While it is evident that behavioral factors influence health, their combined impact on the general population remains to be clarified. This prospective population study attempted to quantify the combined influence of 4 health behaviors on mortality in 20,244 men and women ranging in age from 45 to 79 years who lived in the general community and had no known cancer or cardiovascular disease when first seen in the years 1993–1997. They were followed up to 2006. Participants were nearly all white but were from an area of the United Kingdom having a wide socioeconomic and urban-rural distribution. One point was awarded for each of the 4 health behaviors: current nonsmoking, not physically inactive, moderate alcohol intake, and 5 of more servings a day of fruit and vegetables (as evidenced by a plasma vitamin C level exceeding 50 mmol/L).
Adjusting for age, gender, body mass index, and social class, the total mortality risk increased significantly with a declining number of health behaviors. After an average follow-up of 11 years, the relative risk with 95% confidence interval for participants having 3, 2, 1, and 0 health behaviors, compared to those with all 4 behaviors, were, respectively, 1.39 (1.21–1.60), 1.95 (1.70–2.25), 2.52 (2.13–3.00), and 4.04 (2.95–5.54). The most marked differences were in deaths ascribed to cardiovascular diseases. Vitamin supplementation did not appear to influence the results. The adjusted cumulative survival at follow-up was about 75% for participants scoring zero, and 95% for those scoring 4 for health behaviors. The mortality risk for those with 4 compared to zero health behaviors was equivalent to being 14 years younger in chronological age.
These findings support the view that even small differences in lifestyle can make a major difference in health status. The health behaviors examined in this study are relative modest and readily achievable.