Past trends of obesity-attributable mortality in The Netherlands: An application of age-period -cohort analysis

Introduction: Obesity has dramatically increased over time and constitutes a major health burden which can be estimated by the share of total deaths due to obesity (obesity-attributable mortality). Previous estimates varied widely according to the methodology used, as previous studies didn’t always account for the multiple dimensions of the obesity epidemic: age, period and birth cohort. Aim: To better capture the complexity of the obesity epidemic and its impact on mortality by assessing age, period and birth cohort effects and patterns in the Netherlands, in the period 1981 to 2010. Materials and methods: Data (by age and sex) were obtained from the following sources: Obesity prevalence from Statistics Netherlands, Relative Risks (RR) of dying from obesity from a recent meta-analysis and all-cause mortality by Human Mortality Database. We applied age-period-cohort analysis to assess obesity-attributable mortality by sex in the Netherlands. Results: Obesity-attributable mortality doubled in the Netherlands between 1981 and 2010; in men, the fraction of mortality due to obesity rose from 0.7 % to 1.3 % while in women from 1.0 to 2.0 %. The effect of birth cohort to obesity-attributable mortality was larger among women as compared to men, and for women even more important that the effect of period. In specific, for women born after 1941-1945, obesity-attributable mortality is increasing with every next generation. Conclusions: Next to age and period a substantial effect of birth cohort on obesity-attributable mortality was shown, especially in women. Future studies on obesity–attributable mortality should not ignore the multiple dimensions of obesity