06 Dec Behavioral Risk Factors Cluster and Compound Mortality Risk
MedicalResearch.com Interview with:
Ding Ding (Melody), Ph.D., MPH
NHMRC Early Career Senior Research Fellow
Sydney University Postdoctoral Research Fellow
Prevention Research Collaboration
Sydney School of Public Health
The University of Sydney
Medical Research: What is the background for this study? What are the main findings?
Response: The study followed a large sample (around 200,000) of Australian adults aged 45 or older. Participants reported their lifestyle behaviours (smoking, excessive alcohol use, physical inactivity, unhealthy diet, prolonged sitting, short/long sleep duration) at baseline (2006-2009) and were followed up for around 6 years (up to June 2014). Based on linked administrative data (death records), we found a clear relationship between the total number of lifestyle risk behaviours and the risk of mortality—the more risk behaviours, the higher risk for mortality. This pattern of associations was consistent in men and women, participants in different age groups, of different socioeconomic status, and with and without major chronic disease.
Certain behavioural risk factors have synergistic associations with mortality and appear more harmful together than individually. For example, if people only sit for long hours (defined as >7 hours a day), without having other co-occurring risk behaviours, the risk for mortality was only elevated by 15%, and if people are only physically inactive without having other co-occurring risk behaviours, the risk for mortality was elevated by 60%. However when the two risk factors were combined, say if one is not physically active AND sit for long hours, the combined risk has become much larger (increased by 140%, compared with those with zero risk behaviours). Similarly, the combination of smoking and excessive alcohol use appeared a lot more “deadly” than the two risk factors alone.
Medical Research: What should clinicians and patients take away from your report?
Response: “Healthy living is the best policy”! Clinicians should emphasize the importance of healthy lifestyles that include don’t smoke, don’t drink excessively, be physically active, sit less, eat healthy and get healthy amount of sleep. Clinicians may consider lifestyle assessment in patient consultation to better understand patients’ health situation. Both clinicians and patients should also understand that having multiple lifestyle risk behaviours could have synergistic effects on health and it is important to reduce the total number of risk behaviors.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: Prior research in epidemiology was dominated by a “single risk factor” approach. However, in reality, behaviour risk factors cluster and interact with one another in a complex fashion. Our understanding of exposure-outcome associations could be enhanced if we take a multiple behaviour approach and if we start to draw attention to the patterns of risk factors, rather than single risk factors alone. Understanding the patterns of behavioural risk and the intricate interactions between behavioural risk factors may also help us approach lifestyle interventions in a holistic way, which is different from most behavioral interventions to date.
Ding, Ding (Melody), Rogers, Kris, Van Der Ploeg, Hidde, Stamatakis, Emmanuel (Emmanouil) Bauman, Adrian
Traditional and emerging lifestyle risk behaviors and all-cause mortality in middle-aged and older adults: Evidence from a large population-based Australian cohort
PLoS Medicine 2015
Ding Ding (Melody), Ph.D., MPH (2015). Behavioral Risk Factors Cluster and Compound Mortality Risk