title: Impact of individual and combined health behaviors on all causes of premature mortality among middle aged men in Korea: the Seoul Male Cohort Study.
abstract: OBJECTIVE
  The aim of this study was to evaluate and quantify the risk of both individual and combined health behaviors on premature mortality in middle aged men in Korea.
  
  
  METHODS
  In total, 14 533 male subjects 40 to 59 years of age were recruited. At enrollment, subjects completed a baseline questionnaire, which included information about socio-demographic factors, past medical history, and life style. During the follow-up period from 1993 to 2008, we identified 990 all-cause premature deaths using national death certificates. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of each health risk behavior, which included smoking, drinking, physical inactivity, and lack of sleep hours. Using the Cox model, each health behavior was assigned a risk score proportional to its regression coefficient value. Health risk scores were calculated for each patient and the HR of all-cause premature mortality was calculated according to risk score.
  
  
  RESULTS
  Current smoking and drinking, high body mass index, less sleep hours, and less education were significantly associated with all-cause premature mortality, while regular exercise was associated with a reduced risk. When combined by health risk score, there was a strong trend for increased mortality risk with increased score (p-trend < 0.01). When compared with the 1-9 score group, HRs of the 10-19 and 20-28 score groups were 2.58 (95% confidence intervals [CIs], 2.19 to 3.03) and 7.09 (95% CIs, 5.21 to 9.66), respectively.
  
  
  CONCLUSIONS
  Modifiable risk factors, such as smoking, drinking, and regular exercise, have considerable impact on premature mortality and should be assessed in combination.
authors.affiliation: Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Rhee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Park
authors.forename: Zhong Min
authors.initials: ZM
authors.lastname: Li
authors.forename: Yoon-Ok
authors.initials: YO
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000401:mortality; D015992:Body Mass Index; D002423:Cause of Death; D015331:Cohort Studies; D015444:Exercise / Q000502:physiology; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D007723:Korea; D008019:Life Style; D008297:Male; D054526:Men's Health; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000401:mortality