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Sigrid Bjerge Gribsholt,1,2 Dóra Körmendiné Farkas,3 Reimar Wernich Thomsen,3 Bjørn Richelsen,1,2 Henrik Toft Sørensen3 1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; 2Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, DenmarkCorrespondence: Sigrid Bjerge Gribsholt, Tel +4561651148, Email sigrid.bjerge.gribsholt@clin.au.dkPurpose: Data on long-term mortality among patients with hospital-diagnosed overweight/obesity are limited. Thus, we aim to examine 40-year mortality among patients with hospital-diagnosed overweight/obesity, including cause-specific deaths, secular time trends, and potential effect modification by age, comorbidity, and socioeconomic factors.Patients and Methods: From national registries, we identified all Danes with a first hospital-based overweight/obesity diagnosis (N=331,185), 1979– 2018, and constructed an age- and gender-matched general population comparison cohort (N=1,655,925). We computed mortality rates (MRs) per 1000 person-years and adjusted mortality rate ratios (aMRRs) with 95% confidence intervals (CIs), using Cox regression with adjustment for comorbidities and educational level. We performed stratified analyses on age, comorbidities, and socioeconomic factors.Results: The overall aMRR was 1.70 (95% CI: 1.68– 1.72) for patients with overweight/obesity, mainly due to diabetes and other endocrine diseases (aMRR=2.68 [95% CI: 2.57– 2.81]), cardiovascular (aMRR=1.95 [95% CI: 1.91– 1.98]), and respiratory diseases (aMRR=1.83 [95% CI: 1.77– 1.89]). The 1– 10-year aMRR decreased from 2.06 (95% CI: 2.01– 2.11) in 1979– 1989 to 1.29 (95% CI: 1.26– 1.32) in 2000– 2009. We found effect modification by age: age 18 to < 30 years: aMRR=2.44 (95% CI: 2.24– 2.66) vs age ≥ 70 years: 1.35 (95% CI: 1.33– 1.37); comorbidities: baseline comorbidities: aMRR=1.1

Sigrid Bjerge Gribsholt,1,2 Lars Pedersen,1 Bjørn Richelsen,3 Reimar Wernich Thomsen1 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; 3The Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, DenmarkCorrespondence: Sigrid Bjerge GribsholtDepartment of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, DenmarkTel +45 6 165 1148Email sigrgrib@rm.dkPurpose: Health care databases may be a valuable source for epidemiological research in obesity, if diagnoses are valid. We examined the validity and completeness of International Classification of Diseases, 10th revision [ICD-10] diagnosis coding for overweight/obesity in Danish hospitals.Patients and methods: We linked data from the Danish National Patient Registry on patients with a hospital diagnosis code of overweight/obesity (ICD-10 code E66) with computerized height and weight measurements made during hospital contacts in the Central Denmark Region Clinical Information System. We computed the positive predictive value (PPV) of the IDC-10 diagnosis of overweight/obesity, using a documented body mass index (BMI) ≥25 kg/m2 as gold standard. We also examined the completeness of obesity/overweight diagnosis coding among all patients recorded with BMI ≥25 kg/m2.Results: Of all 19,672 patients registered with a first diagnosis code of overweight/obesity in the National Patient Registry, 17,351 patients (88.2%) had any BMI measurement recorded in the Central Denmark Region Clinical Information System, and 17,240 patients (87.6%) had a BMI ≥25 kg/m2, yielding a PPV of 87.6% (95% CI: 87.2–88.1). The PPV was slightly higher for primary diagnosis codes of overweight/obesity: 94.1% (95% CI: 93.3–94.8) than for secondary diagnosis codes: 86.1% (95% CI: 85.6–86.6). The PPV increas