Prospective cohort study of body mass index and the risk of hospitalisation: findings from 246361 participants in the 45 and Up Study

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–-2 (age-standardised rate:120/1000 py) and in women for BMI 18.5– -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