上海市区男性吸烟与恶性肿瘤死亡的前瞻性研究

目的 探讨上海市区中老年男性吸烟与恶性肿瘤死亡关系,以及随访期间研究对象吸烟情况的改变对这种关系的影响。方法 自1986年1月至1989年9月调查上海市区45～64岁男性居民18244人,每年上门随访一次;用Cox比例风险模型计算相对危险度(RR)。结果 至2002年度随访结束,全队列共随访235762人年,人均随访12.9年。在此期间共死亡3365例,其中恶性肿瘤死亡1381例。基线调查时吸烟者相对于不吸烟者总死亡RR值为1.49,去除随访期间吸烟情况有变化的对象后,一直吸烟者相对于一直不吸烟者的总死亡RR值增至1.78;相应的恶性肿瘤死亡RR值由2.05增至2.58,肺癌死亡RR值由6.40增至8.77。基线调查时吸烟者年龄标化总死亡率及标化恶性肿瘤死亡率为1695.6/10万人年和782.0/10万人年,去除随访期间吸烟情况有变化的对象后,一直吸烟者相应的标化死亡率增至2353.7/10万人年和1144.6/10万人年。结论 吸烟是上海市区中老年男性总死亡及恶性肿瘤死亡的重要危险因素。不考虑随访期间研究对象吸烟状况的改变会低估吸烟对健康的危害性。     

北京市中老年人体质指数与死亡的相关关系

目的探讨北京市中老年人体质指数(BMI)与死亡的相关关系.方法采用前瞻对列研究方法,于1991年对北京市40岁以上的自然人群共6 209人进行基线危险因素调查后,并随访至1999年12月.对在随访期间发生的所有死亡病例按ICD-9编码进行登记,并在个体水平对BMI与总死亡及几种主要死因进行相关分析.结果近10年北京市中老年人前5位主要死因依次为心脑血管疾病、肺心病、消化道肿瘤、不明原因突然死亡、肺癌,其死亡构成比分别为33.3%、13.8%、11.2%、7.4%、5.6%.人群总死亡率及不吸烟者总死亡率均以BMI值23.6～26.2组最小,以此BMI组为参照,BMI＜21.2组上述二组人群总死亡的RR值分别为1.7和1.9,在BMI≥26.2组以上二组人群总死亡的RR值分别为1.3和1.5.BMI与心血管病死亡呈正相关,BMI≥26.2组较BMI＜21.2组心血管病死亡的RR值为1.2;BMI与肺心病、消化道肿瘤、肺癌、肺炎及不明原因突然死亡分别均呈U型关系,均以BMI值23.6～26.2组死亡率最低,与此BMI组相比,BMI＜21.2组因上述5种疾病死亡的RR值分别为14.8、1.1、5.6、2.4和2.6,BMI≥26.2组因上述5种疾病死亡的RR值分别为3.0、1.9、3.7、2.2和1.5.各BMI组均以心血管病死亡构成比最大(28.0%～54.8%).结论北京市中老年人体质指数与总死亡呈U型相关;心脑血管疾病仍是目前影响人们健康的最主要疾病,其死亡危险性随BMI的增加而增加.     

上海市男性饮酒与死亡关系的前瞻性研究

目的　探讨饮酒与上海市市区中老年男性死亡的关系。方法　自 1986年 1月～ 1989年 9月调查上海市区 4 5～ 6 4岁男性居民 182 4 4人 ,每年上门随访一次 ;用COX比例风险模型计算相对危险度。结果　至 2 0 0 2年度随访结束 ,全队列共随访 2 35 76 2人年 ,人均随访 12 .9年。在此期间共死亡 336 5人 ,其中恶性肿瘤死亡 1381人。在调整年龄、吸烟情况及教育程度后 ,相对于不饮酒者每天饮酒酒精量 <15 g和 15～ 2 9g者总死亡相对危险度 (RR)分别为 0 .80 (95 %CI:0 .72～ 0 .89)和 0 .87(95 %CI :0 .78～ 0 .97) ,每天饮酒酒精量 90 g及以上者RR为 1.2 5 (95 %CI:1.0 4～ 1.5 1)。少量饮酒者缺血性心脏病和慢性阻塞性肺部疾病死亡危险性显著降低。每天饮酒酒精量 70 g及以上者食管癌、结直肠癌、脑血管病死亡危险性显著升高 ,RR分别为 5 .0 8,2 .5 7和 1.5 7,肝硬化死亡危险性在每天饮酒酒精量 30 g及以上者中也显著上升 ,RR为 1.89。 结论　少量饮酒会降低中老年男性总死亡危险性 ,大量饮酒则会增加中老年男性食管癌、结直肠癌、脑血管病及肝硬化的死亡危险性。     

