The role of obesity in exceptionally slow US mortality improvement
| Autor: | Yana C. Vierboom, Andrew Stokes, Samuel H. Preston |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Mortality Decline obesity Medical Sciences National Health and Nutrition Examination Survey Social Sciences Population health 030204 cardiovascular system & hematology Body Mass Index 03 medical and health sciences Life Expectancy 0302 clinical medicine Prevalence Humans Medicine 030212 general & internal medicine Aged Aged 80 and over 2. Zero hunger Multidisciplinary business.industry Proportional hazards model Middle Aged Biological Sciences Nutrition Surveys medicine.disease mortality Obesity United States Confidence interval 3. Good health Life expectancy Female business population health Body mass index Demography |
| Zdroj: | Proceedings of the National Academy of Sciences of the United States of America |
| ISSN: | 1091-6490 0027-8424 |
| Popis: | Significance Some have speculated that the rising prevalence of obesity may explain why the rate of mortality improvement in the United States has declined relative to other wealthy countries. This paper estimates that rising body mass index (BMI) has reduced the annual rate of improvement in US death rates between 1988 and 2011 by more than half a percentage point—equivalent to a 23% relative reduction in the rate of mortality decline—a large amount by international standards. The increase in BMI has reduced life expectancy at age 40 by 0.9 years in 2011 and accounted for 186,000 excess deaths that year. Rising BMI has prevented the United States from enjoying the full benefits of factors working to improve mortality. Recent studies have described a reduction in the rate of improvement in American mortality. The pace of improvement is also slow by international standards. This paper attempts to identify the extent to which rising body mass index (BMI) is responsible for reductions in the rate of mortality improvement in the United States. The data for this study were obtained from subsequent cohorts of the National Health and Nutrition Examination Survey (NHANES III, 1988–1994; NHANES continuous, 1999–2010) and from the NHANES linked mortality files, which include follow-up into death records through December 2011. The role of BMI was estimated using Cox models comparing mortality trends in the presence and absence of adjustment for maximum lifetime BMI (Max BMI). Introducing Max BMI into a Cox model controlling for age and sex raised the annual rate of mortality decline by 0.54% (95% confidence interval 0.45–0.64%). Results were robust to the inclusion of other variables in the model, to differences in how Max BMI was measured, and to how trends were evaluated. The effect of rising Max BMI is large relative to international mortality trends and to alternative mortality futures simulated by the Social Security Administration. The increase in Max BMI over the period 1988–2011 is estimated to have reduced life expectancy at age 40 by 0.9 years in 2011 (95% confidence interval 0.7–1.1 years) and accounted for 186,000 excess deaths that year. Rising levels of BMI have prevented the United States from enjoying the full benefits of factors working to improve mortality. |
| Databáze: | OpenAIRE |
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