Obesity and US mortality risk over the adult life course

Am J Epidemiol. 2013 Mar 1;177(5):431-42. doi: 10.1093/aje/kws325. Epub 2013 Feb 3.


In this study, we analyzed age variation in the association between obesity status and US adult mortality risk. Previous studies have found that the association between obesity and mortality risk weakens with age. We argue that existing results were derived from biased estimates of the obesity-mortality relationship because models failed to account for confounding influences from respondents' ages at survey and/or cohort membership. We employed a series of Cox regression models in data from 19 cross-sectional, nationally representative waves of the US National Health Interview Survey (1986-2004), linked to the National Death Index through 2006, to examine age patterns in the obesity-mortality association between ages 25 and 100 years. Findings suggest that survey-based estimates of age patterns in the obesity-mortality relationship are significantly confounded by disparate cohort mortality and age-related survey selection bias. When these factors are accounted for in Cox survival models, the obesity-mortality relationship is estimated to grow stronger with age.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Body Mass Index*
  • Cause of Death
  • Female
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Obesity / classification
  • Obesity / epidemiology
  • Obesity / mortality*
  • Proportional Hazards Models
  • Risk
  • Risk Factors
  • Selection Bias
  • United States / epidemiology