoyo AJK, Bronskill SE, Gruneir A. et al. The increasing burden and complexity of multimorbidity. BMC Public Health 2015;15:415..
    1. Wodchis W. Performance measurement for people with multimorbidity and complex health needs. Healthc Q 2016;19:44–8.
    1. Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA.. Causes and consequences of comorbidity: a review. J Clin Epidemiol 2001;54:661–74.
    1. Thavorn K, Maxwell CJ, Gruneir A. et al. Effect of socio-demographic factors on the association between multimorbidity and healthcare costs: a population-based, retrospective cohort study. BMJ Open 2017;7:e017264.
    1. Corrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K.. Alcohol and coronary heart disease: A meta-analysis. Addiction 2000;95:1505–23.
    1. Baliunas DO, Taylor BJ, Irving H. et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care 2009;32:2123–32.
    1. Litwic A, Edwards MH, Dennison EM, Cooper C.. Epidemiology and burden of osteoarthritis. Br Med Bull 2013;105:185–99.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