中老年男性肥胖流行特征及其与慢性病的关系

目的 了解上海市中老年男性肥胖的流行现状及其与慢性病的关系.方法 利用上海市男性健康队列研究的基线调查资料.研究对象为上海市某区8个街道40～74岁的中老年男性,2002-2006年期间共调查61 500人.采用体重指数(BMI)和腰围臀围比(WHR)作为肥胖的测量指标.利用非条件logistic回归模型分析肥胖和各种慢性病之间的关系.结果 被访者超重、肥胖和向心性肥胖的标化患病率分别为36.8%、7.7%和49.7%.在所有被访者中,66.7%患有一种及以上慢性疾病.高血压标化患病率(26.5%)居首位.分别调整WHR和BMI,高血压、冠心病、胆结石、泌尿道结石、中风的患病率随BMI和WHR的增高而上升.与正常BMI组相比,肥胖组患5种疾病的OR值为1.16～3.13;WHR最大组与最小组相比,5种疾病的OR值为1.20～1.69.趋势检验P值均＜0.05.糖尿病与WHR呈正相关,WHR最大组的患病率是最小组2.40倍(95%CI:2.14～2.70),而糖尿病与BMI无关.慢性阻塞性肺病的患病率随BMI增高而下降,肥胖组与正常BMI组相比,OR=0.87(95%CI:0.77～0.98);而WHR结果 则相反,WHR最大组的OR值为最小组的1.26倍(95%CI:1.14～1.40).结论 高血压、胆结石、泌尿道结石、心脑血管疾病在肥胖男性中患病率较高.糖尿病患病率与向心性肥胖呈正相关.     

妊娠前体重与早产危险性的关系

目的:评估妊娠前体重对早产危险性的影响。方法:根据产前及分娩监护数据,选取2002~2007年在该院连续分娩符合标准的孕妇9 246例,并根据妊娠前BMI分为低体重组(BMI<18.5 kg/m2)、正常体重组(BMI 18.5~24.9 kg/m2)、超重组(BMI 25~29.9 kg/m2)、肥胖组(BMI≥30 kg/m2)。分析各组早产率,评价孕前体重对早产危险性的影响。结果:低体重组妊娠后早产的发生率为(22.9%),早产率和危险性均高于其他各组(RR=2.90,P<0.05)。肥胖组早产率为8.8%,早产危险性与正常体重组相似(P>0.05),但高于超重组(P<0.05)。结论:妊娠前BMI较低者孕期发生早产的危险性增加。     

接尘、吸烟者死亡危险度比较的前瞻性队列研究

目的 比较接尘、吸烟对死亡的影响。方法 以1989～1992年广州市实施并建立的职工职业健康监护档案为基础资料，选年龄≥30岁的80987名接尘和无接尘职工为研究对象，进行前瞻性队列研究。结果 (1)队列平均43．5岁，主要为工人、中学文化程度、已婚，接尘率16．3％，吸烟率43．7％，饮酒率335%。(2)队列平均随访8年，失访35人，死亡1539人，以恶性肿瘤死亡为主。(3)调整相关混杂因素后，全死因、恶性肿瘤、心脑血管疾病等死亡相对危险度(RR)，接尘者和吸烟者基本一致，但鼻咽癌、呼吸系统疾病死亡RR值，接尘者高于吸烟者，而肺癌、胃癌死亡RR值，吸烟者分别是接尘者的2．2倍和1．5倍；接尘可协同吸烟致死亡危险性明显增加。(4)男性总死因、恶性肿瘤和呼吸系统疾病死亡RR值，矽尘接触者高于吸烟者，心脑血管疾病死亡RR值，木尘接触者也高于吸烟者。(5)人群死亡归因危险度百分比(PARP)吸烟者是接尘者的2．5倍。(6)男吸烟者全死因、恶性肿瘤、肺癌、胃癌的死亡危险随日吸烟量、烟龄的增加而明显递增，冠心病、呼吸系统疾病的死亡危险则分别随日吸烟量、烟龄的增加而增加。结论 接尘、吸烟者死亡RR值基本一致，接尘与吸烟存在协同作用，某些死因死亡危险吸烟者较明显，某些接尘者较明显；吸烟者PARP较接尘者高；吸烟与死亡危险存在明显的剂量效应关系。     

