BACKGROUND:Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models. METHODS:For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the "worst practice", "best practice", and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported. RESULTS:Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases). CONCLUSION:Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior.

译文

背景:影响生活方式的危险因素酒精,体重指数(BMI)和吸烟是欧盟(EU)广泛的公共卫生政策目标。这些风险因素对人群的健康影响取决于人群的特定特征,如果没有动态的人群健康模型就很难量化。
方法:适用于11个国家/地区。我们使用了DYNAMO-HIA数据集的证据来证明80%的EU-27人口。对于每个国家,都使用了按年龄和性别划分的危险因素患病率,以及九种慢性疾病的发生率,患病率和超额死亡率;包括将风险因素暴露与疾病发生率和全因死亡率联系起来的相应相对风险。应用DYNAMO-HIA工具,我们以可行的方法(即在其他地方观察到的)以风险因素患病率作为基准来动态地预测国家范围内潜在的健康收益和损失。对“最差做法”,“最佳做法”和当前观察到的危险因素普遍性对人群健康的影响进行了量化,并报告了预期寿命,无发病年,疾病病例和累积死亡率的预期变化。
结果:采用最佳实践吸烟率可带来预期寿命的最大增长,男性为0.4岁,女性为0.3年(分别推迟了332,950和274,200例死亡),而最差的实践吸烟率也导致最大的预期寿命损失,为0.7男性的生命年为0.9年,女性的生命年为0.9年(分别损失了609,400和710,550人的生命)。比较无发病率的生命年,最佳实践吸烟率显示0.4岁的男性获得最高收益(减少342,800例疾病病例),而女性最佳实践BMI发生率则以0.7岁获得最大收益(减少1,075,200例疾病病例)。
结论:吸烟仍然是最大的潜在健康获益因素。但是,BMI对发病率的影响较大。未来的研究应旨在提高人们对政策如何影响和塑造与生活方式相关的个人风险因素行为的认识。

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