Risk analysis of non-Hodgkin lymphoma (NHL) mortality associated with high body mass index (HBMI) in China: a population study

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Methods : The mortality data is obtained from the 2021 Global Burden of Disease (GBD). We used the Age-Period-Cohort Model (APC) method to evaluate the trend of HBMI induced NHL mortality in China. Result : The age-standardized mortality rate (ASMR) of NHL due to HBMI in China has been increasing from 1992 to 2021.Mortality from NHL in China with HBMI is positively associated with age, and males is higher.The period effect show that the death from NHL caused by HBMI in China show a V-shaped trend, while males show increasing trend.The cohort effect suggests that the risk of death from NHL caused by HBMI in China is increasing,and the risk of death has increased by 4-fold.The mortality risk is higher in males. Conclusion :In the past 30 years, HBMI has led to an increasing trend of ASMRs for NHL in China, which requires immediate measures such as weight control and healthy lifestyle, especially for males, to further reduce the proportion of obese or overweight people and reduce the national burden of NHL disease. non-Hodgkin's lymphoma(NHL) disease burden high body mass index (HBMI) age standardized mortality rate (ASMR) Age-Period-Cohort Analysis （APC model） Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Non-hodgkin lymphoma (NHL) is a malignant tumor originating in lymph nodes and lymphoid tissue [1]. Over the past few decades, the incidence of NHL has increased rapidly worldwide. According to the 2021 Global Burden of Disease Database (GBD), the number of cases, deaths and disability-adjusted life years (DALYs) of NHL worldwide are 1,741,300, 254,600 and 6,691,000, respectively [2]. According to GLOBALCAN, NHL ranks tenth among all cancers in 2022, with 553,000 new cases and 251,000 deaths[3].In China, which has one-fifth of the world's population, GBD 2021 shows that there are 410,400 cases of NHL, accounting for a quarter of the global total [2]. The incidence of NHL in China has increased significantly over the past few decades, with an increase of 38.02% from 1988 to 2002 [3]. GLOBALCAN shows that in 2022, China will have 81,000 new cases and 24,000 people with the disease in five years[4]. The disease burden of NHL in China is increasing year by year. Being overweight or obese increases morbidity and mortality from a variety of diseases and conditions, including cancer, cardiovascular disease, osteoarthritis, and more. Among them, cancer is the third leading cause of death and premature disability due to being overweight or obese. Studies have shown that the proportion of obesity population is on the rise, and it has a significant impact on the incidence and mortality of other diseases, and has become a major global public health problem [5-7]. Overweight is defined as a BMI between 25 kg/m2 and 29.9 kg/m2, and obesity is defined as a BMI over 30 kg/m2. A BMI of 25kg /m2 or more is considered high. The epidemic of overweight or obesity places a heavy burden on the world with its high medical costs [8]. With the rapid growth of China's economy, the change of Chinese people's lifestyle and diet structure, mainly including sedentary behavior and the increase of dietary fat content, has led to an increasing number of overweight and obese people in China. According to the Report on Nutrition and Chronic Diseases in Chinese Residents (2020), the overweight rate of Chinese residents over the age of 18 is 34.3%,the obesity rate is 16.4%. According to Teras et al.'s research, long-term overweight has a significant impact on the risk of NHL[9]. Larsson et al.'s meta-analysis showed a positive correlation between body mass index and the risk and mortality of NHL[10] At present, there is no research evaluating the long-term trend of the burden of NHL caused by HBMI in China, especially studying the effects of age, period and cohort on the burden trend of NHL caused by HBMI. Therefore, this study used the GBD database to investigate the current burden of NHL caused by HBMI, and evaluated the disease prevalence trend attributed to HBMI in Chinese NHL patients from 1992 to 2021 using Jionpiont and age period cohort analysis (APC), in order to provide reference for relevant research and prevention and control policy formulation of NHL in China. 2. Methods 2.1 Data sources The mortality rate data for this study is from GBD 2021. GBD 2021（http://ghdx.healthdata.org/gbd）The data has been approved by the Institutional Review Board of the University of ishington, provided by the Institute for Health Indicators and Assessment, and is the world's most comprehensive survey, census, life statistics, and other health-related data used to quantify global health losses related to disease, injury, and risk factors. GBD 2021 is the latest version of this project [11-13]. The data on the mortality rate of NHL caused by HBMI is obtained in GBD 2021 through the following steps: (1) weight NHL matching in metabolic risk is determined based on research, (2) relative risk of high body mass exposure is estimated based on a systematic review, (3) specific BMI levels for age, gender, location, and year type are evaluated, (4) theoretical minimum risk exposure level is determined, (5) population attribution score and attributed mortality rate are calculated to obtain the mortality rate of NHL caused by HBMI in GBD 2021, and (6) comprehensive mortality rate considering HBMI risk factors [14]. 