A study published in the journal JMIR Public Health and Surveillance highlights the importance of adopting a healthy lifestyle in enhancing life expectancy and reducing lifetime healthcare expenditure. 

Study: Impact of Healthy Lifestyle Factors on Life Expectancy and Lifetime Health Care Expenditure: Nationwide Cohort Study. Image Credit: nadianb / Shutterstock

Background

The associations between unhealthy lifestyle factors and the risk of chronic diseases and mortality have been well-established in the literature. Adopting an unhealthy lifestyle, including poor-quality diet, physical inactivity, smoking, and heavy alcohol drinking, has been found to be associated with 60% of all premature deaths worldwide.

An increase in average life expectancy has been observed globally in recent decades. However, it remains uncertain whether increased life expectancy is associated with an overall reduction in healthcare costs. Several studies have highlighted associations between lifestyle risk factors and healthcare-related economic burden.

In this study, scientists investigated the individual and combined effects of five healthy lifestyle factors on Taiwan’s life expectancy and lifetime healthcare expenditure.

Study design

The study included a nationally representative group of more than 19,000 Taiwanese adults participating in the Taiwan National Health Interview Survey (NHIS) in 2001 and 2005.

A rolling extrapolation algorithm estimated the study population’s lifetime survival function. These estimates were used to calculate the study population’s life expectancy and lifetime healthcare expenditures with and without healthy lifestyle factors.

The study analyzed five healthy lifestyle factors, including nonsmoking, avoiding excessive alcohol consumption, performing sufficient physical activity, consuming sufficient amounts of fruit and vegetables, and maintaining a healthy body weight. Information on these lifestyle factors was collected from the survey database.

The survey database also contained information on participants’ sociodemographic characteristics and medical history. These factors were adjusted in the final analysis as potential confounders or covariates.

Important observations

The study included 19,893 participants aged 30 years or above. During the study’s 15-year follow-up period, 3,815 deaths were recorded.

Each of the analyzed lifestyle factors showed a significant association with all-cause mortality risk. Increasing healthy lifestyle behaviors reduces mortality risk.

Life expectancy

An induction in life expectancy was observed with increasing adherence to healthy lifestyle behaviors. Adherence to all five healthy behaviors was found to be associated with a 7.13-year increase in life expectancy.

Regarding individual healthy lifestyle behaviors, a 2.31-year and 1.62-year increase in life expectancy was observed among participants who did not smoke and did not consume excessive alcohol, respectively.

Sufficient physical activity and sufficient intake of fruits and vegetables were associated with an additional life gain of 1.85 years and 3.25 years, respectively.

Lifetime healthcare expenditure

Adherence to all five healthy lifestyle behaviors was found to be associated with a 28.12% reduction in the percentage of annual healthcare expenditure per capita.

Regarding individual health behaviors, non-smoking and having a healthy body weight were found to significantly reduce lifetime healthcare expenditures. Participants who never smoked and those with a healthy body weight observed a 9.78% and 18.36% reduction in annual health care expenditure per capita, respectively.    

The analysis of the dose-response effect revealed that being overweight is associated with an additional life gain of 0.69 years. However, this increased life expectancy was accompanied by a 21% increase in annual healthcare expenditure.

The correlation analysis between life expectancy and lifetime healthcare expenditure revealed that adherence to all five healthy behaviors is associated with a longer life expectancy and a lower annual healthcare expenditure.

Among analyzed lifestyle behaviors, smoking, and non-optimal body weight showed significant association with higher healthcare costs and lower life expectancy.

Study significance

The study reveals that adopting a healthy lifestyle is associated with longer life expectancy and lower healthcare costs in Taiwanese adults. The findings clearly emphasize the potency of the combination of nonsmoking and adequate fruit and vegetable consumption in enhancing life expectancy.

The study also highlights that optimal body weight is the primary determinant of reduced lifetime healthcare expenditures.

The study included only baseline data on healthy lifestyle behaviors and, thus, could not consider the impact of changing lifestyle over time. Moreover, the inclusion of self-reported lifestyle behaviors may have led to misclassification.

As mentioned by scientists, individuals with poor health are less likely to participate in surveys, which may have led to an underestimation of the proportion of individuals with an unhealthy lifestyle.

The scientists have also mentioned that lifetime healthcare expenditures might have been underestimated in this study as they have estimated healthcare costs on the basis of reimbursement data obtained from Taiwan’s National Health Insurance Research Database.  

They have advised that future studies should thoroughly examine the effects of lifestyle factors on composite metrics such as disability-adjusted life years, quality-adjusted life years, or health-adjusted life expectancy at an individual level to gain a more comprehensive understanding.