Research ArticleOriginal Research

Body Mass Index, Diabetes, Hypertension, and Short-Term Mortality: A Population-Based Observational Study, 2000–2006

Anthony Jerant and Peter Franks
The Journal of the American Board of Family Medicine July 2012, 25 (4) 422-431; DOI: https://doi.org/10.3122/jabfm.2012.04.110289

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Adjusted mortality hazard among individuals without and with diabetes, by body mass index category. Bars around point estimates indicate 95% confidence interval. Analyses have been adjusted for sociodemographic characteristics (age, sex, race/ethnicity, education, household income, health insurance status, urban versus rural residence, and Census region) and Medical Expenditure Panel Survey response year. BMI, body mass index (kg/m2); DM, diabetes mellitus.

Tables

  • Table 1. Characteristics of the Study Sample by Body Mass Index Category
    CharacteristicBody Mass Index CategoryTotal (N = 50,994)
    <20 kg/m2 (n = 2673; 5.6%)20–<25 kg/m2 (n = 15,612; 32.5%)25–<30 kg/m2 (n = 18,299; 35.9%)30–<35 kg/m2 (n = 9,098; 16.6%)≥35 kg/m2 (n = 5312; 9.4%)
    Age (years)
        18–2932.1 (1.1)22.5 (0.5)15.6 (0.4)13.9 (0.4)13.9 (0.6)18.3 (0.3)
        30–3919.4 (0.9)20.5 (0.4)19.3 (0.4)19.7 (0.5)21.3 (0.7)19.9 (0.2)
        40–4915.7 (0.8)19.7 (0.4)22.2 (0.4)23.4 (0.5)24.7 (0.7)21.4 (0.3)
        50–599.9 (0.6)14.8 (0.4)18.0 (0.3)19.8 (0.5)21.1 (0.7)17.1 (0.2)
        60–697.0 (0.5)9.2 (0.3)11.9 (0.3)12.3 (0.4)11.4 (0.5)10.8 (0.2)
        ≥7015.9 (0.9)13.3 (0.4)12.9(0.4)11.0 (0.4)7.6 (0.5)12.4 (0.3)
    Female74.6 (1.1)59.2 (0.4)42.0 (0.4)48.9 (0.6)60.8 (0.8)52.3 (0.2)
    Race/ethnicity
        White75.1 (1.0)74.5 (0.7)72.8 (0.8)69.5 (0.9)67.2 (1.2)72.4 (0.7)
        Hispanic7.5 (0.6)9.3 (0.4)12.2 (0.6)13.2 (0.8)11.7 (0.9)11.1 (0.5)
        Black6.9 (0.6)8.0 (0.4)9.8 (0.4)13.1 (0.6)17.7 (1.0)10.4 (0.4)
        Other10.5 (0.8)8.2 (0.4)5.2 (0.3)4.1 (0.3)3.4 (0.4)6.1 (0.3)
    Education
        Less than HS6.2 (0.5)5.5 (0.2)7.3 (0.3)7.3 (0.3)6.6 (0.4)6.6 (0.2)
        Some HS11.0 (0.6)9.5 (0.3)10.5 (0.3)12.9 (0.4)14.4 (0.6)10.9 (0.2)
        HS graduate31.5 (1.2)30.4 (0.5)33.6 (0.5)36.3 (0.7)37.0 (1.0)33.2 (0.4)
        Some college23.0 (1.1)23.7 (0.4)21.8 (0.4)23.5 (0.5)25.8 (0.9)23.2 (0.3)
        College graduate27.9 (1.3)30.9 (0.7)26.8 (0.6)20.0 (0.6)16.2 (0.8)26.1 (0.5)
    Income (% FPL)
        <10013.3 (0.8)9.9 (0.3)8.9 (0.3)10.7 (0.4)14.0 (0.6)10.3 (0.2)
        100-<1254.8 (0.5)3.6 (0.2)4.0 (0.2)4.1 (0.3)4.8 (0.3)4.0 (0.1)
        125-<20015.0 (0.8)12.8 (0.3)13.1 (0.3)13.3 (0.4)15.2 (0.6)13.3 (0.3)
        200-<40030.2 (1.0)30.3 (0.6)30.5 (0.4)32.4 (0.6)34.5 (0.9)31.1 (0.3)
        ≥40036.7 (1.3)43.3 (0.7)43.5 (0.6)39.4 (0.8)31.5 (1.0)41.2 (0.6)
    Health insurance
        Private69.9 (1.1)75.1 (0.5)74.7 (0.5)73.9 (0.7)68.6 (0.9)73.9 (0.5)
        Public16.1 (0.8)12.3 (0.4)12.9 (0.4)14.1 (0.5)17.8 (0.7)13.6 (0.3)
        None14.0 (0.8)12.6 (0.4)12.3 (0.4)12.0 (0.5)13.6 (0.6)12.6 (0.3)
    Urban residence81.8 (1.2)82.8 (0.9)81.2 (0.9)79.4 (1.0)77.9 (1.3)81.2 (0.9)
    Census region
        Northeast17.9 (1.2)19.7 (1.0)19.7 (1.0)19.1 (1.0)17.6 (1.0)16.2 (1.1)
        Midwest23.1 (1.2)22.5 (1.0)23.3 (1.0)23.2 (1.1)24.9 (1.2)23.2 (0.9)
        South36.1 (1.7)34.8 (1.4)36.0 (1.3)38.9 (1.5)41.5 (1.5)36.6 (1.3)
        West22.9 (1.7)23.0 (1.4)21.6 (1.4)20.3 (1.3)17.4 (1.6)21.5 (1.3)
    Smoker29.8 (1.0)24.0 (0.4)21.6 (0.4)20.5 (0.5)19.5 (0.7)22.5 (0.3)
    Diabetes1.9 (0.3)3.5 (0.2)6.4 (0.2)11.2 (0.3)18.2 (0.6)7.1 (0.2)
    Hypertension12.3 (0.7)17.0 (0.4)26.9 (0.5)36.7 (0.6)44.4 (0.9)26.1 (0.3)

    • Values provided are population-weighted percentages (standard errors in parentheses).

