AUTHOR=Rahman Md. Mijanur , Jagger Carol , Leigh Lucy , Holliday Elizabeth , Princehorn Emily , Loxton Deb , Kowal Paul , Beard John , Byles Julie 

TITLE=The Impact of Education and Lifestyle Factors on Disability-Free Life Expectancy From Mid-Life to Older Age: A Multi-Cohort Study

JOURNAL=International Journal of Public Health

VOLUME=Volume 67 - 2022

YEAR=2022

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2022.1605045

DOI=10.3389/ijph.2022.1605045

ISSN=1661-8564

ABSTRACT=Objectives: Low education and unhealthy lifestyle factors such as obesity, smoking, and no physical exercise are modifiable risk factors of disability and premature mortality. We aimed to estimate the joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE).
Methods: Data (n=22,304) were from two birth cohorts (1921-26 & 1946-51) of the Australian Longitudinal Study on Women’s Health and linked National Death Index between 1996 and 2016. Discrete time multi-state Markov models were used to assess the impact on DFLE and TLE. 
Results: Compared to the best combination of education and lifestyle factors, the worst combination (low education, obesity, current/past smoker, and no physical exercise) was associated with loss of 5.0 years TLE, 95% confidence interval (95%CI): 3.2-6.8 and 6.3 years DFLE (95%CI:4.8-7.8) at age 70 in the 1921-26 cohort. Corresponding losses in the 1946-51 cohort were almost double (TLE:11.0 years and DFLE: 13.0 years).
Conclusions: Reducing smoking and obesity and increasing physical activity during mid-life or early older age could potentially improve healthy ageing and longevity at population level.