2.2 Statistical analysis Using a joint regression model to analyze the temporal trend of NHL ASMR caused by high body weight from 1992 to 2021, and further analyzing the long-term trend of ASMR to determine statistically significant trends across different age groups. Estimate the Average annual percentage change (AAPC), annual percentage change for each age group, and 95% confidence interval (CI) to indicate the direction and magnitude of the trend. The age period cohort model is used to evaluate the contribution of HBMI to the age, period, and cohort effects of NHL mortality. Three types of trends are analyzed separately, providing relatively effective estimation results [15]. The age effect refers to the difference in mortality rate of Hodgkin's lymphoma caused by HBMI among different age groups. The period effect represents the variation of NHL mortality rate caused by HBMI over time, and is correlated with all age groups simultaneously. The queue effect is the change in mortality rate among patients in the same age group of NHL caused by HBMI at different stages [16]. In our study, we focused on estimating local drift, longitudinal age curves, period, and cohort risk ratios (RRs). Local drift refers to the annual average percentage change over time in mortality rates for various age groups of NHL caused by HBMI. The longitudinal age curve represents the longitudinal age specific ratio of each cohort of NHL caused by HBMI after period adjustment. Finally, the period (cohort) RRs are multiple mortality risk factors for NHL cohorts caused by HBMI compared to the reference cohort [17]. In the age period cohort analysis, the number of deaths and population are arranged as a continuous 5-year period from 1992 to 2021 and a continuous 5-year age group of 20-24 and 80-84 years old. Due to the relatively small number of individuals aged 85 or older with NHL, and the relatively rare occurrence of high body weight in the elderly, they are excluded from this study. The age group of 20-24 years old, the period group from 2002 to 2006, and the cohort group from 1957 are defined as the reference group. Connection point analysis is conducted using connection point software version 5.0.2 (July 2023) from the National Cancer Institute (Rockville, MD) in the United States. Age Queue Network Tool (Biostatistics Division, National Cancer Institute, Bethesda, Maryland; https://analysistools.nci.nih.gov/apc/ ）Used for age period cohort analysis. All statistical tests are bilateral tests, with P<0.05 indicating statistically significant differences. 3. Results 3.1. Joint point regression analysis From 1992 to 2021, the ASMR trend of NHL mortality caused by HBMI in China showed an upward trend, with higher mortality rates in males compared to females (Figure 1, Supplementary Table S1-1). The HBMI in China led to an increase in ASMR of NHL from 0.06/100,000 (95%CI, 0.02-0.10) in 1992 to 0.08/100,000 (95%CI, 0.03-0.15) in 2021, with males increasing from 0.06/100,000 (95%CI,0.02-0.11) to 0.11/100,000 (95%CI, 0.03-0.19) and females increasing from 0.05/100,000 (95%CI,0.02-0.08) to 0.06/100,000 (95%CI,0.02-0.12). Compared with the world, the ASMRs in China are lower than those in the world, and this situation occurs in both males and females (Supplementary Table S1-1). In addition, the HBMI in China in 2021 led to an increase in the mortality rate of NHL from 0.01/100,000 (95%CI, 0.00-0.02) in the 20-24 age group to 0.62/100,000 (95%CI, 0.21-1.12) in the 80-84 age group, similar patterns also exist in other years (Supplementary Table S1-1) . Meanwhile, HBMI in different age groups led to the increasing mortality rate of NHL patients, with the age group increasing from 0.37/100,000 in (95%CI,0.14-0.63) in 1992 to 0.62/100,000 (95%CI, 0.21-1.12) in 2021(Supplementary Table S1-1). 3.2 Age cohort analysis 3.2.1 Changes with age The increase of NHL mortality in China by HBMI in China is higher than in the whole world, and the AAPC growth rate males are higher than females the in China and world (Figure 2, Supplementary Table S2-1). The local drift amplitude of NHL mortality caused by HBMI in different age groups first decreases and then increases in China and world，but females increase in the drift amplitude with increasing age,with 20-24 years 0.42%(95%CI,-3.49-4.49) increased to 80-84 years 1.35%((95%CI,-0.50-3.23), global females on the contrary, this suggests that Chinese females NHL mortality risk is higher(figure 2, supplementary table S2-1). The longitudinal age curve of NHL mortality caused by HBMI in China (Figure 3) indicates that the mortality rate per 100,000 people increases with age. From 0.01/100,000 (95%CI, 0.00-0.01) for 20-24 years old to 0.68/100,000 (95%CI, 0.58-0.80) for 80-84 years old (Supplementary Table S2-2), males increased from 0.01/100,000 (95%CI, 0.00-0.01) for 20-24 years old to 0.94/100,000 (95%CI, 0.76-1.17) for 80-84 years old, and females increased from 0.01/100,000 (95%CI, 0.00-0.01) for 20-24 years old to 0.48/100,000 (95%CI,0.38-0.61) for 80-84 years old. From this, it can be seen that the mortality rate of NHL caused by HBMI in China males increase with age, and is higher than that in females. 3.2.2 Changes over time and queues The period effect suggested that HBMI in China showed a decrease in NHL-related mortality risk, similar in females and a continuous increase in males (Supplementary Table S3-1).The RR of NHL deaths in China increased from 1.01(95%CI,0.90-1.14) in 1992-1996 to 1.44(95%CI,1.31-1.58) in 2017-2021,the risk of death in males increased from 0.92(95%CI,0.75-1.07) in 1992-1996 to 1.47(95%CI,1.31-1.66) in 2017-2021 (Figure 4).NHL is different in periods,before 2006, females are higher than males, and lower than males after 2006, and the risk of death is decreasing year by year. The cohort effect showed that high risk of NHL mortality in China increased year by year, with a significant increasing trend of death after 1952 (Figure 5 and Supplementary Table S3-1), from 0.50(95%CI,0.32-0.77) in 1912 to 2.21(95%CI,1.05-4.22) in 1997, and the risk of death increased by 4 times, showing a similar situation in males.There are differences in the risk of death among births, and the risk of death from NHL caused by HBMI in males born after 1952 is higher than that in females, and the risk of death in males after 1977 is significantly higher than that in females.Overall, the risk of death in males is greater than that of females in China, and the risk of death in males is negatively correlated with age. Suggesting a need to increase the risk of NHL disease in young obese males. 