Abstract Body: Introduction: Body Mass Index (BMI) has been generally used to measure adiposity, but it can be inaccurate when examining diverse race groups. We examined how the association between cardiovascular disease (CVD) mortality and adiposity – as measured by BMI, Waist-to-Height Ratio (WHtR), and Body Roundness Index (BRI) – differed by race.

Hypothesis: We hypothesized that BRI would have the strongest association with obesity-related mortality risk with the association being more pronounced among Non-White race groups.

Methods: We use 2019 National Death Index Linked Mortality data combined with the pooled adult sample of the 2007-2018 National Health and Nutrition Examination Survey (N = 31,244). We examined four race groups: Non-Hispanic White (n=12,684), Hispanic (n=8,043), Non-Hispanic Black (n=6,669), and Other Races (n=3,848). BMI, WHtR, and BRI were calculated using established equations and scaled by 0.05 increments to improve interpretability for regression analyses. We examined the association between each adiposity measure and CVD-related morality by race using Cox Regression.

Results: Each race group had increased risk of CVD-related mortality for increasing adiposity for all measures (Figure). For BMI, people of “Other Race” had the highest risk (HR = 1.04). Non-Hispanic Black people had the lowest risk (HR = 1.01). For WHtR, Hispanic people had the highest risk (HR = 1.16), while Non-Hispanic Black people had the lowest risk (HR = 1.08). Finally, for BRI, Hispanic people had the highest risk (HR = 1.16) while Non-Hispanic Black people had the lowest risk (HR = 1.06).


Conclusions: While increased adiposity is associated with heighted risk of mortality for all race groups, the association may be stronger for Hispanic people. Further investigation is needed into which adiposity measure is best for assessing CVD risk and mortality.