北京市中老年人体质指数与死亡的关系

目的：探讨北京市中老年人体质指数（BMI）与死亡的关系，方法：采用前瞻队列研究方法，于1991年对北京市40岁以上的自然人群共6209人进行基线危险因素调查后，并随访至1999年12月，对在随访期间发生的所有死亡病例按ICD－9编码进行登记，并在个体水平对BMI与总死亡及几种主要死因的关系进行分析。结果：近10年北京市中老年人前5位主要死因依次为心脑血管疾病，肺心病，消化道肿瘤，不明原因突然死亡，肺癌，其死亡构成比分别为33．3％，13．8％，11．2％，7．4％，5．6％，人群总死亡率及不吸烟者总死亡率均以BMI值23．6－26．2组最小，以此BMI组为参照，BMI＜21．2组上述二组人群总死亡的RR值分别为1．7和1．9，在BMI≥26．2组以上二组人群总死亡的RR值分别为1．3和1．5，BMI与心血管病死亡呈正关联，BMI≥26.2组较BMI＜21．2组心血管病死亡的RR值为1．2，BMI与肺心病，消化道肿瘤，肺癌，肺炎及不明原因突然死亡分别均呈U型关系，均以BMI值23．6－26．2组死亡率最低，与此BMI组相比，BMI＜21．2组因上述5种疾病死亡的RR值分别为14．8，1．1，5．6，2．4和2．6，BMI≥26．2组因上述5种疾病死亡的RR值分别为3．0，1．9，3．7，2．2和1．5，各BMI组均以心血管病死亡构成比最大（28．0％－54．8％），结论：北京市中老年人体质指数与总死亡呈U型关系；心脑血管疾病仍是目前影响人们健康的最主要疾病，其死亡危险性随BMI的增加而增加。     

体质指数与总死亡率关系的Meta分析

目的采用Meta分析方法定量综合国内外前瞻性研究中不同水平体质指数(body mass index,BMI)与总死亡率关系。方法以体质指数、超重、肥胖、死亡率、队列研究、前瞻性研究及随访研究为主题词和关键词联合检索PubMed和中国期刊网全文数据库(CNKI),查找相关文献。合格的文献限定于探讨普通人群BMI与总死亡率关系的前瞻性研究,BMI分组数≥6,且报道了各组死亡的相对危险度(RR)及95%可信区间(95%CI)。结果共纳入32篇文献,含54个队列研究(总人数:7 910 932人,死亡数:1 376 997人)。男女合并发现,BMI和总死亡风险呈U形关系,总死亡风险最低时的BMI为23.0~24.9 kg/m2。与此对照,其他BMI组总死亡风险RR(95%CI)分别为:<18.5 kg/m2:1.53(1.49~1.57);18.5~20.9 kg/m2:1.09(1.07~1.11);21.0~22.9 kg/m2:1.06(1.04~1.08);25.0~26.9 kg/m2:1.01(1.00~1.03);27.0~29.9 kg/m2:1.11(1.10~1.12);30.0~34.9 kg/...     

