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Letters
June 23/30, 2004

Modifiable Behavioral Factors as Causes of Death

Author Affiliations
 

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(24):2941. doi:10.1001/jama.291.24.2941-c

To the Editor: Dr Mokdad and colleagues1 attributed 400 000 US deaths to obesity, just below the 435 000 they attributed to tobacco. The estimate for tobacco was achieved2 by stratifying by cause of death, sex, and age, then adding up the resulting individual causes. The estimate for obesity does not account for important variables, particularly age and unmodifiable genetic factors.3 Because the risk of dying because of obesity decreases at advanced age,4 the authors should have taken this variable into account in the estimations. In addition, the population age distribution is now older than when these studies were performed, so applying unadjusted risk estimates to the current population overestimates the number of deaths.

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