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FIT Insights

Estimating the Impact of Lifestyle Habits on U.S. Life Expectancy:

Can We Learn to Turn Off the Faucet Rather than Mopping the Floor?

It’s well established that the U.S. spends too much money on health care and that our life expectancy is lower than that of other high-income countries. (Just try graduating from medical school without learning this!) In 2014-2015, the U.S. led the world in health care spending as a percentage of the gross domestic product (17.1%) but only ranked 31st in life expectancy.

Numerous global studies have demonstrated the association between the adoption of healthy lifestyle habits and living longer. A recent study in Circulation sought to estimate the effect of adopting healthy lifestyle habits on the life expectancy of the U.S. population. Specifically, this study focused on the effects of adopting five healthy lifestyle habits: not smoking, avoiding excessive alcohol consumption, being physically active, eating a healthy diet, and maintaining a normal body mass index.

The study’s major strength was that it leveraged data from the Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS) to associate the adoption of healthy lifestyle habits with mortality data. Both these cohorts provide detailed information about lifestyle habits with excellent rates of follow-up.  The distribution of healthy lifestyle habits in the U.S. population was estimated from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), which is representative of the national population and should improve the generalizability of the study.

The results should not be surprising to any of us who care for patients. The adoption of each individual healthy lifestyle habit was associated with a significant decrease in total mortality, cancer mortality, and cardiovascular mortality. Adherence to all five healthy lifestyle habits (vs. adherence to none) was associated with an all-cause mortality hazard ratio of 0.26 (95% CI, 0.22-0.31). The key finding in this study: adherence to all five healthy lifestyle habits (vs. adherence to none) could prolong the life expectancy of a 50-year-old man by about 12 years (from 25.5 to 37.6 years) and a 50-year-old woman by 14 years (from 29.0 to 43.1 years).

This study is limited by its reliance on self-reported data from cohort studies and the use of some assumptions and simplifications in its statistical analysis. But does the impressive magnitude of the positive effects of a healthy lifestyle on longevity seem implausible? I would argue no. Further, adoption of these healthy lifestyle habits does not come with the adverse effects, costs, and unintended consequences of routine medical interventions.

So, how adherent is the U.S. population to these healthy lifestyle habits? Well … the good news is that there’s room for improvement. In both the NHS and HPFS cohorts, the prevalence of adherence to all five healthy lifestyle habits was less than 2%. Improving U.S. lifestyle habits, particularly for combating obesity, is the public health challenge of our time and there are no simple solutions. However, the message of this study is clear. Americans could close the life expectancy gap compared with other industrialized countries by adopting a healthier lifestyle.

Author

Christopher Cook, MD

Dr. Christopher Cook is a general cardiology fellow at the University of South Florida in Tampa, Fla. He volunteers as a fellow-in-training blogger for Professional Heart Daily.