Age-Dependent Association Between Body Mass Index and All-Cause Mortality Among Patients with Hypertension: A Longitudinal Population-Based Cohort Study in China

Yifang Huang; Jiahuan Peng; Weibing Wang; Xueying Zheng; Guoyou Qin; Huilin Xu

doi:10.2147/CLEP.S442162

Age-Dependent Association Between Body Mass Index and All-Cause Mortality Among Patients with Hypertension: A Longitudinal Population-Based Cohort Study in China

Clin Epidemiol. 2023 Dec 7:15:1159-1170. doi: 10.2147/CLEP.S442162. eCollection 2023.

Authors

Yifang Huang^{1

2}, Jiahuan Peng², Weibing Wang¹, Xueying Zheng^#², Guoyou Qin^{1

2}, Huilin Xu^#³

Affiliations

¹ Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, People's Republic of China.
² Department of Biostatistics, National Health Commission Key Laboratory of Health Technology Assessment, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, People's Republic of China.
³ Shanghai Minhang Center for Disease Control and Prevention, Shanghai, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: The association between body mass index (BMI) and all-cause mortality may vary among hypertensive patients of different ages. This study aimed to investigate the age-dependent association between BMI and all-cause mortality among patients with hypertension.

Patients and methods: A total of 212,394 participants with hypertension aged 20-85 years from Minhang Hypertension Standardization Management System in Shanghai of China were included. Follow-up began at the time when individuals were first recorded and ended at death, loss to follow-up, or December 31, 2018, whichever came first. Additive Cox proportional hazards models with thin plate smoothing functions and conventional Cox proportional hazards models were adopted to examine the relationship between BMI, age, and mortality. The joint effect of BMI and age on mortality was assessed using a bivariate response model.

Results: We found that the BMI-mortality relationship followed a U-shaped pattern, with a trough at 26-27 kg/m². Compared with normal weight, underweight was associated with a 50% increased risk of premature mortality (hazard ratio 1.50, 95% confidence interval 1.43 to 1.57). Whereas among those aged 45-59 and 60-85 years, overweight was associated with 13% (0.87, 0.80 to 0.94) and 18% (0.82, 0.80 to 0.84) reduction in risk of death, respectively. Bivariate response model indicated a significant interaction between BMI and age (P < 0.05). Among younger and older patients, we found a descending trend for mortality risk, with BMI increasing at different age levels, whereas a reverse J-shaped relation pattern was observed among middle-aged patients.

Conclusion: The impact of BMI on all-cause mortality in hypertensive patients varies with age, and moderate weight gain may benefit longevity in middle-aged and older patients.

Keywords: age; all-cause mortality; body mass index; generalized additive model; hypertension.

Grants and funding

This study was funded by the National Natural Science Foundation of China (grants 82173612 and 82273730); Shanghai Rising-Star Program (21QA1401300); Shanghai Municipal Natural Science Foundation (22ZR1414900); Shanghai Municipal Science and Technology Major Project (ZD2021CY001).