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Research

Influence of individual and combined healthy behaviours on successful aging

Séverine Sabia, Archana Singh-Manoux, Gareth Hagger-Johnson, Emmanuelle Cambois, Eric J. Brunner and Mika Kivimaki
CMAJ December 11, 2012 184 (18) 1985-1992; DOI: https://doi.org/10.1503/cmaj.121080
Séverine Sabia
From the Department of Epidemiology and Public Health (Sabia, Singh-Manoux, Hagger-Johnson, Brunner, Kivimaki), University College London, London, UK; Inserm U1018 (Singh-Manoux), Institut national de la santé et de la recherche médicale, Villejuif Cedex, France; the Centre de Gérontologie (Singh-Manoux), Hôpital Ste Périne, AP-HP, France; and the Institut national d’études démographiques INED (Cambois), Paris, France.
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  • For correspondence: s.sabia@ucl.ac.uk
Archana Singh-Manoux
From the Department of Epidemiology and Public Health (Sabia, Singh-Manoux, Hagger-Johnson, Brunner, Kivimaki), University College London, London, UK; Inserm U1018 (Singh-Manoux), Institut national de la santé et de la recherche médicale, Villejuif Cedex, France; the Centre de Gérontologie (Singh-Manoux), Hôpital Ste Périne, AP-HP, France; and the Institut national d’études démographiques INED (Cambois), Paris, France.
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Gareth Hagger-Johnson
From the Department of Epidemiology and Public Health (Sabia, Singh-Manoux, Hagger-Johnson, Brunner, Kivimaki), University College London, London, UK; Inserm U1018 (Singh-Manoux), Institut national de la santé et de la recherche médicale, Villejuif Cedex, France; the Centre de Gérontologie (Singh-Manoux), Hôpital Ste Périne, AP-HP, France; and the Institut national d’études démographiques INED (Cambois), Paris, France.
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Emmanuelle Cambois
From the Department of Epidemiology and Public Health (Sabia, Singh-Manoux, Hagger-Johnson, Brunner, Kivimaki), University College London, London, UK; Inserm U1018 (Singh-Manoux), Institut national de la santé et de la recherche médicale, Villejuif Cedex, France; the Centre de Gérontologie (Singh-Manoux), Hôpital Ste Périne, AP-HP, France; and the Institut national d’études démographiques INED (Cambois), Paris, France.
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Eric J. Brunner
From the Department of Epidemiology and Public Health (Sabia, Singh-Manoux, Hagger-Johnson, Brunner, Kivimaki), University College London, London, UK; Inserm U1018 (Singh-Manoux), Institut national de la santé et de la recherche médicale, Villejuif Cedex, France; the Centre de Gérontologie (Singh-Manoux), Hôpital Ste Périne, AP-HP, France; and the Institut national d’études démographiques INED (Cambois), Paris, France.
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Mika Kivimaki
From the Department of Epidemiology and Public Health (Sabia, Singh-Manoux, Hagger-Johnson, Brunner, Kivimaki), University College London, London, UK; Inserm U1018 (Singh-Manoux), Institut national de la santé et de la recherche médicale, Villejuif Cedex, France; the Centre de Gérontologie (Singh-Manoux), Hôpital Ste Périne, AP-HP, France; and the Institut national d’études démographiques INED (Cambois), Paris, France.
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  • Re:Residual confounding may have constituted a major limitation
    Severine Sabia
    Posted on: 14 December 2012
  • Residual confounding may have constituted a major limitation
    Philipe S Barreto
    Posted on: 13 December 2012
  • Posted on: (14 December 2012)
    Page navigation anchor for Re:Residual confounding may have constituted a major limitation
    Re:Residual confounding may have constituted a major limitation
    • Severine Sabia
    • Other Contributors:

    We thank Barreto for his considerate comments on our paper.1 In the Whitehall II study, it is indeed possible to take into account a number of covariates that potentially influence the odds of successful aging. The models reported in our paper were adjusted for socio-demographic measures: age, sex, education and marital status. As suggested by Barreto, we undertook new analyses that included further covariates: occupationa...

    Show More

    We thank Barreto for his considerate comments on our paper.1 In the Whitehall II study, it is indeed possible to take into account a number of covariates that potentially influence the odds of successful aging. The models reported in our paper were adjusted for socio-demographic measures: age, sex, education and marital status. As suggested by Barreto, we undertook new analyses that included further covariates: occupational position (high, intermediate and low both in terms of income and status at work), body mass index (BMI), antidepressant use, and self-rated health at baseline. Table 1 shows that the association between health behaviours and successful aging remains robust to these adjustments. However, it is worth noting that some of these covariates (for example BMI or self-reported health) are not only confounders but likely to be on the causal pathway between health behaviours and successful aging.

