Life Expectancy Calculator.
How many good years of life do you likely have left?
And what would change that number?
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A note on what this is. Bank of Health gives you a statistical estimate drawn from large, peer-reviewed population studies — a research-grounded estimate, not medical advice and not a substitute for a professional. Talk to your doctor before making health decisions.
How We Calculate This
We Personalize Everything to You
Every projection, every hour, every data point you see in Bank of Health is built on your actual health history and actual choices. Always.
This means that our "best case scenario" isn't some generic guideline - it's where you in particular could get, starting today, if you started doing all that you could for your long-term health.
The gains and losses we show you - both for today and long-term - are real, modeled against the best realistic version of your health. Not some hypothetical runner who only eats broccoli. Not a version of you who was never obese or never smoked or never had that rough patch in their 30's. You.
Everything we show you is actually on the table today. What you do with that is up to you.
We Build on Data, not Ideologies
A lot of people have opinions on the best way to live a long, healthy life. That's great for them. But here's the thing - there is actually a correct answer, as a species we already know it.
We've done population-level studies on millions of people to understand what helps and what hurts - and exactly how much.
That's the foundation that we've built Bank of Health's models on. Every data point, model, and projection we have is based exclusively on peer-reviewed, large studies.
The honest truth is that big-picture research on health is settled, and has been for a while. The studies we used are linked at the bottom - but, spoiler, in study after study we find the same thing about being healthy, and you already know what it is:
- Move an hour a day.
- Lift heavy things a couple times a week.
- Keep a healthy weight.
- Maintain active, real social connections you care about.
- Don't smoke.
- Don't drink much or at all.
That's it.
Do those things - in whatever way works for you - and you've given yourself the best chance to live to a healthy, active, ripe old age.
It's your life, live it how you want.
Just like a bank won't tell you how to spend your money, we're not here to tell you what to do with the time you have.
Want to have those extra drinks? Go for it. Want to keep smoking, sit 14 hours a day, or skip leg day? All good.
We just believe you deserve to know, as accurately as possible, what each one of those choices does.
So that's what Bank of Health does. We help you track what your choices do, and make informed decisions you're happy with.
And that's all we'll ever do.
No sneaky sponsored links, no pitches to a workout plan, no hawking green hipster juice for $20 a bottle, no ads, no selling your data or skewing our models.
Real models based on real data, from real, highly-reviewed research, made simple, and consistent respect for your autonomy.
How We Calculate Your Daily Numbers
Each day you log data, Bank of Health:
- Aggregates your inputs - workout MET-minutes (from your wearable, manual entry, or other sources), sitting band, sleep hours, alcohol, smoking, weight, and social engagement.
- Maps inputs to factor HRs - activity uses a 7-day rolling average of weekly MET-minutes; strength uses calendar-week session count (resetting on your chosen day); sedentary uses today's sitting band with a PA offset from today's total MET-minutes; sleep, drinking, and social use today's values; BMI uses current weight + your profile height, mapped through your region's BMI–mortality curve.
- Computes combined HR - multiplies all eight factor HRs together.
- Calculates net hours - compares your combined HR to the population baseline (1.0) and converts the difference to hours of healthy life expectancy gained or lost that day. The conversion uses your country- and sex-specific life tables to determine your remaining life expectancy, then prorates the annual HR effect to a single day.
These daily hours accumulate in your ledger. On a good day (combined HR < 1.0), you earn hours. On a bad day (combined HR > 1.0), you spend them. Your lifetime total reflects the cumulative effect of your daily choices.
How We Calculate Your Life Expectancy
This is an example. Log in to see your own numbers.
Step 1: Your baseline. You're a 46-year-old male living in United States. We start with CDC period life tables (2022) for United States males. Without any lifestyle adjustments, the median male in United States lives to about 81.
Step 2: Your lifestyle factors. We adjust the baseline using hazard ratios (HR) from peer-reviewed research. HR = 1.0 means no change; above 1.0 increases mortality risk, below 1.0 decreases it. Each factor also has a disability shift multiplier (DSM) that captures how much it compresses or expands your impaired years relative to its effect on mortality. When you model a future scenario with different choices, we don't flip instantly to the new risk — we use per-factor recovery curves based on the research. For example, quitting smoking takes about 3.5 years to recover half the excess risk, while improving sleep shows benefits within a year. Each factor transitions gradually from your past HR to your future HR using exponential decay at its researched half-life.