4. Discussion The research results show that the ASMR of HBMI related NHL in China has shown an overall growth trend in the past 30 years.High BMI in China caused higher standardized mortality with age, a similar phenomenon in both males and females.Males have higher mortality from NHL,with a higher increase in mortality rate in males. Numerous studies have shown that HBMI may be involved in carcinogenic effects and promote cancer progression, impairing the efficacy of cancer treatment, leading to obesity related comorbidities and poor prognosis in obese cancer patients[18-20]. Although there is a recognized association between obesity and BMI with an increased risk of hematological malignancies. However, its potential mechanisms have not been fully determined and may include chronic inflammation, hormonal imbalance, glucose and lipid metabolism disorders, and other related factors. Chronic inflammation may be caused by pro-inflammatory cytokines released by adipocytes, such as interleukin-6 (IL-6), IL-1β, and tumor necrosis factor -α. These cytokines increase the production of C-reactive protein and serum amyloid A, further promoting the possibility of cancer[21-25]. AAPC with attributable HBMI mortality was high at both ends,if the rules can be found, targeted interventions will have a significant impact on human health.Compared with the world, the mortality rate attributable to NHL in China is lower, but the AAPC is much higher than the global level, indicating that the number of deaths of NHL patients in China is still increasing, and effective interventions are urgently needed to reduce the burden of NHL deaths caused by HBMI.Our findings are similar to a recent study where HBMI increased disease burden and mortality in patients with NHL[26].As China is a developing country, the increased incidence of HBMI-related diseases, inadequate health infrastructure, late cancer detection and poor access can all lead to increased mortality in weight or overweight NHL patients. We also found that the mortality rate of NHL due to HBMI was lower in females than in males in all different age groups, and the period to cohort effect RR increased more significantly in males than females, especially in young and middle-aged males, suggesting that males face a greater burden of NHL than females.Many studies have also fully confirmed this[27-29]. Firstly, the lower mortality rate among females compared to males may be related to changes in physiological factors. Research has shown that a female sex hormone (estradiol) can significantly enhance the activation of macrophages and induce an increase in fat, while the same effect of androgens is not significant[30]. The female population is generally accompanied by non-physiological obesity, such as pregnancy and menopause, which does not cause the body to experience elevated blood sugar or visceral fat due to obesity. Male obesity increases the production of testosterone, leading to higher levels of free testosterone, promoting and exacerbating symptoms such as elevated blood lipids and blood sugar, and increasing the risk of death[31-33]. A study found that as pregnancy increases, the risk of NHL significantly decreases[34]. In addition, compared to females, males often exhibit a lack of emphasis on health management, smoking, and excessive eating, while harmful or unhealthy habits have a significant impact on the mortality rate of NHL[35,36]. Therefore, strategies to control HBMI should focus more on males. This study is of great significance to public health as it provides a comprehensive analysis of the trend of NHL mortality caused by HBMI in China from 1992 to 2021. In the past three decades, the mortality of NHL in China have been rising, so the risk of prevention and control of NHL in China is still serious. It has been proven that effective weight or obesity control can reduce the risk of developing NHL and lower their disease burden[37]. In future research, we can reduce the share of HBMI in the population by improving the health care infrastructure and strengthening the promotion and implementation of healthy lifestyles, which will help reduce the risk of individual death from NHL. This study has certain limitations. Firstly, although the research data is sourced from the GBD 2021 database, the analyzed values cannot be fully attributed to the impact of HBMI on NHL. Secondly, the GBD 2021 database can only analyze the overall situation in China and cannot reflect the specific situation of each province, city, and region. Although studies have shown that exercise and weight loss are associated with reduced risk and improved survival in NHL, there is currently no clinical practice using weight loss to intervene in NHL patients. Therefore, it is recommended that governments, hospitals, and others strengthen publicity to raise awareness of the harmful effects of overweight or obesity, promote healthy eating and moderate exercise, improve healthcare for obese individuals, and reduce the disease burden on NHL patients caused by overweight or obesity. 5. Conclusion Over the past 30 years, China's HBMI has led to an increase in the mortality rate of NHL, and the mortality rate and risk of death have also increased with age, showing a positive correlation. Among them, a higher body mass index in males leads to a higher trend in the mortality rate of NHL and a higher risk of death compared to females. This suggests the need for immediate and effective measures such as weight control and healthy lifestyle, especially for the male population, to further reduce the proportion of obese or overweight individuals and alleviate the burden of NHL disease in the country. Declarations Data availability statemalet This study analyzed publicly available datasets. These data can be found here: the dataset provided in this study can be found in an online repository. The name and login number of the repository/repository can be found at the following location: All data can be accessed from the IHME website: http://ghdx.healthdata.org/gbd. Ethical statemalet Research involving human participants is reviewed and approved by the Global Health Data Exchange query, and does not require informed consent from patients. This study used an anonymous public dataset with no identifiable information about the survey participants. According to national legislation and institutional requirements, this study does not require written informed consent to participate. Author's contribution LC, HY and YSR wrote the manuscript.LC, HY and YSR conducted statistical analysis and interpretation of the data, while CW, SHY and LGQ are responsible for reviewing the content of the manuscript and determining the final version for proofreading. LC and CW conceived and designed this study. All authors participated in this article and approved the submitted version. Funding This work is supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (Approval No.:2022-I2M-1-022), the National Natural Science Foundation of China (Approval No.:82170193). Conflict of interest The author declares that the study is conducted in the absence of any commercial or financial relationships that could be interpreted as potential conflicts of interest. References Shankland KR, Armitage JO, Hancock BW. Non-Hodgkin lymphoma. Lancet. 