Article

The other causality question: estimating attributable fractions for obesity as a cause of mortality.

Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA.
International journal of obesity (2005) (Impact Factor: 5.22). 09/2008; 32 Suppl 3:S4-7. DOI: 10.1038/ijo.2008.81
Source: PubMed

ABSTRACT Recent scientific controversy over the accuracy of population attributable fraction (PAF) estimates for obesity as a cause of mortality has made the concept of PAF visible in both scientific and popular news. The PAF is widely thought to provide information about causation, or attribution, of disease and also to provide information on the consequences of interventions to eliminate the exposure of interest. I discuss the methodological and conceptual limitations of the PAF in providing these two kinds of information. Because of these limitations, the PAF does not provide scientists or policy makers with an accurate answer to the question, How much of the disease burden could be eliminated if the exposure was eliminated from the population? Further, these limitations cannot be overcome merely by better statistical modeling; they must be addressed through more rigorous discussion of specific interventions and the causal consequences of such interventions.

0 Bookmarks
 · 
27 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. We calculated the racial/ethnic-specific percentages of gestational diabetes mellitus (GDM) attributable to overweight and obesity. Methods. We analyzed 1 228 265 records of women aged 20 years or older with a live, singleton birth in California during 2007 to 2009. Using logistic regression, we estimated the magnitude of the association between prepregnancy body mass index and GDM and calculated the percentages of GDM attributable to overweight and obesity overall and by race/ethnicity. Results. The overall estimated GDM prevalence ranged from 5.4% among White women to 11.9% among Asian/Pacific Islander women. The adjusted percentages of GDM deliveries attributable to overweight and obesity were 17.8% among Asians/Pacific Islander, 41.2% among White, 44.2% among Hispanic, 51.2% among Black, and 57.8% among American Indian women. Select Asian subgroups, such as Vietnamese (13.0%), Asian Indian (14.0%), and Filipino (14.2%), had the highest GDM prevalence, but the lowest percentage attributable to obesity. Conclusions. Elevated prepregnancy body mass index contributed to GDM in all racial/ethnic groups, which suggests that decreasing overweight and obesity among women of reproductive age could reduce GDM, associated delivery complications, and future risk of diabetes in both the mother and offspring. (Am J Public Health. Published online ahead of print August 15, 2013: e1-e8. doi:10.2105/AJPH.2013.301469).
    American Journal of Public Health 08/2013; · 3.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the prevalence and the population attributable fraction of chronic obstructive pulmonary disease (COPD) in the U.S. adult workers, we analyzed data obtained from the National Health Interview Surveys for the period 1997–2004. The overall COPD prevalence was 4.0% (95% confidence interval [CI] 3.9–4.1%). The prevalence was higher in females (5.4%, 95% CI 5.3–5.6%) than in males (2.8%, 95% CI 2.7–2.9%); in Whites (4.2%, 95% CI 4.1–4.3%) than in Blacks (3.4%, 95% CI 3.1–3.7%) and other races (2.4%, 95% CI 2.1–2.8%). Compared with insurance, real estate and other finance industry, the top three industries associated with significantly higher prevalence odds ratios (PORs) (adjusted for age, sex, race, and smoking) were other educational services (POR = 1.5, 95% CI 1.0–2.3); transportation equipment (POR = 1.4, 95% CI 1.1–1.8); and social services, religious and membership organizations (POR = 1.4, 95% CI 1.1–1.7). Compared with managers and administrators, except public administration occupation, the top three occupations with significantly higher PORs were health service (1.8, 95% CI 1.5–2.1), other protective service (POR = 1.6, 95% CI 1.2–2.2), and material moving equipment operators (POR = 1.6, 95% CI 1.1–2.3). The overall population attributable fraction for association of COPD with employment was 12.2% for industry and 17.4% for occupation. Further studies are needed to determine specific risk factors associated with COPD in industries and occupations with elevated prevalence and POR.
    COPD Journal of Chronic Obstructive Pulmonary Disease 01/2009; 6(5):380-387. · 2.62 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the percentage of large-for-gestational age (LGA) neonates associated with maternal overweight and obesity, excessive gestational weight gain, and gestational diabetes mellitus (GDM)-both individually and in combination-by race or ethnicity. We analyzed 2004-2008 linked birth certificate and maternal hospital discharge data of live, singleton deliveries in Florida. We used multivariable logistic regression to assess the independent contributions of mother's prepregnancy body mass index (BMI), gestational weight gain, and GDM status on LGA (birth weight-for-gestational age 90 percentile or greater) risk by race and ethnicity while controlling for maternal age, nativity, and parity. We then calculated the adjusted population-attributable fraction of LGA neonates to each of these exposures. Large-for-gestational age prevalence was 5.7% among normal-weight women with adequate gestational weight gain and no GDM and 12.6%, 13.5% and 17.3% among women with BMIs of 25 or higher, excess gestational weight gain, and GDM, respectively. A reduction ranging between 46.8% in Asian and Pacific Islanders and 61.0% in non-Hispanic black women in LGA prevalence might result if women had none of the three exposures. For all race or ethnic groups, GDM contributed the least (2.0-8.0%), whereas excessive gestational weight gain contributed the most (33.3-37.7%) to LGA. Overweight and obesity, excessive gestational weight gain, and GDM all are associated with LGA; however, preventing excessive gestational weight gain has the greatest potential to reduce LGA risk. LEVEL OF EVIDENCE:: III.
    Obstetrics and Gynecology 04/2014; 123(4):737-744. · 4.37 Impact Factor

Preview

Download
0 Downloads
Available from