Article
Prevalence of multiple chronic disease risk factors: 2001 National Health Interview Survey

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Abstract

Background

Four common factors—cigarette smoking, risky drinking of alcoholic beverages, physical inactivity, and overweight—contribute substantially to chronic disease prevalence.

Methods

We used data from the 2001 National Health Interview Survey to provide an up-to-date picture of multiple risk factor prevalence and clustering in the U.S. population. We conducted a multinomial logit analysis to examine the independent association between each covariate and the dependent ordinal risk factor variable with three levels (none or one risk factor, two risk factors, and three or four risk factors).

Results

Seventeen percent of the sample of 29,183 subjects had three or more risk factors. For the entire sample, the mean number of risk factors was 1.68 (95% confidence interval [CI]=1.66–1.70). Many demographic and health factors were significantly associated with the mean number of risk factors including gender, age, ethnic/racial categories, education, martial status, presence of chronic diseases, level of mental distress, country of birth, and presence and type of health insurance. Using the risk factor score as the ordinal dependent variable, adjusted odds for having a risk score of three or four versus zero or one were as follows: men aged <65, 2.49 (95% CI=2.29–2.72); education attainment of high school graduate or less, 3.24 (95% CI=2.86–3.67); and individuals with high levels of mental distress, 2.06 (95% CI=1.65–2.58).

Conclusions

Our analyses confirm earlier reports of the high prevalence of multiple, clustered behavioral risk factors and underline the challenge this presents for primary care and public health systems.

Introduction

There is widespread scientific and public health policy consensus that behavioral factors such as cigarette smoking, risky drinking of alcoholic beverages, physical inactivity, and unhealthy dietary practices contribute significantly to preventable chronic disease morbidity and mortality. In 2000, these four risk factors accounted for approximately 900,000 deaths or 39% of the total deaths annually in the United States.1 Overweight substantially contributes to most of the deaths causally related to unhealthy dietary practices and physical inactivity.1 While other nongenetic and potentially modifiable factors also cause fatal diseases and injuries, cigarette smoking, risky drinking of alcohol beverages, physical inactivity, and unhealthy dietary practices are the most important.1 Although we know a considerable amount about the prevalence of each of these four behavioral risk factors, we know less about the most recent patterns of risk factor occurrence among individuals.

The results of previous nationally representative studies of multiple behavioral risk factor patterns in the United States indicate that risk factors do not occur at random and often occur together in specific combinations.2 These studies also indicate that, in general, highly educated respondents, older respondents, and women have a lower prevalence of behavioral risk factors.3, 4, 5 The most recent data that are reported in these studies were collected during the 1988–1994 period.6 In this descriptive report, we used data from the 2001 National Health Interview Survey (NHIS) to provide an up-to-date picture of multiple risk factor prevalence and clustering in the U.S. population.7 Additionally, we examine demographic, health, and healthcare covariates of multiple risk factor prevalence. The four risk factors we consider from the 2001 NHIS are smoking, physical inactivity, risky alcohol consumption, and being overweight (defined by body mass index [BMI]≥25). Although being overweight is not a behavior, its determinants include several behaviors, including mismatch between dietary energy intake and level of physical activity, and eating patterns such as skipping breakfast.8 Documenting the prevalence, clustering patterns, and covariates of multiple behavioral risk factors provides valuable information for developing flexible screening and brief interventions for addressing these risk factors in primary care. While information on the prevalence of multiple behavioral risk factors will hopefully serve to stimulate effective interventions delivered by the primary care health system, we also recognize that behaviors and specific interventions are shaped by social forces, and that interventions are required on multiple levels.1, 2

Section snippets

Sample and procedure

The NHIS, which is administered by the National Center for Health Statistics of the Centers for Disease Control and Prevention, is an annual, nationally representative survey of the civilian, non-institutionalized, household population of the United States.7 The NHIS over-samples black and Hispanic populations to provide more precise estimation of these minority populations. From each family sampled in the NHIS, one adult (aged ≥18 years) is randomly selected to answer the Sample Adult Core

Results

With regard to the prevalence of each of the four risk factors (Table 1), the most common risk factor was physical inactivity. Sixty-six percent of the sample was physically inactive and 41% reported no regular physical activity. Fifty-eight percent were overweight or obese, 23% smoked, and 21% were classified as risky drinkers.

For each survey participant, we created a total risk factor score, ranging from 0 (having none of the four risk factors) to 4 (having all four of the risk factors).

Discussion

The majority of adult Americans have two or more of the four behavioral risk factors we considered, and 17% have three or more. These risk factors co-occur in specific clusters, with the most common by far being inactivity and overweight, involving 26% of the sample. In a recent study, Berrigan et al.3 examined the patterns of adherence to recommendations to five risk behaviors (physical activity, tobacco use, alcohol consumption, fruit and vegetable consumption, and dietary fat intake). They

Acknowledgements

Preparation of this article was supported by a grant from the Robert Wood Johnson Foundation.

References (17)

  • D Berrigan et al.

    Patterns of health behavior in U.S. adults

    Prev Med

    (2003)
  • R.E Patterson et al.

    Health lifestyle patterns of U.S. adults

    Prev Med

    (1994)
  • A.H Mokdad et al.

    Actual causes of death in the United States, 2000

    JAMA

    (2004)
  • Health and behaviorthe interplay of biological, behavioral and societal influences

    (2001)
  • E.S Ford et al.

    Achieving a healthy lifestyle among United States adultsa long way to go

    Ethn Dis

    (2001)
  • NCHS plan and operation of the National Health and Nutrition Examination Survey, 1988–1994

    Vital Health Stat

    (1994)
  • Data file documentation, National Health Interview Survey, 2001

    (2002)
  • Y Ma et al.

    Association between eating patterns and obesity in a free-living U.S. adult population

    Am J Epidemiol

    (2003)
There are more references available in the full text version of this article.

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