| Factor | Your Input | Mortality HR | Impact | Disability Shift | Source |
|---|---|---|---|---|---|
| Weight | BMI 25.0 (Normal) | 1.0× (neutral) | No change | — | Lancet 2016, 10.6M participants |
| Smoking | Never smoked | 1.0× (neutral) | No change | — | JAMA Int Med 2012 |
| Cardio | 1–2.5 hrs/wk | 0.78× | +2.8 years | 2.3× (compresses impaired years 2.3× more than mortality effect) | Circulation 2022 |
| Strength Training | None | 1.0× (neutral) | No change | — | Am J Prev Med 2022 |
| Drinking | 1 drink/day | 1.00× | No change | — | JAMA Network Open 2023 (sex-stratified) |
| Sleep | Full (6–9 hrs) | 1.0× (neutral) | No change | — | Sleep 2010, 1.38M participants |
| Sitting | 6–8 hrs/day | 1.03× | -0.3 years | 2.3× (expands impaired years 2.3× more than mortality effect) | Patterson, Ann Intern Med 2018 · Ekelund, Lancet 2016, 1M participants |
| Social Connection | 2 of 4 markers (Berkman-Syme index) | 1.10× | -1.0 years | 2× (expands impaired years 2× more than mortality effect) | Perspectives on Psych Sci 2015, 3.4M participants |
| Combined effect | 0.88× | +1.4 years total | |||
Step 3: Your adjusted numbers. After applying all factors, your adjusted median death age is 82 (year 2062). Of the 36.0 years from now until then, we estimate 26.3 healthy years (independent living) and 9.7 impaired years (needing significant assistance).
Want to learn more? Dive all the way in, our methodology is broken down in much more detail below.
Who's Behind This?
Me. Hi, I'm Steven Skoczen, the guy who built Bank of Health.
The Eight Factors
Each factor has specific hazard ratios derived from large-scale epidemiological studies. Here are the exact values we use:
| Activity (Lee 2022 dose-response, MET-minutes/week) | HR |
|---|---|
| 2,100+ MET-min/wk (~300+ min cardio, ceiling) | 0.65 |
| 1,050 MET-min/wk (~150 min cardio, guidelines) | 0.78 |
| 420 MET-min/wk (~60 min cardio or ~112 min walking) | 0.86 |
| None | 1.00 |
| Sedentary Behavior (Patterson 2018 two-slope model) | HR |
| Under 4 hours/day sitting (neutral) | 1.00 |
| 4–6 hours/day sitting | 1.01 |
| 6–8 hours/day sitting | 1.03 |
| 8–10 hours/day sitting | 1.08 |
| 10–12 hours/day sitting | 1.16 |
| 12–14 hours/day sitting | 1.24 |
| 14–16 hours/day sitting | 1.32 |
| Strength Training | HR |
| 2× per week | 0.85 |
| 1× per week | 0.90 |
| None | 1.00 |
| Sleep | HR |
| Full (6–9 hours) | 1.00 |
| Short (Under 6 hours) | 1.17 |
| Long, still tired (9+ hours - pattern associated with underlying health conditions) | 1.34 |
| Drinking - Male | HR |
| 0 drinks | 1.00 |
| 1 drink | 1.00 |
| 2 drinks | 1.00 |
| 3 drinks | 1.08 |
| 4 drinks | 1.25 |
| 5+ drinks | 1.34 |
| Drinking - Female | HR |
| 0 drinks | 1.00 |
| 1 drink | 1.00 |
| 2 drinks | 1.14 |
| 3 drinks | 1.28 |
| 4 drinks | 1.47 |
| 5+ drinks | 1.61 |
| Smoking | HR |
| Never smoked | 1.00 |
| Former smoker, smoked ≤ 5 years (full recovery) | 1.00 |
| Former smoker, smoked 20 years | 1.20 |
| Former smoker, smoked 30 years | 1.50 |
| Former smoker, smoked ≥ 40 years | 1.70 |
| Current smoker, age ≤ 45 | 2.90 |
| Current smoker, age 65 | 2.60 |
| Current smoker, age 75 | 2.10 |
| Current smoker, age 85 | 1.60 |
| Current smoker, age ≥ 95 | 1.30 |
| Weight (lbs) / BMI | HR |
| Under 105 (<15) | 1.80 |
| 105–129 (15–18.5) | 1.51 |
| 129–139 (18.5–20) | 1.09 |
| 139–174 (20–25, reference) | 1.00 |
| 174–192 (25–27.5) | 1.06 |
| 192–209 (27.5–30) | 1.17 |
| 209–244 (30–35) | 1.39 |
| 244–279 (35–40) | 1.93 |
| 279+ (40+) | 2.58 |
| Social Connection (Berkman-Syme score, 0–4) | HR |
| Score 4 (partner + friends + group + community) | 1.00 |
| Score 3 | 1.04 |
| Score 2 | 1.10 |
| Score 1 | 1.18 |
| Score 0 (isolated) | 1.29 |
Between the discrete bands, we use smoothed interpolation - piecewise linear curves anchored at the literature thresholds. This means 300 MET-min/wk of activity gets a proportional benefit between the 0 and 420 MET-min/wk anchors, rather than jumping between bands.
