Mortality Risk of High BMI in Life Insurance Applicants and the US Population

Area of Science:

• Epidemiology
• Public Health
• Biostatistics

Background:

• High body mass index (BMI) is a known risk factor for increased all-cause and cardiovascular mortality.
• The precise impact of accounting for BMI-related diseases on mortality risk is not fully understood.

Purpose of the Study:

• To quantify the mortality risk associated with high BMI in life insurance applicants and NHANES participants.
• To assess how controlling for BMI-related diseases and conditions affects this mortality risk.

Main Methods:

• Utilized Cox proportional hazards models on data from over 7 million life insurance applicants and 23,486 NHANES participants.
• Analyzed BMI as both a continuous and categorical variable.
• Constructed successive models controlling for age, sex, disease status (hypertension, diabetes, heart disease), liver function, blood pressure, renal function, and hemoglobin A1c.

Main Results:

• The association between high BMI and mortality hazard was strongest in univariate models and diminished with successive adjustments for related conditions.
• In life insurance data, significant mortality risk persisted above BMI 35; in NHANES data, it persisted above BMI 40.
• Continuous BMI hazard remained significant in CRL data for both sexes, but only for men in the final NHANES model.

Conclusions:

• The mortality effect of high BMI is substantially attenuated when considering associated diseases and conditions.
• This highlights the importance of managing comorbidities in individuals with high BMI to mitigate mortality risk.