title: Measuring Burden of Unhealthy Behaviours Using a Multivariable Predictive Approach: Life Expectancy Lost in Canada Attributable to Smoking, Alcohol, Physical Inactivity, and Diet.
abstract: Behaviours such as smoking, poor diet, physical inactivity, and unhealthy alcohol consumption are leading risk factors for death. We assessed the Canadian burden attributable to these behaviours by developing, validating, and applying a multivariable predictive model for risk of all-cause death.
  
  
  
  A predictive algorithm for 5 y risk of death-the Mortality Population Risk Tool (MPoRT)-was developed and validated using the 2001 to 2008 Canadian Community Health Surveys. There were approximately 1 million person-years of follow-up and 9,900 deaths in the development and validation datasets. After validation, MPoRT was used to predict future mortality and estimate the burden of smoking, alcohol, physical inactivity, and poor diet in the presence of sociodemographic and other risk factors using the 2010 national survey (approximately 90,000 respondents). Canadian period life tables were generated using predicted risk of death from MPoRT. The burden of behavioural risk factors attributable to life expectancy was estimated using hazard ratios from the MPoRT risk model.
  
  
  
  The MPoRT 5 y mortality risk algorithms were discriminating (C-statistic: males 0.874 [95% CI: 0.867-0.881]; females 0.875 [0.868-0.882]) and well calibrated in all 58 predefined subgroups. Discrimination was maintained or improved in the validation cohorts. For the 2010 Canadian population, unhealthy behaviour attributable life expectancy lost was 6.0 years for both men and women (for men 95% CI: 5.8 to 6.3 for women 5.8 to 6.2). The Canadian life expectancy associated with health behaviour recommendations was 17.9 years (95% CI: 17.7 to 18.1) greater for people with the most favourable risk profile compared to those with the least favourable risk profile (88.2 years versus 70.3 years). Smoking, by itself, was associated with 32% to 39% of the difference in life expectancy across social groups (by education achieved or neighbourhood deprivation).
  
  
  
  Multivariable predictive algorithms such as MPoRT can be used to assess health burdens for sociodemographic groups or for small changes in population exposure to risks, thereby addressing some limitations of more commonly used measurement approaches. Unhealthy behaviours have a substantial collective burden on the life expectancy of the Canadian population.
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Statistics Canada, Ottawa, Ontario, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Bruyère Research Institute, Ottawa, Ontario, Canada.|Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: Douglas G
authors.identifier: 0000-0003-0912-0845
authors.initials: DG
authors.lastname: Manuel
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Perez
authors.affiliation: Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Claudia
authors.identifier: 0000-0002-1273-0305
authors.initials: C
authors.lastname: Sanmartin
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Hennessy
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tanuseputro
authors.affiliation: Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: Heather
authors.identifier: 0000-0002-9212-2739
authors.initials: H
authors.lastname: Manson
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Bennett
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.
authors.forename: Meltem
authors.initials: M
authors.lastname: Tuna
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Stacey
authors.initials: S
authors.lastname: Fisher
authors.affiliation: Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Public Health Ontario, Toronto, Ontario, Canada.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rosella
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D004032:Diet / Q000009:adverse effects*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000009:adverse effects*