Age-adjusted Relative Risk Research Articles

Increased Mortality Risk in Women With Depression and Diabetes Mellitus

Depression and diabetes mellitus have been associated with an increased risk of all-cause and cardiovascular disease (CVD) mortality. However, data evaluating the joint effects of these 2 conditions on mortality are sparse. To evaluate the individual and joint effects of depression and diabetes on all-cause and CVD mortality rate. Prospective cohort study. The 11 states of the Nurses' Health Study. A total of 78 282 women who participated in the Nurses' Health Study aged 54 to 79 years at baseline in 2000 were followed up until 2006. Depression was defined as having self-reported diagnosed depression, treatment with antidepressant medications, or a score indicating severe depressive symptoms (ie, a 5-item Mental Health Index score ≤52). Self-reported type 2 diabetes was confirmed using a supplementary questionnaire. All-cause and CVD-specific mortality rate. During 6 years of follow-up (433 066 person-years), 4654 deaths were documented, including 979 deaths from CVD. Compared with participants without either condition, the age-adjusted relative risks (RRs) (95% confidence interval) for all-cause mortality were 1.76 (1.64-1.89) for women with depression only, 1.71 (1.54-1.89) for individuals with diabetes only, and 3.11 (2.70-3.58) for women with both conditions. The corresponding age-adjusted RRs of CVD mortality were 1.81 (1.54-2.13), 2.67 (2.20-3.23), and 5.38 (4.19-6.91), respectively. These associations were attenuated after multivariate adjustment for other demographic variables, body mass index, smoking status, alcohol intake, physical activity, and major comorbidities (including hypertension, hypercholesterolemia, heart diseases, stroke, and cancer) but remained significant, with the highest RRs for all-cause and CVD mortality found in those with both conditions (2.07 [1.79-2.40] and 2.72 [2.09-3.54], respectively). Furthermore, the combination of depression with a long duration of diabetes mellitus (ie, >10 years) or insulin therapy was associated with a particularly higher risk of CVD mortality after multivariate adjustment (RRs, 3.22 and 4.90, respectively). Depression and diabetes are associated with a significantly increased risk of all-cause and CVD mortality rate. The coexistence of these conditions identifies women at particularly high risk.

Gene-Environment Interactions in 7610 Women With Breast Cancer: Prospective Evidence From the Million Women Study

Both genetic and environmental factors contribute to the risk of breast cancer but it is unclear whether specific gene-environment interactions increase risk. Genome-wide association studies identified a number of breast cancer low-penetrance genetic susceptibility polymorphisms. There are scant data on the combined effects of these polymorphisms and environmental factors on the incidence of breast cancer. Some studies suggested possible interactions between some genetic susceptibility polymorphisms and use of hormone replacement therapy (HRT) or breast cancer, but the data were inconsistent. The aim of this prospective cohort study was to determine whether environmental risk factors modified the relative risks of breast cancer associated with several single nucleotide polymorphisms (SNPs) previously associated with the disease. Routine screening for breast cancer was performed at 66 screening centers in the United Kingdom during 1996-2001 in 1.3 million women (mean age, 56 years). The study participants were 7610 women who developed breast cancer and 10,196 randomly selected women without breast cancer. The investigators tested the association between 10 established environmental risk factors for breast cancer (age at menarche, parity, age at first birth, breast-feeding, menopausal status, age at menopause, use of HRT, body-mass index, height, and alcohol consumption) and 12 SNPs (FGFR2-rs2981582, TNRC9-rs3803662, 2q35-rs 13387042, MAP3K1-rs889312, 8q24-rs13281615, 2p-rs4666451, 5p12-rs981782, CASP8- rs1045485, LSP1-rs3817198, 5q-rs30099, TGFB 1- rs 1982073, and ATM-rs 1800054). Logistic regression models were used to determine the main effect of each of the 12 SNPs on the relative risk for breast cancer by calculating the per-allele age-adjusted relative risks for the high-risk versus the low-risk allele. The data showed that none of 120 possible gene-environment interactions in 7610 women with breast cancer remained significant after allowance for the multiple tests. There was little evidence for interactions between genotype, use of HRT, and estrogen-receptor-positive breast cancer. After adjustment for multiple testing, no significant associations were found between 11 of the 12 polymorphisms and the 10 environmental risk factors. A significant association was found for only 1 of the 12 polymorphisms: carriers of the high-risk C allele of MAP3K1-rs889312 were significantly shorter than noncarriers; the mean heights of carriers versus noncarriers were 162 ± 4 cm (95% confidence interval: 162.1-162.7) and 163 ± 1 cm (162.9-163.2), respectively, after adjustment for multiple testing (P = 0.01). These findings show no significant increased risk of breast cancer associated with low-penetrance susceptibility polymorphisms for 10 established environmental risk factors.

