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A Cleveland Clinic study examines the mortality burden of modifiable behavioral risk factors such as obesity, diabetes, tobacco use, high blood pressure and high cholesterol.
A team of researchers from Cleveland Clinic and New York University School of Medicine have found that based on 2014 data, obesity resulted in as much as 47% more life-years lost than tobacco, and tobacco caused similar life-years lost as high blood pressure.
“We assessed years of life in the US that were lost to preventable risk factors, such as obesity, tobacco or high blood pressure,” says Glen Taksler, PhD, author of “Life-Years Lost to Preventable Causes-of-Death in the US, 2014.”
“We found that more years of life were lost to obesity than any other preventable cause of death,” Taksler says.
Preliminary research by the Cleveland Clinic was recently presented the 2017 Society of General Internal Medicine Annual Meeting analyzed the contribution of modifiable behavioral risk factors to causes-of-death in the U.S. population.
Based on this preliminary work, Taksler and colleagues found the greatest number of preventable life-years lost were due to-in order from greatest to least-obesity, diabetes, tobacco use, high blood pressure and high cholesterol. The researchers also noted that some individuals may have needs that are different than those of the broader U.S. population. For example, for an obese and alcoholic patient, alcohol use may be more important to address than obesity, even though obesity has a greater impact on the population.
Diabetes, hypertension and high cholesterol, three of the top five causes of death can be treated, so helping patients understand treatment options and approaches can have a powerful impact on life-years, according to the study. The results also highlight the importance of preventive care in clinical practice and why it should be a priority for physicians.
Taksler and colleagues built a mathematical model that connected leading causes of death to their underlying risk factors. “We then examined the change in mortality that might have been expected if various risk factors-e.g., high blood pressure, alcohol misuse, etc.-were eliminated,” he says. “We rank-ordered the results by the expected improvement in years of life that could have been survived across the U.S. population.”
Preventable risk factors are common in most healthcare settings, Taksler says.
“Managed care executives might like some guidance on which preventive services they should focus on promoting for their members, such as tobacco cessation or weight loss,” he says.
Results highlight the clinical and public health achievement of smoking cessation efforts because 15 years ago, tobacco would have topped the list, according to the research.
Death certificates show the proximate cause-of-death (for example, heart attack or stroke), but often, deaths are rooted in risk factors (such as high cholesterol) that developed decades earlier, Taksler explains.
“Sometimes, it would have been possible to delay mortality by reducing the risk factor-for example, taking cholesterol-lowering medication," he says. "By improving understanding of preventable causes of death, we may learn more about how to prioritize preventive care in the future.”
As people quit smoking, it appears that obesity may have overtaken tobacco as the leading cause of preventable mortality, according to Taksler. “This may suggest that weight loss is the highest priority preventive care service across the U.S. population. We note that this is still preliminary work.”