Obesity and All-Cause Mortality Among Black Adults and White Adults

American Journal of Epidemiology, Sep 2012

In recent pooled analyses among whites and Asians, mortality was shown to rise markedly with increasing body mass index (BMI; weight (kg)/height (m)2), but much less is known about this association among blacks. This study prospectively examined all-cause mortality in relation to BMI among 22,014 black males, 9,343 white males, 30,810 black females, and 14,447 white females, aged 40–79 years, from the Southern Community Cohort Study, an epidemiologic cohort of largely low-income participants in 12 southeastern US states. Participants enrolled in the cohort from 2002 to 2009 and were followed up to 8.9 years. Hazard ratios and 95% confidence intervals for mortality were obtained from sex- and race-stratified Cox proportional hazards models in association with BMI at cohort entry, adjusting for age, education, income, cigarette smoking, and alcohol consumption. Elevated BMI was associated with increased mortality among whites (hazard ratios for BMI >40 vs. 20–24.9 = 1.37 (95% confidence interval (CI): 1.02, 1.84) and 1.47 (95% CI: 1.15, 1.89) for white males and white females, respectively) but not significantly among blacks (hazard ratios = 1.13 (95% CI: 0.89, 1.43) and 0.87 (95% CI: 0.72, 1.04) for black males and black females, respectively). In this large cohort, obesity in mid-to-late adulthood among blacks was not associated with the same excess mortality risk seen among whites.

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Obesity and All-Cause Mortality Among Black Adults and White Adults

Sarah S. Cohen ) 0 Lisa B. Signorello 0 Elizabeth L. Cope 0 Joseph K. McLaughlin 0 Margaret K. Hargreaves 0 Wei Zheng 0 William J. Blot 0 0 Abbreviations: BMI, body mass index; CI, confidence interval; HR, hazard ratio; ICD-10, International Classification of Diseases , Tenth Revision; SCCS, Southern Community Cohort Study American Journal of Epidemiology The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: . In recent pooled analyses among whites and Asians, mortality was shown to rise markedly with increasing body mass index (BMI; weight (kg)/height (m)2), but much less is known about this association among blacks. This study prospectively examined all-cause mortality in relation to BMI among 22,014 black males, 9,343 white males, 30,810 black females, and 14,447 white females, aged 40-79 years, from the Southern Community Cohort Study, an epidemiologic cohort of largely low-income participants in 12 southeastern US states. Participants enrolled in the cohort from 2002 to 2009 and were followed up to 8.9 years. Hazard ratios and 95% confidence intervals for mortality were obtained from sex- and race-stratified Cox proportional hazards models in association with BMI at cohort entry, adjusting for age, education, income, cigarette smoking, and alcohol consumption. Elevated BMI was associated with increased mortality among whites (hazard ratios for BMI >40 vs. 20-24.9 = 1.37 (95% confidence interval (CI): 1.02, 1.84) and 1.47 (95% CI: 1.15, 1.89) for white males and white females, respectively) but not significantly among blacks (hazard ratios = 1.13 (95% CI: 0.89, 1.43) and 0.87 (95% CI: 0.72, 1.04) for black males and black females, respectively). In this large cohort, obesity in midto-late adulthood among blacks was not associated with the same excess mortality risk seen among whites. African Americans; body mass index; mortality - The rise in obesity levels in the general population over the past 3 decades (13) is expected to result in enormous health burdens and health-care costs as obesity is linked to many adverse health outcomes, including diabetes, cardiovascular disease, cancer, and overall mortality (46). Recent pooled cohort analyses have reported a J-shaped relation between body mass index (BMI) and all-cause mortality with more than doubled mortality risks among extremely obese whites (6, 7) and parallel but less pronounced risks among East Asians (8). Some previous studies have found a weaker obesity-mortality association among African Americans (914), but few studies have examined this question in large populations of African Americans, and none have been concentrated in low-income populations or in the southeastern United States where the obesity epidemic is pronounced (15). Our objective therefore was to prospectively examine the association between BMI and all-cause mortality in the Southern Community Cohort Study (SCCS), a unique cohort with a large African-American population as well as a sizeable group of socioeconomically comparable whites. MATERIALS AND METHODS Study participants The SCCS is a prospective cohort study assessing disparities in chronic diseases among adults in urban and rural areas in 12 southeastern US states (1618). From 2002 to 2009, nearly 86,000 adults were enrolled in the cohort, most (86%) at one of 71 participating community health centers that provide basic health services mainly to lowincome and uninsured persons (19). An additional 14% of the cohort enrolled from 2004 to 2006 by responding to a mailed questionnaire sent to randomly selected residents of the same 12 states. SCCS participants were required to be 4079 years of age, to speak English, and not to be under treatment for cancer in the 12 months preceding cohort enrollment. The enrollment protocol was designed so that overall approximately two-thirds of participants would be black. The SCCS was approved by institutional review boards at Vanderbilt University and Meharry Medical College, and all participants provided written, informed consent. Data collection and BMI assessment Participants completed a baseline survey (via in-person interview for community health center enrollees and a self-administered questionnaire for mail enrollees) at enrollment. This survey, available online (18), contained questions about demographic, medical, familial, lifestyle, and other participant characteristics. Race was self-reported. Current weight and height were self-reported in the baseline survey through September 2007 and, in addition, for 25% of the community health center participants, height and weight measured on the day of the baseline interview were abstracted from community health center medical records. Starting in October 2007, height and weight were measured for all community health center participants by trained interviewers using a SECA 703 digital scale (SECA Corp., Hanover, M (...truncated)


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Sarah S. Cohen, Lisa B. Signorello, Elizabeth L. Cope, Joseph K. McLaughlin, Margaret K. Hargreaves, Wei Zheng, William J. Blot. Obesity and All-Cause Mortality Among Black Adults and White Adults, American Journal of Epidemiology, 2012, pp. 431-442, 176/5, DOI: 10.1093/aje/kws032