Impact of Healthy Lifestyle Factors on Life Expectancy andLifetime Health Care Expenditure:Nationwide Cohort Study

Background: The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established,while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinalindividual data.Objective: We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy andlifetime health care expenditure in Taiwan.Methods: Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed:nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit andvegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probabilityof treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with andwithout healthy lifestyle factors.Results: A total of 19,893 participants aged >= 30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recordedduring a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expendituresfor the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-causemortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those withsufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years;95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%;95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%;P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11;P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore,individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12%(95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none.Conclusions: Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditurein Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on theoverall health and economic burden