Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

Abstract

To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differences, with physical inactivity (PAF 16.5% ELSA; 16.7% SIGa-Bagé) and current smoking (PAF 4.9% for both cohorts) having the strongest association. A clear graded relationship existed between the number of risk factors and subsequent mortality. Wealth gradients in mortality were apparent in both cohorts after full adjustment, especially among men aged 60-74 in ELSA. A different pattern was found among older women, especially in SIGa-Bagé. These findings call attention for the challenge to health systems to prevent and modify the major risk factors related to non-communicable diseases, especially physical inactivity and smoking. Furthermore, wealth inequalities in mortality persist among older adults. Non-communicable diseases (NCDs) are the main cause of death worldwide, killing 41 million people annually, equivalent to 71% of all deaths globally 1. The main groups of NCDs are cardiovascular diseases (17.9 million deaths), cancers (9.0 million deaths), respiratory diseases (3.9 million deaths), and diabetes (1.6 million deaths) 1. NCDs are often associated with deaths at older age, but evidence shows that a considerable percentage of deaths due to NCDs are premature (before 70 years) 1. The four NCDs listed above cause over 80% of premature deaths, with over 85% occurring in low-and middle-income countries 1. NCD-related health and lifestyle behaviours typically follow the social gradient: people who are disadvantaged in terms of socioeconomic position (SEP) have worse health-and live shorter lives-than those more advantaged 2. Inequalities in social conditions have long-lasting effects during a lifetime that contribute to high levels of NCD-related risk factors 3,4. Socioeconomically disadvantaged persons are at greater risk of being exposed to harmful products, such as tobacco, or of having unhealthy diets, and typically they have lower levels of access to healthcare services 1. Having an unhealthy diet, being physically inactive, and being a cigarette smoker may result in raised blood pressure, increased blood glucose, elevated blood...

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