Recovery Curves
When you change a behavior, the health benefit (or harm) doesn't appear instantly. Past behavior leaves a residual effect that decays exponentially over time. We model this with factor-specific half-lives:
| Factor | Half-life | Notes |
|---|---|---|
| Smoking | 3.5 years | Excess risk ~50% gone at 3 yrs; decays from the age-varying current-smoker HR toward a residual floor keyed on how long you smoked (Jha Fig 4): ~1.0 for short-duration smokers, up to ~1.7 for 40+ years |
| BMI | 2.0 years | Excess risk decays over ~2 yrs toward a residual floor keyed on how long you were obese: ~0% of the excess for a year or two, rising to ~35% after decades (SOS bariatric, Framingham scarring) |
| Activity | 2.0 years | Benefit appears within first few years of changing behavior |
| Sedentary | 2.0 years | Habitual sitting patterns and their health effects change over a few years |
| Strength | 1.5 years | Muscle and bone adaptations respond relatively quickly |
| Drinking | 2.0 years | Liver and cardiovascular recovery |
| Sleep | 1.0 year | Sleep debt and recovery are relatively fast-acting |
| Social | 3.0 years | Social network effects on health are slow-building and slow-fading |
This means your decade history matters. If you smoked for 20 years and quit last year, your effective smoking HR is still elevated - it will take several years to approach a never-smoker's risk. The model captures this transition realistically rather than treating a lifestyle change as an instant reset.
There are also two cases where you can't fully recover:- Smoking decays from your current-smoker risk toward a residual floor over a few years. How high that floor sits depends on how long you smoked: a few years of smoking recovers essentially all the way back to a never-smoker (floor ~1.0), while a lifetime of smoking leaves a permanent floor as high as ~1.7 from accumulated damage (Jha 2013). Most of the excess above that floor can still be won back.
- Weight works in two parts. First, how long you carried excess weight sets the size of the risk - a year of obesity barely registers, but many years compound into a larger hazard (see Duration Amplification below). Second, that burden is not locked in: the duration amplifier only applies while you're actually obese, and the obese-years it counts wind back down over your lean years - so getting back to a healthy weight brings you toward the mean rather than leaving you stuck. The BMI hazard itself then decays back toward healthy over a couple of years, toward a residual floor that depends on how long you carried the weight: a year or two of obesity leaves essentially no permanent mark (~0% residual), while decades leave a bounded scar of up to ~35% of the excess - even maximal sustained weight loss (bariatric surgery) doesn't fully erase a lifetime of obesity (SOS trial; Framingham metabolic scarring). Everything above that floor is still yours to win back, and for most people who've recently gained weight, that's nearly all of it.
Healthy Years vs. Impaired Years
Not all years of life are equal. Some you're independent, healthy, and active. Some, if you live long enough, will be impaired - you'll need help from other people for basic daily tasks.
But there's a key insight from the research: exercise and strength training don't just add years to your life - they dramatically compress the period of disability at the end. The impaired period shrinks, meaning more of your remaining life is spent healthy and independent.
So, our model distinguishes between healthy years (independent, functional living) and impaired years (significant disability requiring assistance), using the Sullivan method: for each age we hold a baseline fraction of survivors who are living independently, and weight your survival curve by it.
Each factor affects disability differently than mortality. We use disability shift multipliers (DSM) to capture this:
| Factor | Disability Shift | Meaning |
|---|---|---|
| Strength Training | 3.0× | Prevents sarcopenia - the #1 cause of functional dependence. Effect on independence far exceeds mortality effect. |
| BMI | sex-split curve | Obesity raises disability sharply and out of proportion to its mortality risk - so the disability piece is modeled directly from Reuser 2009's Healthy→Disabled transition (sex-split), not from the mortality HR. (Weight still affects mortality separately.) See "Weight is handled differently" below. |
| Activity | 2.3× | Runners postpone disability onset ~6–12 yrs but death only ~3–7 yrs (Stanford 21-year study). |
| Sedentary Behavior | 2.3× | Prolonged sitting accelerates functional decline - reduced mobility, increased fall risk, and metabolic deterioration compound the disability impact beyond the mortality effect. |
| Social Connection | 2.0× | Social isolation increases dementia risk ~60%. Major impact on cognitive independence. |
| Sleep | 1.5× | Affects cognitive function and metabolic health - accelerates disability. |
| Drinking | 1.5× | Moderate disability acceleration beyond mortality effect. |
| Smoking | per-state curve | "Smoking kills" - it's mortality-dominant, so its disability effect is small and modeled per-state directly from Reuser 2009 (current » former ≈ baseline), not from the mortality HR. See "Weight is handled differently" below - smoking is handled the same way. |
How the shift becomes years:
At each age we convert your hazard ratios into a "disability age" offset:
disability shift = Σ log₂(factor HR) × 8 × DSM
And then we add that disability shift to your age. The log₂ × 8 turns a hazard ratio into an approximate "years of aging" equivalent (8 years per doubling of mortality risk), and the DSM scales it by how much that factor drives disability beyond death. We then read the healthy fraction at your effective age rather than your calendar age. Protective factors (exercise, strength) produce a negative shift - you're "disability-younger" than your years; harmful ones push the lookup older.
Weight is handled differently. For weight, disability and mortality aren't proportional - obesity raises disability far more than it raises the risk of dying - so weight's disability effect isn't read from its mortality hazard at all. We model it straight from the Healthy→Disabled transition rates in Reuser et al 2009 (sex-split, because the effect differs markedly between men and women), calibrated to reproduce their measured loss of disability-free years and held flat above the top of their data (BMI 35+). Weight also still shortens life through the mortality side (using the larger Di Angelantonio data) - so for a heavier person you'll see both effects: fewer total years, and a larger share of the remaining ones impaired.
