Analysis of Multiple Health Risky Behaviours and Associated Disease Outcomes Using Scottish Linked Hospitalisation Data

Damilola Olajide, Barbara Eberth, Anne Ludbrook

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Disease incidence and premature deaths tend to be influenced by multiple health risky behaviours, including smoking, excessive alcohol consumption and unhealthy diet. Risky behaviours tend not to be independent and may have a multiplicative effect on disease incidence and healthcare cost. Thus, understanding the interrelationship between health behaviours and their effect on health outcomes is crucial in designing behavioural intervention programmes.
To examine the interrelationship between health risky behaviours and associated disease outcomes amongst Scottish adults.
We use hospitalisation episode data from the Scottish Morbidity Records, (SMR), that have been administratively linked to Scottish Health Surveys (SHeS) respondents with target disease defined by relevant ICD9 and 10 codes. We apply a recursive multivariate probit model to jointly estimate the health risky behaviours and disease incidence to adequately control for unobserved heterogeneity. The model is estimated separately by gender.
Modelling health risk behaviours and disease incidence equations independently rather than jointly may be misleading. We find a clear socioeconomic gradient predicting health risky behaviours and the results differ by gender. Specifically, smoking appears to be a key driver of other health risky behaviours. Current smokers are more likely to be drinking above the recommended limit, physically inactive, and eating inadequate diet.
Interventions targeting current smokers to quit could spillover to other behaviours by reducing excessive drinking, improve physical activity and adequate diet. Thus, improvements in one behaviour may increase the likelihood of adopting other healthier lifestyle behaviours.
Original languageEnglish
Article number847938
Number of pages13
JournalFrontiers in public health
Early online date11 Jul 2022
Publication statusPublished - 11 Jul 2022

Bibliographical note

The receipt of financial support from the MRC National Preventive Research Initiative Phase 2 Grant G0701874 is greatly acknowledged. The Funding Partners relevant to this award are: British Heart Foundation, Cancer Research UK, Department of Health, Diabetes UK, Economic and Social Research Council, Medical Research Council, Research and Development Office for the Northern Ireland Health and Social Services, Chief Scientist Office, Scottish Government Health Directorates, The Stroke Association, Welsh Assembly Government, and World Cancer Research Fund. The Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The views expressed in this article are those of the authors.
The team is grateful to the Privacy Advisory Committee of the Information Service Division, NHSScotland for granting the permission to access the linked SHeS SMR datasets. We are also grateful for the identification of disease-specific ICD9 and ICD10 codes. We are grateful for the helpful comments received at national and international conferences and workshop where the findings of the paper were presented.


  • multiple health behaviours
  • Scottish adults
  • inked Scottish health survey
  • recursive multivariate probit model
  • lifestyle specific diseases


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