Effect of morbidity on the association between lifestyle and mortality in the Health Examinee cohort

Figure 1.. Flow diagram of sample selection criteria. KoGES-HEXA, Korean Genome and Epidemiology Study- Health Examinee. 1Number of events.

Figure 2.. HRs for mortality by WLS according to morbidity status (A: total, B: male, C: female). The WLS was developed to assess the varying impact of lifestyle factors on mortality risk. Each lifestyle factor was standardised as a z-score and weighted using regression coefficients derived from cubic spline models adjusted for sex, BMI, WHR, energy intake, morbidity status, education, income, marital status, and region. The weighted scores were then summed to calculate the WLS. HRs and 95% CIs were adjusted for energy intake, sex (in both-sex combined models), education, region of residence, marital status, income, BMI, and WHR. Tertile 1 indicates the healthiest lifestyle, and tertile 3 indicates the least healthy lifestyle. HR, hazard ratio; CI, confidence interval; SD, standard deviation; WLS, weighted lifestyle score; BMI, body mass index; WHR, waist–hip ratio. 1p-values were derived from models treating WLS as an ordinal variable to assess linear trends across tertiles. 2Restricted cubic spline transformation used to estimate the regression coefficients for each continuous lifestyle factor in the multivariable Cox proportional hazards model.

Figure 3.. HRs for mortality by accumulated lifestyle score according to morbidity status (A: total, B: male, C: female). HRs were adjusted for energy intake, sex (in both-sex combined models), education, region of residence, marital status, income level, BMI, and WHR. The ALS ranges from 0 to 5 and was calculated by summing binary exposures (0/1) for the following behaviours: smoking, alcohol use (current drinking), poor diet quality (DQI-K ≤5), low physical activity (MET-hr/day <3), and short or long sleep duration. Participants received 1 point for each risk behaviour present. HR, hazard ratio; ALS, accumulated lifestyle score; BMI, body mass index; WHR, waist–hip ratio. 1p-values represent the p for linear trend across increasing numbers of unhealthy lifestyle factors, grouped as ≤2, 3, and 4–5.

Figure 4.. YLL by lifestyle categories and morbidity status. Tertiles of lifestyle quality were derived from the composite WLS, with T1 representing the healthiest lifestyle and T3 representing the least healthy lifestyle (A: total, B: male, C: female). The ALS ranges from 0 to 5 and was calculated by summing binary exposures (0/1) for the following behaviours: smoking, alcohol use (current drinking), poor diet quality (DQI-K ≤5), low physical activity (MET-hr/day <3), and short or long sleep duration (D: total, E: male and F: female). Participants received 1 point for each risk behaviour present. RYL estimates were obtained using multivariable-adjusted survival models that accounted for age, sex (in both-sex combined models), energy intake, BMI, WHR, education, income, marital status, and region of residence. YLL was computed as the difference in RYL between each lifestyle category and the healthiest reference group (WLS: T1; ALS: ≤2). WLS, weighted lifestyle score; ALS, accumulated lifestyle score; YLL, years of life lost; RYL, remaining years of life; T1, tertile 1 of the WLS; T2, tertile 2 of the WLS; T3, tertile 3 of the WLS. *p<0.05; all other values are presented as numbers.