Smoking is handled the same way - in mirror image. Smoking is the opposite of weight: it's mortality-dominant ("smoking kills"), so its disability effect is small. We read it per-state directly from Reuser's Healthy→Disabled rates - a current smoker carries a real but modest disability shift; a former smoker sits back near baseline - independently corroborated by Klijs et al 2011, which found smokers spend essentially the same number of years disabled as non-smokers. When you quit, that disability shift eases smoothly down to the ex-smoker level as your body recovers, over the same few-year timescale your mortality risk takes to fall. The heavy, lasting cost of smoking is on the mortality side, which is unchanged.
Duration amplification does not feed this shift. The obesity duration multiplier below comes from a mortality study and scales your mortality risk only. The disability multipliers come from studies that measured baseline status, not exposure duration, so the shift uses your un-amplified hazard ratios. This keeps the two effects from being double-counted.
Duration Amplification
For obesity, how long you've been exposed matters independently of your current state, so we apply a duration amplifier based on cumulative years of exposure:
Obesity: Based on the Framingham Heart Study (Abdullah et al., 2011), which measured all-cause mortality by cumulative years lived with obesity: HR 1.51 at 1–5 years, 1.94 at 5–15, 2.25 at 15–25, 2.52 at 25+. The cross-sectional BMI hazard above already reflects a typical obese person — who in these cohorts had been obese about 8 years — so rather than stacking the full duration curve on top (which would double-count), we re-center it there: the amplifier is 1.0 at ~8 years, dips to about 0.82 for someone newly obese, and rises to about 1.37 for lifelong obesity. And because losing the weight counts, your accumulated obese-years wind back down during lean years rather than being locked in. It comes from mortality research, so it scales mortality risk only - not the disability shift described above.
Smoking has no separate duration amplifier. Instead, smoking's exposure-duration effect is built directly into the curves above: the current-smoker hazard ratio varies by attained age (drawn from cohorts of typical, lifelong smokers, so it already embodies typical cumulative exposure), and the ex-smoker residual floor is keyed on total years smoked. A genuine late starter - say, someone who took up smoking at 50 - is scaled down from the lifelong-smoker curve in proportion to their actual dose (years smoked ÷ years they could have smoked since age 20), so they never inherit a lifelong smoker's risk. This replaces an earlier flat amplifier that, combined with the age-varying curve, would have double-counted duration.
Smoking
Smoking follows the same rule as every other factor: the daily ledger shows the per-day cost of harmful behaviors and a clean zero for absent ones. If you've never smoked, no smoking card appears at all. If you've ever smoked, the card asks Did you smoke today? - a Yes logs the full current-smoker daily-rate penalty for that day, a No logs nothing.
The benefit of quitting lives where it really is - in your banked days: the LE difference between your current chronic state and the counterfactual where you'd kept smoking right up to today. That number is shown on your Today page and in your weekly email, and it grows monotonically as your chronic hazard ratio decays from the current-smoker level toward your duration-keyed residual floor along an exponential half-life of 3.5 years (Cho et al, NEJM 2024).
Your chronic state is forgiving of isolated slips: it only moves back toward "current smoker" when you've smoked on 7 or more of the last 14 days. A single Yes after a long clean streak still costs you that day's hours in the ledger, but it doesn't erase your banked days - your recovery curve doesn't reset. The long-term projection age-varies your current-smoker risk by attained age and lands your post-quit floor according to how many years you smoked, as described above.
Activity and Movement
For activity, we model using MET-minutes per week as a single unified metric that combines all aerobic exercise types - cardio (7.0 METs) and walking (3.75 METs). This follows the Lee et al. 2022 dose-response curve, where each workout's contribution is its duration in minutes multiplied by its MET intensity. So, a 30-minute run contributes 210 MET-min; a 30-minute walk contributes 112.5 MET-min. Both count toward the same curve, giving proportional credit regardless of intensity.
We anchor on "cardio" (7.0 METs) and "walking" (3.75 METs) to make the interface simpler. In the future, we may add workout type specific METs if most users use fitness trackers that automatically categorize workouts, or provide KJ/MET-min estimates. But for most people 7.0 is a reasonable estimate, and the precision offered is a false one. Work out in a way that gets your heart moving, for 30-60 minutes a day, and you're maximizing the benefit.
Strength training (7.0 METs) is excluded from the activity HR curve because it has its own separate mortality factor. However, strength MET-minutes do count toward the sedentary PA offset (see below).
Sedentary Behavior: Sit Less, Move More
Prolonged sitting is an independent risk factor for all-cause mortality, separate from exercise. We model this using two complementary findings:
Patterson 2018 (two-slope dose-response): The reference group is people who sit less than 4 hours per day (HR 1.0). Above 4 hours, the risk follows a two-slope pattern: from 4 to 8 hours, each additional hour adds a modest relative risk (HR) of 1.01. Above 8 hours, the slope steepens sharply - each additional hour adds relative risk (HR) 1.04. This means moving from 10 to 12 hours of sitting is much more harmful than moving from 4 to 6 hours.
