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

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title = "Modifiable causes of premature death in middle-age in Western Europe: Results from the EPIC cohort study",
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",
author = "Muller, {David C.} and Neil Murphy and Mattias Johansson and Pietro Ferrari and Tsilidis, {Konstantinos K.} and Boutron-Ruault, {Marie Christine} and Francoise Clavel and Laureen Dartois and Kuanrong Li and Rudolf Kaaks and Cornelia Weikert and Manuela Bergmann and Heiner Boeing and Anne Tj{\o}nneland and Kim Overvad and Redondo, {M. Luisa} and Antonio Agudo and Elena Molina-Portillo and Altzibar, {Jone M.} and Llu{\'i}s Cirera and Eva Ardanaz and Khaw, {Kay Tee} and Wareham, {Nicholas J.} and Key, {Timothy J.} and Travis, {Ruth C.} and Christina Bamia and Philippos Orfanos and Antonia Trichopoulou and Domenico Palli and Valeria Pala and Rosario Tumino and Paolo Vineis and Salvatore Panico and Bueno-de-Mesquita, {H. Bas} and Verschuren, {W. M Monique} and Struijk, {Ellen A.} and Peeters, {Petra H.} and Gunnar Engstr{\"o}m and Olle Melander and Malin Sund and Elisabete Weiderpass and Guri Skeie and Eiliv Lund and Teresa Norat and Marc Gunter and Elio Riboli and Paul Brennan",
year = "2016",
month = "6",
day = "14",
doi = "10.1186/s12916-016-0630-6",
language = "English",
volume = "14",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BioMed Central",
number = "1",