Stokes, Andrew

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  • Publication
    Social Determinants and International Comparisons of Health and Mortality
    (2014-01-01) Stokes, Andrew Currier
    Despite substantial gains in population health over recent decades, the US faces a growing epidemic of obesity that threatens continued progress. This dissertation seeks a better understanding of this dire challenge through three chapters that explore obesity from distinct vantage points. The first chapter quantifies the extent to which greater obesity in the US contributes to its low life expectancy ranking with respect to 15 other developed countries. The principal finding is that the higher prevalence of overweight and obesity in the US may contribute between a fifth and a third of the longevity gap above age 50. The second chapter is an investigation of the mortality risks and population impact of obesity in the older adult population of the US. I propose an innovative measurement strategy using weight histories. My findings indicate that the prior literature may substantially underestimate the mortality risks of obesity by failing to fully account for confounding by illness. The third and final chapter investigates the social context of obesity through an examination of eating behaviors of adults in the US. I find that participation in the family dinner is associated with a significantly lower probability of being obese and that the association is robust to adjustment for multiple dimensions of socioeconomic status.
  • Publication
    Is the High Level of Obesity in the United States Related to Its Low Life Expectancy?
    (2011-09-22) Preston, Samuel H.; Stokes, Andrew
    Background. The US has the highest prevalence of obesity and one of the lowest life expectancies among OECD countries. While it is plausible to assume that these two phenomena are related, no previous attempt has been made to identify the connection between them. Our paper uses primary data on body mass index (BMI) in 16 countries and detailed information on the mortality risks of obesity to estimate the effect of international differences in obesity on comparative levels of longevity. Methods. We estimate the fraction of deaths from all causes attributable to obesity by country, age and sex. We then re-estimate life tables in 2006 by removing deaths attributable to obesity. To allow for the possibility of a secular decline in obesity risks, we employ two alternative sets of risks drawn from a more recent period than the baseline risks. Results. In our baseline analysis, we estimate that US life expectancy at age 50 in 2006 was reduced by 1.54 years (95% condence interval (CI) 1.37-1.93) for women and by 1.85 years (1.62-2.10) for men as a result of obesity. Relative to higher life expectancy countries, allowance for obesity reduces the US shortfall in life expectancy by 42% (36-48) for women and 67% (57-76) for men. Using obesity risks that were recorded more recently, differences in obesity still account for a fifth to a third of the shortfall of life expectancy in the US relative to longer-lived countries. Conclusions. The high prevalence of obesity in the US contributes substantially to its poor international ranking in longevity.