    Table 1. Association between health behaviours and successful aging

    Adjusted Odds Ratio* (95% CI)

    Model 1 (M1) 1.33 (1.24, 1.43)

    Model 2: M1 + occupational position 1.29 (1.20, 1.39)

    Model 3: M1 + body mass index 1.31 (1.22, 1.41)

    Model 4: M1 + antidepressant use 1.34 (1.24, 1.44)

    Model 5: M1 + self-rated health 1.25 (1.16, 1.35)

    Fully adjusted model 1.20 (1.11, 1.30)

    *Odds ratio for 1-increment in the healthy behaviour score (the number of healthy behaviours).

    M1 is adjusted for age, sex, marital status, and education.

    Reference List

    (1) Sabia S, Singh-Manoux A, Hagger-Johnson G, Cambois E, Brunner EJ, Kivimaki M. Influence of individual and combined healthy behaviours on successful aging. CMAJ 2012;184:1985-1992.

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
  • Posted on: (13 December 2012)
    Page navigation anchor for Residual confounding may have constituted a major limitation
    Residual confounding may have constituted a major limitation
    • Philipe S Barreto, Researcher

    I read with great interest the work of Sabia et al.1 and the commentary by Wilcox.2 Sabia et al. showed that the accumulation of healthy behaviours reduces the risk of mortality and increases the probability of successful aging linearly. However, the multivariate models presented by the authors were poorly adjusted for confounders (only age, sex, level of education, and marital status were taken into account), which rai...

    Show More

    I read with great interest the work of Sabia et al.1 and the commentary by Wilcox.2 Sabia et al. showed that the accumulation of healthy behaviours reduces the risk of mortality and increases the probability of successful aging linearly. However, the multivariate models presented by the authors were poorly adjusted for confounders (only age, sex, level of education, and marital status were taken into account), which raises the question of important residual confounding. For example, why did not authors adjust their analyses to subjects' body mass index (BMI), self-rated health, income or medications taken? All these variables were, à priori, available for the phase 3 of the Whitehall II study,3 i.e., the baseline data of Sabia et al.'s study. Since BMI,4 self-rated health5 and socio-economic status,6 and some medications (such as psychotropic drugs)7 are associated to adverse health outcomes, they represent potential confounders that should be controlled for. Therefore, Sabia et al.'s findings must be interpreted with caution since the presence of residual cofounding in their analyses is highly possible; this might have changed their results.

    References

    1. Sabia S, Singh-Manoux A, Hagger-Johnson G, et al. Influence of individual and combined healthy behaviours on successful aging. CMAJ. 2012; 184(18):1985-1992.

    2. Willcox B. Successful aging: Is there hope? CMAJ. 2012; 184(18):1973- 1974.

    3. Marmot M, Brunner E. Cohort Profile: the Whitehall II study. Int J Epidemiol. 2005;34(2):251-256.

    4. Katzmarzyk PT, Reeder BA, Elliott S, et al. Body mass index and risk of cardiovascular disease, cancer and all-cause mortality. Can J Public Health. 2012;103(2):147-151.

    5. Nery Guimarães JM, Chor D, Werneck GL, et al. Association between self -rated health and mortality: 10 years follow-up to the Pró-Saúde cohort study. BMC Public Health. 2012;12:676.

    6. Lima-Costa MF, Steptoe A, Cesar CC, et al. The influence of socioeconomic status on the predictive power of self-rated health for 6- year mortality in English and Brazilian older adults: the ELSA and Bambui cohort studies. Ann Epidemiol. 2012;22(9):644-648.

    7. Huybrechts KF, Rothman KJ, Silliman RA, et al. Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes. CMAJ. 2011;183(7):E411-419

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
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Canadian Medical Association Journal: 184 (18)
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11 Dec 2012
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Influence of individual and combined healthy behaviours on successful aging
Séverine Sabia, Archana Singh-Manoux, Gareth Hagger-Johnson, Emmanuelle Cambois, Eric J. Brunner, Mika Kivimaki
CMAJ Dec 2012, 184 (18) 1985-1992; DOI: 10.1503/cmaj.121080

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Influence of individual and combined healthy behaviours on successful aging
Séverine Sabia, Archana Singh-Manoux, Gareth Hagger-Johnson, Emmanuelle Cambois, Eric J. Brunner, Mika Kivimaki
CMAJ Dec 2012, 184 (18) 1985-1992; DOI: 10.1503/cmaj.121080
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