Influence of individual and combined healthy behaviours on successful aging

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Figure 1:
Selection of participants for the study. MI = myocardial infarction.
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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.

Table 1:

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

Characteristic	No. (%)^*		p value
Characteristic	Study participants n =5100	Excluded participants n =1499	p value
Age, yr, mean ± SD	51.3 ± 5.3	51.4 ± 5.1	0.5^†
Female sex	1506 (29.5)	579 (38.6)	< 0.001^‡
Married or living with someone	3963 (77.7)	1118 (74.6)	0.01^‡
University degree or higher	1274 (25.0)	303 (20.2)	0.001^‡
Never smoked	2500 (49.0)	722 (48.2)	0.6^‡
Moderate consumption of alcohol	3271 (64.1)	912 (60.8)	0.02^‡
Physically active	2602 (51.0)	721 (48.1)	0.05^‡
Daily consumption of fruits and vegetables	3200 (62.7)	884 (59.0)	0.01^‡

Table 2:

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

Characteristic	Successful aging^* n = 953	Normal aging^† n = 3598
At baseline
Age, yr, mean ± SD	49.7 ± 4.9	51.3 ± 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 ± SD	120.2 ± 10.9	128.9 ± 17.6
Forced expiratory volume, L/m², mean ± SD	1.1 ± 0.2	0.9 ± 0.2
Walking speed, m/s, mean ± SD	1.3 ± 0.2	1.1 ± 0.3
Cognitive function, z score, mean ± SD	0.5 ± 0.7	–0.2 ± 1.0
Mental health score, mean ± SD	56.3 ± 4.2	52.9 ± 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.

Table 3:

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

Healthy behaviour	Total population	Successful aging^* n = 953			Survival^*^† n = 4551

		No. of people	Adjusted OR^‡ (95% CI)	PAR, %	No. of people	Adjusted OR^‡ (95% CI)	PAR, %
Never smoked

No (reference)	2600	422	1.00		2259	1.00

Yes	2500	531	1.29 (1.11–1.49)	12.4	2292	1.53 (1.27–1.85)	20.6

Moderate consumption of alcohol

No (reference)	1829	287	1.00		1589	1.00

Yes	3271	666	1.31 (1.12–1.53)	16.6	2962	1.40 (1.16–1.68)	20.4

Physically active

No (reference)	2498	386	1.00		2187	1.00

Yes	2602	567	1.45 (1.25–1.68)	18.7	2364	1.32 (1.10–1.60)	14.0

Daily consumption of fruits and vegetables

No (reference)	1900	292	1.00		1658	1.00

Yes	3200	661	1.35 (1.15–1.58)	18.1	2893	1.33 (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.

Table 4:

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

No. of healthy behaviours	Measure of functioning, adjusted^* OR (95% CI)
No. of healthy behaviours	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)	1.00	1.00	1.00	1.00	1.00	1.00	1.00
1	1.69 (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)
2	2.08 (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)
3	2.84 (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)
4	3.63 (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	< 0.001	0.4	< 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.