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John Hyer University of Georgia College of Pharmacy Doctor of Pharmacy Candidate, 2012

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John Hyer University of Georgia College of Pharmacy Doctor of Pharmacy Candidate, 2012

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  1. Obesity, Race, and Risk for Death or Functional Decline Among Medicare BeneficiariesChristina C. Wee, MD, MPH; Karen W. Huskey, MPH; Long H. Ngo, PhD; Angela Fowler-Brown, MD, MPH; Suzanne G. Leveille, RN, PhD; Murray A. Mittlemen, MD, DrPH; and Ellen P. McCarthy, Phd, MPHAnnals of Internal Medicine John Hyer University of Georgia College of Pharmacy Doctor of Pharmacy Candidate, 2012

  2. Study: • Objective: To examine and compare the relationship between obesity and all-cause mortality and functional decline among older U.S. adults. • Design: Longitudinal cohort study.

  3. Methods • Study Sample: 20,975 community-dwelling participants in the Medicare current beneficiary surveys • Secondary analysis of data from the 1994 to 2000 Medicare Current Beneficiaries Surveys, linked to survey results through 22 April 2008 for mortality • Nationally representative survey of the health and health care experiences of Medicare beneficiaries • Baseline information (demographics, health status) • Respondents were interviewed 3 times a year over 4 years, total of 12 interviews

  4. Methods • All cause mortality • Initial baseline interview until death or 22 April 2008 • Functional Status and Disability • At baseline and annually for 2 years therafter • Six Activities of daily living (ADLs) and Six Instrumental Activities of Daily Living (IADLs)

  5. Methods • Functional Status and Disability • Respondents who reported difficulty with at least ONE ADL or IADL • Classified as having disability • Severe disability defined as difficulty with 3 or more ADLs or IADLs

  6. Methods • Body weight • Self reported baseline height and weight • Subdivided normal and overweight categories to explore BMI (kg/m2) range of lowest risk • Underweight (<18.5) • Normal weight 1 (18.5 to 21.9) • Normal weight 2 (22 to 24.9) • Overweight 1 (25 to 27.4) • Overweight 2 (27.5 to 29.9) • Obese class 1 or mild obesity (30 to 34.9) • Obese class 2 to 3 or moderate to severe obesity • Greater or equal to 35

  7. Statistical Analysis • Bivariate statistics used to characterize the sample and outcome measure in terms of BMI and other factors • Wald chi-square test to evaluate for differences in proportions • t-test to evaluate for differences in continuous variables • Relationship between BMI and all-cause mortality • Calc race- and sex-specific mortality rates • Standardized for age and smoking status • 95% confidence intervals (CIs) generated by bootstrapping* • *simulate repeated observations from an unknown population using the obtained sample as a basis.

  8. Results • Sample characteristics • 11,093 (48%) died during the 14 year follow-up for mortality • 21% died within 5 years • African Americans were more likely to be obese • Unadjusted mortality rates were significantly higher in normal-weight adults than in those with a higher BMI

  9. Results • BMI, Race, and Mortality • For all groups: respondents with the lowest mortality had BMIs in the overweight range • Mortality rate was highest in the groups with the lowest and highest BMIs • Comparing BMI of 22 to 24.9 to higher BMIs did not have a higher hazard of death, except for those with a BMI of 35 or greater • True for women and white men • In African Americans, a higher BMI did not confer higher mortality risk at any level

  10. Results • Lowest risk of death associated with a BMI of 25 to 27.4 • Test for trend for the relationship between BMI and mortality was significant for white men (P=0.001) and women (P<0.001) • Test for trend was not significant for African American men and women

  11. Results • BMI, Race, and Disability • 23% of the overall sample had ADL disability and 43% had IADL disability at baseline • African American men and women had statistically higher baseline prevalence of ADL and IADL disability than in white persons in almost every BMI category • Those without severe disability at baseline • 17% developed new or worsening ADL disability, • 26% developed new or worsening IADL disability at 2 years • BMI was significantly associated with disability in all groups except African American men

  12. Authors’ Conclusions • Obesity (as measured by BMI) seems to confer added mortality risks in elderly persons only when BMI is 35kg/m2 • Modest elevations in BMIs above normal range seem to predict functional decline in a 2-year period • There was not a statistically significant different between white and black adults • Although risk estimates for ADL disability associated with obesity seemed lower in African American than in white adults

  13. Strengths Limitations • Large study population • Long study follow up period for mortality • Tested for ADLs and IADLs • Ability to separate race • Relatively small African American sample size • Short study period for ADL and IADL • BMI is a poor measure of adiposity as persons age, lose muscle mass, and gain adipose tissue • Self reported height and weight • Use of surveys • Is advising weight loss in older adults warranted

  14. References • Well, CC, et al. Obesity, race, and risk for death or functional decline among Medicare beneficiaries. Annals. 2011 May; Vol 154, num 10: 645-654.

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