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

Research output: Contribution to journalArticle

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.

Details

Authors
  • David C. Muller
  • Neil Murphy
  • Mattias Johansson
  • Pietro Ferrari
  • Konstantinos K. Tsilidis
  • Marie Christine Boutron-Ruault
  • Francoise Clavel
  • Laureen Dartois
  • Kuanrong Li
  • Rudolf Kaaks
  • Cornelia Weikert
  • Manuela Bergmann
  • Heiner Boeing
  • Anne Tjønneland
  • Kim Overvad
  • M. Luisa Redondo
  • Antonio Agudo
  • Elena Molina-Portillo
  • Jone M. Altzibar
  • Lluís Cirera
  • Eva Ardanaz
  • Kay Tee Khaw
  • Nicholas J. Wareham
  • Timothy J. Key
  • Ruth C. Travis
  • Christina Bamia
  • Philippos Orfanos
  • Antonia Trichopoulou
  • Domenico Palli
  • Valeria Pala
  • Rosario Tumino
  • Paolo Vineis
  • Salvatore Panico
  • H. Bas Bueno-de-Mesquita
  • W. M Monique Verschuren
  • Ellen A. Struijk
  • Petra H. Peeters
  • Malin Sund
  • Elisabete Weiderpass
  • Guri Skeie
  • Eiliv Lund
  • Teresa Norat
  • Marc Gunter
  • Elio Riboli
  • Paul Brennan
Organisations
External organisations
  • International Agency for Research on Cancer, World Health Organization
  • Imperial College London
  • Institut Gustave Roussy
  • Centre for Research in Epidemiology and Population Health (CESP)
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • Danish Cancer Society Research Center
  • Aarhus University
  • Public Health Directorate
  • Catalan Institute of Oncology
  • CIBER Epidemiology and Public Health (CIBERESP)
  • Biodonostia Health Research Institute
  • University of Murcia
  • Health Research Institute of Navarra (IDISNA)
  • University of Cambridge
  • University of Oxford
  • National and Kapodistrian University of Athens
  • Cancer Research and Prevention Institute (ISPO)
  • Istituto Nazionale dei Tumori
  • Civic and M.P Arezzo Hospital
  • Human Genetics Foundation (HuGeF)
  • University of Naples Federico II
  • University of Malaya
  • University Medical Center Utrecht
  • Umeå University
  • Folkhälsan Research Center
  • UiT The Arctic University of Norway, Tromsø
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology
  • Clinical Medicine

Keywords

  • Absolute risk, Attributable fraction, Modifiable risk factors, Mortality, Premature death
Original languageEnglish
Article number87
JournalBMC Medicine
Volume14
Issue number1
Publication statusPublished - 2016 Jun 14
Publication categoryResearch
Peer-reviewedYes