Healthy lifestyle and life expectancy in people with multimorbidity in the UK Biobank: A longitudinal cohort study

Autoři: Yogini V. Chudasama aff001;  Kamlesh Khunti aff001;  Clare L. Gillies aff001;  Nafeesa N. Dhalwani aff001;  Melanie J. Davies aff001;  Thomas Yates aff001;  Francesco Zaccardi aff001
Působiště autorů: Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom aff001;  National Institute for Health Research (NIHR) Applied Research Collaboration—East Midlands (ARC-EM) Leicester Diabetes Centre, Leicester, United Kingdom aff002;  National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester, United Kingdom aff003
Vyšlo v časopise: Healthy lifestyle and life expectancy in people with multimorbidity in the UK Biobank: A longitudinal cohort study. PLoS Med 17(9): e32767. doi:10.1371/journal.pmed.1003332
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003332



Whether a healthy lifestyle impacts longevity in the presence of multimorbidity is unclear. We investigated the associations between healthy lifestyle and life expectancy in people with and without multimorbidity.

Methods and findings

A total of 480,940 middle-aged adults (median age of 58 years [range 38–73], 46% male, 95% white) were analysed in the UK Biobank; this longitudinal study collected data between 2006 and 2010, and participants were followed up until 2016. We extracted 36 chronic conditions and defined multimorbidity as 2 or more conditions. Four lifestyle factors, based on national guidelines, were used: leisure-time physical activity, smoking, diet, and alcohol consumption. A combined weighted score was developed and grouped participants into 4 categories: very unhealthy, unhealthy, healthy, and very healthy. Survival models were applied to predict life expectancy, adjusting for ethnicity, working status, deprivation, body mass index, and sedentary time. A total of 93,746 (19.5%) participants had multimorbidity. During a mean follow-up of 7 (range 2–9) years, 11,006 deaths occurred. At 45 years, in men with multimorbidity an unhealthy score was associated with a gain of 1.5 (95% confidence interval [CI] −0.3 to 3.3; P = 0.102) additional life years compared to very unhealthy score, though the association was not significant, whilst a healthy score was significantly associated with a gain of 4.5 (3.3 to 5.7; P < 0.001) life years and a very healthy score with 6.3 (5.0 to 7.7; P < 0.001) years. Corresponding estimates in women were 3.5 (95% CI 0.7 to 6.3; P = 0.016), 6.4 (4.8 to 7.9; P < 0.001), and 7.6 (6.0 to 9.2; P < 0.001) years. Results were consistent in those without multimorbidity and in several sensitivity analyses. For individual lifestyle factors, no current smoking was associated with the largest survival benefit. The main limitations were that we could not explore the consistency of our results using a more restrictive definition of multimorbidity including only cardiometabolic conditions, and participants were not representative of the UK as a whole.


In this analysis of data from the UK Biobank, we found that regardless of the presence of multimorbidity, engaging in a healthier lifestyle was associated with up to 6.3 years longer life for men and 7.6 years for women; however, not all lifestyle risk factors equally correlated with life expectancy, with smoking being significantly worse than others.

Klíčová slova:

Alcohol consumption – Body mass index – Diet – Life expectancy – Medical risk factors – Physical activity – Public and occupational health – Sedentary behavior


1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.

2. National Institute for Health and Care Excellence. Multimorbidity: clinical assessment and management. NICE in development [GID-CGWAVE0704]: NICE; 2016. [cited 2020 Aug 31]. Available from:

3. The Academy of Medical Sciences April 2018. Multimorbidity: a priority for global health research Portland Place, London, UK: The Academy of Medical Sciences 2018. Updated April 2018. 127. [cited 2020 Aug 31]. Available from:

4. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ: 2012;345:e5205.

5. Tamakoshi A, Kawado M, Ozasa K, Tamakoshi K, Lin Y, Yagyu K, et al. Impact of smoking and other lifestyle factors on life expectancy among japanese: findings from the Japan Collaborative Cohort (JACC) Study. J Epidemiol. 2010;20(5):370–6.

6. Li K, Hüsing A, Kaaks R. Lifestyle risk factors and residual life expectancy at age 40: a German cohort study. BMC Med. 2014;12(1):59.

7. Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, et al. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population. Circulation. 2018;138(4):345–55.

8. Chudasama YV, Khunti KK, Zaccardi F, Rowlands AV, Yates T, Gillies CL, et al. Physical activity, multimorbidity, and life expectancy: a UK Biobank longitudinal study. BMC Med. 2019;17(1):108.

9. Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513–23.

10. Rizzuto D, Orsini N, Qiu C, Wang H-X, Fratiglioni L. Lifestyle, social factors, and survival after age 75: population based study. BMJ. 2012;345:e5568.

11. Manuel DG, Perez R, Sanmartin C, Taljaard M, Hennessy D, Wilson K, et al. Measuring Burden of Unhealthy Behaviours Using a Multivariable Predictive Approach: Life Expectancy Lost in Canada Attributable to Smoking, Alcohol, Physical Inactivity, and Diet. PLoS Med. 2016;13(8):e1002082.

