Smoking, drinking, diet and physical activity-modifiable lifestyle risk factors and their associations with age to first chronic disease.
BACKGROUND
This study examined the incidence of a person's first diagnosis of a selected chronic disease, and the relationships between modifiable lifestyle risk factors and age to first of six chronic diseases.


METHODS
Ontario respondents from 2001 to 2010 of the Canadian Community Health Survey were followed up with administrative data until 2014 for congestive heart failure, chronic obstructive respiratory disease, diabetes, lung cancer, myocardial infarction and stroke. By sex, the cumulative incidence function of age to first chronic disease was calculated for the six chronic diseases individually and compositely. The associations between modifiable lifestyle risk factors (alcohol, body mass index, smoking, diet, physical inactivity) and age to first chronic disease were estimated using cause-specific Cox proportional hazards models and Fine-Gray competing risk models.


RESULTS
Diabetes was the most common disease. By age 70.5 years (2015 world life expectancy), 50.9% of females and 58.1% of males had at least one disease and few had a death free of the selected diseases (3.4% females; 5.4% males). Of the lifestyle factors, heavy smoking had the strongest association with the risk of experiencing at least one chronic disease (cause-specific hazard ratio = 3.86; 95% confidence interval = 3.46, 4.31). The lifestyle factors were modelled for each disease separately, and the associations varied by chronic disease and sex.


CONCLUSIONS
We found that most individuals will have at least one of the six chronic diseases before dying. This study provides a novel approach using competing risk methods to examine the incidence of chronic diseases relative to the life course and how their incidences are associated with lifestyle behaviours.
['Ng|Ryan|R|', 'Sutradhar|Rinku|R|', 'Yao|Zhan|Z|', 'Wodchis|Walter P|WP|', 'Rosella|Laura C|LC|']
D000328:Adult D017668:Age of Onset D000368:Aged D000369:Aged, 80 and over D000428:Alcohol Drinking D015992:Body Mass Index D002318:Cardiovascular Diseases D002908:Chronic Disease D015897:Comorbidity D003924:Diabetes Mellitus, Type 2 D004032:Diet D015444:Exercise D005260:Female D006306:Health Surveys D006801:Humans D015994:Incidence D008019:Life Style D008297:Male D008875:Middle Aged D009765:Obesity D009864:Ontario D029424:Pulmonary Disease, Chronic Obstructive D012307:Risk Factors D057185:Sedentary Behavior D012907:Smoking D000073869:Tobacco Smoking
smoking diet chronic disease Alcohol body mass index competing risks life course multimorbidity physical activity