BACKGROUND: Estimates of obesity-associated deaths in the United States for 1991 were published by Allison et al (JAMA 1999;282:1530-8) and subsequently for 2000 by Mokdad et al (JAMA 2004;291:1238-45). Flegal et al (JAMA 2005;293:1861-7) then published lower estimates of obesity-associated deaths for 2000. All 3 studies incorporated data from the first National Health and Nutrition Examination Survey (NHANES I). OBJECTIVE: The objective was to clarify the effects of methodologic differences between the 3 studies in estimates of obesity-associated deaths in the US population by using NHANES I hazard ratios. DESIGN: The earlier reports used imputed smoking data for much of the NHANES I sample rather than the available reported data and applied a method of calculating attributable fractions that did not adjust for the effects of age, sex, and smoking on mortality in the target US population and did not account for effect modification by age. The effects of these and other methodologic factors were examined. RESULTS: The NHANES I hazard ratios in the earlier reports were too low, probably because of the imputed smoking data. The low hazard ratios obscured the magnitude and direction of the bias arising from the incompletely adjusted attributable fraction method. When corrected hazard ratios were used, the incompletely adjusted attributable fraction method overestimated obesity-associated mortality in the target population by >100,000 deaths. CONCLUSION: Methodologic sources of bias in the reports by Allison et al and Mokdad et al include the assessment of smoking status in NHANES I and the method of calculating attributable fractions.
BACKGROUND: Estimates of obesity-associated deaths in the United States for 1991 were published by Allison et al (JAMA 1999;282:1530-8) and subsequently for 2000 by Mokdad et al (JAMA 2004;291:1238-45). Flegal et al (JAMA 2005;293:1861-7) then published lower estimates of obesity-associated deaths for 2000. All 3 studies incorporated data from the first National Health and Nutrition Examination Survey (NHANES I). OBJECTIVE: The objective was to clarify the effects of methodologic differences between the 3 studies in estimates of obesity-associated deaths in the US population by using NHANES I hazard ratios. DESIGN: The earlier reports used imputed smoking data for much of the NHANES I sample rather than the available reported data and applied a method of calculating attributable fractions that did not adjust for the effects of age, sex, and smoking on mortality in the target US population and did not account for effect modification by age. The effects of these and other methodologic factors were examined. RESULTS: The NHANES I hazard ratios in the earlier reports were too low, probably because of the imputed smoking data. The low hazard ratios obscured the magnitude and direction of the bias arising from the incompletely adjusted attributable fraction method. When corrected hazard ratios were used, the incompletely adjusted attributable fraction method overestimated obesity-associated mortality in the target population by >100,000 deaths. CONCLUSION: Methodologic sources of bias in the reports by Allison et al and Mokdad et al include the assessment of smoking status in NHANES I and the method of calculating attributable fractions.
Authors: Cora E Lewis; Kathleen M McTigue; Lora E Burke; Paul Poirier; Robert H Eckel; Barbara V Howard; David B Allison; Shiriki Kumanyika; F Xavier Pi-Sunyer Journal: Circulation Date: 2009-06-08 Impact factor: 29.690
Authors: Sandahl H Nelson; Catherine R Marinac; Ruth E Patterson; Sarah J Nechuta; Shirley W Flatt; Bette J Caan; Marilyn L Kwan; Elizabeth M Poole; Wendy Y Chen; Xiao-ou Shu; John P Pierce Journal: Breast Cancer Res Treat Date: 2016-02-10 Impact factor: 4.872
Authors: Alyssa Marie M Antonio; Pebbles Fagan; Faith D Hamamura; Ian Joseph N Lagua; Jenny Liu; Devin J Park; Pallav Pokhrel; Thaddeus A Herzog; Ian Pagano; Kevin Cassel; Angela Sy; Dorothy Jorgensen; Tania Lynch; Crissy Kawamoto; Carol J Boushey; Adrian Franke; Mark S Clanton; Eric T Moolchan; Linda A Alexander Journal: Prev Med Rep Date: 2015-10-30