2012 Sep 1;380(9844):848-57. doi: 10.1016/S0140-6736(12)60605-9. Epub 2012 Jul 25. PMID: 22835603. 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Dietary factors of one-carbon metabolism in relation to non-Hodgkin lymphoma and multiple myeloma in a cohort of male smokers. Cancer Epidemiol Biomarkers Prev. 2006 Jun;15(6):1109-14. Matos A, Marinho-Dias J, Ramalheira S, Oliveira MJ, Bicho M, Ribeiro R. Mechanisms underlying the association between obesity and Hodgkin lymphoma. Tumour Biol. 2016 Oct;37(10):13005-13016. Additional Declarations No competing interests reported. Supplementary Files Supplementarydata.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6952017","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489803971,"identity":"59dbd686-b8fe-4a13-aba7-589649b8df14","order_by":0,"name":"Lin Chen","email":"","orcid":"","institution":"State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Chen","suffix":""},{"id":489803972,"identity":"012a4907-427a-42b4-a862-d2e7d9c0801f","order_by":1,"name":"Hui Yang","email":"","orcid":"","institution":"State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Yang","suffix":""},{"id":489803973,"identity":"512e65f5-411a-423f-9688-50e56f706624","order_by":2,"name":"Yansong Ren","email":"","orcid":"","institution":"State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem","correspondingAuthor":false,"prefix":"","firstName":"Yansong","middleName":"","lastName":"Ren","suffix":""},{"id":489803974,"identity":"3a5f7a80-b8ef-4fdc-8014-d366c605caf3","order_by":3,"name":"shuhua Yi","email":"","orcid":"","institution":"State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem","correspondingAuthor":false,"prefix":"","firstName":"shuhua","middleName":"","lastName":"Yi","suffix":""},{"id":489803975,"identity":"81e1d8e7-7832-4091-8bd5-a2ed57e73ffb","order_by":4,"name":"Lugui Qiu","email":"","orcid":"","institution":"State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem","correspondingAuthor":false,"prefix":"","firstName":"Lugui","middleName":"","lastName":"Qiu","suffix":""},{"id":489803976,"identity":"d6f34e3b-ff84-42b9-bbce-a25e0105d318","order_by":5,"name":"Chuan Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYLACxgYgwd7YRqoWnoMka5FIYCNOtcHxs4df/NxxWN5c8nHbgx812+wZ2A8/YPi5A4+WM3lplr1nDhvunJ3Ybthz7HZiA0+aAWPvGdxazA7kmBkzth1m3HA7sU2age12AgNDDgMzIx5/mZ1/A9Ziv+HmQaCWf7ftGfjfENByI8f4MVBL4oYbjG3SjG23GRskCNhif+ONGWNvW3ryhjOJbZK9fUDnSTwzONiLR4tkf47xh59t1rYbjh9/JvHj2217fv7khw9+4o8jNglULhAfwKuBgYH5AwEFo2AUjIJRMNIBACCuVqbYIfHOAAAAAElFTkSuQmCC","orcid":"","institution":"State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem","correspondingAuthor":true,"prefix":"","firstName":"Chuan","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-06-23 02:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6952017/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6952017/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87507961,"identity":"4ea904b3-4049-4fee-a847-b0bed6e051d8","added_by":"auto","created_at":"2025-07-24 15:08:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27381,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in ASMR of NHL Caused by HBMI in China from 1992 to 2021\u003c/p\u003e\n\u003cp\u003eProvide data for all individuals, including the total population, males and females; HBMI, High body mass index; ASMR, Age standardized mortality rate.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6952017/v1/01e485c8e980ae27174ddd41.png"},{"id":87507964,"identity":"7c4f08ff-e326-452e-9bc7-782fb4461a6e","added_by":"auto","created_at":"2025-07-24 15:08:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":28636,"visible":true,"origin":"","legend":"\u003cp\u003eLocal drift in mortality rate of NHL caused by HBMI in China .\u003c/p\u003e\n\u003cp\u003eProvide data for all individuals, including the total population, males and females; The local drift value\u0026lt;0 shows a downward trend, while the opposite trend shows an upward trend. The error bar represents 95% CI of the local drift value.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6952017/v1/6dfddb774b4c2ff7b71879be.png"},{"id":87507962,"identity":"e881094b-d603-4a97-b46b-24ca50ea3b89","added_by":"auto","created_at":"2025-07-24 15:08:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":86887,"visible":true,"origin":"","legend":"\u003cp\u003eLongitudinal age curve of NHL mortality caused by HBMI in China.\u003c/p\u003e\n\u003cp\u003eProvide data to all individuals, including the total population, male and female. Longitudinal age specificity (per 100,000) for HBMI attributable NHL mortality.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6952017/v1/39b8f24787b417b1c7a2555f.png"},{"id":87509070,"identity":"3457a5bc-5b04-420e-a571-55d4c5f356d9","added_by":"auto","created_at":"2025-07-24 15:16:02","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":82597,"visible":true,"origin":"","legend":"\u003cp\u003eThe period leading to mortality from NHL in China.\u003c/p\u003e\n\u003cp\u003eProvide data to all individuals, including the total population, male and female. The RR for each period compared to the reference period (1992-1996) is adjusted for age and non-linear cohort effects. The error bar represents 95% CI of queue RR. RR, rate ratio; CI, confidence interval。\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6952017/v1/75e70201699f62c08684cfe7.png"},{"id":87507968,"identity":"44542677-899b-4554-912f-a9acbe22bdd0","added_by":"auto","created_at":"2025-07-24 15:08:02","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":86248,"visible":true,"origin":"","legend":"\u003cp\u003eThe cohort leading to mortality from NHL in China.\u003c/p\u003e\n\u003cp\u003eProvide data to all individuals, including the total population, male and female. The RR of each queue compared to the reference queue (1970 queue) adjusted for age and non-linear periodic effects. The error bar represents 95% CI of queue RR. RR, rate ratio; CI, confidence interval。