@misc{10481/49913,
year = {2016},
url = {http://hdl.handle.net/10481/49913},
abstract = {Background: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely
before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking,
hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death.
Methods: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between
40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death
conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years
were calculated based on the fitted models.
Results: We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for
smoking was 31 % (95 % confidence interval (CI), 31–32 %) and 14 % (95 % CI, 12–16 %) for poor diet. Important
contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8–12 %)
and high blood pressure (9 %; 95 % CI, 7–11 %). AFs for physical inactivity and excessive alcohol intake were 7 %
and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55–59 %), being 35 % (95 % CI,
32–37 %) among never smokers and 74 % (95 % CI, 73–75 %) among current smokers.
Conclusions: While smoking remains the predominant risk factor for premature death in Europe, poor diet,
overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute
substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed.},
organization = {This work was supported by the French Social Affairs & Health Ministry,
Department of Health (Direction Générale de la Santé). The work undertaken
by David C Muller for this project was performed during the tenure of an
IARC-Australia fellowship supported by Cancer Council Australia. Elio Riboli
was supported by the Imperial College Biomedical Research Centre funded
by the National Institute of Health Research of UK. The coordination of EPIC
is financially supported by the European Commission (DG-SANCO) and the
International Agency for Research on Cancer. The national cohorts are supported
by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave
Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et
de la Recherche Médicale (INSERM) (France); Deutsche Krebshilfe, Deutsches
Krebsforschungszentrum and Federal Ministry of Education and Research
(Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la
Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry
of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR),
LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek
Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands
(The Netherlands); Nordic Centre of Excellence programme on Food, Nutrition
and Health. (Norway); Health Research Fund (FIS), PI13/00061 to Granada,
Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236)
and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish
Scientific Council and County Councils of Skåne and Västerbotten (Sweden);
Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 to EPIC-Oxford),
Medical Research Council (1000143 to EPIC-Norfolk) (United Kingdom).
The sponsors did not have any input into study design, study conduct, data
collection, analysis, or interpretation nor did they influence the preparation,
review, or approval of the manuscript.},
publisher = {Biomed Central},
keywords = {Premature death},
keywords = {Mortality},
keywords = {Modifiable risk factors},
keywords = {Attributable fraction},
keywords = {Absolute risk},
title = {Modifiable causes of premature death in middle-age in Western Europe: results from the EPIC cohort study},
doi = {10.1186/s12916-016-0630-6},
author = {Muller, David C. and Molina Portillo, Elena},
}