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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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  • Figure 1:
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    Figure 1:

    Selection of participants for the study. MI = myocardial infarction.

  • Figure 2:
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    Figure 2:

    Association between the number of healthy behaviours participants showed at baseline and (A) successful aging or (B) survival. In model 1, each number of healthy behaviours is included in the model as a category, and ORs are calculated with “0 healthy behaviours” as the reference group. In model 2, the category 1–4 includes all participants with 1–4 healthy behaviours, and the ORs are calculated with “0 healthy behaviours” as the reference group. The binary outcomes are successful aging versus death or normal aging, and survival to the end of follow-up versus death. OR = odds ratio. Error bars indicate 95% confidence intervals. *Models were adjusted for age, sex, level of education and marital status, and were mutually adjusted for all health behaviours. †Reference.

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    Table 1:

    Baseline characteristics of participants included in the analysis in comparison with those excluded because of missing data on health outcomes

    CharacteristicNo. (%)*p value
    Study participants
    n =5100
    Excluded participants
    n =1499
    Age, yr, mean ± SD51.3 ± 5.351.4 ± 5.10.5†
    Female sex1506 (29.5)579 (38.6)< 0.001‡
    Married or living with someone3963 (77.7)1118 (74.6)0.01‡
    University degree or higher1274 (25.0)303 (20.2)0.001‡
    Never smoked2500 (49.0)722 (48.2)0.6‡
    Moderate consumption of alcohol3271 (64.1)912 (60.8)0.02‡
    Physically active2602 (51.0)721 (48.1)0.05‡
    Daily consumption of fruits and vegetables3200 (62.7)884 (59.0)0.01‡
    • Note: SD = standard deviation.

    • ↵* Unless otherwise indicated.

    • ↵† t test.

    • ↵‡ χ2 test.

    • View popup
    Table 2:

    Comparison of characteristics between participants in the successful and normal aging groups

    CharacteristicSuccessful aging*
    n = 953
    Normal aging†
    n = 3598
    At baseline
    Age, yr, mean ± SD49.7 ± 4.951.3 ± 5.3
    Married or living with someone, no. (%)774 (81.2)2798 (77.8)
    University degree or higher, no. (%)301 (31.6)872 (24.2)
    Female sex, no. (%)247 (25.9)1087 (30.2)
    At follow-up
    Coronary artery disease, no. (%)0 (0)581 (16.1)
    Stroke‡, no. (%)0 (0)178 (5.3)
    Cancer‡, no. (%)0 (0)614 (17.1)
    Diabetes mellitus‡, no. (%)0 (0)618 (17.1)
    ≥ 1 limitation in ADL/IADL, no. (%)0 (0)581 (16.2)
    Systolic blood pressure, mm Hg, mean ± SD120.2 ± 10.9128.9 ± 17.6
    Forced expiratory volume, L/m2, mean ± SD1.1 ± 0.20.9 ± 0.2
    Walking speed, m/s, mean ± SD1.3 ± 0.21.1 ± 0.3
    Cognitive function, z score, mean ± SD0.5 ± 0.7–0.2 ± 1.0
    Mental health score, mean ± SD56.3 ± 4.252.9 ± 9.2
    • Note: ADL = activities of daily living, IADL = instrumental activities of daily living, SD = standard deviation.

    • ↵* For criteria defining successful aging, see Methods.

    • ↵† Participants who were alive at the end of follow-up, but who were not classified as successful agers.

    • ↵‡ Calculated using available data. For stroke, data were missing for 239 participants; for cancer, data were missing for 6 participants; for diabetes, data were missing for 5 participants.

    • View popup
    Table 3:

    Association between healthy behaviours, successful aging and survival to end of follow-up among 5100 participants

    Healthy behaviourTotal populationSuccessful aging*
    n = 953
    Survival*†
    n = 4551
    No. of peopleAdjusted OR‡ (95% CI)PAR, %No. of peopleAdjusted OR‡ (95% CI)PAR, %
    Never smoked
    No (reference)26004221.0022591.00
    Yes25005311.29 (1.11–1.49)12.422921.53 (1.27–1.85)20.6
    Moderate consumption of alcohol
    No (reference)18292871.0015891.00
    Yes32716661.31 (1.12–1.53)16.629621.40 (1.16–1.68)20.4
    Physically active
    No (reference)24983861.0021871.00
    Yes26025671.45 (1.25–1.68)18.723641.32 (1.10–1.60)14.0
    Daily consumption of fruits and vegetables
    No (reference)19002921.0016581.00
    Yes32006611.35 (1.15–1.58)18.128931.33 (1.10–1.60)17.2
    • Note: CI = confidence interval, OR = odds ratio, PAR = population-attributable risk.

    • ↵* The binary outcomes are successful aging versus normal aging or death, and survival to the end of follow-up versus death.

    • ↵† Includes successful and normal aging groups.

    • ↵‡ Adjusted for age, sex, level of education and marital status, mutually adjusted for each healthy behaviour.

    • View popup
    Table 4:

    Associations between the number of healthy behaviours and measures of functioning used to define successful aging

    No. of healthy behavioursMeasure of functioning, adjusted* OR (95% CI)
    Good lung function†Good cognitive function†Good physical function†No disability‡Good mental health§Good systolic BP¶Good systolic BP or no use of antihypertensive drugs
    0 (reference)1.001.001.001.001.001.001.00
    11.69 (1.12–2.55)0.85 (0.58–1.26)1.34 (0.93–1.91)1.19 (0.81–1.74)1.18 (0.75–1.83)0.78 (0.50–1.22)1.02 (0.73–1.41)
    22.08 (1.41–3.07)1.12 (0.77–1.63)1.82 (1.29–2.56)1.60 (1.11–2.31)1.81 (1.17–2.79)0.79 (0.55–1.15)1.30 (0.96–1.79)
    32.84 (1.91–4.22)1.62 (1.10–2.37)2.17 (1.54–3.08)1.82 (1.25–2.63)2.33 (1.50–3.62)0.98 (0.71–1.39)1.40 (1.02–1.91)
    43.63 (2.31–5.71)2.15 (1.39–3.33)2.97 (1.99–4.45)2.27 (1.49–3.47)3.12 (1.83–5.29)1.05 (0.80–1.71)1.61 (1.15–2.26)
    p for trend< 0.001< 0.001< 0.001< 0.001< 0.0010.4< 0.001
    • Note: BP = blood pressure, CI = confidence interval, OR = odds ratio.

    • ↵* Adjusted for age, sex, level of education and marital status. Numbers of participants vary from 3487 to 4455, depending on the measure of functioning (see Appendix 3 for further details).

    • ↵† Defined as not being in the lowest age- and sex-standardized quintile.

    • ↵‡ Defined as no self-reported difficulties in basic and instrumental activities of daily living.

    • ↵§ Defined as score > 42 on mental component of the 2007–2009 questionnaire.

    • ↵¶ Defined as not being in the highest age- and sex-standardized quintile of systolic blood pressure.

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Canadian Medical Association Journal: 184 (18)
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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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