title: Health practices and mortality in Japan: combined effects of smoking, drinking, walking and body mass index in the Miyagi Cohort Study.
abstract: BACKGROUND
  Evidence is limited regarding the association between the combinations of multiple health practices and mortality.
  
  
  METHODS
  In 1990, 28,333 men and women in Miyagi Prefecture in rural northern Japan (40-64 year of age) completed a self-administered questionnaire. A lifestyle score was calculated by adding the number of high-risk practices (smoking, consuming > or = 22.8 g alcohol/d, walking < 1 hr/d, body mass index < 18.5 or > or = 30.0). Cox regression was used to estimate relative risk (RR) of mortality according to the lifestyle score, with adjustment for age, education, marital status, past history of diseases, and dietary variables. During 11 years of follow-up, 1,200 subjects had died.
  
  
  RESULTS
  We observed linear increase in risk of death associated with increasing number of high-risk practices: compared with men who had no high-risk practices, multivariate RRs for men who had 1 to 4 practices were 1.20, 1.66, 1.94, and 3.96, respectively (P for trend<0.001), and corresponding RRs for women were 1.31, 2.14, 3.98, 5.56, respectively (P for trend<0.001). A unit increase in the number of high-risk practices corresponded to being 2.8 and 4.8 years older for men and women, respectively.
  
  
  CONCLUSIONS
  In this prospective cohort study of middle-aged men and women in rural Japan, a larger number of high-risk practices was associated with linear increase in risk of all-cause mortality.
authors.affiliation: Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Tsubono
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Koizumi
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakaya
authors.forename: Kazuki
authors.initials: K
authors.lastname: Fujita
authors.forename: Hideko
authors.initials: H
authors.lastname: Takahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Yoko
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
authors.forename: Akira
authors.initials: A
authors.lastname: Fukao
authors.forename: Shigeru
authors.initials: S
authors.lastname: Hisamichi
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000401:mortality; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D016138:Walking