title: Smoking, physical inactivity and obesity as predictors of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study.
abstract: Smoking, physical inactivity and obesity are modifiable risk factors for morbidity and mortality. The aim of this study was to examine the extent to which the co-occurrence of these behaviour-related risk factors predict healthy life expectancy and chronic disease-free life expectancy in four European cohort studies.
  
  
  
  Data were drawn from repeated waves of four cohort studies in England, Finland, France and Sweden. Smoking status, physical inactivity and obesity (body mass index ≥30 kg/m2) were examined separately and in combination. Health expectancy was estimated by using two health indicators: suboptimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years.
  
  
  
  Compared with men and women with at least two behaviour-related risk factors, those with no behaviour-related risk factors could expect to live on average8 years longer in good health and 6 years longer free of chronic diseases between ages 50 and 75. Having any single risk factor was also associated with reduction in healthy years. No consistent differences between cohorts were observed.
  
  
  
  Data from four European countries show that persons with individual and co-occurring behaviour-related risk factors have shorter healthy life expectancy and shorter chronic disease-free life expectancy. Population level reductions in smoking, physical inactivity and obesity could increase life-years lived in good health.
authors.affiliation: Department of Public Health, University of Turku, Turku, Finland, sari.stenholm@utu.fi.|National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Stenholm
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Head
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.|Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: Department of Social & Behavioural Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Finnish Institute of Occupational Health, Turku, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Aalto
authors.affiliation: Population-based Epidemiologic Cohorts Unit-UMS 011, F-94807, Villejuif, France.|Versailles St-Quentin Univ, UMS 011, F-94807, Villejuif, France.|Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U 1168, Villejuif, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Zins
authors.affiliation: Population-based Epidemiologic Cohorts Unit-UMS 011, F-94807, Villejuif, France.|Aging and Chronic Diseases, Epidemiological and Public Health Approaches, U 1168, Villejuif, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Goldberg
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Paola
authors.initials: P
authors.lastname: Zaninotto
authors.affiliation: Stress Research Institute, Stockholm University, Stockholm, Sweden and.
authors.forename: Linda
authors.initials: L
authors.lastname: Magnuson Hanson
authors.affiliation: Stress Research Institute, Stockholm University, Stockholm, Sweden and.
authors.forename: Hugo
authors.initials: H
authors.lastname: Westerlund
authors.affiliation: Department of Public Health, University of Turku, Turku, Finland.|Turku University Hospital, Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D015444:Exercise; D005260:Female; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D057185:Sedentary Behavior; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*
keywords: healthy life expectancy; obesity; physical inactivity; smoking, cohort study