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  • Original Article
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Prospective cohort study of body mass index and the risk of hospitalisation: findings from 246 361 participants in the 45 and Up Study

International Journal of Obesity volume 37, pages 790–799 (2013)Cite this article

Subjects

Abstract

Objective:

To quantify the risk of hospital admission in relation to fine increments in body mass index (BMI).

Design, setting and participants:

Population-based prospective cohort study of 246 361 individuals aged ⩾45 years, from New South Wales, Australia, recruited from 2006–2009. Self-reported data on BMI and potential confounding/mediating factors were linked to hospital admission and death data.

Main outcomes:

Cox-models were used to estimate the relative risk (RR) of incident all-cause and diagnosis-specific hospital admission (excluding same day) in relation to BMI.

Results:

There were 61 583 incident hospitalisations over 479 769 person-years (py) of observation. In men, hospitalisation rates were lowest for BMI 20–<25 kg m−2 (age-standardised rate:120/1000 py) and in women for BMI 18.5–<25 kg m−2 (102/1000 py); above these levels, rates increased steadily with increasing BMI; rates were 203 and 183/1000 py, for men and women with BMI 35–50 kg m−2, respectively. This pattern was observed regardless of baseline health status, smoking status and physical activity levels. After adjustment, the RRs (95% confidence interval) per 1 kg m−2 increase in BMI from ⩾20 kg m−2 were 1.04(1.03–1.04) for men and 1.04(1.04–1.05) for women aged 45–64; corresponding RRs for ages 65–79 were 1.03(1.02–1.03) and 1.03(1.03–1.04); and for ages ⩾80 years, 1.01(1.00–1.01) and 1.01(1.01–1.02). Hospitalisation risks were elevated for a large range of diagnoses, including a number of circulatory, digestive, musculoskeletal and respiratory diseases, while being protective for just two—fracture and hernia.

Conclusions:

Above normal BMI, the RR of hospitalisation increases with even small increases in BMI, less so in the elderly. Even a small downward shift in BMI, among those who are overweight not just those who are obese, could result in a substantial reduction in the risk of hospitalisation.

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Acknowledgements

We thank the men and women participating in the 45 and Up Study. The 45 and Up Study is managed by The Sax Institute in collaboration with major partner Cancer Council New South Wales; and partners the National Heart Foundation of Australia (New South Wales Division); New South Wales Department of Health; beyondblue: the national depression initiative; Ageing, Disability and Home Care, Department of Human Services New South Wales; and Uniting Care Ageing. We also acknowledge the support of the Centre for Health Record Linkage. This specific project was supported by Australian National Health and Medical Research Council (NHMRC) Project Grant number 585402 and arose as an initiative of the MBF Policy in Action Roundtable, funded solely by the Bupa Health Foundation. Funding sources had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication. Emily Banks and Bette Liu are supported by the NHMRC.

Data sharing: The 45 and Up Study is an accessible data resource for approved research projects; see www.45andUp.org.au for details.

Author information

Authors and Affiliations

  1. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia

    R J Korda & E Banks

  2. Australian Centre for Economic Research on Health, The Australian National University, Canberra, Australian Capital Territory, Australia

    R J Korda

  3. The Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia

    B Liu

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden

    M S Clements

  5. Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

    A E Bauman

  6. School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia

    L R Jorm & H J Bambrick

  7. The Sax Institute, Sydney, New South Wales, Australia

    L R Jorm & E Banks

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  1. R J Korda
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Correspondence to R J Korda.

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Korda, R., Liu, B., Clements, M. et al. Prospective cohort study of body mass index and the risk of hospitalisation: findings from 246 361 participants in the 45 and Up Study. Int J Obes 37, 790–799 (2013). https://doi.org/10.1038/ijo.2012.155

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