University of Michigan, School of Public Health, 3628 SPH Tower, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
Demography. 2009 Nov;46(4):851-72. doi: 10.1353/dem.0.0077.
Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI > or = or = 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI > or = 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.
肥胖被认为是导致过早死亡的主要原因，也是美国长期以来死亡率持续下降的潜在威胁。我们利用健康与退休研究（1992-2004 年）的数据，衡量了中年人群中肥胖与相对风险和归因风险的关系。尽管与正常体重指数（BMI=18.5-24.9）相比，II/III 类肥胖（BMI≥35.0kg/m2）使女性的死亡率增加了 40%，男性的死亡率增加了 62%，但 I 类肥胖（BMI=30.0-34.9）和超重（BMI=25.0-29.9）与超额死亡率无关。就归因死亡率而言，II/III 类肥胖（BMI≥35.0）导致女性约 4%的死亡和男性约 3%的死亡。肥胖通常被比作吸烟，是可避免死亡的主要原因之一。在这个队列中，吸烟导致的死亡率要大得多：女性约 36%，男性约 50%。研究结果不受先前存在的疾病、社会经济地位（SES）的多个维度、吸烟和其他相关因素的混杂影响。这些发现挑战了肥胖将阻止美国长期以来死亡率持续下降的观点。
