Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study
Objectives This study aims to estimate the impact of the co-occurrence of behavioural risk factors on mortality in the Spanish adult population.Design Population-based cohort study based on data from the 2011–2012 Spanish National Health Survey and the 2014 European Health Survey (n=35 053 participa...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e093037.full |
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| author | Iñaki Galán Cristina Ortiz Carmen Rodriguez-Blazquez Teresa López-Cuadrado Ana Ayuso-Álvarez |
| author_facet | Iñaki Galán Cristina Ortiz Carmen Rodriguez-Blazquez Teresa López-Cuadrado Ana Ayuso-Álvarez |
| author_sort | Iñaki Galán |
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| description | Objectives This study aims to estimate the impact of the co-occurrence of behavioural risk factors on mortality in the Spanish adult population.Design 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/m2 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.Results 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.Conclusions 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. |
| format | Article |
| id | doaj-art-dce32e885a374044881496ecc6ac226b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-dce32e885a374044881496ecc6ac226b2025-01-27T09:05:08ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-093037Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort studyIñaki Galán0Cristina Ortiz1Carmen Rodriguez-Blazquez2Teresa López-Cuadrado3Ana Ayuso-Álvarez42 Departmento de Medicina Preventiva y Salud Pública, Universidad Autonoma de Madrid/IdiPAZ, Madrid, Spain2 Internal Medicine I, University of Frankfurt, Frankfurt, GermanyCenter for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Health Institute, Madrid, SpainDepartment of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, SpainCarlos III Health Institute, Madrid, SpainObjectives This study aims to estimate the impact of the co-occurrence of behavioural risk factors on mortality in the Spanish adult population.Design 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/m2 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.Results 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.Conclusions 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.https://bmjopen.bmj.com/content/15/1/e093037.full |
| spellingShingle | Iñaki Galán Cristina Ortiz Carmen Rodriguez-Blazquez Teresa López-Cuadrado Ana Ayuso-Álvarez Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study BMJ Open |
| title | Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study |
| title_full | Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study |
| title_fullStr | Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study |
| title_full_unstemmed | Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study |
| title_short | Co-occurrence of behavioural risk factors for non-communicable diseases and mortality risk in Spain: a population-based cohort study |
| title_sort | co occurrence of behavioural risk factors for non communicable diseases and mortality risk in spain a population based cohort study |
| url | https://bmjopen.bmj.com/content/15/1/e093037.full |
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