Abstract
OBJECTIVE: Evidence has indicated a healthy lifestyle linked to lower mortality and longer life expectancy, but very few existing health score have included sleep and psychological health. This study developed an updated behavioral and mental health score (BMHS) incorporating these factors and examined its associations with mortality and life expectancy.
METHODS: We prospectively analyzed data from 413,180 participants in the UK Biobank (2006-2022) and the US National Health and Nutrition Examination Survey (NHANES) (1999-2018). BMHS was constructed based on diet, physical activity, alcohol consumption, smoking, sleep duration, and depression. Cox models and life tables were used to assess associations with all-cause and cause-specific mortality and life expectancy.
RESULTS: During a mean follow-up of 13.3 years, 34,155 deaths occurred. After multivariable adjustment, a higher BMHS was significantly associated with lower risks of all-cause mortality (HR for the highest vs. lowest quintile: 0.56, 95% CI: 0.47-0.67), cardiovascular disease mortality (0.64, 0.59-0.70), cancer mortality (0.62, 0.58-0.65), and other mortality (0.47, 0.31-0.70). A higher score also correlated with longer life expectancy by 5.60 years (3.82-8.19) in the highest versus lowest quintile. Associations were stronger in those aged <65 years or with BMI <25 kg/m2.
CONCLUSIONS: Among UK and US adults, a higher BMHS additionally incorporating sleep and mental health was strongly associated with reduced mortality and longer life expectancy. Our findings suggest that promotion of behavioral and mental health would help to reduce mortality, extend life expectancy, and lower the healthcare burdens.