Nobody’s (health is) perfect

4 minute read

Let him who is without risk factors cast the first stone.

Have you ever quietly, secretly, illicitly wondered whether public health boffins are setting us unrealistic standards?

Good news, then (at least that’s how the Back Page chooses to interpret it).

A PLoS ONE paper with the title kicker “Is anyone truly healthy?” compares two NHANES (National Health and Nutrition Examination Surveys) cohorts, from 1988-94 and 1999-2014 (for a total sample of 28,000), on a range of health risk factors. It then compares those risk factors’ association with five-year odds ratio for mortality (5YMO), adjusting for age, sex, obesity category and white ethnicity.

Nineteen health risk factors were counted, classed into lifestyle (no physical activity, high fat diet, current smoking, alcohol consumption); physiological (high blood pressure, hyperglycaemia, dyslipidaemia, CVD, cancer, lung problems): social/mental (lack of health insurance, low education, food insecurity, low income, use of mental health medication); and physical (arthritis, use of pain medication, obesity, limitations of activities of daily living if over 60).

The top-line result is that overall, 97% of the sample had at least one risk factor, leaving just 3% of humans getting a perfect mark. The BP doesn’t know who those shiny happy 3-percenters are, but they sound really annoying.

The prevalence of the various types of risk factor changed over time, with lifestyle, social/mental and physical factors increasing (and increasing by a greater margin in women) and physiological factors decreasing (by a smaller margin in women). Overall, lifestyle and physical factors were more common in women, and there were no sex differences in the others.

Between the two cohorts, couch potatoism and drinking too much went up, smoking went down, as you would expect, and men curbed their high-fat-diet habits.

Hypertension, hyperglycaemia and cancer went up, high lipids became less common, while CVD had a net loss in women only and lung disease saw no change in prevalence.

With social/mental risk factors, lack of health insurance, food insecurity and use of mental health meds went up, though less-than-high-school education became less prevalent.

Use of pain meds, arthritis and obesity all went up, while having limited daily activities as an older person went down.

The relationship between the risk factors and mortality did some funny things.

5YMO from having any of the factors actually decreased by 30% between the two samples.

Having any lifestyle risk factor meant higher 5YMO for the later cohort, but not for the earlier one.

There was a higher mortality risk from any social or mental factor in both cohorts, subtly higher in the later one, especially from low education or using mental health medication.

The increased 5YMO from physiological factors decreased over time – for example, while obesity prevalence has gone up, its associated mortality risk has gone down, presumably because treatment for obesity’s associated outcomes has improved.

To take one individual factor, excessive alcohol consumption was associated with higher mortality risk in 1999-2014, but not in 1988-94 – for reasons that the study cannot elucidate.

Mortality risk from the use of mental health drugs also increased over time.

Lead author Associate Professor Jennifer Kuk from York University sums up the results thus: “Overall, most of us have something wrong with us, and we’re more likely to have a lifestyle health-risk factor now than in the 80s and that’s actually associated with even greater mortality risk now than before.”

She points out that while most of us have room for lifestyle improvement, there is a bleak message – for US readers at least – in the increasing prevalence of factors beyond personal control, such as food insecurity and lack of insurance: “as a society, we’re making it so that health might not be an easy choice for a lot of people. We need to be sensitive to that when we take a look at these risk factors.”

Send story tips to for offset points against your risk factor of choice.

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