Research Paper Volume 11, Issue 18 pp 7605—7619

Adherence to a healthy lifestyle counteracts the negative effects of risk factors on all-cause mortality in the oldest-old

Zhi Cao1, *, , Rui Wang2, *, , Yangyang Cheng1, , Hongxi Yang1,3, , Shu Li1, , Li Sun1, , Weili Xu2, , Yaogang Wang1, ,

  • 1 School of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
  • 2 Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm SE-17177, Sweden
  • 3 Department of Biostatistics, School of Public Health, Yale University, New Haven, CT 06520, USA
* Equal contribution

Received: July 3, 2019       Accepted: September 5, 2019       Published: September 16, 2019
How to Cite

Copyright © 2019 Cao et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


In the study, we examined the extent to which the harmful effects of risk factors on all-cause mortality can be counteracted by healthy lifestyle practices in the oldest-old (80 years of age and older). A total of 17,660 oldest-old from China were followed up for up to 10 years. The data were analyzed using the Cox proportional hazard model with adjustment for potential confounders. We found that having a rural residence, not being married, having lower economic status, physical disability, impaired cognitive function, or comorbidity were all associated with an elevated risk of mortality. Using these factors, we computed a weighted “risk score.” Because never smoking, never drinking, doing physical exercise, having an ideal diet, and a normal weight were independently associated with lower mortality, we also combined them to compute a weighted “protection score.” Both scores were divided into lowest, middle, and highest groups using their tertiles. In joint effect analyses, participants with the combined highest-risk score and lowest-protection score profile had a nearly threefold higher joint death risk. These analyses show that adherence to a healthy lifestyle counteracts the negative effect of risk factors on all-cause mortality in the oldest-old by more than 20%.


ADL: Activities of Daily Living; BMI: body mass index; BP: blood pressure; CI: confidence interval; HR: hazard ratio; MMSE: Mini-Mental State Examination; PAF: population attributable fraction; SD: standard deviation.