体质指数与死亡率关系的时间趋势：来自糖尿病、癌症等多原因的3.5百万瑞典青年成人数据分析

Time trends of the association of body mass index with mortality in 3.5 million young Swedish adults

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ANNALS OF EPIDEMIOLOGY

影响因子:3

分区:医学3区 / 公共卫生3区

发表日期:2024 Sep

作者: Innocent B Mboya, Josef Fritz, Marisa da Silva, Ming Sun, Jens Wahlström, Patrik K E Magnusson, Sven Sandin, Weiyao Yin, Stefan Söderberg, Nancy L Pedersen, Ylva Trolle Lagerros, Bright I Nwaru, Hannu Kankaanranta, Abbas Chabok, Jerzy Leppert, Helena Backman, Linnea Hedman, Karolin Isaksson, Karl Michaëlsson, Christel Häggström, Tanja Stocks

DOI: 10.1016/j.annepidem.2024.07.043

keywords: Body mass index; Mortality; Time trends

摘要

我们研究了体重指数（BMI）与死亡率关系的时间变化趋势，考虑了年龄、性别和死因差异。分析了瑞典全国范围内从1963年至2016年，基线时年龄为17-39岁的3,472,310名个体的数据。采用Cox回归和灵活参数生存模型，探讨不同性别和基线年代（男性：<1975，1975-1985，≥1985；女性：<1985，1985-1994，≥1995）下的BMI-死亡率关系。与正常体重的肥胖男性相比，各时期全因死亡和“其他原因”死亡的关联均减弱；在<1975和≥1985时期，全因死亡的风险比（HR）分别为1.92（1.83-2.01）和1.70（1.58-1.82），而“其他原因”死亡的HR为1.72（1.58-1.87）和1.40（1.28-1.53）；心血管疾病（CVD）死亡的HR则增加至2.71（2.51-2.94）和3.91（3.37-4.53）。早逝年龄与较高年龄段的肥胖相关死亡增加有关。此外，男性不同年龄段的全因死亡关系在不同时间段没有明显差异（p交互=0.09），提示在控制达成年龄后，时间对BMI-死亡关系的影响有限。女性的类似分析结果较不明显。癌症死亡的关系没有显著变化趋势。考虑到不同时间段的年龄和死因差异，有助于避免误解肥胖随时间变化的风险。

Abstract

We investigated time trends of the obesity-mortality association, accounting for age, sex, and cause-specific deaths.We analysed pooled nationwide data in Sweden for 3,472,310 individuals aged 17-39 years at baseline in 1963-2016. Cox regression and flexible parametric survival models investigated BMI-mortality associations in sub-groups of sex and baseline calendar years (men: <1975, 1975-1985, ≥1985 and women: <1985, 1985-1994, ≥1995).Comparing men with obesity vs. normal weight, all-cause and "other-cause" mortality associations decreased over periods; HR (95% CI) 1.92 (1.83-2.01) and 1.70 (1.58-1.82) for all-cause and 1.72 (1.58-1.87) and 1.40 (1.28-1.53) for "other-cause" mortality in <1975 and ≥1985, but increased for CVD mortality; HR 2.71 (2.51-2.94) and 3.91 (3.37-4.53). Higher age at death before 1975 coincided with more obesity-related deaths at higher ages. Furthermore, the all-cause mortality association for different ages in men showed no clear differences between periods (p-interaction=0.09), suggesting no calendar effect after accounting for attained age. Similar, but less pronounced, results were observed in women. Associations with cancer mortality showed no clear trends in men or in women.Accounting for differences in age and death causes between calendar periods when investigating BMI-mortality time trends may avoid misinterpreting the risks associated with obesity over time.