Journal
ANNALS OF EPIDEMIOLOGY
Volume 25, Issue 12, Pages 907-911Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.annepidem.2015.07.012
Keywords
Body mass index; Obesity; Body weight; Mortality; Epidemiologic methods
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Funding
- National Institute on Aging [R01AG040212]
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Purpose: The health consequences of obesity are often assessed using categorical, self-reported data on body mass index (BMI). This article investigates the combined effects of categorization and self-report bias on the estimated association between obesity and mortality. Methods: We used the National Health and Nutrition Examination Survey (1988-2008) linked to death records through 2011. Cox models and age-standardized death rates were used to evaluate the effects of categorization and self-report bias on the mortality risks and percent of deaths attributable to obesity. Results: Despite a correlation between measured and self-reported BMI of 0.96, self-reports miscategorized 20% of adults. Hazard ratios using self-reports were overstated for the obese I (BMI, 30-35 kg/m(2)) and obese 2 (BMI >= 35 kg/m(2)) categories. The bias was much smaller using a continuous measure of BMI. In contrast, the percent of deaths attributable to excess weight was lower using self-reported versus measured data because self-reports led to systematic downward bias in the BMI distribution. Conclusions: Categorization of BMI and self-report bias combine to produce substantial error in the estimated hazard ratios and percent of deaths attributable to obesity. Future studies should use caution when estimating the association between obesity and mortality using categorical self-reported data. (C) 2015 The Authors. Published by Elsevier Inc.
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