Forecast of future premature mortality as a result of trends in obesity and smoking: nationwide cohort simulation study (original) (raw)

Abstract

In many countries obesity has increased dramatically during the last decades, while there has been a parallel decrease in smoking. The objective of the present study was to estimate the net effect on premature mortality of these trends. A simulation model was developed to estimate the expected number of deaths between ages 19–56 years for cohorts of young men (n = 50,000), depending on inputs of obesity and smoking prevalence. The model was populated with nationwide data of Swedish men performing mandatory military conscription tests between 1969 and 2005. Risk equations for all cause mortality with smoking and obesity status as predictors were developed based on the 1969–1970 conscription cohort (n = 45,920; 2,897 deaths, median follow-up 38 years). It was found that between 1969 and 2005, the prevalence of smoking decreased from 58.6 to 23.2%, while overweight increased from 5.7 to 15.6% and obesity from 0.8 to 5.5%. As a result of these trends, a 14% (CI95% 6, 21%) reduction of premature deaths between ages 19 and 56 years was forecasted for men aged 19 year in 2004–2005 compared to men aged 19 years in 1969–1970 (2,679 vs. 3,116 deaths). However, one-third of the survival benefit from reduced smoking during the period was offset due to the parallel increase in obesity. This study shows that despite large increases in overweight and obesity, a continued decline in premature deaths among Swedish males is expected due to reduced smoking during the last four decades.

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Abbreviations

BMI:

Body mass index

HR:

Hazard ratio

CI:

Confidence interval

SD:

