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The combined effects of overweight and smoking in late adolescence on subsequent disability pension: a nationwide cohort study

International Journal of Obesity volume 34, pages 75–82 (2010)Cite this article

Abstract

Background:

Smoking and obesity are two of the most important risk factors for chronic disease today. Their combined effect on the risk of disability pension is not known.

Methods:

A nationwide cohort of 45 920 Swedish men (18.7±0.5years) were followed for 38 years. The body mass index (BMI), based on measured height and weight, was used to define underweight (<18.5), normal weight (18.5–24.9), overweight (25.0–29.9) and obesity (⩾30.0). The hazard ratios (HRs) associated with BMI and smoking status at baseline for receiving disability pension were adjusted for socio-economic index (SEI), muscular strength, geographic region and place of residence.

Results:

During 1.6 million person-years, 4631 disability pensions and 2897 deaths occurred. After adjustment, overweight (HR 1.34, 95% CI 1.19–1.51) and obesity (HR 1.55, 1.18–2.05) were associated with an increased risk of disability pension, independent of smoking, whereas underweight (18.5; HR 1.07, 0.97–1.17) was not compared with normal weight. Similarly, smoking 1–10 (HR 1.37, 1.27–1.49) or >10 cigarettes per day (HR 2.01, 1.86–2.17) showed independent risk increases versus non-smoking. Although obese individuals smoking >10 daily cigarettes were at greatly increased risk (HR 2.98, 1.98–4.47), no evidence of interaction between the two risk factors could be detected.

Conclusions:

Both increased adiposity and smoking are strong and independent predictors of disability pension, but they do not act synergistically.

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Author information

Authors and Affiliations

  1. Department of Public Health Sciences, Karolinska Institutet, Norrbacka, Stockholm, Sweden

    K Neovius & F Rasmussen

  2. Department of Medicine, Karolinska Institutet, Norrbacka, Stockholm, Sweden

    M Neovius

Authors
  1. K Neovius
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  2. M Neovius
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  3. F Rasmussen
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Corresponding author

Correspondence to F Rasmussen.

Appendix

Appendix

Table A1 Figure A1

Table a1 Hazard ratios for disability pension when smoking is included and excluded from the model, using four categories for smoking status, compared with normal weight non-smokers
Full size table
Figure A1
figure 5

The relative risks of disability pension with separate contributions from the exposure categories of body mass index (BMI) status, smoking status and their interaction. The point estimates and 95% confidence intervals for relative excess risk due to interaction (RERI) between BMI and smoking status (black areas) are provided above (or below) the bars. The models were adjusted for muscular strength, socio-economic index (SEI), place of residence and geographical region.

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Neovius, K., Neovius, M. & Rasmussen, F. The combined effects of overweight and smoking in late adolescence on subsequent disability pension: a nationwide cohort study. Int J Obes 34, 75–82 (2010). https://doi.org/10.1038/ijo.2009.178

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