Mental-physical comorbidity in an ethnically diverse population

The relationship between mental disorders and chronic physical conditions is well established, but the possibility of ethnic group differences in mental-physical associations has seldom been investigated. This study investigated ethnic differences in associations between four physical conditions (chronic pain, cardiovascular disease, diabetes, and respiratory disease) and 12-month mood and anxiety disorders. A nationally representative face-to-face household survey was carried out in New Zealand from 2003 to 2004 with 12,992 participants aged 16 and older, achieving a response rate of 73.3%. The current study is of the subsample of 7,435 participants who were assessed for chronic physical conditions (via a standard checklist), and compares Maori, Pacific and Other New Zealanders. DSM-IV mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). The ethnic groups differed significantly in prevalences of both physical and mental disorders, but almost no ethnic differences in mental-physical associations were found. Independent of ethnicity, associations were observed between chronic pain and mood and anxiety disorders, cardiovascular disease and anxiety disorders, respiratory disease and mood and anxiety disorders. Despite differences in mental and physical health status between ethnic groups in New Zealand, mental-physical disorder associations occur with considerable consistency across the groups. These results suggest that whatever factors are conducive to the development of a mental disorder from a physical disorder (or vice versa), they are either unaffected by the cultural differences manifest in these ethnic groups, or, any cultural factors operating serve to both increase and decrease comorbidity such that they cancel each other out.     

Chronic venous disease in an ethnically diverse population: the San Diego Population Study

In a 1994-1998 cross-sectional study of a multiethnic sample of 2,211 men and women in San Diego, California, the authors estimated prevalence of the major manifestations of chronic venous disease: spider veins, varicose veins, trophic changes, and edema by visual inspection; superficial and deep functional disease (reflux or obstruction) by duplex ultrasonography; and venous thrombotic events based on history. Venous disease increased with age, and, compared with Hispanics, African Americans, and Asians, non-Hispanic Whites had more disease. Spider veins, varicose veins, superficial functional disease, and superficial thrombotic events were more common in women than men (odds ratio (OR) = 5.4, OR = 2.2, OR = 1.9, and OR = 1.9, respectively; p < 0.05), but trophic changes and deep functional disease were less common in women (OR = 0.7 for both; p < 0.05). Visible (varicose veins or trophic changes) and functional (superficial or deep) disease were closely linked; 92.0% of legs were concordant and 8.0% discordant. For legs evidencing both trophic changes and deep functional disease, the age-adjusted prevalences of edema, superficial events, and deep events were 48.2%, 11.3%, and 24.6%, respectively, compared with 1.7%, 0.6%, and 1.3% for legs visibly and functionally normal. However, visible disease did not invariably predict functional disease, or vice versa, and venous thrombotic events occurred in the absence of either.     

Body mass index and cardiovascular disease mortality in Japan: the Ohsaki Study

OBJECTIVE: Although there is a clear positive association between obesity and the incidence and severity of cardiovascular disease, the association between underweight and cardiovascular disease is unclear. The objective of this study was to examine the relation between body mass index (BMI) and cardiovascular disease in Japan, where the proportion of the population that is underweight is relatively high. METHOD: A total of 43,916 Japanese adults (21,003 men and 22,913 women) aged 40 to 79 years who had no history of cancer, ischemic heart disease (IHD), or stroke participated in the baseline survey in 1994. Hazard ratios (HR) and their 95% confidence intervals (CIs) for death due to total cardiovascular disease, all strokes, ischemic stroke, hemorrhagic stroke, and IHD were calculated according to BMI by using Cox's proportional hazards regression models. The 22.5-24.9 kg/m(2) BMI category was used as the reference category in all analyses. RESULTS: There were U-shaped associations between BMI and total cardiovascular disease, all stroke, hemorrhagic stroke, and IHD mortality, and a J-shaped association between BMI and ischemic stroke mortality. Participants with a BMI <18.5 kg/m(2) had a significantly increased risk of total cardiovascular disease, all stroke, hemorrhagic stroke, and IHD mortality, and the multivariate HR (95% CI) was 1.62 (1.19-2.19), 1.50 (1.02-2.21), 2.11 (1.07-4.17), 1.83 (1.11-3.01), respectively. CONCLUSION: Underweight was substantially associated with hemorrhagic stroke and IHD mortality in Japan, while obesity was associated with increased risk of total cardiovascular disease mortality and mortality from individual cardiovascular diseases.     

Body mass index and mortality in nonsmoking older adults: the Cardiovascular Health Study.

OBJECTIVES: This study assesses the relationship of body mass index to 5-year mortality in a cohort of 4317 nonsmoking men and women aged 65 to 100 years. METHODS: Logistic regression analyses were conducted to predict mortality as a function of baseline body mass index, adjusting for demographic, clinical, and laboratory covariates. RESULTS: There was an inverse relationship between body mass index and mortality; death rates were higher for those who weighed the least. Inclusion of covariates had trivial effects on these results. People who had lost 10% or more of their body weight since age 50 had a relatively high death rate. When that group was excluded, there was no remaining relationship between body mass index and mortality. CONCLUSIONS: The association between higher body mass index and mortality often found in middle-aged populations was not observed in this large cohort of older adults. Over-weight does not seem to be a risk factor for 5-year mortality in this age group. Rather, the risks associated with significant weight loss should be the primary concern.     