Epidemiological surveillance of lumbar disc surgery in the general population: A pilot study in a French region

Objectives Disc-related sciatica (DRS) is a significant and costly health problem in the working population. The aim of this pilot study was to assess the feasibility of a surveillance system for DRS using hospital databases for lumbar disc surgery (LDS). Methods A total of 272 inpatients (119 men and 153 women) living in a French region and discharged in 2002–2003 from a spine center of a large University Hospital following LDS were compared with demographic and socioeconomic data on the population of the same region. Medical and occupational histories were gathered using a mailed questionnaire. The age-adjusted relative risks and population attributable fraction of risk (PAF) were calculated in relation to occupations and industries. Results Information on employment was available for the 75 women and 71 men. The risk of LDS varied according to occupations and industries. PAFs ranged between 30% (12–48) for male blue collar workers and 22% (4–40) for female lower white collar workers. PAFs ranged between 7 and 17% in the economic sectors at high risk. Conclusion The surveillance of LDS can identify occupations and industries at risk.

Increased incidence of meningococcal disease in HIV-infected individuals associated with higher case-fatality ratios in South Africa

We aimed to compare the incidence of meningococcal disease amongst HIV-infected and uninfected individuals and to evaluate whether HIV is a risk factor for mortality and bacteremia amongst patients with meningococcal disease. Cohort surveillance study. We conducted laboratory-based surveillance for meningococcal disease in Gauteng Province, South Africa. HIV status and outcome data were obtained at sentinel sites. Incidence in HIV-infected and uninfected persons was calculated assuming a similar age-specific HIV prevalence in tested and untested individuals. Risk factors for death and bacteremia (as compared with meningitis) were evaluated using multivariable logistic regression. From 2003 to 2007, 1336 meningococcal cases were reported. Of 504 patients at sentinel sites with known outcome, 308 (61%) had HIV serostatus data. HIV prevalence amongst cases of meningococcal disease was higher than the population HIV prevalence in all age groups. The incidence of meningococcal disease in HIV-infected individuals was elevated in all age groups with an age-adjusted relative risk of 11.3 [95% confidence interval (CI) 8.9-14.3, P < 0.001]. The case-fatality ratio (CFR) was 20% (27/138) amongst HIV-infected and 11% (18/170) amongst HIV-uninfected individuals [odds ratio (OR) 2.1, 95% CI 1.1-3.9]. On multivariable analysis, CFR was greater amongst patients with bacteremia (35%, 29/82) compared with meningitis (7%, 16/226) (OR 7.8, 95% CI 3.4-17.7). HIV infection was associated with increased odds of bacteremia (OR 2.7, 95% CI 1.5-5.0). HIV-infected individuals may be at increased risk of meningococcal disease. The increased CFR in HIV-infected patients may be explained by their increased odds of bacteremia compared to meningitis.

Comparison of Cystatin C and Creatinine as Predictors of Cardiovascular Events in a Community-Based Elderly Population

Reduced renal function is an established risk factor for cardiovascular events. We compared 3 measures of renal function--serum cystatin C, serum creatinine, and calculated creatinine clearance--as predictors of subsequent cardiovascular events in a community-based population of elderly individuals. Comprehensive cardiovascular risk factor data were available for 1410 surviving participants of previous Busselton health surveys who were >or=60 years old. Hazard ratios for risk of incident coronary heart disease and cardiovascular disease over 10 years of follow-up were derived for each baseline measure of renal function by use of Cox regression. All measures of renal function were significantly related to risks of morbidity and mortality from coronary heart disease and cardiovascular disease. There were 453 incident cardiovascular disease events; and the age- and sex-adjusted hazard ratios (95% CIs) were 1.34 (1.23-1.46), 1.32 (1.20-1.45), and 1.22 (1.06-1.41) per 1-SD deterioration in cystatin C, creatinine, and creatinine clearance, respectively. All 3 measures gave approximately the same age-adjusted relative risk estimates. After further adjustment for established cardiovascular risk factors, the relative risk estimates were all reduced but remained statistically significant (P < 0.05). Cystatin C was not a significant predictor for cardiovascular disease after adjustment for creatinine clearance. In relation to predicting risk for coronary heart disease or cardiovascular disease over a 10-year follow-up in a community-based population of elderly subjects, there was no evidence that cystatin C was a better risk predictor than creatinine or creatinine clearance.