Standard deviation

References

  1. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32(9):1431–7.
    Article CAS Google Scholar
  2. Neovius M, Teixeira-Pinto A, Rasmussen F. Shift in the composition of obesity in young adult men in Sweden over a third of a century. Int J Obes (Lond). 2008;32(5):832–6.
    Article CAS Google Scholar
  3. Falkstedt D, Hemmingsson T, Rasmussen F, Lundberg I. Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men. Int J Obes (Lond). 2007;31(5):777–83.
    CAS Google Scholar
  4. Rissanen A, Heliovaara M, Knekt P, Reunanen A, Aromaa A, Maatela J. Risk of disability and mortality due to overweight in a Finnish population. BMJ. 1990;301(6756):835–7.
    Article CAS PubMed Google Scholar
  5. Neovius M, Kark M, Rasmussen F. Association between obesity status in young adulthood and disability pension. Int J Obes (Lond). 2008;32(8):1319–26.
    Article CAS Google Scholar
  6. Sonne-Holm S, Sorensen TI, Christensen U. Risk of early death in extremely overweight young men. Br Med J (Clin Res Ed). 1983;287(6395):795–7.
    Article CAS Google Scholar
  7. Neovius M, Sundstrom J, Rasmussen F. Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study. BMJ. 2009;338:b496.
    Article PubMed Google Scholar
  8. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.
    Article PubMed Google Scholar
  9. Neovius K, Neovius M, Rasmussen F. The combined effects of overweight and smoking in late adolescence on subsequent disability pension: a nationwide cohort study. Int J Obes (Lond). 2009;34(1):75–82.
    Article Google Scholar
  10. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328(7455):1519.
    Article PubMed Google Scholar
  11. Center for Disease Control and Prevention (CDC). National Health Interview Survey 1965–2007. www.cdc.gov. Accessed 20090923.
  12. UK National Statistics. www.statistics.gov.uk. Accessed 20090923.
  13. McGee R, Williams S, Stanton W. Smoking among New Zealand adolescents 1960–1993. N Z Med J. 1995;108(995):85–7.
    CAS PubMed Google Scholar
  14. Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Mak. 1993;13(4):322–38.
    Article CAS Google Scholar
  15. Andreasson S, Allebeck P, Romelsjo A. Alcohol and mortality among young men: longitudinal study of Swedish conscripts. Br Med J (Clin Res Ed). 1988;296(6628):1021–5.
    Article CAS Google Scholar
  16. Carroll KJ. On the use and utility of the Weibull model in the analysis of survival data. Control Clin Trials. 2003;24(6):682–701.
    Article PubMed Google Scholar
  17. WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894(I–xii):1–253.
    Google Scholar
  18. CAN. Drug habits among conscripts 2005 (Mönstrandes drogvanor 2005). Report 95. Stockholm, 2006.
  19. Asplund K. Alarms of obesity bomb grossly exaggerated (Larmen om fetmabomb är kraftigt överdrivna). Dagens Nyheter 2008-08-12. Accessible at http://www.dn.se/opinion/debatt/larmen-om-fetmabomb-ar-kraftigt-overdrivna-1.716654. 2008.
  20. Bergstrom E, Blomquist HK. Is the prevalence of overweight and obesity declining among 4-year-old Swedish children? Acta Paediatr. 2009;98(12):1956–8.
    Article PubMed Google Scholar
  21. Sjoberg A, Lissner L, Albertsson-Wikland K, Marild S. Recent anthropometric trends among Swedish school children: evidence for decreasing prevalence of overweight in girls. Acta Paediatr. 2008;97(1):118–23.
    Article PubMed Google Scholar
  22. Sundblom E, Petzold M, Rasmussen F, Callmer E, Lissner L. Childhood overweight and obesity prevalences levelling off in Stockholm but socioeconomic differences persist. Int J Obes (Lond). 2008;32(10):1525–30.
    Article CAS Google Scholar
  23. Stewart ST, Cutler DM, Rosen AB. Forecasting the effects of obesity and smoking on US life expectancy. N Engl J Med. 2009;361(23):2252–60.
    Article CAS PubMed Google Scholar
  24. Lawlor DA, Hart CL, Hole DJ, Davey Smith G. Reverse causality and confounding and the associations of overweight and obesity with mortality. Obesity (Silver Spring). 2006;14(12):2294–304.
    Article Google Scholar
  25. Guo SS, Chumlea WC. Tracking of body mass index in children in relation to overweight in adulthood. Am J Clin Nutr. 1999;70(1):145S–8S.
    CAS Google Scholar
  26. van Dam RM, Willett WC, Manson JE, Hu FB. The relationship between overweight in adolescence and premature death in women. Ann Intern Med. 2006;145(2):91–7.
    PubMed Google Scholar
  27. Rasmussen F, Tynelius P, Kark M. Importance of smoking habits for longitudinal and age-matched changes in body mass index: a cohort study of Swedish men and women. Prev Med. 2003;37(1):1–9.
    Article PubMed Google Scholar
  28. Walter S, Kunst A, Mackenbach J, Hofman A, Tiemeier H. Mortality and disability: the effect of overweight and obesity. Int J Obes (Lond). 2009;33(12):1410–8.
    Article CAS Google Scholar
  29. Boffetta P, Straif K. Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis. BMJ. 2009;339:b3060.
    Article PubMed Google Scholar
  30. Gartner CE, Hall WD, Vos T, Bertram MY, Wallace AL, Lim SS. Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study. Lancet. 2007;369(9578):2010–4.
    Article PubMed Google Scholar

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Conflict of interest statement

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Author information

Authors and Affiliations

  1. Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institutet, 17176, Stockholm, Sweden
    Kristian Neovius & Finn Rasmussen
  2. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, 751 85, Uppsala, Sweden
    Johan Sundström
  3. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, 171 76, Stockholm, Sweden
    Martin Neovius

Authors

  1. Kristian Neovius
  2. Finn Rasmussen
  3. Johan Sundström
  4. Martin Neovius

Corresponding author

Correspondence toFinn Rasmussen.

Appendix

Appendix

See Table 3.

Table 3 Mean number of deaths according to the simulation model during 37 years of follow-up in a hypothetical cohort of 45,920 participants compared to observed data (n = 45,920, median follow-up = 37.7 years)

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Neovius, K., Rasmussen, F., Sundström, J. et al. Forecast of future premature mortality as a result of trends in obesity and smoking: nationwide cohort simulation study.Eur J Epidemiol 25, 703–709 (2010). https://doi.org/10.1007/s10654-010-9485-x

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