\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6952017/v1/61d90ccad4a5683297e6a573.png"},{"id":95829332,"identity":"2ae9a8f6-ef54-4b6d-b3b9-5e6564ba9a66","added_by":"auto","created_at":"2025-11-13 11:53:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":618793,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6952017/v1/bd62996e-bc18-4e18-90c4-baae231b05f5.pdf"},{"id":87509071,"identity":"e0a7148e-46aa-4580-ab0e-c23f85b7539d","added_by":"auto","created_at":"2025-07-24 15:16:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":47812,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarydata.docx","url":"https://assets-eu.researchsquare.com/files/rs-6952017/v1/fbac3df15415b36c1113399b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk analysis of non-Hodgkin lymphoma (NHL) mortality associated with high body mass index (HBMI) in China: a population study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eNon-hodgkin lymphoma (NHL) is a malignant tumor originating in lymph nodes and lymphoid tissue [1]. Over the past few decades, the incidence of NHL has increased rapidly worldwide. According to the 2021 Global Burden of Disease Database (GBD), the number of cases, deaths and disability-adjusted life years (DALYs) of NHL worldwide are 1,741,300, 254,600 and 6,691,000, respectively [2]. According to GLOBALCAN, NHL ranks tenth among all cancers in 2022, with 553,000 new cases and 251,000 deaths[3].In China, which has one-fifth of the world\u0026apos;s population, GBD 2021 shows that there are 410,400 cases of NHL, accounting for a quarter of the global total [2]. The incidence of NHL in China has increased significantly over the past few decades, with an increase of 38.02% from 1988 to 2002 [3]. GLOBALCAN shows that in 2022, China will have 81,000 new cases and 24,000 people with the disease in five years[4]. The disease burden of NHL in China is increasing year by year.\u003c/p\u003e\n\u003cp\u003eBeing overweight or obese increases morbidity and mortality from a variety of diseases and conditions, including cancer, cardiovascular disease, osteoarthritis, and more. Among them, cancer is the third leading cause of death and premature disability due to being overweight or obese. Studies have shown that the proportion of obesity population is on the rise, and it has a significant impact on the incidence and mortality of other diseases, and has become a major global public health problem [5-7]. Overweight is defined as a BMI between 25 kg/m2 and 29.9 kg/m2, and obesity is defined as a BMI over 30 kg/m2. A BMI of 25kg /m2 or more is considered high. The epidemic of overweight or obesity places a heavy burden on the world with its high medical costs [8]. With the rapid growth of China\u0026apos;s economy, the change of Chinese people\u0026apos;s lifestyle and diet structure, mainly including sedentary behavior and the increase of dietary fat content, has led to an increasing number of overweight and obese people in China. According to the Report on Nutrition and Chronic Diseases in Chinese Residents (2020), the overweight rate of Chinese residents over the age of 18 is 34.3%,the obesity rate is 16.4%.\u003c/p\u003e\n\u003cp\u003eAccording to Teras et al.\u0026apos;s research, long-term overweight has a significant impact on the risk of NHL[9]. Larsson et al.\u0026apos;s meta-analysis showed a positive correlation between body mass index and the risk and mortality of NHL[10] At present, there is no research evaluating the long-term trend of the burden of NHL caused by HBMI in China, especially studying the effects of age, period and cohort on the burden trend of NHL caused by HBMI. Therefore, this study used the GBD database to investigate the current burden of NHL caused by HBMI, and evaluated the disease prevalence trend attributed to HBMI in Chinese NHL patients from 1992 to 2021 using Jionpiont and age period cohort analysis (APC), in order to provide reference for relevant research and prevention and control policy formulation of NHL in China.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e2.1 Data sources\u003c/p\u003e\n\u003cp\u003eThe mortality rate data for this study is from GBD 2021. GBD 2021（http://ghdx.healthdata.org/gbd）The data has been approved by the Institutional Review Board of the University of ishington, provided by the Institute for Health Indicators and Assessment, and is the world\u0026apos;s most comprehensive survey, census, life statistics, and other health-related data used to quantify global health losses related to disease, injury, and risk factors. GBD 2021 is the latest version of this project [11-13].\u003c/p\u003e\n\u003cp\u003eThe data on the mortality rate of NHL caused by HBMI is obtained in GBD 2021 through the following steps: (1) weight NHL matching in metabolic risk is determined based on research, (2) relative risk of high body mass exposure is estimated based on a systematic review, (3) specific BMI levels for age, gender, location, and year type are evaluated, (4) theoretical minimum risk exposure level is determined, (5) population attribution score and attributed mortality rate are calculated to obtain the mortality rate of NHL caused by HBMI in GBD 2021, and (6) comprehensive mortality rate considering HBMI risk factors [14].\u003c/p\u003e\n\u003cp\u003e2.2 Statistical analysis\u003c/p\u003e\n\u003cp\u003eUsing a joint regression model to analyze the temporal trend of NHL ASMR caused by high body weight from 1992 to 2021, and further analyzing the long-term trend of ASMR to determine statistically significant trends across different age groups. Estimate the Average annual percentage change (AAPC), annual percentage change for each age group, and 95% confidence interval (CI) to indicate the direction and magnitude of the trend.