Body mass index and mortality in middle-aged Korean women

PURPOSE: We sought to evaluate the association between body mass index (BMI) and mortality in Korean women and to determine whether the association differs depending on menopausal status. METHODS: A total of 338,320 Korean women ages 40 to 64 years categorized into seven groups by BMI level were prospectively followed for mortality from approximately 1994 to 2004. RESULTS: Multivariable-adjusted analysis using Cox proportional hazards model showed a U-shaped association between BMI and all-cause deaths, with the lowest risk at BMI between approximately 25 and 26.9 kg/m2, even after excluding earlier deaths, which did not change when we did a stratified analysis according to menopausal status. A U-shaped association was observed between BMI and cancer death, and the risk associated with low BMI decreased significantly after excluding earlier cancer deaths. There was a J-shaped association between BMI and coronary heart disease (CHD) with a significantly increased risk at greater BMI (>26 kg/m2). Additional adjustment for possible biological effects of obesity (i.e., serum total cholesterol, glucose, and systolic blood pressure) changed the U-shaped association between BMI and all-causes mortality into an inverse shape and substantially reduced the size of risk for CHD death associated with high BMI level. In stratified analysis, the association between BMI and CHD was positive linear in women at premenopausal status, whereas it was U-shaped in women at postmenopausal status. CONCLUSIONS: Obesity was associated with an increased risk of mortality in both premenopausal and postmenopausal Korean women, indicating that preventive strategies to control obesity are important even in population with a relatively low mean BMI level.     

Prevalence of breast arterial calcifications in an ethnically diverse population of women

PURPOSE: Breast arterial calcifications (BAC) identified on routine mammography have been associated with coronary heart disease (CHD) risk factors including diabetes and hypertension, angiographically defined CHD, and increased cardiovascular mortality. Accumulating evidence suggests that the mammogram may be an important tool to identify women at risk for CHD, however, the epidemiology of BAC has been poorly defined and previous studies limited to white populations. METHODS: The mammograms of 1905 consecutive women (51.2% Hispanic, 25.8% white, 15.3% black, 5.4% other, 2.2% Asian, ages 35-92 years) were evaluated for the presence of BAC and the number of calcified arteries. RESULTS: The overall prevalence of BAC was 29.4% and was significantly higher for Hispanics compared with whites (34.5% vs. 24.0%, p=0.0002) and lower for Asians compared with whites (7.1% vs. 24.0%, p < 0.02). Among BAC-positive women aged 65 years or less, blacks had more calcified arteries than whites (p < 0.01). The presence of BAC increased with age (p for trend < 0.0001). In age-adjusted models, older Hispanics were more likely to be BAC-positive than whites of similar age (p < 0.02). CONCLUSION: These results indicate that BAC varies significantly by age and race/ethnicity. These findings should be taken into consideration when designing future studies of BAC and CHD.     

Body mass index, dementia, and mortality in the elderly

Objectives: To explore the association between body mass index and mortality in the elderly taking the diagnosis of dementia into account.Design: Cohort study.Setting: cohort study of aging in Medicare recipients in New York City.Participants: 1,452 elderly individuals 65 years and older of both genders.Measurements: We used proportional hazards regression for longitudinal multivariate analyses relating body mass index (BMI) and weight change to all-cause mortality.Results: There were 479 deaths during 9,974 person-years of follow-up. There were 210 cases of prevalent dementia at baseline, and 209 cases of incident dementia during follow-up. Among 1,372 persons with BMI information, the lowest quartile of BMI was associated with a higher mortality risk compared to the second quartile (HR = 1.5; 95% CI: 1.1,2.0) after adjustment for age, gender, education, ethnic group, smoking, cancer, and dementia. When persons with dementia were excluded, both the lowest (HR = 1.9; 95% CI =1.3,2.6) and highest (HR = 1.6; 95% CI: 1.1,2.3) quartiles of BMI were related to higher mortality. Weight loss was related to a higher mortality risk (HR = 1.5; 95% CI: 1.2,1.9) but this association was attenuated when persons with short follow-up or persons with dementia were excluded.Conclusion: The presence of dementia does not explain the association between low BMI and higher mortality in the elderly. However, dementia may explain the association between weight loss and higher mortality.     

Body mass index and mortality: a twelve-year prospective study in Korea

The relation between body mass index (kg/m2) and noncoronary mortality is not well established. To study this relation, a population with low coronary mortality may be especially useful. We conducted a 12-year follow-up study of 235,398 Korean men 40-64 years of age. Study subjects had undergone health examinations in 1986 (baseline) and 1990. We excluded subjects with substantial weight loss during this period. There were 13,387 deaths, including 600 deaths from coronary events, between 1990 and 1998. We estimated the relation of body mass index to the risk of death after adjusting for common risk factors. There was a positive relation between body mass index and coronary mortality, but this relation was attenuated after serum total cholesterol, blood pressure, and fasting serum glucose were taken into account. A J-shaped relation with cerebrovascular mortality was also attenuated after adjustment. Even after this adjustment and exclusion of early deaths between 1990 and 1994, the relation of body mass index to all-cause (U-shaped), cancer (J-shaped), and noncancer noncoronary noncerebrovascular (inverse J-shaped) mortality remained. Both high and low body mass index were related to increased mortality among these Korean men.     