Ekelund 2016 (physical activity offset): Approximately 60–75 minutes per day of moderate physical activity (~250 MET-min/day) fully eliminates the excess mortality risk from prolonged sitting. At lower Physical Activity levels, the offset is proportional - 125 MET-min/day eliminates about half the sitting penalty. This is why the "Sit Less, Move More" card shows how many more minutes of activity would eliminate your sitting risk for the day.
All workout types contribute to the Physical Activity offset, including strength training. The offset applies to the sedentary penalty only - it doesn't affect the activity factor curve.
Known Limitations & Honest Caveats
This model is a research-grounded estimate, not a medical prediction. We'd rather be honest about where it's approximate than over-claim precision. The most important caveats:
- Period, not cohort, life tables. The baseline survival curves reflect today's death rates, applied unchanged across your whole life. They assume medicine and mortality stay frozen at current levels. Real future cohorts will likely live longer as treatment improves, so the absolute numbers are conservative.
- Factors are treated as independent. We multiply the eight hazard ratios together, which assumes each factor's effect is independent of the others. In reality they interact (e.g. exercise and weight, drinking and sleep). The research on most pairwise interactions is thin, so we use the simpler multiplicative model rather than invent interaction terms.
- One hazard ratio per factor. Each factor collapses to a single HR drawn from population-average studies. Your personal genetics, medical history, medications, and environment can move your real risk substantially in either direction. This is a population model wearing your inputs, not a personalized clinical risk score.
- The disability model is approximate. The healthy-vs-impaired split uses the Sullivan method with disability shift multipliers calibrated on a handful of cohort studies (Klijs 2011, Reuser 2009, Chakravarty 2008). The weight–disability piece has been recalibrated directly from Reuser's sex-split transition data and bounded at the top of their range, but the other factors still use the simpler multiplier and remain directional at the extremes. Read the healthy-years figure as directional, not exact.
- Social connection is a proxy. We approximate the Berkman-Syme social network research with four self-reported inputs (partner, friends, group, activity). Real social integration is richer and harder to measure than four checkboxes. Find people you care about, and spend time with them.
- Recovery curves are modeled, not measured. The "banked days" from quitting smoking, losing weight, or getting active follow exponential decay curves anchored to a few longitudinal studies. The shape is reasonable but your individual recovery trajectory may differ.
- No genetic, environmental, or healthcare factors. The model knows nothing about your family history, pollution exposure, access to care, income, or stress. These are major drivers of real-world life expectancy that simply aren't in this model.
Use this as a directional tool for understanding which habits move the needle most for someone like you - not as a forecast of your actual lifespan.
Research Sources
Every number in this model comes from peer-reviewed epidemiological research. The full citations are organized by topic below.
Baseline Survival Data
Period life tables for US males and females. Provides the lx (survivors per 100,000) column by single year of age from 0 to 100+. This is the foundation of the survival curves.
WHO Global Health Observatory - Life tables by country, 2021
Abridged life tables (nqx - probability of dying in each age interval) for 183 WHO Member States by sex, computed using standardized WHO methodology. We interpolate to single-year-of-age lx values using log-linear interpolation within each age interval. These are period life tables reflecting 2021 mortality conditions.
Healthy Life Expectancy
Provides active life expectancy vs total life expectancy by age (65–95) and sex, using the National Health and Aging Trends Study. Key data: at age 65, US males have 12.1 active years out of 17.9 total (68% active). We use this to anchor the disability fraction curve for ages 65+.
GBD 2021 - Global Burden of Disease Study: HALE estimates (Lancet, 2024)
Healthy life expectancy at birth for the US: 63.2 years for males, 65.7 for females (vs total LE of 74.3/80.0). Used to calibrate the disability onset curve for younger ages.
WHO Global Health Observatory - Healthy Life Expectancy (HALE) at birth, 2021
HALE estimates for all countries, by sex. We compute the HALE/LE ratio for each country and use it to scale our age-specific healthy fraction curves. Countries with higher HALE/LE ratios (e.g. Japan, Singapore) have their disability onset shifted later; countries with lower ratios have it shifted earlier. The US baseline healthy fraction curve (derived from NHIS and PLOS data above) serves as the reference.
Mortality Risk Factors (Hazard Ratios)
The definitive BMI-mortality study. 10.6 million participants, never-smokers, reference band 22.5–<25.0 (HR 1.00). Overall (pooled) all-cause J-curve: 25–27.5 HR 1.07; 27.5–30 HR 1.20; 30–35 HR 1.45; 35–40 HR 1.94; 40+ HR 2.76; 18.5–20 HR 1.13; 15–18.5 HR 1.51. We pin the 20–25 healthy band flat at HR 1.00 (its nadir) and ramp modestly below 15. The study also reports region-specific curves — we apply your region's (Europe, North America, or East Asia) and fall back to this pooled set for everyone else. The "Eight Factors" table above shows your region's exact values, sampled live from the model.
