Date Published: February 4, 2019
Publisher: Public Library of Science
Author(s): Silvan Licher, Alis Heshmatollah, Kimberly D. van der Willik, Bruno H. Ch. Stricker, Rikje Ruiter, Emmely W. de Roos, Lies Lahousse, Peter J. Koudstaal, Albert Hofman, Lana Fani, Guy G. O. Brusselle, Daniel Bos, Banafsheh Arshi, Maryam Kavousi, Maarten J. G. Leening, M. Kamran Ikram, M. Arfan Ikram, Sanjay Basu
Abstract: BackgroundNon-communicable diseases (NCDs) are leading causes of premature disability and death worldwide. However, the lifetime risk of developing any NCD is unknown, as are the effects of shared common risk factors on this risk.Methods and findingsBetween July 6, 1989, and January 1, 2012, we followed participants from the prospective Rotterdam Study aged 45 years and older who were free from NCDs at baseline for incident stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease. We quantified occurrence/co-occurrence and remaining lifetime risk of any NCD in a competing risk framework. We additionally studied the lifetime risk of any NCD, age at onset, and overall life expectancy for strata of 3 shared risk factors at baseline: smoking, hypertension, and overweight. During 75,354 person-years of follow-up from a total of 9,061 participants (mean age 63.9 years, 60.1% women), 814 participants were diagnosed with stroke, 1,571 with heart disease, 625 with diabetes, 1,004 with chronic respiratory disease, 1,538 with cancer, and 1,065 with neurodegenerative disease. NCDs tended to co-occur substantially, with 1,563 participants (33.7% of those who developed any NCD) diagnosed with multiple diseases during follow-up. The lifetime risk of any NCD from the age of 45 years onwards was 94.0% (95% CI 92.9%–95.1%) for men and 92.8% (95% CI 91.8%–93.8%) for women. These risks remained high (>90.0%) even for those without the 3 risk factors of smoking, hypertension, and overweight. Absence of smoking, hypertension, and overweight was associated with a 9.0-year delay (95% CI 6.3–11.6) in the age at onset of any NCD. Furthermore, the overall life expectancy for participants without these risk factors was 6.0 years (95% CI 5.2–6.8) longer than for those with all 3 risk factors. Participants aged 45 years and older without the 3 risk factors of smoking, hypertension, and overweight at baseline spent 21.6% of their remaining lifetime with 1 or more NCDs, compared to 31.8% of their remaining life for participants with all of these risk factors at baseline. This difference corresponds to a 2-year compression of morbidity of NCDs. Limitations of this study include potential residual confounding, unmeasured changes in risk factor profiles during follow-up, and potentially limited generalisability to different healthcare settings and populations not of European descent.ConclusionsOur study suggests that in this western European community, 9 out of 10 individuals aged 45 years and older develop an NCD during their remaining lifetime. Among those individuals who develop an NCD, at least a third are subsequently diagnosed with multiple NCDs. Absence of 3 common shared risk factors is associated with compression of morbidity of NCDs. These findings underscore the importance of avoidance of these common shared risk factors to reduce the premature morbidity and mortality attributable to NCDs.
Partial Text: Non-communicable diseases (NCDs), including stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease, are the most frequent causes of prolonged disability and premature death worldwide [1–3]. Major changes in lifestyle and medicine over the past decades have led to significant reductions in premature mortality from NCDs such as heart disease and cancer, especially in high-income countries [4,5], shifting the burden of disease in these countries from premature mortality to prolonged disability. In low- and middle-income countries, however, rates of premature mortality caused by NCDs are rapidly increasing, leading to severe socio-economic burdens in these societies .
Study population characteristics are presented in Table 1. Median age at baseline was 61.7 years (range 45–107 years), and 60.1% of the population were women. Study population characteristics stratified by study wave are presented in Table A in S1 Results. Compared to participants included in the first study wave, participants in the second and third wave were generally younger at the start of follow-up. They attained a higher educational level, and were more likely to smoke or be overweight at baseline. Participants in the third wave were less likely to have hypertension at baseline than participants in the 2 other recruitment waves. During 75,354 person-years of follow-up (99.3% of potential person-years observed), 6,617 events occurred among 9,061 participants: 814 participants were diagnosed with stroke, 1,571 with heart disease, 625 with diabetes, 1,004 with chronic respiratory disease, 1,538 with cancer, and 1,065 with neurodegenerative disease. In total, 2,941 participants died during follow-up, of whom 421 died free of these diseases.
In this population-based cohort study, a substudy of the ongoing prospective Rotterdam Study, we assessed the lifetime risks of developing co-occurring NCDs, and quantified their multimorbidity. We show that 9 out of 10 individuals develop an NCD from the age of 45 years onwards. Among those individuals, at least a third are subsequently diagnosed with multiple NCDs. Importantly, absence of 3 common shared NCD risk factors—namely smoking, hypertension, and overweight—is associated with a 9-year delay in the first diagnosis of any NCD compared to those with these 3 risk factors. Furthermore, absence of these risk factors is associated with an extended life expectancy of 6 years. These findings highlight the potential to lower the proportion of a lifetime spent with disability and the number of premature deaths caused by NCDs through prevention of shared risk factors among community-dwelling individuals.