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Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: a 39-year prospective study

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Abstract

This study estimated the long-term mortality hazards and disability risks associated with various combinations of smoking and physical inactivity measured over time in a sample of middle-aged adults. Data have been collected from a national sample of Swedish adults, originally interviewed in 1968 and followed until 2007 (N = 1,682). Smoking and physical activity status were measured at baseline and 13 years later (1981). Different patterns of change and stability in smoking and physical inactivity over this 13 year period were used as predictors of mortality through 2007. Also, associations between different patterns of these health behaviors and the odds of disability (measured in 2004) were estimated among survivors (n = 925). Results suggest that mortality rates were elevated among persistent (HR = 1.7; 95 % CI = 1.5–2.0) and new smokers (HR = 2.5; 95 % CI = 1.6–4.1), but not among discontinued smokers. However, mortality rates remained elevated among discontinued smokers who were also persistently inactive (HR = 1.9; 95 % CI = 1.3–2.6). Additional findings suggest that persistent physical inactivity during midlife was associated with increased odds of late life disability (OR = 1.8; 95 % CI = 1.1–2.7), but that smoking had no clear additive or multiplicative effects on disability. As such, these findings indicate that while persistent smoking during midlife primarily impacts subsequent mortality, persistent physical inactivity during midlife appears to counteract the survival benefits of smoking cessation, while also imposing a long-term risk on late life disability among those who do survive to old age.

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Acknowledgments

This work was supported by the National Institutes of Health, National Institute on Aging, Grant R01 AG031109, “Health Behaviors and Lifestyles in Old Age in the United States and Japan” (BAS), and the Swedish Council for Working Life and Social Research, Grant 2010-0954, “Do health behaviors still matter for survival to advanced ages?”, and Grant 2010-1788, “Health and health behavior in a lifecourse perspective”.

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Authors and Affiliations

  1. Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany State University of New York, One University Place, Rensselaer, NY, 12144-3456, USA

    Benjamin A. Shaw

  2. Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30, Stockholm, Sweden

    Neda Agahi

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  1. Benjamin A. Shaw
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Correspondence to Benjamin A. Shaw.

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Responsible editor: D. J. H. Deeg.

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Shaw, B.A., Agahi, N. Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: a 39-year prospective study. Eur J Ageing 11, 195–204 (2014). https://doi.org/10.1007/s10433-013-0298-0

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  • DOI: https://doi.org/10.1007/s10433-013-0298-0

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