Smoking, divorce and alcohol abuse are biggest drivers of death rate in the US, finds study

The research team analyzed survey data collected from 13,611 adults in the US between 1992 and 2008 and identified which factors applied to those who died between 2008 and 2014

                            Smoking, divorce and alcohol abuse are biggest drivers of death rate in the US, finds study
(Getty Images)

Smoking, divorce and alcohol abuse have the closest connection to death out of 57 social and behavioral factors, according to researchers who analyzed the top factors linked with the greatest risk of death among Americans. 

Life expectancy in the US has stagnated for three decades compared to other industrialized countries, raising questions about which factors might be contributing, says the research team. Accordingly, they examined survey data collected from 13,611 adults in the US between 1992 and 2008 and identified which factors applied to those who died between 2008 and 2014. Biological factors and medical conditions are always at the top of the list, so this study intentionally excluded those in favor of social, psychological, economic and behavioral factors.

In the current investigation, the authors compared 57 factors within a multidisciplinary framework: adverse socioeconomic and psychosocial experiences during childhood, socio-economic conditions, health behaviors, social connections, psychological characteristics and adverse experiences during adulthood. Of the factors analyzed, the 10 most closely associated with death, in order of significance, were current smoker, history of divorce, history of alcohol abuse, recent financial difficulties, history of unemployment, previous history as a smoker, lower life satisfaction, never married, history of food stamps and negative affectivity. 

Top 10 factors most closely associated with death (PNAS)

The next 10 were negative interactions with family and children, daily discrimination, trait anxiety, lower positive interactions with children, childhood psychosocial adversities, anger out, major discrimination, negative interactions with friends and cynical hostility, the analysis shows.

"We demonstrate that, in addition to the well-established behavioral risk factors of smoking, alcohol abuse, and lack of physical activity, economic (for example, recent financial difficulties, unemployment history), social (for example, childhood adversity, divorce history), and psychological (such as negative affectivity) factors were also among the strongest predictors of mortality among older American adults," write authors in their analysis published in the Proceedings of the National Academy of Sciences (PNAS). "The strength of these predictors should be used to guide future transdisciplinary investigations and intervention studies across the fields of epidemiology, psychology, sociology, economics, and medicine to understand how changes in these factors alter individual mortality risk," says the research team. It includes experts from the University of British Columbia, Vancouver; University of Pennsylvania, Philadelphia; Johns Hopkins Bloomberg School of Public Health, Baltimore; University of California, San Francisco; and Stanford University, Palo Alto. They found little evidence that the strength of prediction differed by gender, between white and non-white participants, or between those who completed high school and those who did not.

According to Eli Puterman, assistant professor at the University of British Columbia's school of kinesiology and lead author of the study, the findings reveal that a "lifespan approach" is needed to understand health and mortality. "For example, instead of just asking whether people are unemployed, we looked at their history of unemployment over 16 years. If they were unemployed at any time, was that a predictor of mortality? It's more than just a one-time snapshot in people's lives, where something might be missed because it did not occur. Our approach provides a look at potential long-term impacts through a lifespan lens," Puterman explains in the analysis. 

Life expectancy in the US has stagnated for three decades relative to other industrialized countries and the researchers wanted to find out which factors might be contributing (Getty Images)

The study used nationally representative data from the US Health and Retirement Study, whose participants ranged in age from 50 to 104, with an average age of 69.3. These surveys did not capture every possible adversity — neither food insecurity nor domestic abuse was addressed, for example — but the new findings indicate where various factors stand in relation to each other.

"If we're going to put money and effort into interventions or policy changes, these areas could potentially provide the greatest return on that investment. Smoking has been understood as one of the greatest predictors of mortality for 40 years, if not more, but by identifying a factor like negative affectivity — this idea that you tend to see and feel more negative things in your life — we can see that we might need to start targeting this with interventions. Can we shift it and have an impact on mortality rates? Similarly, can we target interventions for the unemployed and those with financial difficulties to reduce their risk?" questions Puterman.

The researchers recommend that future studies should develop lifespan models that include genetic, biological and health markers in addition to the individual-level factors considered in the current analysis, such as economic, behavioral, social and psychological. "It should include more macro-level markers — built, natural, and social environments, including structural racism, neighborhood cohesion, policies at state/provincial and national levels — that have previously been demonstrated as determinants of health and mortality," says the team.

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