Characterizing the changing morbidity and cause-specific mortality burden of the obesity epidemic in england
File(s)
Author(s)
Sophiea, Marisa
Type
Thesis
Abstract
Nearly two-thirds of adults are overweight or obese in England. Whilst cardiovascular disease (CVD) mortality rates have contributed to declines in all-cause mortality, there is limited research on these shifts and the impact of mortality and morbidity as a result. My thesis aims to estimate the trends and diversification of obesity-related mortality and morbidity in patients and to estimate the contributors to morbidity in obese individuals by applying a clinical definition for obesity. Data was extracted from the Clinical Practice Research Datalink, consisting of primary healthcare records, for over 1.4 million adults in England with at least one body mass index (BMI) measurement between 1998 and 2019, linked to national death registration data and hospital data. I used discrete Poisson regression to analyse obesity-related mortality and incidence trends and binomial logistical regression to analyse the prevalence of comorbidities by BMI category. I utilised joinpoint regression to estimate if the trends are significant across the study period. Finally, I calculated crude prevalence to identify the most prominent conditions in obese individuals, using a novel definition. Between 2004 and 2019, I observed declines in all-cause and CVD mortality rates, and as a result, cancers became the primary contributor of death in males in all BMI categories and females in the overweight category by 2019. Across obesity-related co-morbidities, in the obese category, type 2 diabetes remains one of the most prevalent conditions, but conditions are diversifying, and osteoarthritis and depression are becoming major contributors to incidence and prevalence. Amongst those with obesity, high blood pressure, joint pain, and respiratory conditions are the most prominent conditions. Shifts in the major contributors to mortality and morbidity indicate a greater focus on prevention and management for a broader set of diseases for continued improvement in health in obese individuals and the general population.
Version
Open Access
Date Issued
2024-08-21
Date Awarded
01/04/2025
License URL
Advisor
Gregg, Edward
Vamos, Eszter
Zaccardi, Francesco
Sponsor
Imperial College London
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)