Jha et al - 21st-Century Hazards of Smoking and Benefits of Cessation in the United States (NEJM, 2013)
Our primary smoking source. Current-smoker all-cause hazard ratios vs never-smokers peak in midlife (~2.8 men, ~3.0 women) and decline at older attained ages as competing mortality and survivor selection compress the ratio - the basis for our age-varying current-smoker curve (HR ~2.9 at ≤45, falling to ~1.3 by 95). Figure 4 gives the residual ex-smoker hazard by age at cessation; we re-key it on total years smoked (via a start-at-20 bridge) to set the post-quit floor (~1.0 for short-duration smokers up to ~1.7 for 40+ years).
Gellert et al - Smoking and all-cause mortality in older people: systematic review and meta-analysis (Arch Intern Med, 2012)
Independent corroboration of the old-age decline in current-smoker risk: pooled current-smoker RR 1.83, falling with age (1.94 at 60–69 → 1.86 at 70–79 → 1.66 at ≥80), the same shape as our age-varying curve. Also anchors the older-adult former-smoker rate at ~1.3–1.5 (pooled former RR 1.34, 60–69 band [1.41, 1.68]) - consistent with our duration-keyed floor for a typical long-term smoker, and well above an earlier flat 1.15 figure we have retired.
Lee et al - Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality (Circulation, 2022)
108,009 participants. Meeting guidelines (150–300 min/wk moderate): 20–25% lower mortality. 2–4× guidelines: 30–35% lower. Sedentary as reference.
Zhao et al - Association between daily alcohol intake and risk of all-cause mortality: a systematic review and meta-analyses (JAMA Network Open, 2023)
Systematic review of 107 cohort studies (4.8M participants, 425K deaths). After correcting for abstainer bias, light drinking shows no mortality benefit. Sex-stratified analysis (Table 2, fully adjusted model): women face significantly elevated risk at 25+ g/day (~1.8 drinks), while men show elevated risk only above 45+ g/day (~3.2 drinks). We use the sex-specific dose-response data with piecewise-linear interpolation through bin midpoints, anchored at 14 g per standard drink. All sub-1.0 RRs capped at 1.0 (no protective effect modeled).
Global BMI Mortality Collaboration - BMI and all-cause mortality by region (Lancet, 2016)
Reports BMI-mortality hazard ratios separately for the three well-powered regions (Europe, North America, East Asia) plus the limited-data Australia/NZ and South Asia. The J-curve shape is shared, but its magnitude differs materially at the extremes - e.g. the 40+ band runs HR ~3.04 in Europe vs ~2.38 in East Asia. We apply each well-powered region's own curve and fall back to the pooled all-region curve for everyone else (including Australia/NZ and South Asia, the study's own limited-data regions). Only the BMI curve and the baseline survival tables vary by region; the other lifestyle hazard ratios are shared across all countries.
Duration of Exposure (Decade History Model)
Framingham Heart Study, 5,036 participants, 48 years follow-up. Duration of obesity independently predicts mortality after adjusting for current BMI. HR 1.51 for 1–5 years obese, 1.94 for 5–15 years, 2.25 for 15–25 years, 2.52 for 25+ years. We interpolate these four points and re-center the amplifier at ~8 years (the mean obesity duration already embodied in the cross-sectional BMI hazard, from the Framingham Offspring cohort), so it adjusts the BMI hazard up for long exposure and down for recent onset rather than double-counting.
Abdullah et al - Estimating the risk of cardiovascular disease using an obese-years metric (BMJ Open, 2014)
Introduced "obese-years" (BMI units above 29 × years at that BMI). Outperformed both current BMI and duration alone for predicting CVD. This is the epidemiological equivalent of "pack-years" for weight.
Xu et al - Obesity and mortality over 24 years of weight history (JAMA Network Open, 2018)
Maximum lifetime BMI predicts mortality better than current BMI. People previously obese but currently normal weight still had 2.4× the mortality rate of never-obese people.
Doll et al - Mortality in relation to smoking: 50 years' observations on male British doctors (BMJ, 2004)
The 50-year British Doctors Study established that lung cancer risk scales with duration to the fourth power but intensity only linearly. Duration of smoking is dramatically more important than amount smoked. We don't apply a separate smoking duration amplifier (that would double-count, since our age-varying current-smoker curve is drawn from typical lifelong-smoker cohorts); instead duration enters through the attained-age curve and the years-smoked-keyed recovery floor, with late starters dose-scaled down.
Lubin et al - Risk of cardiovascular disease from cumulative cigarette use (Epidemiology, 2016)
14,233 ARIC participants. For identical 50 pack-year exposure, 20 cigs/day × 50 years gave RR 2.1 while 50 cigs/day × 20 years gave RR 1.6 - confirming duration dominates intensity.
Recovery After Lifestyle Change
Excess mortality risk after quitting: ~50% remaining at 3 years, declining over the following years. We model the route as exponential decay with half-life 3.5 years; the destination is a residual floor keyed on how long you smoked (Jha Fig 4, above) - from full recovery (~1.0) for short-duration smokers up to ~1.7 for lifelong smokers - rather than a single flat floor.