Body mass index and mortality in a middle-aged Japanese cohort

BACKGROUND: The relative risk of mortality in low and high body mass index (BMI) categories in various ethnic groups remains a controversial subject. METHODS: To examine the relationship between BMI and mortality, a population-based prospective cohort study was conducted in two areas of Gunma Prefecture, Japan, in 1993. A total of 5,554 men and 5,827 women aged 40-69 years completed a self-administered questionnaire and were followed up until the year 2000. The hazard ratios (HRs) were estimated by the Cox proportional hazards model for different BMI classes. RESULTS: During the seven year follow-up period, 329 men and 147 women died. As compared with those in the reference BMI category (22.0-24.9 kg/m(2)), men and women in the lowest BMI category (<18.5 kg/m(2)) had a HR (95% confidence interval [CI]) of death from all-causes of 2.66 (1.59-4.46) and 3.14 (1.38-7.13), respectively, and women in the highest BMI category (28.0+ kg/m(2)) had a HR of death of 3.25 (1.48-7.15), after adjusting for all possible confounding factors including smoking and after excluding deaths occurring during the first three years of follow-up. CONCLUSION: In this prospective study of a Japanese cohort consisting of subjects ranging in age from 40 to 69 years, the curve depicting the relationship between BMI and all-cause mortality was L-shaped in men and U-shaped in women.     

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.     

Body mass index and mortality in aboriginal Australians in the Northern Territory

OBJECTIVE: To assess the association between body mass index and the risk of all-cause and disease-specific mortalities in Australian Aborigines in a remote community. DESIGN: A community based cohort study. PARTICIPANTS AND SETTING: 744 Aboriginal adults aged 20 to 77 years in a remote community in Northern Territory. Eighty-seven deaths occurred during the follow-up period of 5,040.8 person-years. MEASURES: Mortality data for the period of 1992 and June 2000 were collected. Mortality rate ratios for each body mass index quartile was determined using a Cox proportional hazards model with adjustment for age, sex, and smoking and drinking status. RESULTS: An inverse relationship between BMI quartiles and the risk of all-cause, natural, and non-CVD mortality was found. Adjusted rate ratios (95% CI) of all-cause mortality were 0.92 (0.54-1.59), 0.71 (0.40-1.26) and 0.38 (0.19-0.75) for second, third and fourth BMI quartiles, respectively, with the first quartile as the reference. The fourth BMI quartile had the lowest risk of mortality with adjusted rate ratios of 0.38, 0.28, and 0.16 for deaths from all-cause, natural, and non-CVD, respectively. However, the associations between BMI and CVD and renal deaths did not reach statistical significance. CONCLUSIONS: BMI and mortality are inversely associated in Aboriginal adults in a remote community. Individuals with relatively higher BMI have a lower risk of death.     

Body mass index and mortality in asian populations: implications for obesity cut-points

Investigators have questioned whether body mass index (BMI, kg/m2) cut-points for obesity used in the United States and Europe are appropriate for Asian countries. A recent study examined the association between BMI and mortality in a population-based cohort of Japanese men and women. These and other results did not indicate a need for lower cut-points in Asians.     

Body mass index in young adulthood and cancer mortality: a retrospective cohort study

STUDY OBJECTIVE: To examine the relation between body mass index (BMI) in young adulthood and subsequent mortality from cancer. DESIGN: Cohort study. SETTING: University of Glasgow student health service. Weight and height were measured by a physician, and used to calculate BMI. PARTICIPANTS: 8335 men and 2340 women who attended the student health service while at university between 1948 and 1968, and who were followed up with the NHS central register. MAIN RESULTS: The main outcome measure was cancer mortality. Three hundred and thirty nine men and 82 women died of cancer during the follow up (mean 41 years). BMI was associated with mortality from all cancers in men and women, although it did not reach conventional statistical significance. The adjusted hazard ratio (HR) (95% CI) per 5 kg/m(2), was 1.22 (0.97 to 1.53) in men and 1.43 (0.95 to 2.16) in women. Two hundred men and 61 women died from cancers not related to smoking. The adjusted HR for mortality from these were 1.36 (1.02 to 1.82) and 1.80 (1.13 to 2.86) respectively. These results are adjusted for height, number of siblings, pulse rate, year of birth, age, smoking, birth order, number of siblings, and age at menarche in women. Site specific analyses, comparing the highest with the lowest quartile of the BMI distribution found increased risks of prostate cancer (n=28) and breast cancer among heavier subjects. No association between BMI and colorectal cancer was found. CONCLUSIONS: BMI in adolescence has lasting implications for risk of cancer mortality in later life. Future research will include measures of BMI throughout the lifecourse, to determine the period of greatest risk of obesity, in terms of cancer mortality.