BMI与恶性肿瘤发病风险的前瞻性队列研究

目的利用大规模人群队列研究,探讨BMI与恶性肿瘤发病的关联性及其强度。方法采用2006年开滦集团体检人群队列(收集基线调查时人口学、生活方式和身高、体重等测量指标信息).通过主动和被动随访相结合方式,收集肿瘤发病、死亡等结局信息。排除随访时问<1年的新发病例后,采用多因素Cox比例风险回归模型分析低体重、超重和肥胖与肿瘤发病的风险比(HR)和95%CI,调整变量包括年龄、受教育程度、吸烟、饮酒和HBsAg(仅在肝癌中调整)：对男性肺癌、肝癌和女性乳腺癌分别按吸烟、HBsAg和绝经状态分层后纳入模型重新分析。结果至2011年12月31 Et,随访人群纳入队列133 273人,其中男性106 630人(80.0l%)、女性26 643人(19.99%),共随访570 531.02人年,平均随访时间为4.28年。男性低体重(BMI<18.5kg／m2)2 387人(2.24%),正常体重(BMI 18.5～23.9 kg／m2)45 090人(42.29%),超重(BMI 24.0-27.9 kg／m2)43 774人(41.05%),肥胖(BMI≥28.0 kg／m2)15 379人(14.42%);女性低体重858人(3.22%),正常体重14 037人(52.69%),超重8 507人(31.93%),肥胖3 241人(12.16%)。共收集肿瘤新发病例1 647例,其中男性1 348例,女性299例。多因素Cox比例风险回归模型分析表明,与正常体重者相比,男性低体重者胃癌(a／／R=3.82,95%CI：1.97。7.38)和肝癌(棚月=3.00,95%C1：1.36～6.65)的发病风险增加;男性肥胖(aHR=2.75,95%C1：1.25.6.06)和超重(a／／R=1.98,95%CI：1.03,3.82)者结肠癌发病风险增加;男性膀胱癌病例中,超重为保护性因素(aHR=0.44,95%CI：0.23-0,84);男性肺癌病例中,超重和肥胖均为保护性因素(超重：aHR=0.59,95%Cl：O.46一O.76;肥胖：aHR=0.64,95%CI：O.44。O.92)。而较之体重正常女性,女性肥胖者乳腺癌(aHR=1.86,95%C1：1.05～3.31)的发病风险增加：分层分析显示：刘‘于男性肺癌,超重对不吸烟者和吸烟者均起保护作用(小吸烟者：aHR=0.50,95%C1：O.35-0.72;吸烟者：aHR=0.70,95%CI：0.50一O.98),肥胖仅对男性不吸烟者起保护作用(a／／R=0 57,95%CI：O.33～O.97),而男性吸烟者与肺癌发病风险不存在相关性(aHR=0.72,95%C1：0.43～1.21)。按女性绝经状态分层后,肥胖增加了绝经后乳腺癌的发病风险(aHR=1.97,95%CI：1.01～3.82),而与绝经前乳腺癌的发病风险之间的关联无统计学意义：结论BMI与恶性肿瘤发病风险的相关性因肿瘤不同而存在差异。低体重与男性胃癌和肝癌的发病风险存在相关性,肥胖与男性结肠癌、女性绝经后乳腺癌和卵巢癌的发病风险存在相关性,而超重可能刘‘于男性肺癌和膀胱癌发病起到保护作用,肥胖可能对于非吸烟男性肺癌发病起到保护作用。     

体重指数与死亡的前瞻性研究

目的：探讨不同体重指数（BMI）水平与总死亡及不同死因死亡的关系。方法;1982－1985年在我国不同地区的10组人群中（年龄35－39岁）进行心血管病危险因素调查,并对研究对象中无脑卒中、无心肌梗死及无恶性肿瘤史的30560人（男性15723人,女性14837人）,随访至1999－2000年,登记各种死亡的发生情况。结果：在平均15．2年的随访中,共死亡3212例,其中冠心病和脑卒中共死亡676例,恶性肿瘤死亡1281例,其他原因死亡1255例。用Cox比例风险回归模型（调整年龄、性别0估计低BMI组（BMI＜18．5）、正常BMI组（BMI为18．5－23．9）、超重组（BMI为24－27．9）和肥胖组（BMI≥28）总死亡的相对危险分别为1．21,1．00,0．901,1．12,呈“U”形关系,当同时剔除前5年死亡病例及吸烟者后,低BMI组死亡的相对危险降低,而肥胖组增加,正常BMI组的相对危险最小。 随着BMI水平的上升,冠心病和脑卒中死亡的相对危险增加,恶性肿瘤死亡的相对危险降低,其他原因死亡的相对危险与BMI水平呈“U”形关系,当剔除早期死亡病例及吸烟者后,这些趋势依然存在。结论：BMI在正常范围内,总死亡的相对危险较低,且冠心病和脑卒中死亡,恶性肿瘤死亡及其它原因死亡的 综合风险也处于相对较低水平,有着重要的公共卫生学意义。     

Body Mass Index and Mortality in a Prospectively Studied Cohort of Scandinavian Women: The Women’s Lifestyle and Health Cohort Study

Overweight and obesity increase the risk of numerous chronic diseases, including several forms of cancer. However, the association between excess body weight and all-cause mortality among young and middle-aged women is incompletely known, and the impact of menopausal status on the association has hardly been investigated. We studied prospectively a cohort comprising a population sample of 102,446 women from Norway and Sweden aged 30–50 years when they answered an extensive questionnaire in 1991/1992. During follow-up through year 2000, 1187 women in the cohort died. We used Cox proportional hazard models to estimate multivariate Hazard rate ratios (HRR) with 95% confidence intervals (CI) of death in relation to body mass index (BMI, weight (kg)/height (m²)) at start of follow-up. Both in age-adjusted models and in models adjusting for several variables (including smoking and physical activity) mortality increased with increasing BMI among premenopausal women, whereas a U-shaped relationship was seen among the postmenopausal women. Among premenopausal women obesity (BMI 30.0) doubled the mortality (HRR = 2.2, 95% CI: 1.7–3.0) when compared to women of normal weight (BMI 18.5–24.9), whilst the association was modest after menopause. Although we had limited power to analyze women who were underweight (BMI<18.5), an excess mortality of about 50% was seen among postmenopausal women. No excess risk was found for underweight premenopausal women. The data indicate that the rapidly growing prevalence of obesity in many Western countries will substantially increase premature deaths among young women.     

