International Journal of Epidemiology, Vol 28, 1073-1080, Copyright © 1999 by International Epidemiological Association
SE Johansson and J Sundquist
BACKGROUND: The purpose of this study was to analyse both cross- sectional
associations and how longitudinal changes in lifestyle factors from one
state in 1980-1981 to another in 1988-1989 influence self-reported health
status. Another aim was to estimate the hazard ratios for all-cause
mortality for the changes in lifestyle factors and self-reported
hypertension during the same period of time. METHOD: The cross-sectional
and the longitudinal analyses are based on the same simple random sample of
3,843 adults, aged 25-74, interviewed in 1980- 1981 and 1988-1989 and is
part of the Swedish Annual Level-of-Living Survey. About 85% of the
respondents in the first interview participated in a second interview in
1988-1989. Cross-sectional odds ratios, based on a marginal model, were
estimated using the generalized estimating equations. The transitional
models were analysed using unconditional logistic regression. A
proportional hazard model was applied to investigate the influence of
lifestyle transitions on mortality. RESULTS: Physical inactivity, being a
current or former smoker and obesity (women only) were strong risk factors
for poor health either as main effects and/or combined (interactions).
There was a strong interaction between physical activity and smoking, and
for women, also between body mass index (BMI) and physical activity.
Smoking, physically inactive and obese women had about a ten times higher
risk of poor health status than non-smoking, physically active, and
normal-weight women. The corresponding risk for men was about five times
higher. Physically active, but smoking and obese individuals showed only
moderately increased risks for poor health status. The transitional model
showed that those who were physically inactive in 1980-1981, but did
exercise in 1988-1989, improved their health after adjustments for
sociodemographic and other lifestyle factors. Continuing to smoke or being
physically inactive or having hypertension at both points in time were all
associated with higher hazard ratios for all-cause mortality (1.6, 1.9 and
1.8, respectively) than those who reported that they were in good status at
both points in time. CONCLUSIONS: We found that physical activity protects
against poor health irrespective of an increased BMI and smoking. The major
clinical implications are the long-standing benefits of physical activity
and not smoking.
Change in lifestyle factors and their influence on health status and all-cause mortality
Department of Welfare and Social Statistics, Stockholm, Sweden. svenerik.johansson@scb.se
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