The impact of smoking and obesity on disability-free life expectancy in older Australians
Abstract Background Smoking and obesity are two modifiable risk factors for disability. We examine the impact of smoking and obesity on disability-free life expectancy (DFLE) at older ages, using two levels of disability. Methods We used the DYNOPTA dataset, derived by harmonizing and pooling risk factors and disability outcomes from five Australian longitudinal ageing studies. We defined mobility disability as inability to walk one kilometre, and more severe (ADL) disability by the inability to dress or bathe. Mortality data for the analytic sample (N=20,401; 81.2% women) were obtained from Government Records via data linkage. We estimated sex-specific total life expectancy, DFLE, and years spent with disability by Interpolated Markov Chain (IMaCh) software for each combination of smoking (never vs ever), obesity (Body Mass Index ≥30 vs 18.5-<30), and education (left school age 14 or younger vs age 15 or older). Results Compared to those without either risk factor, high educated non-obese smokers at age 65 lived shorter lives (men and women: 2.5 years) and fewer years free of mobility disability (men: 2.1 years; women: 2.0 years), with similar results for ADL disability. Obesity had the largest effect on mobility disability in women; high educated obese non-smoking women lived 1.3 years less than non-smoking, not obese women but had 5.1 years fewer free of mobility disability and 3.2 fewer free of ADL disability. Differences between risk factor groups were similar for the low educated. Conclusions Our findings suggest eliminating obesity would lead to an absolute reduction of disability, particularly in women.