Longitudinal Analysis of the Prevalence and Incidence of Obesity-Related Comorbidities and Associated Outcomes: An Electronic Health Record Study in Patients with Overweight and Obesity

BackgroundOverweight and obesity are increasing alarmingly in the United States and most substantially increases the burden of obesity-related comorbidities (ORCs). Understanding the prevalence, incidence, and long-term outcomes of ORCs is critical to addressing this public health challenge. MethodsA retrospective cohort study was conducted using electronic health records (EHR). A total of 100,000 patients, consisting of 25,000 from each of the four Body Mass Index (BMI) categories, were randomly selected based on their initial BMI from the University of Pittsburgh Medical Center EHR system. Demographic and clinical characteristics were compared using chi-square tests and ANOVA. The prevalence, incidence, hospitalization rates of ORCs by BMI categories were analyzed. Multivariable Cox regression models were employed to identify risk factors associated with mortality. ResultsWe identified 87,010 eligible patients. A higher prevalence of heart failure (HF), chronic kidney disease (CKD), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH), obstructive sleep apnea (OSA), osteoarthritis (OA), and type 2 diabetes (T2DM) was observed among patients with higher BMI categories compared to those classified as overweight. Patients with class III obesity demonstrated significantly higher incidence rates of CKD, HF, hypertension, OSA, OA, and T2DM than other BMI categories. Additionally, a higher cumulative hospitalization rate and an increased risk of mortality were observed among patients with more severe obesity. The Multivariate Cox regression shows several ORCs are positively associated with post-5-year mortality, with CKD (HR: 1.75, 95% CI: 1.63-1.87), HF (HR: 1.68, 95% CI: 1.57-1.80), and T2DM (HR: 1.65, 95% CI: 1.57-1.73) identified as the strongest predictor. ConclusionOur retrospective cohort study elucidates the epidemiology of ORCs across various BMI categories and identifies key risk factors of post-5-year mortality. These findings emphasize the public health burden of obesity and ORCs and highlight the critical need for integrating comprehensive obesity care into clinical practice according to the severity of obesity.