Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA Netw Open. 2022 Mar 1;5(3):e222318. doi: 10.1001/jamanetworkopen.2022.2318.
Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures.
To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 and January 1973 linked with Medicare follow-up between January 1985 and December 2015. Participants included 29 621 adults who were at least age 65 years in follow-up and enrolled in Medicare. Data were analyzed from January 2020 to December 2021.
Standard BMI categories.
(1) Morbidity burden at 65 years and older assessed with the Gagne combined comorbidity score (ranging from -2 to 26, with higher score associated with higher mortality), which is a well-validated index based on International Classification of Diseases, Ninth Revision codes for use in administrative data sets; (2) longevity (age at death); and (3) health care costs based on Medicare linkage in older adulthood (aged ≥65 years).
Among 29 621 participants, mean (SD) age was 40 (12) years, 57.1% were men, and 9.1% were Black; 46.0% had normal BMI, 39.6% were overweight, and 11.9% had classes I and II obesity at baseline. Higher cumulative morbidity burden in older adulthood was observed among those who were overweight (7.22 morbidity-years) and those with classes I and II obesity (9.80) compared with those with a normal BMI (6.10) in midlife (P < .001). Mean age at death was similar between those who were overweight (82.1 years [95% CI, 81.9-82.2 years]) and those who had normal BMI (82.3 years [95% CI, 82.1-82.5 years]) but shorter in those who with classes I and II obesity (80.8 years [95% CI, 80.5-81.1 years]). The proportion (SE) of life-years lived in older adulthood with Gagne score of at least 1 was 0.38% (0.00%) in those with a normal BMI, 0.41% (0.00%) in those with overweight, and 0.43% (0.01%) in those with classes I and II obesity. Cumulative median per-person health care costs in older adulthood were significantly higher among overweight participants ($12 390 [95% CI, $10 427 to $14 354]) and those with classes I and II obesity ($23 396 [95% CI, $18 474 to $28 319]) participants compared with those with a normal BMI (P < .001).
In this cohort study, overweight in midlife, compared with normal BMI, was associated with higher cumulative burden of morbidity and greater proportion of life lived with morbidity in the context of similar longevity. These findings translated to higher total health care expenditures in older adulthood for those who were overweight in midlife.
大量证据表明肥胖与不良健康后果有关。然而，关于超重状态与正常体重指数（BMI；计算方法为体重除以身高的平方）相比是否与更长的生存时间有关，以及这种关系是否以更大的长期发病率和医疗保健支出为代价，仍存在争议。
研究中年 BMI 与 65 岁及以上成年人的发病率负担、寿命和医疗保健支出的关系。
设计、地点和参与者：在芝加哥心脏协会工业检测项目中的前瞻性队列研究，基线在 1967 年 11 月至 1973 年 1 月之间进行，与 1985 年 1 月至 2015 年 12 月之间的医疗保险随访相关联。参与者包括 29621 名至少在随访中年龄为 65 岁并参加了医疗保险的成年人。数据于 2020 年 1 月至 2021 年 12 月进行分析。
标准 BMI 类别。
（1）65 岁及以上的发病率负担评估采用 Gagne 综合合并症评分（范围从-2 到 26，分数越高与死亡率越高相关），这是一种基于疾病分类的有效性指数，第九版代码用于行政数据集；（2）寿命（死亡年龄）；（3）基于老年（年龄≥65 岁）时的医疗保险关联的医疗保健费用。
在 29621 名参与者中，平均（标准差）年龄为 40（12）岁，57.1%为男性，9.1%为黑人；46.0%的人有正常的 BMI，39.6%超重，11.9%在中年时患有 I 类和 II 类肥胖（基线时）。在中年时期，超重（7.22 年发病率）和 I 类和 II 类肥胖（9.80 年发病率）的成年人与具有正常 BMI（6.10 年发病率）的成年人相比，老年时的累积发病率负担更高（P<0.001）。超重者（82.1 岁[95%CI，81.9-82.2 岁]）和具有正常 BMI 者（82.3 岁[95%CI，82.1-82.5 岁]）的平均死亡年龄相似，但 I 类和 II 类肥胖者的死亡年龄较短（80.8 岁[95%CI，80.5-81.1 岁]）。在具有正常 BMI 的人中，有至少 1 分的 Gagne 评分的生命年比例（SE）为 0.38%（0.00%），在超重的人中为 0.41%（0.00%），在 I 类和 II 类肥胖的人中为 0.43%（0.01%）。在中年超重的参与者（$12390[95%CI，$10427 至 $14354]）和 I 类和 II 类肥胖的参与者（$23396[95%CI，$18474 至 $28319]）中，老年时的累积人均医疗保健费用明显更高，与具有正常 BMI 的参与者相比（P<0.001）。
在这项队列研究中，与正常 BMI 相比，中年超重与更高的累积发病率负担和更大的发病率生活比例相关，而在相似的寿命中，这些发现转化为中年超重的人在老年时更高的总医疗保健支出。