Pirie et al - The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK (Lancet, 2013)
Women who quit around age 40 after long-term heavy smoking avoided ~90% of the excess mortality but still carried elevated all-cause risk decades later - corroborating context for why long-term smokers keep a permanent residual floor rather than recovering all the way to never-smoker. We take our floor values from Jha Fig 4 (keyed on years smoked), not from Pirie; Pirie and Thun stand here as directional corroboration of both the midlife current-smoker magnitude and the incomplete-recovery shape.
Xie et al - Association of Weight Loss Between Early Adulthood and Midlife With All-Cause Mortality Risk in the US (JAMA Network Open, 2020)
Weight loss from obese to overweight associated with 54% mortality reduction. Benefits appear within 2–3 years. We model the route as exponential decay with half-life 2 years; the destination is a residual floor keyed on how long you were obese (cumulative obese-years) - from essentially full recovery (~0%) for a year or two up to ~35% of the excess after decades - rather than a single flat 15%.
Carlsson, Sjöström et al - Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study (NEJM, 2020)
Maximal sustained weight loss still does not return a long-duration obese person to never-obese: surgery patients had all-cause mortality HR ~0.77 vs usual-care-obese over a median 24 years - roughly a third of the excess risk irreversible. This anchors the upper end (~35%) of our duration-keyed BMI residual floor for decades-long obesity.
Metabolic Scarring - The Persistent Impact of Past Obesity on Long-Term Metabolic Health Despite Weight Loss
Formerly-obese adults who return to a normal BMI still carry substantial elevated risk - "metabolic scarring" that scales with cumulative exposure and earlier onset. Directional corroboration that obesity's residual is duration-dependent (near-zero for brief exposure, a bounded scar after decades), the shape of our keyed floor.
Mok et al - Physical activity trajectories and mortality: population based cohort study (BMJ, 2019)
14,599 participants in the EPIC-Norfolk cohort. Those who increased physical activity from inactive to moderately active had significantly lower mortality. Benefit appeared within the first few years of changing behavior. We model the transition as exponential decay with half-life 2 years.
Compression of Morbidity (Disability Shift Model)
The landmark Stanford runners study. 538 runners vs matched controls, 21 years. Runners postponed the onset of disability (HAQ disability threshold) by roughly 6–12 years while postponing death by only ~3.3–7 years. This proves exercise compresses morbidity - the disabled period shrinks. We use a disability shift multiplier of 2.3× for exercise.
Fries et al - Compression of Morbidity 1980–2011: A Focused Review of Paradigms and Progress (Journal of Aging Research, 2011)
Reviews 30 years of evidence. Low-risk cohorts (no smoking, no obesity, exercising) postponed disability by 8.3 years vs death by 3.6 years. Ratio ~2.3:1. "Postponement of disability is several-fold the postponement of mortality."
Klijs et al - Obesity, smoking, alcohol and years lived with disability: a Sullivan life table approach (BMC Public Health, 2011)
Dutch cohort, n=6,446. Critical finding: each factor affects disability differently than mortality. Obese: 5.9 yrs disabled vs 3.2 for normal weight (LE diff only 1.1 yrs). Smokers: 3.8 yrs disabled regardless of status - smoking compresses disability by killing first. Its current-smoker disability-incidence odds ratio (1.36-1.58) independently corroborates Reuser's value, and we use both to source the smoking and weight disability shifts directly from these transitions rather than from the mortality hazard.
Reuser et al - "Smoking kills, obesity disables" - a multistate approach (Obesity, 2009)
The source for our sex-split weight–disability model: Table 3's Healthy→Disabled transition hazard ratios (men vs women, by BMI band) drive the disability shift for weight, replacing a mortality-derived multiplier.
US Health and Retirement Survey analysis confirming that smoking primarily affects mortality while obesity primarily affects disability, with fundamentally different pathways through the healthy→disabled→dead transitions.
Sedentary Behavior and Physical Activity Offset
1 million participants across 13 studies. Established the two-slope dose-response for daily sitting time: RR 1.01 per hour below 8h/day, accelerating to RR 1.04 per hour above 8h/day. This is the primary source for our sedentary HR curve. The steep increase above 8 hours means very long sitting days carry disproportionate risk.
Ekelund et al - Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women (Lancet, 2016)
1,005,791 participants across 16 studies. 60–75 minutes/day of moderate-intensity physical activity (~250 MET-min/day) eliminated the excess mortality risk associated with high sitting time (≥8h/day). At lower activity levels, PA proportionally offsets the sitting penalty. This is the basis for our physical activity offset model - the "Sit Less, Move More" card shows how many more minutes of exercise would fully offset today's sitting risk.
Wilmot et al - Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis (Diabetologia, 2012)
794,577 participants. Highest vs lowest sedentary time: HR 1.49 for cardiovascular mortality, HR 1.24 for all-cause mortality. Confirms sedentary behavior as an independent risk factor separate from physical activity level - the risk exists even among people who meet exercise guidelines.
