title: The prognostic role of body mass index on mortality amongst the middle-aged and elderly: a competing risk analysis.
abstract: OBJECTIVE
  To determine the relationship between body mass index (BMI) including its 5-year changes and mortality, and compare the results obtained using Cox and competing risks models.
  
  
  METHODS
  Our study subjects included 2216 persons aged ≥49 years who participated in the Blue Mountains Eye Study, Australia between 1992 and 1994, and returned for further follow-up examinations between 1997 and 1999. We examined the relationship between BMI and mortality using cubic spline. The Cox and competing risks models were used to assess the associations between baseline BMI and its 5-year changes with all-cause and cause-specific mortality.
  
  
  RESULTS
  Amongst subjects aged ≤70 years, the relationship between BMI and all-cause mortality was U-shaped. For those aged >70 years, an L-shaped relationship was seen with no elevation in risk amongst the overweight/obese. Based on the competing risks model, obesity at baseline was associated with increased risk of cardiovascular death and reduction in BMI at 5-year was linked to an increase risk of cancer death amongst those aged ≤70 years. The cause-specific Cox model showed that reduction in BMI at 5-year was associated with cancer-death regardless of age, and with cardiovascular deaths among subjects aged ≤70 years. Cox regression model showed larger magnitude of effect with wider confidence interval as compared with competing risks model.
  
  
  CONCLUSIONS
  Conditions associated with obesity are more likely to affect mortality among subjects aged ≤70 years, but not among those aged over 70 years. Cox model shows larger magnitude of effect in comparison with competing risks model.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Haleh
authors.initials: H
authors.lastname: Ghaem Maralani
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore. Electronic address: ephtbc@nus.edu.sg.
authors.forename: Bee Choo
authors.initials: BC
authors.lastname: Tai
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Duke-NUS Graduate Medical School, Singapore.
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.affiliation: Department of Statistics and Applied Probability, National University of Singapore, Singapore.
authors.forename: Jialiang
authors.initials: J
authors.lastname: Li
authors.affiliation: Centre for Vision Research, University of Sydney, Sydney, Australia; Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Centre for Vision Research, University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D001315:Australia; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000401:mortality*; D050177:Overweight / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate
keywords: All-cause mortality; Body mass index; Cause-specific mortality; Competing risks model; Elderly; Middle-aged