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Association between TV viewing and heart disease mortality: observational study using negative control outcome


Aims Sedentary behaviour (particularly television (TV) viewing) is thought to be a risk factor for cardiovascular disease. We employed a negative control outcome to explore whether the association between TV viewing and heart disease mortality is explained by confounding.

Methods The sample was drawn from the UK Biobank study and comprised 479 658 participants (aged 56.5±8.0 years; 45.7% men) followed up over a mean of 10.4 years. TV viewing was measured from self-report.

Results There were 1437 ischaemic heart disease (IHD) deaths, and 214 accidental deaths (employed as the negative control outcome). TV viewing was related to the following confounding variables: age, smoking, alcohol, diet, obesity, physical inactivity, cardiovascular disease and education. The confounding structures were similar for both outcomes. TV viewing (per hour/d) was associated with IHD (hazard ratio (HR)=1.30, 95% CI, 1.27 to 1.33) and accidental death (HR=1.15, 95% CI, 1.07 to 1.24) in unadjusted models. Associations were attenuated for both outcomes and were considerably converged after adjustment for confounders; IHD (HR=1.09, 95% CI, 1.06 to 1.12) and accidental death (HR=1.06, 95% CI, 0.98 to 1.15).

Conclusion The pattern of results for TV with an implausible outcome mirrored that of IHD, suggesting that observed associations between TV and heart disease are likely to be driven by confounding.

  • cardiovascular disease
  • cohort studies
  • epidemiological methods

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