title: Adverse lifestyle leads to an annual excess of 2 million deaths in China.
abstract: BACKGROUND
  Adverse lifestyle factors have been associated with increased mortality, but data are lacking on their combined effect in developing populations, which we address in the present study.
  
  
  METHODS
  In a death registry-based, case-control study among Hong Kong Chinese aged 30+y, proxy-reported lifestyle factors 10 y ago were collected for 21,363 cases (81% of all deaths) and 12,048 living controls. Risks associated with poor diet, inactivity, heavy alcohol intake, and smoking for all-cause and cause-specific mortality, adjusting for potential confounders, were determined, and excess deaths for the Chinese population were calculated.
  
  
  RESULTS
  Adjusted odds ratios for all-cause mortality were 1.15 (95% CI 1.09, 1.23), 1.34 (1.27, 1.43), 1.36 (1.21, 1.52), and 1.58 (1.46, 1.70) for poor diet, inactivity, heavy alcohol intake and smoking, respectively. Increasing numbers of adverse lifestyle factors were associated with a dose-dependent increase in adjusted odds ratios of 1.30 (1.20, 1.40), 1.67 (1.54, 1.81), 2.32 (2.08, 2.60), and 3.85 (3.12, 4.75) for 1, 2, 3, and 4 risk factors relative to those with none. The population attributable fraction for all-cause, all-CVD and all-cancer mortality were 26.6%, 15.0%, and 32.1%, resulting in an excess of 2,017,541; 489,884; and 607,517 deaths annually, respectively. Although smoking was associated with the greatest excess loss of life (867,530), heavy drinking (680,466), and physical inactivity (678,317) were similarly important.
  
  
  CONCLUSIONS
  Adverse lifestyle factors contribute to one quarter of all deaths in China. Improving lifestyle practices, particularly focussing on moderating alcohol intake and increasing activity, and smoking cessation are critical to reducing the lifestyle-associated health burden.
authors.affiliation: Public Health, Epidemiology, and Biostatistics, University of Birmingham, Birmingham, United Kingdom ; Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.
authors.forename: G Neil
authors.initials: GN
authors.lastname: Thomas
authors.affiliation: School of Nursing, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Man Ping
authors.initials: MP
authors.lastname: Wang
authors.affiliation: School of Public Health, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Sai Yin
authors.initials: SY
authors.lastname: Ho
authors.affiliation: Department of Health, Hong Kong SAR Government, Hong Kong SAR, China.
authors.forename: Kwok Hang
authors.initials: KH
authors.lastname: Mak
authors.affiliation: Public Health, Epidemiology, and Biostatistics, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Kar Keung
authors.initials: KK
authors.lastname: Cheng
authors.affiliation: School of Public Health, University of Hong Kong, Hong Kong SAR, China.
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000401:mortality; D044466:Asian People; D016022:Case-Control Studies; D002423:Cause of Death; D004032:Diet / Q000009:adverse effects; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009369:Neoplasms / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000401:mortality