\u003c/p\u003e\n\u003cp\u003eThe age period cohort model is used to evaluate the contribution of HBMI to the age, period, and cohort effects of NHL mortality. Three types of trends are analyzed separately, providing relatively effective estimation results [15]. The age effect refers to the difference in mortality rate of Hodgkin\u0026apos;s lymphoma caused by HBMI among different age groups. The period effect represents the variation of NHL mortality rate caused by HBMI over time, and is correlated with all age groups simultaneously. The queue effect is the change in mortality rate among patients in the same age group of NHL caused by HBMI at different stages [16]. In our study, we focused on estimating local drift, longitudinal age curves, period, and cohort risk ratios (RRs). Local drift refers to the annual average percentage change over time in mortality rates for various age groups of NHL caused by HBMI. The longitudinal age curve represents the longitudinal age specific ratio of each cohort of NHL caused by HBMI after period adjustment. Finally, the period (cohort) RRs are multiple mortality risk factors for NHL cohorts caused by HBMI compared to the reference cohort [17].\u003c/p\u003e\n\u003cp\u003eIn the age period cohort analysis, the number of deaths and population are arranged as a continuous 5-year period from 1992 to 2021 and a continuous 5-year age group of 20-24 and 80-84 years old. Due to the relatively small number of individuals aged 85 or older with NHL, and the relatively rare occurrence of high body weight in the elderly, they are excluded from this study. The age group of 20-24 years old, the period group from 2002 to 2006, and the cohort group from 1957 are defined as the reference group.\u003c/p\u003e\n\u003cp\u003eConnection point analysis is conducted using connection point software version 5.0.2 (July 2023) from the National Cancer Institute (Rockville, MD) in the United States. Age Queue Network Tool (Biostatistics Division, National Cancer Institute, Bethesda, Maryland; https://analysistools.nci.nih.gov/apc/ ）Used for age period cohort analysis. All statistical tests are bilateral tests, with P\u0026lt;0.05 indicating statistically significant differences.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1. Joint point regression analysis\u003c/p\u003e\n\u003cp\u003eFrom 1992 to 2021, the ASMR trend of NHL mortality caused by HBMI in China showed an upward trend, with higher mortality rates in males compared to females (Figure 1, Supplementary Table S1-1). The HBMI in China led to an increase in ASMR of NHL from 0.06/100,000 (95%CI, 0.02-0.10) in 1992 to 0.08/100,000 (95%CI, 0.03-0.15) in 2021, with males increasing from 0.06/100,000 (95%CI,0.02-0.11) to 0.11/100,000 (95%CI, 0.03-0.19) and females increasing from 0.05/100,000 (95%CI,0.02-0.08) to 0.06/100,000 (95%CI,0.02-0.12). Compared with the world, the ASMRs in China are lower than those in the world, and this situation occurs in both males and females (Supplementary Table S1-1).\u003c/p\u003e\n\u003cp\u003eIn addition, the HBMI in China in 2021 led to an increase in the mortality rate of NHL from 0.01/100,000 (95%CI, 0.00-0.02) in the 20-24 age group to 0.62/100,000 (95%CI, 0.21-1.12) in the 80-84 age group, similar patterns also exist in other years (Supplementary Table S1-1) . Meanwhile, HBMI in different age groups led to the increasing mortality rate of NHL patients, with the age group increasing from 0.37/100,000 in (95%CI,0.14-0.63) in 1992 to 0.62/100,000 (95%CI, 0.21-1.12) in 2021(Supplementary Table S1-1).\u003c/p\u003e\n\u003cp\u003e3.2 Age cohort analysis\u003c/p\u003e\n\u003cp\u003e3.2.1 Changes with age\u003c/p\u003e\n\u003cp\u003eThe increase of NHL mortality in China by HBMI in China is higher than in the whole world, and the AAPC growth rate males are higher than females the in China and world (Figure 2, Supplementary Table S2-1). The local drift amplitude of NHL mortality caused by HBMI in different age groups first decreases and then increases in China and world，but females increase in the drift amplitude with increasing age,with 20-24 years 0.42%(95%CI,-3.49-4.49) increased to 80-84 years 1.35%((95%CI,-0.50-3.23), global females on the contrary, this suggests that Chinese females NHL mortality risk is higher(figure 2, supplementary table S2-1).\u003c/p\u003e\n\u003cp\u003eThe longitudinal age curve of NHL mortality caused by HBMI in China (Figure 3) indicates that the mortality rate per 100,000 people increases with age. From 0.01/100,000 (95%CI, 0.00-0.01) for 20-24 years old to 0.68/100,000 (95%CI, 0.58-0.80) for 80-84 years old (Supplementary Table S2-2), males increased from 0.01/100,000 (95%CI, 0.00-0.01) for 20-24 years old to 0.94/100,000 (95%CI, 0.76-1.17) for 80-84 years old, and females increased from 0.01/100,000 (95%CI, 0.00-0.01) for 20-24 years old to 0.48/100,000 (95%CI,0.38-0.61) for 80-84 years old. From this, it can be seen that the mortality rate of NHL caused by HBMI in China males increase with age, and is higher than that in females.\u003c/p\u003e\n\u003cp\u003e3.2.2 Changes over time and queues\u003c/p\u003e\n\u003cp\u003eThe period effect suggested that HBMI in China showed a decrease in NHL-related mortality risk, similar in females and a continuous increase in males (Supplementary Table S3-1).The RR of NHL deaths in China increased from 1.01(95%CI,0.90-1.14) in 1992-1996 to 1.44(95%CI,1.31-1.58) in 2017-2021,the risk of death in males increased from 0.92(95%CI,0.75-1.07) in 1992-1996 to 1.47(95%CI,1.31-1.66) in 2017-2021 (Figure 4).NHL is different in periods,before 2006, females are higher than males, and lower than males after 2006, and the risk of death is decreasing year by year.\u003c/p\u003e\n\u003cp\u003eThe cohort effect showed that high risk of NHL mortality in China increased year by year, with a significant increasing trend of death after 1952 (Figure 5 and Supplementary Table S3-1), from 0.50(95%CI,0.32-0.77) in 1912 to 2.21(95%CI,1.05-4.22) in 1997, and the risk of death increased by 4 times, showing a similar situation in males.There are differences in the risk of death among births, and the risk of death from NHL caused by HBMI in males born after 1952 is higher than that in females, and the risk of death in males after 1977 is significantly higher than that in females.Overall, the risk of death in males is greater than that of females in China, and the risk of death in males is negatively correlated with age. Suggesting a need to increase the risk of NHL disease in young obese males.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe research results show that the ASMR of HBMI related NHL in China has shown an overall growth trend in the past 30 years.High BMI in China caused higher standardized mortality with age, a similar phenomenon in both males and females.Males have higher mortality from NHL,with a higher increase in mortality rate in males.