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Healthy lifestyle and life expectancy free of major chronic diseases at age 40 in China

Nature Human Behaviour volume 7, pages 1542–1550 (2023)Cite this article

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Abstract

Whether a healthy lifestyle helps achieve gains in life expectancy (LE) free of major non-communicable diseases and its share of total LE in Chinese adults remains unknown. We considered five low-risk lifestyle factors: never smoking or quitting for reasons other than illness, no excessive alcohol use, being physically active, healthy eating habits and healthy body fat levels. Here we show that after a median follow-up of 11.1 years for 451,233 Chinese adults, the LE free of cardiovascular diseases, cancer and chronic respiratory diseases (95% confidence interval) at age 40 years for individuals with all five low-risk factors was on average 6.3 (5.1–7.5) years (men) and 4.2 (3.6–5.4) years (women) longer than those with 0–1 low-risk factors. Correspondingly, the proportion of disease-free LE to total LE increased from 73.1% to 76.3% for men and from 67.6% to 68.4% for women. Our findings suggest that promoting healthy lifestyles could be associated with gains in disease-free LE in the Chinese population.

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Fig. 1: Multivariable-adjusted hazard ratios (95% CIs) for each transition by individual low-risk lifestyle factors in men (n = 181,544) and women (n = 269,689) separately.
Fig. 2: LE at age 40 years with and without CVDs, cancer and/or CRDs by levels of individual lifestyle risk factors in men (n = 181,544) and women (n = 269,689) separately.
Fig. 3: LE at age 40 years with and without CVDs, cancer and/or CRDs by the number of low-risk lifestyle factors in men (n = 181,544) and women (n = 269,689) separately.
Fig. 4: LE at age 40 years without chronic diseases and LE differences by the number of low-risk lifestyle factors in men (n = 181,544) and women (n = 269,689) separately.

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Data availability

CKB data are available to all bona fide researchers. Details of how to access and details of the data release schedule are available from www.ckbiobank.org/site/Data+Access. As stated in the access policy, the CKB study group must maintain the integrity of the database for future use and regulate data access to comply with prior conditions agreed with the Chinese government. Data security is an integral part of CKB study protocols. Data can be released outside the CKB research group only with appropriate security safeguards.

Code availability

Analysis code for this study is available at https://github.com/qiufen-code/Lifestyle-and-disease-free-LE.

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Acknowledgements

The most important acknowledgement is to the participants in the study and the members of the survey teams in each of the ten regional centres, as well as to the project development and management teams based at Beijing, Oxford and the ten regional centres. This work was supported by National Natural Science Foundation of China (82192904 (J.L.), 82192901 (L.L.), 82192900 (L.L.) and 81941018 (J.L.)). The CKB baseline survey and the first resurvey were supported by a grant from the Kadoorie Charitable Foundation in Hong Kong. The long-term follow-up is supported by grants from the UK Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z and 088158/Z/09/Z) (Z.C.), grants (2016YFC0900500 (Y.G.)) from the National Key R&D Program of China, National Natural Science Foundation of China (81390540 and 91846303) (L.L.) and Chinese Ministry of Science and Technology (2011BAI09B01) (L.L.). The funders had no role in the study design, data collection, data analysis, interpretation, writing of the report or the decision to submit the article for publication.

Author information

Author notes

  1. A full list of members and their affiliations appears in the Supplementary Information.

Authors and Affiliations

  1. Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China

    Qiufen Sun, Yizhen Hu, Canqing Yu, Dianjianyi Sun, Yuanjie Pang, Liming Li & Jun Lv

  2. Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China

    Canqing Yu, Pei Pei, Dianjianyi Sun, Liming Li & Jun Lv

  3. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China

    Canqing Yu, Dianjianyi Sun, Yuanjie Pang, Liming Li & Jun Lv

  4. Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China

    Yu Guo

  5. Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK

    Ling Yang, Yiping Chen & Huaidong Du

  6. Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK

    Ling Yang, Yiping Chen, Huaidong Du, Sushila Burgess, Sam Sansome & Zhengming Chen

  7. NCDs Prevention and Control Department, Qingdao CDC, Qingdao, China

    Feng Ning

  8. China National Center for Food Safety Risk Assessment, Beijing, China

    Junshi Chen

Consortia

The China Kadoorie Biobank Collaborative Group

  • Qiufen Sun
  • , Yizhen Hu
  • , Canqing Yu
  • , Yu Guo
  • , Pei Pei
  • , Ling Yang
  • , Yiping Chen
  • , Huaidong Du
  • , Dianjianyi Sun
  • , Yuanjie Pang
  • , Sushila Burgess
  • , Sam Sansome
  • , Feng Ning
  • , Junshi Chen
  • , Zhengming Chen
  • , Liming Li
  •  & Jun Lv

Contributions

J.L. and L.L. conceived and designed the study and contributed to the interpretation of the results and critical revision of the paper for valuable intellectual content. L.L., Z.C. and J.C., as the members of the CKB steering committee, designed and supervised the conduct of the whole study, obtained funding and together with C.Y., Y.G., P.P., L.Y., Y.C., H.D., S.B., S.S. and F.N. acquired the CKB data. Q.S. and Y.H. accessed, verified and analysed the data. Q.S. drafted the paper. All authors had access to the data and have read and approved the final paper. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. J.L. and L.L. are the guarantors.

Corresponding authors

Correspondence to Liming Li or Jun Lv.

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Competing interests

The authors declare no competing interests.

Peer review

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Nature Human Behaviour thanks Josje Schoufour and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Peer reviewer reports are available. Primary Handling Editor: Charlotte Payne, in collaboration with the Nature Human Behaviour team.

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Supplementary information

Supplementary Information

Supplementary Text (including a list of CKB members and their affiliations), Methods, Tables 1–4 and Figs. 1–12.

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The China Kadoorie Biobank Collaborative Group. Healthy lifestyle and life expectancy free of major chronic diseases at age 40 in China. Nat Hum Behav 7, 1542–1550 (2023). https://doi.org/10.1038/s41562-023-01624-7

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