Previous research has demonstrated that unhealthy behaviors raise a person’s risks of obesity, diabetes, cancer, stroke, and sudden cardiac death. Alexis Elbaz, from the Institut National de la Sante et de la Recherche Medicale (France), and colleagues analyzed data collected in the French Three- City study, which enrolled community-living adults ages 65 and older in Dijon, Bordeaux, and Montpelier.

Participants were recruited from electoral rolls in 1999, 2000, and 2001, and were free of disability at the study’s start. Subjects were interviewed to ascertain lifestyle factors when they enrolled, and disability was assessed by an in-person interview six times over 12 years. The team used three disability scales—mobility, instrumental activities of daily living, and basic activities of daily living—and constructed a hierarchical indicator of disability that combined the three. Low or intermediate physical activity, consumption of fruit and vegetables less than once a day, current smoking or having quit less than 15 years before, and either heavy or no consumption of alcohol were all considered unhealthy behaviors. The researchers collected complete data on 3,982 people who contributed 27,141 person-years in a total follow-up of 12 years; 1,236 developed a disability, for an incidence of 45.5 per 1,000 person-years. Adjusted survival analyses revealed that physical activity was associated with a 72 percent increase in the risk of disability. Consuming an unhealthy diet—including fruit and vegetables less than once a day—associated with a 24 percent increase in disability. Current smoking or having quit less than 15 years before entering the study associated with a 26 percent increase in the chance of disability. Moreover, the risk of disability increased significantly with the number of unhealthy behaviors, and participants with three unhealthy behaviors had a 2.53-fold increased hazard of disability, as compared with those with none. The study investigators warn: “An unhealthy lifestyle is associated with greater hazard of incident disability, and the hazard increases progressively with the number of unhealthy behaviors.”


  1. Artaud F, Dugravot A, Sabia S, Singh-Manoux A, Tzourio C, Elbaz A. “Unhealthy behaviors and disability in older adults: Three-City Dijon cohort study.” BMJ. 2013 Jul 23;347:f4240.