\u003c/p\u003e\n\u003cp\u003eNumerous studies have shown that HBMI may be involved in carcinogenic effects and promote cancer progression, impairing the efficacy of cancer treatment, leading to obesity related comorbidities and poor prognosis in obese cancer patients[18-20]. Although there is a recognized association between obesity and BMI with an increased risk of hematological malignancies. However, its potential mechanisms have not been fully determined and may include chronic inflammation, hormonal imbalance, glucose and lipid metabolism disorders, and other related factors. Chronic inflammation may be caused by pro-inflammatory cytokines released by adipocytes, such as interleukin-6 (IL-6), IL-1\u0026beta;, and tumor necrosis factor -\u0026alpha;. These cytokines increase the production of C-reactive protein and serum amyloid A, further promoting the possibility of cancer[21-25].\u003c/p\u003e\n\u003cp\u003eAAPC with attributable HBMI mortality was high at both ends,if the rules can be found, targeted interventions will have a significant impact on human health.Compared with the world, the mortality rate attributable to NHL in China is lower, but the AAPC is much higher than the global level, indicating that the number of deaths of NHL patients in China is still increasing, and effective interventions are urgently needed to reduce the burden of NHL deaths caused by HBMI.Our findings are similar to a recent study where HBMI increased disease burden and mortality in patients with NHL[26].As China is a developing country, the increased incidence of HBMI-related diseases, inadequate health infrastructure, late cancer detection and poor access can all lead to increased mortality in weight or overweight NHL patients.\u003c/p\u003e\n\u003cp\u003eWe also found that the mortality rate of NHL due to HBMI was lower in females than in males in all different age groups, and the period to cohort effect RR increased more significantly in males than females, especially in young and middle-aged males, suggesting that males face a greater burden of NHL than females.Many studies have also fully confirmed this[27-29]. Firstly, the lower mortality rate among females compared to males may be related to changes in physiological factors. Research has shown that a female sex hormone (estradiol) can significantly enhance the activation of macrophages and induce an increase in fat, while the same effect of androgens is not significant[30]. The female population is generally accompanied by non-physiological obesity, such as pregnancy and menopause, which does not cause the body to experience elevated blood sugar or visceral fat due to obesity. Male obesity increases the production of testosterone, leading to higher levels of free testosterone, promoting and exacerbating symptoms such as elevated blood lipids and blood sugar, and increasing the risk of death[31-33]. A study found that as pregnancy increases, the risk of NHL significantly decreases[34]. In addition, compared to females, males often exhibit a lack of emphasis on health management, smoking, and excessive eating, while harmful or unhealthy habits have a significant impact on the mortality rate of NHL[35,36]. Therefore, strategies to control HBMI should focus more on males.\u003c/p\u003e\n\u003cp\u003eThis study is of great significance to public health as it provides a comprehensive analysis of the trend of NHL mortality caused by HBMI in China from 1992 to 2021. In the past three decades, the mortality of NHL in China have been rising, so the risk of prevention and control of NHL in China is still serious. It has been proven that effective weight or obesity control can reduce the risk of developing NHL and lower their disease burden[37]. In future research, we can reduce the share of HBMI in the population by improving the health care infrastructure and strengthening the promotion and implementation of healthy lifestyles, which will help reduce the risk of individual death from NHL.\u003c/p\u003e\n\u003cp\u003eThis study has certain limitations. Firstly, although the research data is sourced from the GBD 2021 database, the analyzed values cannot be fully attributed to the impact of HBMI on NHL. Secondly, the GBD 2021 database can only analyze the overall situation in China and cannot reflect the specific situation of each province, city, and region.\u003c/p\u003e\n\u003cp\u003eAlthough studies have shown that exercise and weight loss are associated with reduced risk and improved survival in NHL, there is currently no clinical practice using weight loss to intervene in NHL patients. Therefore, it is recommended that governments, hospitals, and others strengthen publicity to raise awareness of the harmful effects of overweight or obesity, promote healthy eating and moderate exercise, improve healthcare for obese individuals, and reduce the disease burden on NHL patients caused by overweight or obesity.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOver the past 30 years, China\u0026apos;s HBMI has led to an increase in the mortality rate of NHL, and the mortality rate and risk of death have also increased with age, showing a positive correlation. Among them, a higher body mass index in males leads to a higher trend in the mortality rate of NHL and a higher risk of death compared to females. This suggests the need for immediate and effective measures such as weight control and healthy lifestyle, especially for the male population, to further reduce the proportion of obese or overweight individuals and alleviate the burden of NHL disease in the country.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability statemalet\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study analyzed publicly available datasets. These data can be found here: the dataset provided in this study can be found in an online repository. The name and login number of the repository/repository can be found at the following location: All data can be accessed from the IHME website: http://ghdx.healthdata.org/gbd.