12. Manuel DG, Perez R, Bennett C, Rosella L, Taljaard M, Roberts M, et al. Seven more years: the impact of smoking, alcohol, diet, physical activity and stress on health and life expectancy in Ontario: Toronto. Institute for Clinical Evaluative Sciences and Public Health Ontario. 2012. [cited 2020 Aug 31]. Available from:

13. O’Doherty MG, Cairns K, O’Neill V, Lamrock F, Jørgensen T, Brenner H, et al. Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES). Eur J Epidemiol. 2016;31(5):455–68.

14. Lee C-D, Sui X, Hooker SP, Hébert JR, Blair SN. Combined impact of lifestyle factors on cancer mortality in men. Ann Epidemiol. 2011;21(10):749–54.

15. Khaw K-T, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study. PLoS Med. 2008;5(1):e12.

16. Pan XF, Li Y, Franco OH, Yuan JM, Pan A, Koh WP. Impact of combined lifestyle factors on all-cause and cause-specific mortality and life expectancy in Chinese: the Singapore Chinese Health Study. J Gerontol A Biol Sci Med Sci. 2019. doi: 10.1093/gerona/glz271

17. Li Y, Schoufour J, Wang DD, Dhana K, Pan A, Liu X, et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020;368:l6669.

18. Zaninotto P, Head J, Steptoe A. Behavioural risk factors and healthy life expectancy: evidence from two longitudinal studies of ageing in England and the US. Sci Rep. 2020;10(1):1–9.

19. Nyberg ST; Singh-Manoux A; Pentti J MI, Sabia S, Alfredsson L, et al. Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases. JAMA Intern Med. 2020;180(5):760–8.

20. Rizzuto D, Fratiglioni L. Lifestyle Factors Related to Mortality and Survival: A Mini-Review. Gerontology. 2014;60(4):327–35.

21. Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: A systematic review and meta-analysis. Prev Med. 2012;55(3):163–70.

22. UK Biobank. UK Biobank: Protocol for a large-scale prospective epidemiological resource 2007. Updated 21 March 2007. [cited 2020 Aug 31]. Available from:

23. UK Biobank. UK Biobank ethics and governance framework 2007. [cited 2020 Aug 31]. Available from:

24. Griffiths RI, O’Malley CD, Herbert RJ, Danese MD. Misclassification of incident conditions using claims data: impact of varying the period used to exclude pre-existing disease. BMC Med Res Methodol. 2013;13(1):32.

25. Doran T, Kontopantelis E, Reeves D, Sutton M, Ryan AM. Setting performance targets in pay for performance programmes: what can we learn from QOF? BMJ: 2014;348.

26. Diederichs C, Berger K, Bartels DB. The measurement of multiple chronic diseases—a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci. 2011;66(3):301–11.

27. Zemedikun DT, Gray LJ, Khunti K, Davies MJ, Dhalwani NN. Patterns of Multimorbidity in Middle-Aged and Older Adults: An Analysis of the UK Biobank Data. Mayo Clin Proc. 2018;93(7):857–866

28. NHS. Physical activity guidelines for adults 2018. [cited 2020 Aug 31]. Available from:

29. NHS. 5 A Day portion sizes: NHS Choices; 2018. [cited 2020 Aug 31]. Available from:

30. NHS. Alcohol units: NHS Choices; 2015. [cited 2020 Aug 31]. Available from:

31. NHS. NICE publishes guidance on cutting down smoking 2013. [cited 2020 Aug 31]. Available from:

32. Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report U.S2018. [cited 2020 Aug 31]. Available from:

33. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9; SUPP/1):S498–S504.

34. Goddard E. Estimating alcohol consumption from survey data: updated method of converting volumes to units: Office for National Statistics Newport; 2007. [cited 2020 Aug 31]. Available from:

35. Royston P, Lambert PC. Flexible parametric survival analysis using Stata: beyond the Cox model. College Station: Stata Press; 2011.

36. Schwingshackl L, Hoffmann G. Diet Quality as Assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension Score, and Health Outcomes: A Systematic Review and Meta-Analysis of Cohort Studies. J Acad Nutr Diet. 2015;115(5):780-800.e5.

37. Swanson JM. The UK Biobank and selection bias. Lancet. 2012;380(9837):110.

38. Fry A, Littlejohns TJ, Sudlow C, Doherty N, Adamska L, Sprosen T, et al. Comparison of Sociodemographic and Health-Related Characteristics of UK Biobank Participants With Those of the General Population. Am J Epidemiol. 2020;186(9):1026–34.

39. Hernán MA, Hernández-Díaz S, Robins JM. A structural approach to selection bias. Epidemiology. 2004;15(5):615–25.

40. Harrell F. Implications of Interactions in Treatment Comparisons Statistical Thinking 2020. [cited 2020 Aug 31]. Available from:

41. Batty GD, Gale CR, Kivimäki M, Deary IJ, Bell S. Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis. BMJ. 2020;368:m131.

42. Silsbury Z, Goldsmith R, Rushton A. Systematic review of the measurement properties of self-report physical activity questionnaires in healthy adult populations. BMJ Open. 2015;5(9):e008430.

43. National Statistics. Health Survey for England 2017 Cardiovascular diseases. 2018. [cited 2020 Aug 31]. Available from:

44. Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(8):2532–53.

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PLOS Medicine

2020 Číslo 9

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