The clustering effects of current smoking status, overweight/obesity, and physical inactivity with all-cause and cause-specific mortality risks in U.S. adults

Luisa N Borrell; Sandra E Echeverria

doi:10.1016/j.pmedr.2024.102742

The clustering effects of current smoking status, overweight/obesity, and physical inactivity with all-cause and cause-specific mortality risks in U.S. adults

Prev Med Rep. 2024 Apr 26:42:102742. doi: 10.1016/j.pmedr.2024.102742. eCollection 2024 Jun.

Authors

Luisa N Borrell^{1

2}, Sandra E Echeverria³

Affiliations

¹ Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA.
² Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala, Alcalá de Henares, Spain.
³ Department of Public Health Education, The University of North Carolina at Greensboro, North Carolina, NC, USA.

Abstract

Objective: To estimate the associations of smoking, weight status and physical inactivity with all-cause and cause-specific deaths, and the advanced rate period (RAP) to determine how early death was advanced among United States (U.S.) adults aged 18 years or older.

Methods: We used data from the third National Health and Nutrition Examination Survey (NHANES III) and the 2019 Linked Mortality File (LMF) with a follow-up period of 21.6 years (n = 16,612, including 7,278 deaths). Smoking, weight status, and physical inactivity were obtained from NHANES III and mortality outcomes from the 2019 LMF. Cox regression was used to estimate hazard ratios, RAPs and their corresponding confidence intervals.

Results: For adults who currently smoke, were obese and physically inactive, the rate of dying from all-cause, CVD, and cancer was at least 231 % greater than for those who never smoked, were normal weight and physically active. The RAPs associated with the clustering of these risk factors for all cause, CVD- and cancer-specific cause of deaths were 13.0, 12.1 and 18.9 years older, respectively.

Conclusions: Our findings underscore the need to focus on modifiable risk factors for illness prevention and health promotion and call attention to the increasing clustering of unhealthy risk factors in the U.S. population.

Keywords: Body mass index; Mortality risk; NHANES; Physical activity; Rate advancement period; Smoking status; Survey; USA.