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statemalet\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch involving human participants is reviewed and approved by the Global Health Data Exchange query, and does not require informed consent from patients. This study used an anonymous public dataset with no identifiable information about the survey participants. According to national legislation and institutional requirements, this study does not require written informed consent to participate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLC, HY and YSR wrote the manuscript.LC, HY and YSR conducted statistical analysis and interpretation of the data, while CW, SHY and LGQ are responsible for reviewing the content of the manuscript and determining the final version for proofreading. LC and CW conceived and designed this study. All authors participated in this article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (Approval No.:2022-I2M-1-022), the National Natural Science Foundation of China (Approval No.:82170193).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares that the study is conducted in the absence of any commercial or financial relationships that could be interpreted as potential conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eShankland KR, Armitage JO, Hancock BW. Non-Hodgkin lymphoma. Lancet. 2012 Sep 1;380(9844):848-57. doi: 10.1016/S0140-6736(12)60605-9. Epub 2012 Jul 25. 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(2021) 8:743180.\u003c/li\u003e\n\u003cli\u003eChu Y, Liu Y, Fang X, Jiang Y, Ding M, Ge X, Yuan D, Lu K, Li P, Li Y, Xu H, Fan J, Zhou X, Wang X. The epidemiological patterns of non-Hodgkin lymphoma: global estimates of disease burden, risk factors, and temporal trends. Front Oncol. 2023 Jun 2;13:1059914.\u003c/li\u003e\n\u003cli\u003eClayton D, Schifflers E. Models for temporal variation in cancer rates. II: age-period-cohort models. Stat Med. 1987;6:469\u0026ndash;481.\u003c/li\u003e\n\u003cli\u003eYang Y, Land KC. Age-period-cohort analysis: new models, methods, and empirical applications. Boca Raton, FL: CRC Press; 2013. Accessed January 12, 2019. https://www.taylorfrancis.com/books/9781466507531.\u003c/li\u003e\n\u003cli\u003eRosenberg PS, Check DP, Anderson WF. A web tool for age-period-cohort analysis of cancer incidence and mortality rates. Cancer Epidemiol, Biomarkers Prev: Publ Am Assoc Cancer Res,Cosponsored Am Soc Preventive Oncol. 2014;23:2296-2302.\u003c/li\u003e\n\u003cli\u003eCelind J, Ohlsson C, Bygdell M, Martikainen J, Lewerin C, Kindblom JM. Childhood body mass index is associated with the risk of adult hematologic malignancies in men-The best Gothenburg cohort. Int J Cancer. 2020 Nov 1;147(9):2355-2362.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Sullivan J, Lysaght J, Donohoe CL, Reynolds JV. Obesity and gastrointestinal cancer: the interrelationship of adipose and tumour microenvironments. Nat Rev Gastroenterol Hepatol. (2018) 15:699\u0026ndash;714.\u003c/li\u003e\n\u003cli\u003eStrulov Shachar S, Williams GR. The obesity paradox in cancer-Moving beyond BMI. Cancer Epidemiol Biomarkers Prev. (2017) 26:13\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eRiaz H, Khan MS, Siddiqi TJ, et al. 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(2018) 7:220\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eKane EV, Roman E, Becker N, Bernstein L, Boffetta P, Bracci PM, et al. Menstrual and reproductive factors, and hormonal contraception use: associations with non-Hodgkin lymphoma in a pooled analysis of InterLymph case\u0026ndash;control studies. Ann Oncol (2012) 23(9):2362\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eSkibola CF. Obesity, diet and risk of non-Hodgkin lymphoma. Cancer Epidemiol Biomarkers Prev. 2007 Mar;16(3):392-5.\u003c/li\u003e\n\u003cli\u003eLim U, Weinstein S, Albanes D, Pietinen P, Teerenhovi L, Taylor PR, Virtamo J, Stolzenberg-Solomon R. Dietary factors of one-carbon metabolism in relation to non-Hodgkin lymphoma and multiple myeloma in a cohort of male smokers. Cancer Epidemiol Biomarkers Prev. 2006 Jun;15(6):1109-14.\u003c/li\u003e\n\u003cli\u003eMatos A, Marinho-Dias J, Ramalheira S, Oliveira MJ, Bicho M, Ribeiro R. Mechanisms underlying the association between obesity and Hodgkin lymphoma. Tumour Biol. 2016 Oct;37(10):13005-13016.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"non-Hodgkin's lymphoma(NHL), disease burden, high body mass index (HBMI), age standardized mortality rate (ASMR), Age-Period-Cohort Analysis （APC model）","lastPublishedDoi":"10.21203/rs.3.rs-6952017/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6952017/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: This study aims to explore the trend of NHL mortality caused by high body mass index (HBMI) in China from 1992 to 2021.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The mortality data is obtained from the 2021 Global Burden of Disease (GBD). We used the Age-Period-Cohort Model (APC) method to evaluate the trend of HBMI induced NHL mortality in China.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e: The age-standardized mortality rate (ASMR) of NHL due to HBMI in China has been increasing from 1992 to 2021.Mortality from NHL in China with HBMI is positively associated with age, and males is higher.The period effect show that the death from NHL caused by HBMI in China show a V-shaped trend, while males show increasing trend.The cohort effect suggests that the risk of death from NHL caused by HBMI in China is increasing,and the risk of death has increased by 4-fold.The mortality risk is higher in males.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e:In the past 30 years, HBMI has led to an increasing trend of ASMRs for NHL in China, which requires immediate measures such as weight control and healthy lifestyle, especially for males, to further reduce the proportion of obese or overweight people and reduce the national burden of NHL disease.\u003c/p\u003e","manuscriptTitle":"Risk analysis of non-Hodgkin lymphoma (NHL) mortality associated with high body mass index (HBMI) in China: a population study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-24 15:07:57","doi":"10.21203/rs.3.rs-6952017/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cc8dcde-eb19-441f-96f5-aaddd0ca97a5","owner":[],"postedDate":"July 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-13T11:53:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-24 15:07:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6952017","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6952017","identity":"rs-6952017","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}