Role of lifestyle factors on the development and long-term prognosis of pneumonia and cardiovascular disease in the Chinese population

Yizhen Hu; Qiufen Sun; Yuting Han; Canqing Yu; Yu Guo; Dianjianyi Sun; Yuanjie Pang; Pei Pei; Ling Yang; Yiping Chen; Huaidong Du; Mengwei Wang; Rebecca Stevens; Junshi Chen; Zhengming Chen; Liming Li; Jun Lv; China Kadoorie Biobank Collaborative Group

doi:10.1097/CM9.0000000000003160

Role of lifestyle factors on the development and long-term prognosis of pneumonia and cardiovascular disease in the Chinese population

Chin Med J (Engl). 2025 Jun 20;138(12):1456-1464. doi: 10.1097/CM9.0000000000003160. Epub 2024 Aug 28.

Authors

Yizhen Hu^{1

2}, Qiufen Sun¹, Yuting Han¹, Canqing Yu^{1

3

4}, Yu Guo⁵, Dianjianyi Sun^{1

3

4}, Yuanjie Pang^{1

3

4}, Pei Pei³, Ling Yang^{6

7}, Yiping Chen^{6

7}, Huaidong Du^{6

7}, Mengwei Wang⁸, Rebecca Stevens⁷, Junshi Chen⁹, Zhengming Chen⁷, Liming Li^{1

3

4}, Jun Lv^{1

3

4

10}; China Kadoorie Biobank Collaborative Group

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
² Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian 350000, China.
³ Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing 100191, China.
⁴ Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China.
⁵ Fuwai Hospital Chinese Academy of Medical Sciences, Beijing 100037, China.
⁶ Medical Research Council Population Health Research Unit, University of Oxford, Oxford OX3 7LF, UK.
⁷ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
⁸ NCDs Prevention and Control Department, Henan CDC, Zhengzhou, Henan 450016, China.
⁹ China National Center for Food Safety Risk Assessment, Beijing 100022, China.
¹⁰ State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing 100191, China.

Abstract

Background: Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization.

Methods: Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality.

Results: Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases.

Conclusion: In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.

Keywords: Cardiovascular disease; Lifestyle; Multistate; Pneumonia; Prospective cohort study; Risk.

MeSH terms

Adult
Aged
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / etiology
Cardiovascular Diseases* / mortality
China / epidemiology
Female
Humans
Life Style*
Male
Middle Aged
Pneumonia* / epidemiology
Pneumonia* / etiology
Pneumonia* / mortality
Prognosis
Risk Factors
Smoking