Screen-Based Entertainment Time, All-Cause Mortality, and Cardiovascular Events: Population-Based Study With Ongoing Mortality and Hospital Events Follow-Up

Study Questions:

Does screen time increase the risk of all-cause mortality and cardiovascular disease (CVD) events?


Participants from the Scottish Health Survey, a population-based cohort, were included in the present study. Respondents from the year 2003 were included and then were followed up to 2007 for the primary outcomes including all-cause mortality and CVD events (fatal and nonfatal). The exposure of interest, screen time, included television viewing and other screen-based entertainment. Screen time was grouped from <2 hours/day to 2-4 hours/day to >4 hours per day. Information on moderate to vigorous physical activity was also collected. A secondary objective was to examine associations between screen time and body mass index, high-density lipoprotein cholesterol, and C-reactive protein in terms of CVD events.


A total of 4,512 respondents were included in this analysis. During the follow-up period, 215 CVD events and 325 all-cause deaths occurred over 19,364 follow-up person-years. Increased risk of all-cause mortality was observed for those reporting >4 hours/day of screen time compared to those reporting <2 hours/day, after adjustment for multiple potential confounders including age, sex, ethnicity, obesity, smoking, social class, marital status, diabetes mellitus, and hypertension (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.06-2.16). An increased risk was also observed for CVD events for participants reporting >4 hours of screen time/day compared to <2 hours/day (HR, 2.3; 95% CI, 1.33-3.96). After adjustment for physical activity, these associations remained significant for all-cause mortality (HR, 1.48; 95% CI, 1.04-2.13), and for CVD events (HR, 2.25; 95% CI, 1.30-3.89). Approximately 25% of the association between screen time and CVD events was explained collectively by C-reactive protein, body mass index, and high-density lipoprotein cholesterol.


The investigators concluded that recreational sitting, as reflected by television/screen viewing time, is related to increased mortality and CVD risk regardless of physical activity participation. Inflammatory and metabolic risk factors partly explain this relationship.


This study highlights the risk of sedentary behaviors related to increased CVD events, but also for all-cause mortality. As expected, markers of inflammation and lipids explained part of this association, but not all of it. Interventions to decrease sedentary behaviors and increase physical activity in our culture will have significant public health implications.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins

Keywords: Inflammation, Follow-Up Studies, Lipids, Risk Factors, Health Surveys, Cholesterol, Cause of Death, Television, Public Health, Body Mass Index, Motor Activity, Cardiovascular Diseases, Obesity, Sedentary Lifestyle

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