Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom.
National Institute for Health Research (NIHR) Applied Research Collaboration-East Midlands (ARC-EM) Leicester Diabetes Centre, Leicester, United Kingdom.
PLoS Med. 2020 Sep 22;17(9):e1003332. doi: 10.1371/journal.pmed.1003332. eCollection 2020 Sep.
Whether a healthy lifestyle impacts longevity in the presence of multimorbidity is unclear. We investigated the associations between healthy lifestyle and life expectancy in people with and without multimorbidity.
A total of 480,940 middle-aged adults (median age of 58 years [range 38-73], 46% male, 95% white) were analysed in the UK Biobank; this longitudinal study collected data between 2006 and 2010, and participants were followed up until 2016. We extracted 36 chronic conditions and defined multimorbidity as 2 or more conditions. Four lifestyle factors, based on national guidelines, were used: leisure-time physical activity, smoking, diet, and alcohol consumption. A combined weighted score was developed and grouped participants into 4 categories: very unhealthy, unhealthy, healthy, and very healthy. Survival models were applied to predict life expectancy, adjusting for ethnicity, working status, deprivation, body mass index, and sedentary time. A total of 93,746 (19.5%) participants had multimorbidity. During a mean follow-up of 7 (range 2-9) years, 11,006 deaths occurred. At 45 years, in men with multimorbidity an unhealthy score was associated with a gain of 1.5 (95% confidence interval [CI] -0.3 to 3.3; P = 0.102) additional life years compared to very unhealthy score, though the association was not significant, whilst a healthy score was significantly associated with a gain of 4.5 (3.3 to 5.7; P < 0.001) life years and a very healthy score with 6.3 (5.0 to 7.7; P < 0.001) years. Corresponding estimates in women were 3.5 (95% CI 0.7 to 6.3; P = 0.016), 6.4 (4.8 to 7.9; P < 0.001), and 7.6 (6.0 to 9.2; P < 0.001) years. Results were consistent in those without multimorbidity and in several sensitivity analyses. For individual lifestyle factors, no current smoking was associated with the largest survival benefit. The main limitations were that we could not explore the consistency of our results using a more restrictive definition of multimorbidity including only cardiometabolic conditions, and participants were not representative of the UK as a whole.
In this analysis of data from the UK Biobank, we found that regardless of the presence of multimorbidity, engaging in a healthier lifestyle was associated with up to 6.3 years longer life for men and 7.6 years for women; however, not all lifestyle risk factors equally correlated with life expectancy, with smoking being significantly worse than others.
在患有多种疾病的情况下，健康的生活方式是否会影响寿命尚不清楚。我们研究了健康的生活方式与患有和不患有多种疾病的人群的预期寿命之间的关系。
共分析了英国生物库 480940 名中年成年人（中位年龄为 58 岁[范围 38-73]，46%为男性，95%为白人）；这项纵向研究于 2006 年至 2010 年期间收集数据，参与者的随访时间截至 2016 年。我们提取了 36 种慢性疾病，并将多种疾病定义为 2 种或多种疾病。根据国家指南使用了 4 个生活方式因素：休闲时间的体力活动、吸烟、饮食和饮酒。制定了一个综合加权评分，并将参与者分为 4 类：非常不健康、不健康、健康和非常健康。应用生存模型预测预期寿命，调整了种族、工作状态、贫困、体重指数和久坐时间。共有 93746（19.5%）名参与者患有多种疾病。在平均 7 年（范围 2-9 年）的随访期间，有 11006 人死亡。在 45 岁时，与非常不健康评分相比，患有多种疾病的男性不健康评分与获得 1.5 年（95%置信区间[CI] -0.3 至 3.3；P = 0.102）的额外寿命有关，尽管这种关联并不显著，而健康评分与获得 4.5 年（3.3 至 5.7；P < 0.001）的寿命和非常健康评分与获得 6.3 年（5.0 至 7.7；P < 0.001）的寿命显著相关。女性的相应估计值分别为 3.5 年（95%CI 0.7 至 6.3；P = 0.016）、6.4 年（4.8 至 7.9；P < 0.001）和 7.6 年（6.0 至 9.2；P < 0.001）。在没有多种疾病的人群中和在几项敏感性分析中，结果是一致的。对于个别生活方式因素，目前不吸烟与最大的生存获益相关。主要限制是我们无法使用包括心血管代谢疾病在内的更严格的多种疾病定义来探索我们结果的一致性，并且参与者不能代表整个英国。
在对英国生物库数据的这项分析中，我们发现，无论是否存在多种疾病，更健康的生活方式与男性长达 6.3 年、女性长达 7.6 年的寿命延长有关；然而，并非所有的生活方式风险因素都与预期寿命同样相关，吸烟的影响明显比其他因素更严重。
