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Combined healthy lifestyle behaviours and incident disability in an elderly population: the Ohsaki Cohort 2006 Study
  1. Shu Zhang1,
  2. Yasutake Tomata1,
  3. Roger B Newson2,
  4. Yumi Sugawara1,
  5. Ichiro Tsuji1
  1. 1 Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan
  2. 2 Department of Primary Care and Public Health, Imperial College London, London, UK
  1. Correspondence to Dr. Yasutake Tomata, Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai 980-8575, Japan; y-tomata{at}


Background The joint impact of healthy lifestyle behaviours (HLBs) on incident disability among elderly populations is still uncertain. This cohort study was conducted to estimate the population-attributable fraction (PAF) of combined HLBs for disability reduction in elderly Japanese.

Methods We analysed 10-year follow-up data for 9910 community-dwelling elderly people (≥65 years) in a prospective cohort study. Information on lifestyle behaviours and food consumption was collected via a questionnaire in 2006. The exposure variable was defined as a healthy lifestyle index (HLI), which represented the summed number of HLBs (‘never or former smoker’, ‘time spent walking ≥0.5 hour/day’ and ‘vegetable and fruit consumption volume ≥median’). Data on incident disability were retrieved from the public Long term Care Insurance database. HRs and 95% CIs were estimated by Cox proportional regression and the PAFs and their 95% CIs were estimated with the multivariate-adjusted model.

Results The 10-year incidence of disability was 35.7%. An inverse dose–response relationship was observed (HR (95% CI): 0.85(0.81 to 0.90) for each one-point increase of the HLI score, p-trend <0.001). Based on multivariate-adjustment, adherence to each one additional HLB gives PAF of 10.5%(95% CI 9.0% to 12.0%) for disability reduction. The PAF would have been 25.9%(14.2% to 36.0%) if all subjects had adhered to all three HLBs.

Conclusion Combined HLBs may have a substantial impact on reducing the risk of incident disability among elderly people. Even having one more healthy lifestyle habit may bring considerable benefit.

  • disability
  • epidemiology of ageing
  • health behaviour
  • health impact assessment
  • lifestyle

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  • Contributors SZ and IT designed research. YT and IT conducted research. SZ and YT analysed data. SZ wrote the paper. YT, RBN, YS and IT gave the constructive suggestions. SZ had primary responsibility for final content. All authors read and approved the final manuscript.

  • Funding This work was supported by Health Sciences Research grants (no. H28-Junkankitou-Ippan-008) from the Ministry of Health, Labour and Welfare of Japan.

  • Disclaimer Sponsors played no role in the design, methods, subject recruitment, data collections, analysis and preparation of the paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Ethics Committee of Tohoku University Graduate School of Medicine (Sendai, Japan).

  • Provenance and peer review Not commissioned; externally peer reviewed.