Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study

Importance: Steps per day is a meaningful metric for physical activity promotion in clinical and population settings. To guide promotion strategies of step goals, it is important to understand the association of steps with clinical end points, including mortality. Objective: To estimate the association of steps per day with premature (age 41-65 years) all-cause mortality among Black and White men and women. Design, Setting, and Participants: This prospective cohort study was part of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants were aged 38 to 50 years and wore an accelerometer from 2005 to 2006. Participants were followed for a mean (SD) of 10.8 (0.9) years. Data were analyzed in 2020 and 2021. Exposure: Daily steps volume, classified as low (<7000 steps/d), moderate (7000-9999 steps/d), and high (≥10 000 steps/d) and stepping intensity, classified as peak 30-minute stepping rate and time spent at 100 steps/min or more. Main Outcomes and Measures: All-cause mortality. Results: A total of 2110 participants from the CARDIA study were included, with a mean (SD) age of 45.2 (3.6) years, 1205 (57.1%) women, 888 (42.1%) Black participants, and a median (interquartile range IQR) of 9146 (7307-11 162) steps/d. During 22 845 person years of follow-up, 72 participants (3.4%) died. Using multivariable adjusted Cox proportional hazards models, compared with participants in the low step group, there was significantly lower risk of mortality in the moderate (hazard ratio HR, 0.28 95% CI, 0.15-0.54; risk difference RD, 53 95% CI, 27-78 events per 1000 people) and high (HR, 0.45 95% CI, 0.25-0.81; RD, 41 95% CI, 15-68 events per 1000 people) step groups. Compared with the low step group, moderate/high step rate was associated with reduced risk of mortality in Black participants (HR, 0.30 95% CI, 0.14-0.63) and in White participants (HR, 0.37 95% CI, 0.17-0.81). Similarly, compared with the low step group, moderate/high step rate was associated with reduce risk of mortality in women (HR, 0.28 95% CI, 0.12-0.63) and men (HR, 0.42 95% CI, 0.20-0.88). There was no significant association between peak 30-minute intensity (lowest vs highest tertile: HR, 0.98 95% CI, 0.54-1.77) or time at 100 steps/min or more (lowest vs highest tertile: HR, 1.38 95% CI, 0.73-2.61) with risk of mortality. Conclusions and Relevance: This cohort study found that among Black and White men and women in middle adulthood, participants who took approximately 7000 steps/d or more experienced lower mortality rates compared with participants taking fewer than 7000 steps/d. There was no association of step intensity with mortality.