期刊
PREVENTIVE MEDICINE
卷 62, 期 -, 页码 96-102出版社
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ypmed.2014.02.003
关键词
Obesity paradox; Cardiovascular disease; Selection bias; Epidemiology
资金
- Fonds de la Recherche en Sante du Quebec
- Society for Epidemiologic Research Travel Award
- CIHR Institute of Circulatory and Respiratory Health Skills Development Award
- Canada Research Chair program
Objective. To discuss possible explanations for the obesity paradox and explore whether the paradox can be attributed to a form of selection bias known as collider stratification bias. Method. The paper is divided into three parts. First, possible explanations for the obesity paradox are reviewed. Second, a simulated example is provided to describe collider stratification bias and how it could generate the obesity paradox. Finally, an example is provided using data from 17,636 participants in the US National and Nutrition Examination Survey (NHANES III). Generalized linear models were fit to assess the effect of obesity on mortality both in the general population and among individuals with diagnosed cardiovascular disease (CVD). Additionally, results from a bias analysis are presented. Results. In the general population, the adjusted risk ratio relating obesity and all-cause mortality was 1.24 (95% CI 1.11, 1.39). Adjusted risk ratios comparing obese and non-obese among individuals with and without CVD were 0.79 (95% CI 0.68, 0.91) and 130 (95% CI = 1.12, 1.50), indicating that obesity has a protective association among individuals with CVD. Conclusion. Results demonstrate that collider stratification bias is one plausible explanation for the obesity paradox. After conditioning on CVD-status in the design or analysis, obesity can appear protective among individuals with CVD. (C) 2014 Elsevier Inc. All rights reserved.
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