    • FPL, Federal Poverty Level; HS, high school.

  • Table 2. Adjusted* Mortality by Body Mass Index Category, without and with Adjustment for Diabetes and Hypertension
    Model VariablesModel without Diabetes or HypertensionModel with Diabetes or Hypertension
    HR (95% CI)PHR (95% CI)P
    Age1.09 (1.08–1.10)<.0011.09 (1.08–1.09)<.001
    Female0.54 (0.47–0.62)<.0010.54 (0.47–0.62)<.001
    Race/ethnicity (reference = white)
        Hispanic0.65 (0.54–0.78)<.0010.62 (0.52–0.75)<.001
        Black1.26 (1.04–1.52).021.18 (0.98–1.42).09
        Other1.05 (0.80–1.39).721.04 (0.79–1.37).77
    Education (reference = <high school)
        Some high school0.99 (0.83–1.18).910.98 (0.82–1.17).85
        High school graduate0.83 (0.71–0.97).020.85 (0.73–0.99).03
        Some college0.76 (0.61–0.93).0090.78 (0.63–0.96).02
        College graduate0.64 (0.52–0.80)<.0010.67 (0.54–0.83)<.001
    Income, % FPL (reference = <100% FPL)
        100-<1251.02 (0.76–1.37).871.03 (0.77–1.37).84
        125-<2000.98 (0.80–1.20).840.97 (0.80–1.19).79
        200-<4000.88 (0.74–1.05).160.89 (0.74–1.06).19
        ≥4000.77 (0.62–0.96).020.78 (0.63–0.97).02
    Health insurance (reference = private)
        Public1.30 (1.12–1.51).0011.26 (1.08–1.46).003
        None1.08 (0.77–1.49).661.13 (0.81–1.58).46
    Urban residence0.89 (0.78–1.01).070.89 (0.78–1.02).09
    Census region (reference = Northeast)
        Midwest0.98 (0.82–1.17).800.99 (0.83–1.18).88
        South1.20 (1.02–1.40).021.18 (1.01–1.36).03
        West1.14 (0.96–1.35).151.13 (0.95–1.34).16
    Smoker1.71 (1.49–1.96)<.0011.75 (1.52–2.00)<.001
    Diabetes——1.80 (1.56–2.08)<.001
    Hypertension——1.22 (1.07–1.38).003
    BMI category, kg/m2 (reference = 20–<25 kg/m2)
        <201.78 (1.44–2.20)<.0011.90 (1.54–2.34)<.001
        25-<300.80 (0.69–0.92).0020.75 (0.65–0.87)<.001
        30-<350.93 (0.78–1.11).440.81 (0.68–0.97).02
        ≥351.26 (1.00–1.59).051.02 (0.80–1.30).89

    • ↵* Analyses also adjusted for Medical Expenditure Panel Survey response year.

    • BMI, body mass index; CI, confidence interval; FPL, Federal Poverty Level; HR, hazard ratio.

  • Table 3. Adjusted* Relationship Between Body Mass Index Category and Mortality, Including Interaction Between Body Mass Index and Diabetes
    Model VariablesHR (95% CI)P
    Age1.09 (1.08–1.09)<.001
    Female0.54 (0.48–0.62)<.001
    Race/ethnicity (reference = white)
        Hispanic0.61 (0.50–0.74)<.001
        Black1.19 (0.98–1.43).07
        Other1.04 (0.79–1.37).78
    Education (reference = <high school)
        Some high school0.98 (0.83–1.17).86
        High school graduate0.85 (0.73–0.98).03
        Some college0.77 (0.63–0.95).01
        College graduate0.66 (0.54–0.82)<.001
    Income, % FPL (reference = <100% FPL)
        100-<1251.02 (0.76–1.36).89
        125-<2000.98 (0.80–1.20).82
        200-<4000.89 (0.74–1.06).19
        ≥4000.78 (0.63–0.96).02
    Health insurance (reference = private)
        Public1.27 (1.09–1.47).002
        None1.12 (0.80–1.56).51
    Urban residence0.89 (0.78–1.02).09
    Census region (reference = Northeast)
        Midwest0.99 (0.83–1.18).90
        South1.18 (1.02–1.38).03
        West1.13 (0.95–1.34).16
    Smoker1.74 (1.51–1.99)<.001
    Diabetes2.60 (2.00–3.38)<.001
    BMI category, kg/m2 (reference = 20-<25 kg/m2)
        <202.00 (1.59–2.50)<.001
        25-<300.80 (0.68–0.95).01
        30-<350.97 (0.78–1.19).76
        ≥351.27 (0.96–1.69).10
    Diabetes (present)*BMI interaction, kg/m2
        <200.58 (0.24–1.40).22
        25-<300.73 (0.50–1.08).11
        30-<350.54 (0.36–0.81).003
        ≥350.53 (0.34–0.83).006

    • ↵* Analyses also adjusted for Medical Expenditure Panel Survey response year.

    • BMI, body mass index; CI, confidence interval; FPL, Federal Poverty Level; HR, hazard ratio.

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