Eligibility for obesity treatment and risk of mortality in men

OBJECTIVE: To evaluate the risk of all-cause and cardiovascular disease (CVD) mortality associated with each outcome of the NIH obesity treatment algorithm and to examine the effects of cardiorespiratory fitness on the risk of mortality associated with these outcomes. RESEARCH METHODS AND PROCEDURES: The NIH obesity treatment algorithm was applied to 18,666 men (20 to 64 years of age) from the Aerobics Center Longitudinal Study in Dallas, TX, examined between 1979 and 1995. Risk of all-cause and CVD mortality was assessed using Cox proportional hazards regression. RESULTS: A total of 7029 men (37.7%) met the criteria for needing weight loss treatment [overweight (BMI = 25 to 29.9 kg/m2 or WC > 102 cm) with > or =2 CVD risk factors or obese (BMI > or = 30 kg/m2)]. Mortality surveillance through 1996 identified 435 deaths (151 from CVD) during 191,364 man-years of follow-up. Compared with the normal weight reference group, the hazard ratios (95% confidence interval) for death from all causes were 0.63 (0.45 to 0.88), 1.23 (0.98 to 1.54), 1.05 (0.60 to 1.85), and 1.71 (1.64 to 2.31) for men who were overweight with <2 CVD risk factors, overweight with > or = 2 CVD risk factors, obese with <2 CVD risk factors, and obese with > or =2 CVD risk factors, respectively. Corresponding hazard ratios for CVD mortality were 0.72 (0.38 to 1.37), 1.67 (1.12 to 2.50), 1.69 (0.67 to 4.30), and 3.31 (2.07 to 5.30). Including physical fitness as a covariate significantly attenuated all risk estimates. DISCUSSION: The NIH obesity treatment algorithm is useful in identifying men at increased risk of premature mortality; however, including an assessment of fitness would help improve risk stratification among all groups of patients.     

体重指数、腰围和高龄老年人死亡风险的关联

目的 分析体重指数、腰围与高龄老年人死亡风险的关联,为完善高龄老人的体重管理提供科学依据。方法 采用中国老年人健康长寿影响因素调查（Chinese Longitudinal Healthy Longevity Survey, CLHLS）2011—2018队列数据库4 508例样本,暴露变量为体重指数（body mass index, BMI）和腰围（waist circumference, WC）,结局为死亡。采用Cox比例风险回归模型分析体重指数、腰围和高龄老年人死亡风险的关联。结果 中位随访时间为3.08年,死亡3 416人。按照BMI分类,体重过轻对高龄老年人死亡风险最大（HR=1.31,95%CI:1.19～1.43）,超重是老年人死亡风险的保护因素（HR=0.85,95%CI:0.74～0.98）。按照WC分类,中心型肥胖是老年人死亡风险保护因素(HR=0.84,95%CI:0.76～0.93)。BMI和WC构建的综合体重表型结果显示,BMI超重合并腰围肥胖是老年人死亡风险的保护因素（HR=0.82,95%CI:0.69～0.97）,而BMI过轻合并腰围肥胖是老年人死亡风险...     

Body mass index and mortality among US male physicians

PURPOSE: To assess the relationship between body mass index and mortality in a population homogeneous in educational attainment and socioeconomic status. METHODS: We analyzed the association between body mass index (BMI) and both all-cause and cause-specific mortality among 85,078 men aged 40 to 84 years from the Physicians' Health Study enrollment cohort. RESULTS: During 5 years of follow-up, we documented 2856 deaths (including 1212 due to cardiovascular diseases and 891 due to cancer). In age-adjusted analyses, we observed a U-shaped relation between BMI and all-cause mortality; among men who never smoked a linear relation was observed with no increase in mortality among leaner men (P for trend, <0.001). Among never smokers, in multivariate analyses adjusted for age, alcohol intake, and physical activity, the relative risks of all-cause mortality increased in a stepwise fashion with increasing BMI. Excluding the first 2 years of follow-up further strengthened the association (multivariate relative risks, from BMI<20 to > or = 30 kg/m2, were 0.93, 1.00, 1.00, 1.16, 1.45, and 1.71 [P for trend, <0.001]). In all age strata (40-54, 55-69, and 70-84 years), never smokers with BMIs of 30 or greater had approximately a 70% increased risk of death compared with the referent group (BMI 22.5-24.9). Higher levels of BMI were also strongly related to increased risk of cardiovascular mortality, regardless of physical activity level (P for trend, <0.01). CONCLUSIONS: All-cause and cardiovascular mortality was directly related to BMI among middle-aged and elderly men. Advancing age did not attenuate the increased risk of death associated with obesity. Lean men (BMI<20) did not have excess mortality, regardless of age.     

