Influence of socioeconomic status on the association between bodymass index and cause-specific mortality among older Japanese adults: The AGES Cohort Study
Miyo Nakade, Daisuke Takagi, Kayo Suzuki, Jun Aida, Toshiyuki Ojima, Katsunori Kondo, Hiroshi Hirai, Naoki Kondo
Preventive Medicine 77 (2015) 112-118
http://dx.doi.org/10.1016/j.ypmed.2015.05.015
Objective.Many studies have suggested a U-shaped curve for the association between body size andmortality risks, i.e., mortality risks increase in those who are both overweight and underweight. The strength of the associationsmay vary according to socioeconomic statuses (SES), as they determine levels of access to healthcare and psychosocial stresses. We investigated the modifying effects of SES on the relationship between body mass index (BMI) and mortality.
Method.We used prospective cohort data of participants in the Aichi Gerontological Evaluation Study in 2003(n=14,931),whowere 65 years or older and physically and cognitively independent at baseline, and residing in eightmunicipalities in Japan. Data on all-causesmortality andmortality from cancer, cardiovascular disease, and respiratory disease was obtained from municipal government registries.
Results. Proportional hazard regression analyses showed that, among men, the associations between overweight (BMI ? 25 kg/m2) and highermortality risks by any causewere stronger among lower incomegroups. Even adjusting for multiple confounding factors, hazard ratios (95% confidence intervals) for mortality by all causes among low income group (household income b 1.5 million yen) were 1.96 (1.02-3.73) for overweight compared with BMIs between 23.0 and 24.9, whereas they were 0.94 (0.57-1.38) among men in high income group (income N 3 million yen). The modifying effects of income were not marked among women.
Conclusion. Household income, which may directly reflect accessibility to healthcare and psychosocial stress among older Japanese men, may be an important modifying factor in the health risks attributable to overweight.