Hassan, Ibrahim

Abstract Background Obesity is a major public health concern and a leading contributor to premature mortality worldwide. While body mass index (BMI) has long been the standard measure for assessing obesity-related health risks, it fails to distinguish between fat and lean mass or capture the distribution of adiposity—key determinants of metabolic and cardiovascular (CV) health. The Body Roundness Index (BRI), a novel anthropometric measure incorporating waist circumference and height, offers a more precise assessment of body fat distribution and its associated health risks. Although prior studies have linked BRI to all-cause and CV mortality in general populations, its predictive value for premature mortality and potential disparities remain unexplored. Purpose To investigate the association between BRI and premature all-cause (primary outcome) and cardiovascular-specific mortality (secondary outcome) in U.S. adults younger than 65 years. Additionally, we examine whether these associations vary across sociodemographic subgroups. Methods We conducted a nationally representative cohort study using the National Health and Nutrition Examination Survey (NHANES) data (1999–2018) linked to mortality records through December 31, 2019. Adults younger than 65 years were included, excluding those with CV disease or missing covariates. BRI, derived from waist circumference and height, was categorized into quintiles (Q3 as reference). Premature mortality was defined as deaths before age 65. Multivariable Cox proportional hazards models, accounting for NHANES’ complex survey design, were used to assess associations and ensure nationally representative estimates. Nonlinear relationships were examined using restricted cubic splines. Results Among 29,016 (weighted N=1,349,437,788) adults (mean age 42 years; 50% female), 751 premature deaths occurred over a median follow-up of 10 yrs, including 163 attributed to CV causes. In fully adjusted models*, participants in the highest BRI quintile (Q5 vs. Q3) had a 47% higher risk of premature all-cause mortality (HR 1.47; 95% CI, 1.12–1.93; p=0.006) and a 96% higher risk of premature cardiovascular mortality (HR 1.96; 95% CI, 1.12–3.41; p=0.02; Fig.1). Subgroup analyses indicated that the association between high BRI and premature mortality was most pronounced among middle-aged adults (45-64 years: HR 1.80; p-interaction=0.004), males (HR 1.66; p=0.006), and Hispanics (HR 2.17; p=0.007). Similar patterns were observed for premature cardiovascular mortality (Fig.2). Conclusions High BRI is independently associated with increased risks of premature all-cause and cardiovascular mortality, with the strongest effects observed in middle-aged adults. These findings highlight the potential of BRI in risk stratification and underscore the need for targeted interventions to address disparities in premature mortality. Integrating BRI into preventive cardiology and public health strategies may help reduce early mortality.Figure 1 Figure 2

Abstract Aims Obesity, particularly visceral adiposity, is a key driver of cardiovascular mortality (CVM), yet conventional measures such as body mass index (BMI) inadequately capture fat distribution. The Body Roundness Index (BRI) is a novel anthropometric measure integrating waist circumference and height to better reflect body shape and visceral fat. This study examined the association between BRI and CVM in U.S. adults and across sociodemographic subgroups. Methods and results We analysed data from 31 351 adults (median age 43 yrs, 50% females) aged ≥20 years in NHANES 1999–2018, excluding those with prior cardiovascular disease or cancer. BRI was computed using a validated equation and categorized into quintiles (Q3 as reference). The primary outcome was CVM; secondary outcomes included all-cause, heart disease, and cerebrovascular mortality. Weighted Cox proportional hazards and restricted cubic spline (RCS) models evaluated associations after adjustment for demographic, behavioural, and clinical factors. Subgroup and sensitivity analyses tested consistency and effect modification. During a median follow-up of 10.1 years (IQR: 5.3–14.9 years), 883 cardiovascular deaths occurred. In fully adjusted models, participants in the highest BRI quintile had a 54% higher risk of CVM (HR, 1.54; 95% CI, 1.13–2.08; P = 0.006) vs. Q3. This risk remained high even among those with normal BMI. RCS analysis indicated a modest U-shaped association. Stronger effects were observed among middle-aged adults (45–64 years) and those with higher educational attainment. Conclusion Higher BRI is independently associated with increased cardiovascular mortality, particularly among middle aged adults and those with normal BMI, underscoring its potential as a practical, noninvasive tool for cardiovascular risk stratification. Incorporating BRI into clinical and public health assessment may improve identification of individuals at elevated risk.

Abstract Introduction Hodgkin's lymphoma is known to have favorable survival outcomes; however, limited data exist regarding survival disparities between rural and urban populations. In this study, we aimed to investigate the differences in survival outcomes between the two populations. Methods Data for patients diagnosed with Hodgkin lymphoma (HL) between 2000 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Rurality was identified using the Rural-Urban Continuum Codes (RUCC). Patients aged ≥ 20 years with HL as the only primary malignancy were included. Individuals with unknown race or those diagnosed at autopsy were excluded. The Ann Arbor Staging system was utilized for HL staging at diagnosis. HL-specific survival was defined as the time from diagnosis to death attributable to HL and was censored at the time of death from other causes or at last follow-up. Meanwhile, overall survival (OS) was defined as the time from diagnosis to death from any cause and was censored if the patient was still alive. A Cox proportional hazards model was performed to analyze the predictors for 10-year overall and HL-specific mortality. All statistical analyses were conducted using RStudio (version 2024.12.0). Results Between 2000 and 2015, a total of 22,505 patients diagnosed with Hodgkin lymphoma (HL) were included in the analysis. Among them, 13,657 (61%) were aged between 20 and 44 years. Overall, 10,137 patients (47%) were female, 14,885 (66%) were White, 2,672 (12%) were Black, and 3,724 (17%) were Hispanic. The majority of patients resided in urban counties, while only 2,266 (10.1%) lived in rural areas. Among rural patients, 845 (37%) were diagnosed with stage II disease, followed by 475 (21%) with stage III at the time of diagnosis. Notably, both the 10-year overall survival (69.5%) and Hodgkin lymphoma–specific survival (79.7%) were significantly lower among rural patients compared with urban patients (75.3% and 83.5%, respectively; p < 0.001). In the multivariable model for 10-year HL-specific survival, older age (> 65 years) was associated with the highest risk of mortality (HR 10.32; 95% CI 9.42–11.32). Although survival improved over the study period, male patients remained at increased risk of mortality (HR 1.26; 95% CI 1.18–1.35). Urban residence, diagnosis in more recent years, early stage, female sex, White race, and married status were independently associated with improved overall survival (p < 0.01). Conclusion In this population-based study, both the 10-year overall and HL-specific survival were consistently lower among rural vs. urban patients. Male sex, older age, and unmarried status were particularly associated with worse survival outcomes. Further research is warranted to identify possible strategies for improving healthcare access and reducing survival disparities among rural patients.