Causes of death in obesity: Relevant increase in cardiovascular but not in all-cancer mortality

Accepted 17 January 2006. published online 28 May 2006.

Abstract

Background and Objective

To assess the relation between body mass index (BMI) and the risk of death from various causes in a prospective cohort study.

Methods

In 6,192 obese patients (BMI ≥25kg/m2) with mean BMI 36.6 kg/m2 (SD 6.1) and mean age 40.4 years (SD 12.9) who had been referred to the obesity clinic of the Heinrich-Heine-University Düsseldorf, Germany, between 1961 and 1994, there were 1,058 deaths from all causes during a median follow-up time of 14.8 years. We calculated standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) for death from predefined groups of diseases by using Germany as reference population.

Results

In both sexes, risk of death from cardiovascular diseases (men: SMR = 2.2, CI 1.9–2.5; women: SMR = 1.6, CI 1.5–1.8), from diabetes (men: SMR = 5.4, CI 3.2–8.7; women: SMR = 3.5, CI 2.6–4.8), and in men from digestive diseases (SMR = 1.6, CI 1.01–2.3) was significantly increased. In contrast to other studies, an association between obesity and all-cancer mortality could not be found. Only in morbidly obese women (BMI ≥40 kg/m2), all-cancer mortality was significantly increased (SMR = 1.5, CI 1.1–1.9).

Conclusion

Obesity is associated with increased risk of death from cardiovascular diseases and diabetes in both sexes, and from diseases of the digestive system in men.

Keywords: Body mass index, Excess mortality, Cause of death, ICD codes, Morbid obesity, Obesity

a Institute for Quality and Efficiency in Health Care, Dillenburger Str. 27, Cologne D-51105, Germany

b Department of Epidemiology and International Public Health, School of Public Health, University of Bielefeld, Universitätsstr. 25, D-33615 Bielefeld, Germany

c Department of Gastroenterology, Hepatology and Infectiology, University Clinics, Heinrich-Heine-University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany

d Institute for Medical Informatics, Biometry and Epidemiology, University Clinics of Essen, University Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany

e Department of Metabolic Diseases and Nutrition (WHO-Collaborating Centre for Diabetes), University Clinics, Heinrich-Heine-University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany

Corresponding author. Tel.: +49 221 35685-451; fax: +49 221-35685-891.

† Present address: Radiation and Environmental Health, World Health Organization, Geneva, Switzerland.

‡ Deceased August 18, 2002.

PII: S0895-4356(06)00044-8

doi:10.1016/j.jclinepi.2006.01.006

10 of 17