Joint association of smoking and physical activity with mortality in elderly hypertensive patients: A Chinese population-based cohort study in 2007-2018

Yating Yang; Huilin Xu; Xiaoqin Liu; Jiong Li; Zeyan Liew; Xing Liu; Chen Huang; Jingjing Zhu; Jinling Zhang; Linli Chen; Yuantao Hao; Guoyou Qin; Yongfu Yu

doi:10.3389/fpubh.2022.1005260

Joint association of smoking and physical activity with mortality in elderly hypertensive patients: A Chinese population-based cohort study in 2007-2018

Front Public Health. 2022 Sep 29:10:1005260. doi: 10.3389/fpubh.2022.1005260. eCollection 2022.

Authors

Yating Yang¹, Huilin Xu², Xiaoqin Liu³, Jiong Li^{4

5}, Zeyan Liew⁶, Xing Liu⁷, Chen Huang¹, Jingjing Zhu¹, Jinling Zhang², Linli Chen², Yuantao Hao⁸, Guoyou Qin⁹, Yongfu Yu¹

Affiliations

¹ Department of Biostatistics, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
² Shanghai Minhang Center for Disease Control and Prevention, Shanghai, China.
³ NCRR-National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.
⁴ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁵ Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
⁶ Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States.
⁷ Department of Epidemiology, School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
⁸ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
⁹ Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, China.

Abstract

Background: Although associations of physical activity and smoking with mortality have been well-established, the joint impact of physical activity and smoking on premature mortality among elderly hypertensive population was still unclear. This study aimed to assess association of physical activity, smoking, and their interaction with all-cause and cardiovascular disease (CVD) mortality risk in elderly hypertensive patients.

Methods: We included 125,978 Chinese hypertensive patients aged 60-85 years [mean (SD) age, 70.5 (6.9) years] who had records in electronic health information system of Minhang District of Shanghai, China in 2007-2015. Cox regression was used to estimate individual and joint association of smoking and physical activity on all-cause and CVD mortality. Interactions were measured both additively and multiplicatively. Additive interaction was evaluated by relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S).

Results: Among 125,978 elderly hypertensive patients (median age 70.1), 28,250 deaths from all causes and 13,164 deaths from CVD were observed during the follow-up up to 11 years. There was an additive interaction between smoking and physical inactivity [RERI: all-cause 0.19 (95% CI: 0.04-0.34), CVD 0.28 (0.06-0.50); AP: all-cause 0.09 (0.02-0.16), CVD 0.14 (0.04-0.23); S: all-cause 1.21 (1.04-1.42), CVD 1.36 (1.06-1.75)], while the concurrence of both risk factors was associated with more than 2-fold risk of death [hazard ratio (HR): all-cause 2.10 (1.99-2.21), CVD 2.19 (2.02-2.38)].

Conclusion: Our study suggested that smoking and physical inactivity together may have amplified association on premature death compared to the sum of their individual associations, highlighting the importance of improving behavioral factors in combination and promoting a comprehensive healthy lifestyle in hypertensive elderly.

Keywords: all-cause mortality; cardiovascular disease; elderly; hypertension; interaction; physical activity; smoking.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
China / epidemiology
Cohort Studies
Exercise
Humans
Hypertension* / epidemiology
Smoking / epidemiology