Stokes Andrew C, Xie Wubin, Lundberg Dielle J, Hempstead Katherine, Zajacova Anna, Zimmer Zachary, Glei Dana A, Meara Ellen, Preston Samuel H
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Robert Wood Johnson Foundation, Princeton, NJ, USA.
SSM Popul Health. 2020 Aug 10;12:100644. doi: 10.1016/j.ssmph.2020.100644. eCollection 2020 Dec.
Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a greater cumulative exposure to excess adiposity during their lifetime than any previous generation. Prior work has demonstrated a link between obesity and mortality risk at midlife, but the mechanisms remain unclear. Pain may represent one important pathway linking obesity to mortality trends. Pain is a debilitating condition that has increased significantly over recent decades and is associated with both morbidity and mortality, including suicide and opioid-related mortality. Evidence suggests obesity and pain may be linked, but there is little evidence of an association at the population level. In this paper, we examine to what extent increases in overweight and obesity explain the rising trends in chronic pain observed among middle-aged adults in the US from 1992 to 2016. We assess trends in both mild/moderate nonlimiting pain and severe and/or limiting pain. In doing so, we draw attention to one mechanism through which overweight/obesity may have contributed to recent population health trends. Our analysis found that increases in BMI from 1992 to 2016 may account for up to 20% of the upward trend in mild/moderate nonlimiting pain and 32% of the trend in severe and/or limiting pain for women, and 10% and 19% of the trends respectively for men.
近期美国中年人群死亡率和发病率前所未有的上升，通常被归因于民众日益加剧的绝望情绪。另一种较少被审视的解释是，这些趋势至少部分反映了肥胖流行的滞后影响。与以往任何一代相比，如今的中年成年人更易患有肥胖症，且一生中累积接触过多肥胖因素的情况更为严重。先前的研究已证明肥胖与中年死亡率风险之间存在关联，但其机制仍不明晰。疼痛可能是将肥胖与死亡率趋势联系起来的一个重要途径。疼痛是一种使人衰弱的病症，在近几十年显著增加，且与发病率和死亡率（包括自杀和阿片类药物相关死亡率）相关。有证据表明肥胖与疼痛可能存在关联，但在人群层面几乎没有相关关联的证据。在本文中，我们研究超重和肥胖的增加在多大程度上解释了1992年至2016年美国中年成年人中观察到的慢性疼痛上升趋势。我们评估了轻度/中度非限制性疼痛以及重度和/或限制性疼痛的趋势。在此过程中，我们关注到超重/肥胖可能导致近期人群健康趋势的一种机制。我们的分析发现，1992年至2016年体重指数（BMI）的增加可能分别占女性轻度/中度非限制性疼痛上升趋势的20%以及重度和/或限制性疼痛趋势的32%，男性的这两个比例分别为10%和19%。
