Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
Int J Epidemiol. 2019 Dec 1;48(6):1783-1794. doi: 10.1093/ije/dyz129.
Previous studies have shown an association between body mass index (BMI) and infections, but the literature on type-specific community acquired infections is still limited.
We included 39 163 Swedish adults who completed a questionnaire in September 1997 and were followed through record-linkages until December 2016. Information on BMI was self-reported and infections were identified from the Swedish National Patient Register using International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes. We fitted multivariable Cox proportional hazards models for time-to-first-event analysis, and we used extensions of the standard Cox model when repeated events were included.
During a 19-year follow-up 32% of the subjects had at least one infection requiring health care contact, leading to a total of 27 675 events. We found an increased incidence of any infection in obese women [hazard ratio (HR) = 1.22; 95% confidence interval (CI) = 1.12; 1.33] and obese men (HR = 1.25; 95% CI = 1.09; 1.43) compared with normal weight subjects. For specific infections, higher incidences were observed for skin infections in both genders (HR = 1.76; 95% CI = 1.47; 2.12 for obese females and HR = 1.74; 95% CI = 1.33; 2.28 for obese males) and gastrointestinal tract infections (HR = 1.44; 95% CI = 1.19; 1.75), urinary tract infections (HR = 1.30; 95% CI = 1.08; 1.55) and sepsis (HR = 2.09; 95% CI = 1.46; 2.99) in obese females. When accounting for repeated events, estimates similar to the aforementioned ones were found.
Obesity was associated with an increased risk of infections in both genders. Results from multiple-failure survival analysis were consistent with those from classic Cox models.
先前的研究表明，体重指数（BMI）与感染之间存在关联，但有关特定类型社区获得性感染的文献仍然有限。
我们纳入了 39163 名在 1997 年 9 月完成问卷调查并通过记录链接随访至 2016 年 12 月的瑞典成年人。BMI 信息为自我报告，感染则通过瑞典国家患者登记系统使用国际疾病分类（ICD）第十版（ICD-10）代码确定。我们通过多变量 Cox 比例风险模型进行首次事件时间分析，并在存在重复事件时使用标准 Cox 模型的扩展来进行分析。
在 19 年的随访期间，32%的受试者至少发生了一次需要医疗保健的感染，共发生了 27675 例感染事件。我们发现肥胖女性（HR=1.22；95%CI=1.12；1.33）和肥胖男性（HR=1.25；95%CI=1.09；1.43）的任何感染发生率均高于正常体重受试者。对于特定的感染，两性的皮肤感染发生率均较高（肥胖女性的 HR=1.76；95%CI=1.47；2.12，肥胖男性的 HR=1.74；95%CI=1.33；2.28）、胃肠道感染（HR=1.44；95%CI=1.19；1.75）、尿路感染（HR=1.30；95%CI=1.08；1.55）和败血症（HR=2.09；95%CI=1.46；2.99）。当考虑重复事件时，发现与上述结果类似的估计值。
肥胖与两性感染风险增加相关。多次失败生存分析的结果与经典 Cox 模型的结果一致。
