The association of a healthy lifestyle index with risk of all-cause hospitalization and mortality in US postmenopausal women

Rita Peila; Xiaonan Xue; Michael J. La Monte; Linda G. Snetselaar; Bernhard Haring; Aladdin H. Shadyab; JoAnn E. Manson; Thomas E. Rohan

doi:10.1016/j.ypmed.2025.108433

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The association of a healthy lifestyle index with risk of all-cause hospitalization and mortality in US postmenopausal women

Journal article

Peer reviewed

The association of a healthy lifestyle index with risk of all-cause hospitalization and mortality in US postmenopausal women

Rita Peila, Xiaonan Xue, Michael J. La Monte, Linda G. Snetselaar, Bernhard Haring, Aladdin H. Shadyab, JoAnn E. Manson and Thomas E. Rohan

Preventive medicine, Vol.202, 108433

01/2026

DOI: 10.1016/j.ypmed.2025.108433

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Abstract

Objective A healthy lifestyle—characterized by physical activity, non-smoking, healthy diet, no alcohol, adequate sleep, and normal body mass index—has been linked to reduced chronic and acute disease risk. However, its impact on hospitalizations and mortality in postmenopausal women remains unclear. This study evaluated the association between a composite Healthy Lifestyle Index (HLI) and risk of all-cause hospitalization and mortality. Methods We analyzed 111,000 postmenopausal women aged 50–79 years at enrollment in the Women's Health Initiative (1993–1998, United States), followed for up to 30 years. HLI scores (range 0–24; higher = healthier) were derived from baseline lifestyle and anthropometric measures. Outcomes included first hospitalization, recurrent hospitalizations, and mortality. Cox regression estimated hazard ratios (HRs) and 95 % confidence intervals (CIs), excluding events within two years. Results A total of 75,703 women were hospitalized and 35,530 died. During the first 10 years, each HLI-unit increase was associated with lower risk of first hospitalization (HR 0.95, 95 %CI 0.94, 0.95) and mortality (HR 0.93, 95 %CI 0.92, 0.93). Associations remained consistent beyond 10 years. Conclusions Healthier lifestyle patterns were associated with reduced hospitalization and mortality risk in postmenopausal women, which supports public health efforts to promote healthy behaviors in aging populations.

Hospitalization

Mortality

Lifestyle behaviors

Postmenopause

Women

Prospective study

Details

Title: Subtitle: The association of a healthy lifestyle index with risk of all-cause hospitalization and mortality in US postmenopausal women
Creators: Rita Peila
Xiaonan Xue
Michael J. La Monte
Linda G. Snetselaar
Bernhard Haring
Aladdin H. Shadyab
JoAnn E. Manson
Thomas E. Rohan
Resource Type: Journal article
Publication Details: Preventive medicine, Vol.202, 108433
DOI: 10.1016/j.ypmed.2025.108433
ISSN: 0091-7435
eISSN: 1096-0260
Publisher: ACADEMIC PRESS INC ELSEVIER SCIENCE
Grant note: National Heart, Lung, and Blood Institute (NHLBI) , National Institutes of Health, U.S. Department of Health and Human Services: HHSN268201600018C, HHSN268201600001C, HHSN26820160000 2C, HHSN268201600003C, HHSN268201600004C
This study did not receive specific funding; it utilized data from the Women's Health Initiative program, which is funded by the National Heart, Lung, and Blood Institute (NHLBI) , National Institutes of Health, U.S. Department of Health and Human Services, through contracts HHSN268201600018C, HHSN268201600001C, HHSN26820160000 2C, HHSN268201600003C, and HHSN268201600004C.
Language: English
Electronic publication date: 10/25/2025
Date published: 01/2026
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9985019044202771

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