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Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study

Muller DC 1 , Murphy N 2 , Johansson M 1 , Ferrari P 1 , Tsilidis KK 3 , Boutron-Ruault MC 4 Show all authors , Clavel F 5 , Dartois L 5 , Li K 6 , Kaaks R 6 , Weikert C 7 , Bergmann M 7 , Boeing H 7 , Tjønneland A 8 , Overvad K 9 , Redondo ML 10 , Agudo A 11 , Molina-Portillo E 12 , Altzibar JM 13 , Cirera L 13 , Ardanaz E 13 , Khaw KT 14 , Wareham NJ 15 , Key TJ 16 , Travis RC 16 , Bamia C 17 , Orfanos P 17 , Trichopoulou A 17 , Palli D 18 , Pala V 19 , Tumino R 20 , Vineis P 2 , Panico S 21 , Bueno-de-Mesquita HB 2 , Verschuren WM 22 , Struijk EA 23 , Peeters PH 2 , Engström G 24 , Melander O 25 , Sund M 26 , Weiderpass E 27 , Skeie G 27 , Lund E 27 , Norat T 2 , Gunter M 2 , Riboli E 2 , Brennan P 28

Affiliations 

  • 1 International Agency for Research on Cancer, 69008, Lyon, France
  • 2 School of Public Health, Imperial College London, London, SW7 2AZ, UK
  • 3 Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110, Ioannina, Greece
  • 4 Centre for Research in Epidemiology and Population Health (CESP), 94805, Villejuif, France
  • 5 Université Paris Sud, Villejuif, France
  • 6 Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), DE-69120, Heidelberg, Germany
  • 7 German Institute of Human Nutrition Potsdam-Rehbrücke (DifE), DE-14558, Nuthetal, Germany
  • 8 Danish Cancer Society Research Center, DK-2100, Copenhagen, Denmark
  • 9 Department of Public Health, Section for Epidemiology, Aarhus University, DK-8000, Aarhus, Denmark
  • 10 Public Health Directorate, 33006, Asturias, Spain
  • 11 Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, 08908, Barcelona, Spain
  • 12 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, 18012, Granada, Spain
  • 13 Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain
  • 14 School of Clinical Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK
  • 15 MRC Epidemiology Unit, University of Cambridge, Cambridge, CB2 0SR, UK
  • 16 Cancer Epidemiology Unit, University of Oxford, Oxford, OX3 7LF, UK
  • 17 Hellenic Health Foundation, GR-115 27, Athens, Greece
  • 18 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), 50134, Florence, Italy
  • 19 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy
  • 20 Cancer Registry and Histopathology Unit, "Civic - M. P. Arezzo" Hospital, ASP Ragusa, Ragusa, 97100, Italy
  • 21 Dipartimento di Medicina Clinica e Sperimentale, Federico II University, 80138, Naples, Italy
  • 22 Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), 3720 BA, Bilthoven, The Netherlands
  • 23 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  • 24 Department of Clinical Science, Malmö Lund University, Lund, SE-205 02, Sweden
  • 25 Department of Clinical Sciences, Hypertension & Cardiovascular Disease, Clinical Research Centre, Malmö University Hospital, SE-20502, Malmö, Sweden
  • 26 Department of Surgical and Perioperative Sciences, Umea University, 901 85, Umea, Sweden
  • 27 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 9037, Tromsø, Norway
  • 28 International Agency for Research on Cancer, 69008, Lyon, France. gep@iarc.fr
BMC Med, 2016 Jun 14;14:87.
PMID: 27296932 DOI: 10.1186/s12916-016-0630-6

Abstract

BACKGROUND: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death.

METHODS: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models.

RESULTS: We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31-32 %) and 14 % (95 % CI, 12-16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8-12 %) and high blood pressure (9 %; 95 % CI, 7-11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55-59 %), being 35 % (95 % CI, 32-37 %) among never smokers and 74 % (95 % CI, 73-75 %) among current smokers.

CONCLUSIONS: While smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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