The findings are consistent with those from a cross-sectional subgroup analysis of the Framingham cohort,25 in which an association between osteoarthritis of the lumbar spine and a tendency for radiological LSS associated with increased BMI was shown.25 The analysis included 187 participants, of whom 13 had radiological findings of LSS. Another recent cross-sectional study of participants (n = 938), in whom 78% were considered to have more than moderate radiographical central spinal stenosis, also displayed a positive association between radiological LSS and BMI.31
The main strengths of our study are the prospective design, the large sample size, and the high validity of both exposure and outcome. Date of diagnosis, date of surgery, occurrence of death, and emigration data were collected through national registers known to have high accuracy.33 Complete linkage between the registers is rendered by the individual personal identification number provided to all Swedish residents.37 Furthermore, the sensitivity analysis using only cases with codes for diagnosis connected to a surgical procedure revealed similar results as the original analysis.
The work was supported by Swedish Council for Health Working Life and Welfare (2011–426), and the Department of Research and Development Västernorrland County Council.
Supplemental digital content is available for this article. Direct URL citation appearing in the printed text is provided in the HTML and PDF version of this article on the journal's Web site (www.spinejournal.com).
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