The combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe

Abstract

Background Smoking, obesity and alcohol abuse greatly affect mortality and exhibit a distinct time dynamic, with their prevalence and associated mortality rates increasing and (eventually) declining over time. Their combined impact on secular trends in life expectancy is unknown but is relevant for understanding these trends. We therefore estimate the combined impact of smoking, obesity and alcohol on life-expectancy trends in Europe. Methods We used estimated national age-specific smoking-, obesity- and alcohol-attributable mortality fractions for 30 European countries by sex, 1990–2014, which we aggregated multiplicatively to obtain lifestyle-attributable mortality. We estimated potential gains in life expectancy by eliminating lifestyle-attributable mortality and compared past trends in life expectancy at birth (e0) with and without lifestyle-attributable mortality. We examined all countries combined, by region and individually. Results Among men, the combined impact of smoking, obesity and alcohol on e0 declined from 6.6 years in 1990 to 5.8 years in 2014, mainly due to declining smoking-attributable mortality. Among women, the combined impact increased from 1.9 to 2.3 years due to mortality increases in all three lifestyle-related factors. The observed increase in e0 over the 1990–2014 period was 5.0 years for men and 4.0 years for women. After excluding lifestyle-attributable mortality, this increase would have been 4.2–4.3 years for both men and women. Conclusion Without the combined impact of smoking, obesity and alcohol, the increase over time in life expectancy at birth would have been smaller among men but larger among women, resulting in a stable increase in e0, parallel for men and women.

Future life expectancy in Europe taking into account the impact of smoking, obesity, and alcohol

“… *Based on the available information. Reproduced from various panels in Supplementary Figure 3b from Janssen et al, 2021 , under the terms of a Creative Commons Attribution License (CC-BY 4.0; https://creativecommons.org/licenses/by/4.0/ ). Data behind Figure 2—figure supplement 1 .…”

“…First, we determined the long-term decline in mortality and life expectancy without the combined effect of smoking, obesity, and alcohol. To this end, we used existing recent age- and sex-specific estimates of mortality after excluding the combined impact smoking, obesity, and alcohol ( Janssen et al, 2021 ), which we refer to as non-lifestyle-attributable mortality. Second, we projected this long-term underlying mortality decline into the future, while taking into account the mortality experiences of other populations.…”

“…We applied our projection approach to the national populations of 18 European countries (see Table 1 for the included countries) using country, sex, and age-specific all-cause mortality and exposure data for the 1990–2014 period from the Human Mortality Database ( HMD and University of California, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany), 2019 ), and similar data for lifestyle-attributable mortality and non-lifestyle-attributable mortality from a recent study ( Janssen et al, 2021 ). We were restricted in both the starting year and the end year because lifestyle-attributable mortality data was available only for this period.…”

“…While life expectancy has increased overall as a result of socio-economic and medical progress ( Omran, 1998 ; Oeppen and Vaupel, 2002 ; Mackenbach, 2013 ), past trends in mortality and life expectancy were characterised by periods of stagnation or even decline and exhibited large differences between countries and sexes (e.g., Vallin and Meslé, 2004 ; Leon, 2011 ). Lifestyle factors, particularly smoking, alcohol abuse, and obesity, contributed greatly to these deviations and differences (e.g., Lhachimi et al, 2016 ; WHO, 2018a ; Janssen et al, 2021 ). For example, the decelerating life expectancy improvements among men in many north-western European countries in the 1950s and 1960s, and, in later decades, in other European countries and among women, can be largely explained by the smoking epidemic ( Rostron and Wilmoth, 2011 ; Janssen et al, 2015 ; Lindahl-Jacobsen et al, 2016 ).…”

Mortalidad atribuida al consumo de tabaco en España: Revisión sistemática

“…Se identificaron 34 registros potencialmente relevantes y de estos se excluyeron 12 después de la lectura a texto completo. Los motivos de exclusión fueron que las estimaciones se realizaron en una población específica (población en edad de trabajar: 35-64 años) (Olivia-Moreno, Trapero-Bertran y Peña-Longobardo, 2019), la estimación era conjunta con otros factores de riesgo (Janssen, Trias-Llimós y Kunst, 2021), realizaban un reanálisis de la MA calculada en anteriores estudios (Haeberer et al, 2020), no realizaban atribución de mortalidad (Gregoraci et al, 2017;Kulik et al, 2014;Long et al, 2021;Mackenbach et al, 2015, Rodríguez Tapioles, Pueyos Sánchez, Bueno Cavanillas, Delgado Rodríguez y Gálvez Vargas, 1994, estimaban APVP (García Benavides y Hernández Aguado, 1989), analizaban morbilidad (González-Enríquez et al, 2002;) o eran proyecciones (Banegas Banegas et al, 1993;Sánchez et al, 2010). El proceso de selección de registros aparece reflejado en la Figura 1, y en la Tabla 1 se describen las principales características de los estudios incluidos.…”