Understanding the Association of Harmful Risk Factors with Lower Mortality Among those with Disease: An Illustration Using Obesity and End-stage Renal Disease Open Access

Abstract

Background: Obesity has been shown to increase the risk of developing chronic disease as well as the risk of all-cause mortality. However, an "obesity paradox" has been observed, in that obese individuals tend to live longer than normal weight individuals after developing disease. The reasons for this are unclear, but may be related to analytic methods.

Methods: Using the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a longitudinal nationally recruited cohort study of adults age 45 and older, we conducted a survival analysis of end-stage renal disease (ESRD) patients, stratified by obesity status. We measured three primary outcomes: hazards of developing ESRD, overall mortality, and mortality after ESRD, truncated at age 60 years. We compared obese and overweight individuals to normal weight individuals, defined by body mass index, controlling for race, gender and smoking status.

Results: Obese persons had, on average, slightly lower hazard of developing ESRD and mortality after ESRD, but a slighter higher hazard of all-cause mortality, compared to normal weight persons; however, these results were not statistically significant. Overall, differences in disease-free, overall, and with-ESRD survival time between normal weight, overweight, and obese persons did not differ meaningfully in our analyses. Our findings were not affected by excluding those with chronic kidney disease at baseline, and were impacted only mildly by adjusting for age.

Discussion: Our findings highlight the need for greater understanding of the complicated relationship between obesity and both the development and the progression of chronic disease. With respect to ESRD, further study among a cohort focused upon kidney disease risk factors would provide greater insight into important factors involved in this relationship.

Table of Contents

Table of Contents

Background and Literature Review ....1

Methods .......................................11

Results ........................................18

Discussion ....................................23

Conclusion ...................................30

References ...................................31

Tables and Figures ........................38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Obesity Reverse Epidemiology ESRD
Committee Chair / Thesis Advisor	Flanders, W Dana, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs University, college or educational institution (other than Emory)

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