Ortiz Cristina, López-Cuadrado Teresa, Ayuso-Álvarez Ana, Rodríguez-Blázquez Carmen, Galán Iñaki
Carlos III Health Institute, Madrid, Spain.
Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
BMJ Open. 2025 Jan 25;15(1):e093037. doi: 10.1136/bmjopen-2024-093037.
This study aims to estimate the impact of the co-occurrence of behavioural risk factors on mortality in the Spanish adult population.
Population-based cohort study based on data from the 2011-2012 Spanish National Health Survey and the 2014 European Health Survey (n=35 053 participants ≥15 years of age) both linked to mortality data as of December 2022. Risk factors included tobacco use, high-risk alcohol consumption, low adherence to the Mediterranean diet, leisure time sedentary lifestyle and body mass index outside the 18.5-24.9 kg/m range. Deaths from any cause (n=2784), from diseases of the circulatory system (n=678) and from tumours (n=869) were identified. Standardised rate differences (SRD) and standardised rate ratios (SRR) were estimated using Poisson regression models adjusted for sociodemographic variables.
Compared with those with no unhealthy behaviours, overall mortality risk increased gradually as the co-occurrence of risk behaviours increased. Individuals with two factors had an SRD of 3.0 deaths per 1000 person-years (95% CI 1.8; 4.3) and an SRR of 1.88 (95% CI 1.35; 2.62). A coexistence of five risk factors increased SRD and SRR to 11.5 (95% CI 7.2; 15.8) and 4.34 (95% CI 2.84; 6.63), respectively. The association was stronger among individuals under 65 years of age, whereas it did not vary by sex and educational level. Those reporting five risk factors had SRRs of 6.35 (95% CI 2.91; 13.83) and 2.57 (95% CI 1.11; 5.98) for tumour-related and cardiovascular disease mortality, respectively.
The co-occurrence of unhealthy behaviours increases the risk of overall and cause-specific mortality. Targeting multiple risk behaviours should be incorporated into the public health strategy.
本研究旨在评估行为风险因素共存对西班牙成年人群死亡率的影响。
基于2011 - 2012年西班牙国家健康调查和2014年欧洲健康调查数据（n = 35053名年龄≥15岁的参与者）的基于人群的队列研究，这些数据均与截至2022年12月的死亡率数据相关联。风险因素包括吸烟、高风险饮酒、对地中海饮食的低依从性、休闲时间久坐的生活方式以及体重指数不在18.5 - 24.9 kg/m²范围内。确定了各种原因导致的死亡（n = 2784）、循环系统疾病导致的死亡（n = 678）和肿瘤导致的死亡（n = 869）。使用针对社会人口统计学变量进行调整的泊松回归模型估计标准化率差（SRD）和标准化率比（SRR）。
与没有不健康行为的人相比，随着风险行为共存情况的增加，总体死亡风险逐渐上升。有两个风险因素的个体每1000人年的标准化率差为3.0例死亡（95%置信区间1.8；4.3），标准化率比为1.88（95%置信区间1.35；2.62）。五个风险因素共存使标准化率差和标准化率比分别增加到11.5（95%置信区间7.2；15.8）和4.34（95%置信区间2.84；6.63）。这种关联在65岁以下的个体中更强，而在性别和教育水平方面没有差异。报告有五个风险因素的个体，与肿瘤相关的死亡率和心血管疾病死亡率的标准化率比分别为6.35（95%置信区间2.91；13.83）和2.57（95%置信区间1.11；5.98）。
不健康行为的共存会增加总体和特定原因死亡率的风险。针对多种风险行为的干预应纳入公共卫生策略。
