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    • The bottom portion of Table shows results for obesity

    2018-11-05

    The bottom portion of Table 3 shows results for obesity pertinent to the time of the survey. Among both women and men, the risks from obesity were highly similar in the two countries. For example, among women the risks in deaths per 1000 person-years were 5.02 in the United States and 4.36 in Finland (Model 1). Among men, the risks were 5.54 in the United States and 6.16 in Finland (deaths per 1000 person-years, Model 1). Among women, there was virtually no trend in the risk in either country. Among men, the trend in the risk for the United States was flat (β=0.06), but the trend for Finland is suggestive of a declining risk (β=−0.27) with a p-value of 0.06. Stratification by smoking status did not reveal a substantively different pattern (Table A2). Note that for purposes of exposition we did not allow the risks from the behavioral factors to vary by age in Models 1 and 2. Therefore, the coefficients shown in Table 3 represent an average for adults over age 30. However, there is evidence that the risks from smoking and obesity vary by age (Mehta & Preston, 2012; Mehta, 2015). Alternative models that included linear terms for age and age-squared and interactions between age and the behavioral factors produced similar conclusions as those just described, both with respect to the cross-national comparisons of risks and trends in the risks (results not shown). Models 3–6 of Table 4 show results for linear BMI at time of survey and during early adulthood. Each unit increase in BMI at time of survey is associated with an increase of between 0.70 and 1.33 deaths per 1000 person-years (Model 3). The coefficients were not significantly different across the two countries for either sex. The goal of Models 4–6 were to evaluate BMI pertaining to early adulthood and were restricted to the U.S. NHANES 3 and 1999–2004 and Finnish Health 2000 in which early adulthood BMI data was available. Both sexes were combined and the sample was restricted to ages 40–69 at time of survey. Model 4 included only BMI at time of survey to obtain results for this order ceterizine variable with the restricted analytic sample. Model 5 included only BMI pertaining to early adulthood. Each measure of BMI was significantly and positively associated with death risks in both countries. The risks appear higher in the United States than in Finland, but these comparisons were not statistically significant (p>0.05). Model 6 included both BMI indicators. Each of the four coefficients was positive indicating that both BMI indicators contributes to death risk independent of the other. However, coefficients for Finland were not statistically significant.
    Discussion In a combined analysis of men and women aged 50–74, Mehta and Preston (2012) found an approximate 1% annual increase in the relative risks of death from current smoking in the U.S. National Health Interview Survey (period 1987–2006) and NHANES (period 1971–2006). Thun et al. (2013) showed that the relative risks of death from smoking among U.S. women aged 55–85 rose from 2.1 to 2.8 between 1982–1985 and 2000–2010 in the first and second Cancer Prevention Studies with no parallel increase among men. As men have historically experienced higher relative risks of death from smoking compared to women, Thun et al. (2013) find that the relative risks of death from smoking have, over time, converged for men and women. Our results confirm that such a convergence is reflected in a nationally representative white population and on an additive risk difference scale: in 1990 the estimated risks from current smoking were 9.9 (women) and 14.5 (men) deaths per 1000 person-years and by 2013 they were 13.8 (women) and 15.7 (men). We find that a similar phenomenon is occurring in the Finnish population: the risks of death from smoking are rising among Finnish women, but not among Finnish men, leading to a male-female convergence of risks over time. As indicated, in both countries women picked up smoking later than men and the convergence of the risks from smoking may reflect a parallel convergence in male-female smoking patterns over time as the smoking epidemic “matures” (Mehta & Preston, 2012; Thun et al., 2013). We also documented that American women suffer higher risks from smoking compared to Finnish women. It is unlikely that differences in smoking intensity at time of survey between the two populations of women is the main explanatory factor as Finnish women over this period appear to smoke more intensively than American women (Table A3). Potential explanations that could be investigated include differences in smoking duration and at age of initiation (the smoking epidemic among Finnish women may not have reached full maturity) and in medical care for smoking-related diseases. In addition, the finding that the risks associated with former smoking in Finland have been changing, increasing for women and declining for men, indicate changes in quitting order ceterizine patterns over time as the smoking epidemic evolves.