Muller David C, Murphy Neil, Johansson Mattias, Ferrari Pietro, Tsilidis Konstantinos K, Boutron-Ruault Marie-Christine, Clavel Francoise, Dartois Laureen, Li Kuanrong, Kaaks Rudolf, Weikert Cornelia, Bergmann Manuela, Boeing Heiner, Tjønneland Anne, Overvad Kim, Redondo M Luisa, Agudo Antonio, Molina-Portillo Elena, Altzibar Jone M, Cirera Lluís, Ardanaz Eva, Khaw Kay-Tee, Wareham Nicholas J, Key Timothy J, Travis Ruth C, Bamia Christina, Orfanos Philippos, Trichopoulou Antonia, Palli Domenico, Pala Valeria, Tumino Rosario, Vineis Paolo, Panico Salvatore, Bueno-de-Mesquita H Bas, Verschuren W M Monique, Struijk Ellen A, Peeters Petra H, Engström Gunnar, Melander Olle, Sund Malin, Weiderpass Elisabete, Skeie Guri, Lund Eiliv, Norat Teresa, Gunter Marc, Riboli Elio, Brennan Paul
International Agency for Research on Cancer, 69008, Lyon, France.
School of Public Health, Imperial College London, London, SW7 2AZ, UK.
BMC Med. 2016 Jun 14;14:87. doi: 10.1186/s12916-016-0630-6.
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.
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.
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.
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.
欧洲的预期寿命正在增加，但仍有相当一部分成年人在70岁之前过早死亡。我们试图评估吸烟、高血压、肥胖、缺乏身体活动、饮酒和不良饮食对过早死亡风险的共同及相对影响。
我们分析了来自欧洲癌症与营养前瞻性队列研究（EPIC）的264,906名欧洲成年人的数据，这些人在招募时年龄在40至70岁之间。使用灵活的参数生存模型对基于风险因素的死亡风险进行建模，并根据拟合模型计算70岁之前死亡的生存函数和归因分数（AF）。
我们确定了11,930例在70岁之前发生的死亡。吸烟导致过早死亡的归因分数为31%（95%置信区间（CI），31 - 32%），不良饮食为14%（95%CI，12 - 16%）。通过腰臀比衡量的超重和肥胖（10%；95%CI，8 - 12%）以及高血压（9%；95%CI，7 - 11%）也有重要影响。缺乏身体活动和过量饮酒的归因分数分别为7%和4%。总体而言，所有六个风险因素的归因分数为57%（95%CI，55 - 59%），从不吸烟者中为35%（95%CI，32 - 37%），当前吸烟者中为74%（95%CI，73 - 75%）。
虽然吸烟仍然是欧洲过早死亡的主要风险因素，但不良饮食、超重和肥胖、高血压、缺乏身体活动以及过量饮酒也有很大影响。任何将过早死亡降至最低的尝试最终都需要解决所有这六个因素。
