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project big life: can a website improve your life expectancy?
project big life is a website that includes calculators designed to estimate risk of heart attack or stroke, chronic kidney disease, dementia, and life expectancy.
with a life expectancy of 90, sharon butler hopes to stay active for many years to come.
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sharon butler considers herself a pretty healthy 66-year-old. the suburban vancouver mother of two follows a healthy diet, never smoked, drinks alcohol moderately, walks about 16,000 steps every day and kayaks several times a month for about three hours a trip.
she’s also a good sleeper: “i put my head on the pillow and i’m gone” for eight hours a night, she says.
she sports a rosy glow, has no health issues, and maintains a positive, optimistic outlook on life, even while under stress.
still, she wondered: “how long will i live?”
when a friend told her about an online calculator, called project big life, that purports to answer that very question, she jumped on it. after filling out a three-minute questionnaire, which asked such basic questions as her age, sex, ethnicity, education, as well as lifestyle habits like smoking, drinking and exercise, butler learned she would live to the ripe old age of 90.
“i didn’t have any expectation [about a number],” she says. relatives on her mother’s side of the family lived up to 95, but her sister died of cancer in her fifties. “i just live life,” she shrugs.
winning the numbers game
doctors, particularly in the u.s. have long used risk calculators, such as eprognosis, to determine “time to benefit” interventions for their patients. for example, would those patients benefit from certain medicines or procedures based on not just their age but on their health status and life expectancy. others, such as medcalc, estimates everything from stroke risk, arterial pressure and body mass index, while the mayo clinic’s galad calculator assesses complications of liver disease.
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canadian physicians use similar tools, but a team of researchers at the ottawa hospital wanted to make one available to the general public. project big life (or pbl) launched about 10 years ago and has undergone various tweaks and upgrades over the years to include calculators designed to estimate risk of heart attack or stroke, chronic kidney disease, dementia, and life expectancy.
the project initially sprang from a report by the hospital’s researchers that found six out of 10 deaths in ontario were linked to five controllable habits — smoking, alcohol consumption, physical inactivity, unhealthy eating and stress. almost everyone in ontario, they determined, has at least one of these behaviours, and researchers found that if they addressed just one, average life expectancy would increase by nearly four years.
most people do want to live a good, long life and do all the right things to make that happen, but many don’t really know if their efforts are paying off. the researchers wondered, is there a way to quantify and measure those efforts in terms of disease risk and life expectancy? and if so, could those measurements provide guidelines for making informed choices that further enhanced health? on the flip side, can an objective tool help guard against fearmongering advertisements or news reports that drive people to seek unnecessary testing that often leads to over-diagnosis and over-treatment?
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“it was just about making research meaningful for people,” explains dr. douglas manuel, md, m.sc., frcpc and one of the creators of pbl, about the impetus for the site. he and his colleagues simply wanted to transfer some of the information they themselves use and disseminate in terms of reports, algorithms and other projects to the general public to make their own risk assessments. but, they wondered, would the average person be interested or motivated to use such a tool?
they got their answer when, in the first half-hour of the website going live, it crashed under the weight of 50,000 users. since then, millions of people from canada, the u.s. and around the world have logged on looking to gauge their own potential health risks.
“some people might [take the kidney disease test] for various reasons, such as being a diabetic or a clinician having raised concerns,” says manuel. “but life expectancy is of interest to everyone. it’s our largest use by far.”
knowledge into practice
manuel says one of the tag lines within his team is: it’s not informed public health policy unless you know how it affects you and your family. “taking your blood pressure won’t change your blood pressure, and doing a risk calculator won’t change your health by itself. it has to be coupled with [action]. so a lot of it is raising people’s awareness of what affects their health.”
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he says the team is always tweaking and updating the site to add more conditions and diseases, particularly for diabetes, which they hope to do soon with additional funding. a new addition, coming this summer and designed by dr. mahsa jessri, assistant professor at ubc’s department of food, nutrition and health, and canada research chair in nutritional epidemiology for public health, focuses on diet.
“when we estimate the burden of health behaviours in canada, diet is now number one, exceeding smoking,” says manuel. “so, it’s a priority for us to get better eyes on it.”
many people have longed for the mythical magic wand that will transform their poor health into good, but no matter the latest fad or breakthrough medication (and absent any genetic predispositions), it always tends to come down to the basics: healthy diet, regular exercise, not smoking, reducing stress, and getting sufficient sleep. most people know that, but not everyone puts that knowledge into practice. not everyone can.
“at project big life, we want to raise awareness but we don’t want to put the burden on individuals when there are so many barriers to live healthy,” says manuel. “the more important factor is the environment where we live. it’s hard to eat a good diet in canada [especially for those who don’t have access or can’t afford to].”
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and lest anyone suspect pbl deceptively tracks you or collects your personal data, manuel says have no fear. “we don’t collect postal code or ip addresses. we collect anonymous information and we’ve [abided by] research ethics for that. we’re not allowed to hold or retain individual information.”
caveats and cautions
just as your horoscope can’t predict whether you’ll find love on a boat under a full moon on monday, neither can an online tool predict with 100 per cent accuracy the day you’ll breathe your last breath. the site uses language such as “for people like you”, and “on average.”
“but, of course, if you walk out the door and get hit by a car, you’re not going to live to that 90 years that the calculator says,” notes manuel. “there’s still randomness, and there’s a lot of things that aren’t included in the calculator. probably the number one people ask about is family history and how that relates to their life expectancy. unfortunately, we just don’t have that in the data so we haven’t been putting that in. [nor does the calculator ask if you’re living with a serious illness, such as cancer or heart disease.]”
“the site is still evolving, which is one reason we created it as a sort of testing ground for how to communicate risk to individuals.”
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he says any updates cost money, and while the team is fairly well-funded, mostly from the canadian institute for health research, “we can get funding to develop new [calculators] but not to update our existing ones. but we always use a new project to advance research in different ways. and what we learn from the research we’ll fold back into the previous algorithms as well.”
as for the danger that someone will receive a life expectancy score of 100 years and suddenly start skydiving or extreme skiing at age 75, manuel says there’s more concern around what would happen should someone receive a shorter time frame. the elder life calculator, for example, estimates life expectancy in your last five years, which drops as low as three to six weeks. would that compel you to sell your house or give away all your money?
“that’s a real concern but it’s [still] reducing the risk, and [the site features] lots of warnings,” he says. “there are potential benefits and harms but, at this point, the benefits are greater than the harms. there is a bit of buyer beware, that [your result] isn’t written in stone. use it in consultation with your physician or caregiver or other information to assess your health. but it’s still going to be helpful because a lot of the questions we ask are universal. if you have a condition, it’s still important to eat well and be physically active and it will make an affect your health. so use it as a guidepost to inform you but not by itself.”
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as for sharon butler, if her calculated score comes to fruition, she says she foresees herself “out walking with my walker with a hop, skip and a jump. maybe i’ll be the only 90-year-old on the dragon boat team!”
robin roberts is a vancouver-based writer.
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