Absence of hypertension, overweight and smoking results in 9 disease-free years and prolonged life expectancy of 6 years

Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: A population-based cohort study

Literature - Licher S, Heshmatollah A, Van der Willik KD et al. - PLoS Med 2019, doi.org/10.1371/journal.pmed.1002741

Introduction and methods

Risks for most non-communicable diseases (NCDs), including stroke, heart disease, diabetes, chronic respiratory disease, cancer and neurogenerative disease, can be highly modified by preventing the occurrence of risk factors. More population-based data on multimorbidity of NCDs are needed to understand the impact of risk factors on lifetime risk and age of onset of NCD. In addition, longitudinal studies have focused on single NCD, although NCDs often co-occur. As multimorbidity has become a global healthcare priority, more data is needed. Increased life expectancy and improved healthcare systems result in higher numbers of survival of first NCD and higher risk for multimorbid age-related NCDs.

In this analysis of the Rotterdam Study, a community-based, prospective cohort, lifetime risk of any NCD was calculated accounting for NCD multimorbidity and competing risk of death from other causes. In addition, the association of shared risk factor burden (presence of hypertension, overweight and smoking) with lifetime risk of NCDs, age at onset of NCD, and life expectancy with and without NCDs was studied.

Between 1989 and 2012, individuals ≥45 years from the Rotterdam Study were followed. From the total of 14,926 participants, those with history of 1 or more NCDs at baseline or incompletely screened were excluded leaving 9061 participants in this subanalysis.

Main results

  • Overall lifetime risk of developing any NCD was slightly higher for men vs women: 94.0% (95% CI: 92.9–95.1%) for a 45-year-old man and 92.8% (95% CI: 91.8–93.8%) for a 45-year-old woman (P<0.001).
  • Lifetime risk of heart disease as first NCD was significantly higher in men (22.5%) than women (17.0%, P<0.001).
  • 33.7% of individuals with an NCD were diagnosed with multiple NCDs at follow-up.
  • Overall lifetime risk of developing any NCD was increased from 90.3% (95%CI:87.8–92.9%) for those without the risk factors to 96.8% (95%CI:95.3–98.2%) for those with the 3 risk factors.
  • Individuals without the 3 risk factors smoking, overweight and hypertension were 9.0 years older (95%CI:6.3-12.6) when first diagnosed for NCD, compared to those who smoked, were overweight and hypertensive. Similar trends were observed across the entire age range.
  • Those with the 3 shared risk factors were particularly at risk for development of heart disease (lifetime risk was 25.8% compared to 16.8% in those without the 3 risk factors), diabetes and chronic respiratory disease.
  • Individuals of 45 years without the 3 shared risk factors lived 6.0 years (95%CI:5.2-6.8) longer than those with the 3 risk factors.


This subanalysis of the Rotterdam Study showed that absence of the 3 common shared risk factors smoking, hypertension and overweight, results in 9 disease-free years and an increased life expectancy of 6 years compared to those with these 3 risk factors. These data emphasize that prevention of occurrence of smoking, hypertension and overweight may result in healthy aging and prevent premature death caused by NCDs in community-dwelling individuals.


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Find this article online at PLoS Medicine

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