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Research Paper|Volume 13, Issue 17|pp 21513—21525

Converting health risks into loss of life years - a paradigm shift in clinical risk communication

Shan Pou Tsai1, Chi Pang Wen2,3, Min Kuang Tsai2, Po Jung Lu2, Jackson Pui Man Wai4, Christopher Wen5, Wayne Gao6, Xifeng Wu7,8
  • 1MJ Health Management Institution, Taipei, Taiwan
  • 2Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
  • 3China Medical University Hospital, Taichung, Taiwan
  • 4Institute of Sport Science, National Taiwan Sport University, Taoyuan, Taiwan
  • 5Long Beach VAMC Hospital, University of Irvine Medical Center, Irvine, CA 92868, USA
  • 6Taipei Medical University, Taipei, Taiwan
  • 7Center for Biostatistics, Bioinformatics and Big Data, The Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
  • 8National Institute for Data Science in Health and Medicine, Zhejiang University, Hangzhou, China
Received: April 6, 2021Accepted: July 9, 2021Published: September 7, 2021
https://doi.org/10.18632/aging.203491

Copyright: © 2021 Tsai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

For facilitating risk communication in clinical management, such a ratio-based measure becomes easier to understand if expressed as a loss of life expectancy. The cohort, consisting of 543,410 adults in Taiwan, was recruited between 1994 and 2008. Health risks included lifestyle, biomarkers, and chronic diseases. A total of 18,747 deaths were identified. The Chiang’s life table method was used to estimate a loss of life expectancy. We used Cox regression to calculate hazard ratios (HRs) for health risks. The increased mortality from cardio-metabolic risks such as high cholesterol (HR=1.10), hypertension (HR=1.48) or diabetes (HR=2.02) can be converted into a loss of 1.0, 4.4, and 8.9 years in life expectancy, respectively. The top 20 of the 30 risks were associated with a loss of 4 to 10 years of life expectancy, with 70% of the cohort having at least two such risk factors. Smoking, drinking, and physical inactivity each had 5-7 years loss. Individuals with diabetes or an elevated white count had a loss of 7-10 years, while prolonged sitting, the most prevalent risk factor, had a loss of 2-4 years. Those with diabetes (8.9 years) and proteinuria (9.1 years) present at the same time showed a loss of 16.2 years, a number close to the sum of each risk. Health risks, expressed as life expectancy loss, could facilitate risk communication. The paradigm shift in expressing risk intensity can help set public health priorities scientifically to promote a focus on the most important ones in primary care.