Smoking – divorce and alcohol abuse have the closest connection to death

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Smoking, divorce and alcohol abuse have the closest connection to death out of 57 social and behavioral factors analyzed in research published today in Proceedings of the National Academy of Sciences.

The study analyzed survey data collected from 13,611 adults in the U.S. between 1992 and 2008, and identified which factors applied to those who died between 2008 and 2014.

“It shows that a lifespan approach is needed to really understand health and mortality,” said Eli Puterman, assistant professor at the University of British Columbia’s school of kinesiology and lead author of the study.

“For example, instead of just asking whether people are unemployed, we looked at their history of unemployment over 16 years.

If they were unemployed at any time, was that a predictor of mortality?

It’s more than just a one-time snapshot in people’s lives, where something might be missed because it did not occur. Our approach provides a look at potential long-term impacts through a lifespan lens.”

Life expectancy in the U.S. has stagnated for three decades relative to other industrialized countries, raising questions about which factors might be contributing. Biological factors and medical conditions are always at the top of the list, so this study intentionally excluded those in favor of social, psychological, economic, and behavioral factors.

Of the 57 factors analyzed, the 10 most closely associated with death, in order of significance, were:

1. Current smoker

2. History of divorce

3. History of alcohol abuse

4. Recent financial difficulties

5. History of unemployment

6. Previous history as a smoker

7. Lower life satisfaction

8. Never married

9. History of food stamps

10. Negative affectivity

The data came from the nationally representative U.S. Health and Retirement Study, whose participants ranged in age from 50 to 104, with an average age of 69.3.

These surveys didn’t capture every possible adversity – neither food insecurity nor domestic abuse was addressed, for example – but the new findings provide an indication of where various factors stand in relation to each other.

“If we’re going to put money and effort into interventions or policy changes, these areas could potentially provide the greatest return on that investment,” Puterman said.

“Smoking has been understood as one of the greatest predictors of mortality for 40 years, if not more, but by identifying a factor like negative affectivity – this idea that you tend to see and feel more negative things in your life – we can see that we might need to start targeting this with interventions.

Can we shift it and have an impact on mortality rates?

Similarly, can we target interventions for the unemployed and those with financial difficulties to reduce their risk?”

UBC kinesiology masters student Benjamin Hives also contributed to the study, along with Puterman’s colleagues from the University of Pennsylvania, Johns Hopkins University, University of California San Francisco, and Stanford University.


Alcohol—whether consumed on a single occasion or over time—can take a serious toll on your health. Alcohol interferes with the brain’s communication pathways. It can change your mood and behavior, and make it harder to think and move properly. Drinking too much can even lead to death, either from an accident, an overdose, or a disease related to chronic use, like heart, pancreas, or liver problems or cancer.

Alcohol consumption and hospital visits have increased in the U.S. over the past twenty years. To determine whether alcohol-related deaths have also changed over this time, Dr. Aaron White at NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) and colleagues analyzed data from all U.S. death certificates filed from 1999 to 2017.

A death was considered alcohol-related if an alcohol-induced cause was listed as the underlying cause or a contributing cause of death. Results were published online on January 7, 2020, in Alcoholism: Clinical and Experimental Research.

The number of death certificates for people aged 16 and up that mentioned alcohol more than doubled from about 36,000 in 1999 to more than 72,000 in 2017. Nearly 1 million people died from alcohol-related causes between 1999 and 2017. Alcohol played a role in 2.6% of all deaths in the U.S. in 2017.

In 2017, 31% of alcohol-related deaths resulted from liver disease and 18% were from overdoses on alcohol alone or with other drugs. People aged 45–74 had the highest rates of deaths related to alcohol, but the biggest increases over time were among people age 25 –34. However, by the end of the study period, alcohol-related deaths were increasing among people in almost all age and racial and ethnic groups.

The rates of death involving alcohol increased more for women (85%) than men (35%) over the 18-year study period. Women also appear to be at a greater risk than men for alcohol-related cardiovascular diseases, liver disease, alcohol use disorder, and other consequences.

“Alcohol is not a benign substance, and there are many ways it can contribute to mortality,” says NIAAA Director Dr. George F. Koob. “The current findings suggest that alcohol-related deaths involving injuries, overdoses, and chronic diseases are increasing across a wide swath of the population. The report is a wakeup call to the growing threat alcohol poses to public health.”

Studies have shown that alcohol’s contribution often goes unreported on death certificates. Since the study examined death certificates only, the actual number of alcohol-related deaths in 2017 may far exceed the number determined by the authors. 

“Better surveillance of alcohol involvement in mortality is essential in order to better understand and address the impact of alcohol on public health.” Koob notes.


More information: Eli Puterman el al., “Predicting mortality from 57 economic, behavioral, social, and psychological factors,” PNAS (2020). www.pnas.org/cgi/doi/10.1073/pnas.1918455117

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