Background To examine the combined influence of changes in physical activity, diet, smoking and alcohol consumption on all-cause mortality.
Methods Health behaviours were assessed in 1984/1985 and 1991/1992 in 8123 adults from the UK (4666 women, median age 41.0 years). An unhealthy lifestyle score was calculated, allocating one point for smoking, fruits and vegetables <3 times a day, physical activity <2 hours a week and >14 units (women) or >21 units of alcohol (men) per week.
Results There were 2003 deaths over a median follow-up of 6.6 years (IQR 5.9–7.2) following the resurvey. The modal change in the unhealthy lifestyle score was zero, 41.8% had the same score, 35.5% decreased and 22.7% increased score between surveys. A one unit decrease in the unhealthy lifestyle score was not associated with a beneficial effect on mortality (HR 0.93; 95% CI 0.83 to 1.04). A one unit increase in the unhealthy lifestyle score increased the risk of mortality (adjusted HR 1.09; 95% CI 1.01 to 1.18).
Conclusions In this general population sample, the adoption of an unhealthy lifestyle was associated with an increased risk of mortality.
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Contributors JW and GDB designed the study. JW acquired the data and undertook the analyses. GG and MK contributed to refining the analyses. All authors drafted the manuscript and approved its publication.
Funding This work is undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (JW).
Disclaimer All funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.
Competing interests None declared.
Patient consent Obtained.
Ethics approval UK HALS I and II approved by the local ethics committees in England, Scotland and Wales.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data are openly available from the UK Data Archive (https://discover.ukdataservice.ac.uk/).
Correction notice This article has been corrected since it published Online First. The survey name has been changed to title case in the article title.
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