title: The combined effect on survival of four main behavioural risk factors for non-communicable diseases.
abstract: OBJECTIVE
  To quantify and illustrate the combined effects of WHO's four behavioural risk factors for non-communicable diseases (NCDs) on mortality.
  
  
  METHODS
  Participants (n=16,721) were part of two Swiss population studies conducted between 1977 and 1993. Smoking status, alcohol consumption, physical activity and diet were assessed at baseline. With record linkage in 2008, up to 31years of follow-up with 3,533 deaths could be recorded. Mortality was assessed with Cox proportional hazard models for each risk factor and their combinations. Ten-year survival probabilities for 65- and 75-year-olds were estimated with Weibull regression models.
  
  
  RESULTS
  Hazard ratios for the combination of all four risk factors compared to none were 2.41 (1.99-2.93) in men and 2.46 (1.88-3.22) in women. For 65-year-olds, the probability of surviving the next 10years was 86% for men with no risk factors and 67% for men with four. In women, the respective numbers were 90% and 77%. In 75-year-olds, probabilities were 67% and 35% in men, and 74% and 47% in women.
  
  
  CONCLUSIONS
  The combined impact of four behavioural NCD risk factors on survival probability was comparable in size to a 10-year age difference and bigger than the gender effect.
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich CH-8001, Switzerland. Electronic address: eva.martin@ifspm.uzh.ch.
authors.forename: Eva
authors.initials: E
authors.lastname: Martin-Diener
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich CH-8001, Switzerland. Electronic address: julia.meyer@ifspm.uzh.ch.
authors.forename: Julia
authors.initials: J
authors.lastname: Meyer
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich CH-8001, Switzerland. Electronic address: julia.braun@ifspm.uzh.ch.
authors.forename: Julia
authors.initials: J
authors.lastname: Braun
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich CH-8001, Switzerland. Electronic address: silvan.tarnutzer@ifspm.uzh.ch.
authors.forename: Silvan
authors.initials: S
authors.lastname: Tarnutzer
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich CH-8001, Switzerland. Electronic address: david.faeh@uzh.ch.
authors.forename: David
authors.initials: D
authors.lastname: Faeh
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich CH-8001, Switzerland. Electronic address: sabine.rohrmann@ifspm.uzh.ch.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rohrmann
authors.affiliation: Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zürich CH-8001, Switzerland. Electronic address: brian.martin@uzh.ch.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Martin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D002908:Chronic Disease; D004032:Diet / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D012307:Risk Factors; D057185:Sedentary Behavior; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects*; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology; D014944:World Health Organization
keywords: Cancer; Cardiovascular disease; Lifestyle; Mortality; Prevention; Survival probability