Age and race impact the association between BMI and CVD mortality in women

OBJECTIVES: In previous studies, we have shown that obesity is associated with increased cardiovascular disease (CVD) mortality in white women but not in black women. Earlier research suggests that body mass index (BMI) has a greater effect on CVD mortality in younger white females than older white females, whereas this relationship in black women is not as clear. This study examines the effect of age on the association of BMI to CVD in black and white women. METHODS: The Black Pooling Project includes data on 2,843 black women with 50,464 person-years of follow-up, and 12,739 white women with 214,606 person-years of follow-up. A Cox proportional hazards model was used to examine the association between BMI and CVD mortality for specific age/race groups. The younger group was < 60 years of age and the older group was > 60 years of age. RESULTS: In younger white women, the relative risk (95% confidence interval [CI]) for CVD mortality was significant in obese women (BMI > 30 kg/m2) vs. women of normal weight (BMI 18.5-24.9 kg/m2) (1.59 [CI 1.20, 2.09]). Similarly, in older white women, the relative risk for CVD mortality in obese women vs. women of normal weight was significant (1.21 [CI 1.04, 1.41]). There were no such associations for black women. Overweight (BMI 25-29.9 kg/m2) was not associated with increased risk in black or white women. CONCLUSION: These findings indicate that obesity is associated with a significantly greater risk of CVD mortality among white women, with the strongest association among white women < 60 years of age.     

Joint association of adiposity and smoking with mortality among U.S. adults

ObjectiveAssessment of death risk for different combinations of body-mass index (BMI) and smoking status among a nationally representative cohort of U.S. adults.MethodA total of 210,818 participants of the National Health Interview Surveys 1987–1995 were followed through 2006. Relative risks of death from all causes, cardiovascular disease (CVD), and cancer were estimated for each joint group of smoking and BMI by age, using Cox models with the adjustment for age, gender, education, and race.ResultsAcross all the joint groups of BMI and smoking, extremely obese and underweight current smokers were the two groups having the highest risks of death from all causes, CVD, and cancer. For example, among middle-aged adults, the hazard ratios of death from all causes were 4.47 (95% confidence interval [CI], 3.59–5.57) and 5.28 (4.38–6.37) for extremely obese and underweight current smokers, respectively. Overweight was associated with a higher risk of death in middle-aged never smokers, but not in the elderly or in current smokers.ConclusionThe coexistence of obesity or underweight with current smoking was associated with an especially large risk of death and the associations of BMI with mortality varied by smoking status, age, and cause of death.     

Lifestyle and sociodemographic risk factors for death among middle-aged and elderly residents in japan from a five-year follow-up cohort study

To examine the relationship between lifestyle and sociodemographic risk factors and mortality, a population-based prospective cohort study was conducted in two areas of Gunma Prefecture, Japan, and a cohort consisting of 11,565 subjects aged 40-69 at baseline in 1993 was followed. During the five-year follow-up period, 201 men and 103 women died. The relative risks (RRs) of risk factors were estimated by the Cox proportional-hazards model. Significant RRs with multivariate adjustment for all-cause mortality was observed for body mass index (BMI). The curve for the relationship between BMI and all-cause mortality was L-shaped in men and U-shaped in women, with the lowest RRs at a BMI of 22-25 in both men and women. Other significant RRs for all-cause mortality were observed for obesity in the subjects' 30's in both men and women (RR: 2.42 and RR: 2.75), poor perceived health status in men (RR: 4.55), and having had a health examination in the past three years in both men and women (RR: 0.49 and RR: 0.46). These results suggested that increased risk of death was independently associated with a lower BMI, obesity in the subjects' 30's, and not undergoing health examinations, among both men and women, and poor perceived health status among men.