Strength Training
Meta-analysis of 10 studies. Any resistance training reduced all-cause mortality by 15% (RR 0.85, 95% CI 0.77–0.93) independent of aerobic exercise. This is the basis for our mortality HR of 0.85 for regular strength training.
Shailendra et al - Weight training and risk of all-cause, cardiovascular disease and cancer mortality among older adults (Int J Epidemiol, 2024)
NIH-AARP Diet and Health Study. Any weight training: HR 0.94 for all-cause mortality, 0.92 for CVD, 0.95 for cancer - after adjusting for aerobic exercise. Confirms the independent, additive effect of strength training.
Law, Clark & Clark - Resistance Exercise to Prevent and Manage Sarcopenia and Dynapenia (Ann Rev Gerontol Geriatr, 2016)
Sarcopenia (age-related muscle loss) is the #1 cause of functional dependence in older adults - prevalence 10% at age 60, over 50% at 80+. Resistance training is the most effective intervention. This is why we use a disability shift multiplier of 3.0× for strength training - its effect on staying independent far exceeds its effect on mortality.
Fragala et al - Resistance Training for Older Adults: Position Statement From the NSCA (J Strength Cond Res, 2019)
Comprehensive position statement. Progressive resistance training increases muscle strength, muscle size, and functional capacity. Directly prevents the loss of independence that defines the transition from "healthy years" to "impaired years."
Sleep Duration
Meta-analysis of 16 studies covering 1.38 million participants. Short sleep (<6 hrs) HR 1.12 for all-cause mortality. Long sleep (>8 hrs) HR 1.30. We use Short (<6h) HR 1.17, Full (6–9h) as reference, and Long-still-tired (9+h) HR 1.34.
The healthy range is wide. We treat any sleep between 6 and 9 hours as Full (HR 1.00). Population dose-response curves show only a tiny mortality bump for 8h vs 7h (RR ~1.07) which Mendelian-randomization studies largely attribute to reverse causation - sicker people sleep more, not the other way around. So we don't penalize the wide healthy middle.
The Long bucket applies only when the user reports waking unrested. The 9+ hours signal in population data is largely a marker of underlying disease (depression, sleep apnea, hypothyroidism, post-illness recovery), not a causal risk factor on its own. People who genuinely need more sleep - recovery athletes, certain genotypes, weekend catch-up sleepers - are not penalized when they wake rested. Our UI folds duration and felt restoration into one bucket choice ("Long, still tired") so users self-route into the disease-marker bucket only when both signals are present.
Van Dongen et al - The cumulative cost of additional wakefulness (Sleep, 2003)Landmark study. People restricted to 6 hours of sleep for 14 nights showed cognitive performance equivalent to two full nights of total sleep deprivation, but their subjective sleepiness ratings plateaued after a few days. They thought they were fine. This is why our Short bucket applies regardless of whether the user reports feeling rested - the duration penalty stands.
Itani et al - Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression (Sleep Medicine, 2017)
Confirmed short sleep duration is significantly associated with mortality, diabetes, hypertension, cardiovascular disease, and obesity. Short sleep is both a mortality risk and a disability accelerator through its effects on cognitive function and metabolic health.
Alcohol Consumption
Systematic review of 107 cohort studies (4.8M participants, 425K deaths). After correcting for abstainer bias, light drinking shows no mortality benefit. Sex-stratified analysis (Table 2, fully adjusted model): women face significantly elevated risk at 25+ g/day (~1.8 drinks), while men show elevated risk only above 45+ g/day (~3.2 drinks). We use the sex-specific dose-response data with piecewise-linear interpolation through bin midpoints, anchored at 14 g per standard drink. All sub-1.0 RRs capped at 1.0 (no protective effect modeled).
We use a sex-differentiated drinking model: research shows alcohol affects mortality risk differently by sex. Women face significantly elevated risk at lower intake levels - about 1.8 drinks per day vs 3 drinks per day for men. Our model uses sex-specific hazard ratios interpolated the bandings in the Zhao et al study. For our calculations, one standard drink is 14 g of ethanol (roughly one beer, glass of wine, or cocktail).
Social Connection
Landmark meta-analysis of 70 studies covering 3.4 million participants. Social isolation HR 1.29, loneliness HR 1.26 for all-cause mortality. The effect size is comparable to smoking 15 cigarettes per day. This is the basis for our isolation HR of 1.29.
Livingston et al - Dementia prevention, intervention, and care (Lancet, 2020)
Social isolation is identified as one of 12 modifiable risk factors for dementia, increasing risk by approximately 60%. This is why we apply a disability shift multiplier of 2.0× for social isolation - its impact on cognitive decline and functional independence is substantially larger than its mortality effect. Maintaining social connections is one of the strongest interventions for preserving independence in later life.
A note on what this is. Bank of Health gives you a statistical estimate drawn from large, peer-reviewed population studies — a research-grounded estimate, not medical advice and not a substitute for a professional. Talk to your doctor before making health decisions.