Socioeconomic Variation in the Magnitude of the Association between Self-Rated Health and Mortality

To assess socioeconomic variation in the association between self-rated health (SRH) and mortality and to determine whether socioeconomic inequalities in SRH and socioeconomic inequalities in mortality differ in magnitude. We used data from a cohort of Spanish people 60 years of age and older with an 8-year follow-up of mortality. The association between SRH at baseline and mortality was estimated by the age-adjusted relative risk of mortality in people with low, medium, and high education. The measures of health inequalities were the prevalence ratio of poor SRH and the age-adjusted relative risk of mortality according to educational level. The validity of SRH to reflect life-threatening and non-life-threatening health conditions was summarized with the likelihood ratio for poor SRH in each educational category. The relative risk of mortality according to SRH in subjects with high and low education was 3.24 and 1.62 in men and 2.25 and 1.50 in women, respectively. Inequalities in poor self-rated health were larger than inequalities in mortality: -1.63 versus 1.07 in men and 1.45 versus 1.30 in women. The highest likelihood ratio for SRH was seen in persons with high education in the case of life-threatening conditions, and for those with low education, in the case of non-life-threatening conditions. Socioeconomic variation in the validity of SRH to reflect life-threatening and non-life-threatening conditions could explain the greater ability of SRH to predict mortality in persons with high education and why inequalities in poor SRH are larger than inequalities in mortality.

1724 INITIAL PSA &gt;= 1.5 NG/ML IN MEN =&lt; 50 YEARS OLD PREDICTS A SUBSEQUENT HIGHER RISK OF PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Detection and Screening I1 Apr 20101724 INITIAL PSA >= 1.5 NG/ML IN MEN =< 50 YEARS OLD PREDICTS A SUBSEQUENT HIGHER RISK OF PROSTATE CANCER Matthew Uhlman, Ping Tang, Leon Sun, Cary Robertson, Thomas Polascik, David Albala, Craig Donatucci, and Judd Moul Matthew UhlmanMatthew Uhlman More articles by this author , Ping TangPing Tang More articles by this author , Leon SunLeon Sun More articles by this author , Cary RobertsonCary Robertson More articles by this author , Thomas PolascikThomas Polascik More articles by this author , David AlbalaDavid Albala More articles by this author , Craig DonatucciCraig Donatucci More articles by this author , and Judd MoulJudd Moul More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1572AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studies have shown that an initial PSA higher than the median in young men predicts a subsequent higher risk of prostate cancer (PCa). No study has examined this relationship when patients are stratified by race. METHODS A cohort of 3,530 African American (AA) men and 6,118 Caucasian American (CA) men =< 50 years old and with a PSA < 4 ng/ml at their first PSA screening was retrieved from the Duke Prostate Center database. Patients were divided into groups based on their initial PSA (0.1-0.6, 0.7-1.4, 1.5-2.4 and 2.5- 4.0 ng/ml). Univariate and age-adjusted multivariate logistic regression were used to estimate the relative risk of cancer in these PSA groups. The incidences of PCa during subsequent periods of follow up were calculated RESULTS The median PSA for both AA and CA men was 0.7 ng/ml at age =< 50 years old. The incidence of PCa was not significant different between PSA < 0.6 ng/ml and 0.7-1.4 groups for either AA or CA men. AA and CA men with an initial PSA in the 1.5-2.4 ng/ml range had a 9.3- and 6.7-fold increase in age-adjusted relative risk of PCa, respectively. After a follow-up of up to 9 years, an initial PSA >= 1.5 ng/ml was associated with gradually increased detection rates during periods of follow-up in both AA and CA men. CONCLUSIONS Using an initial PSA cutoff of 1.5 ng/ml may be better than a median PSA (0.7 ng/ml) to determine the risk of PCa in both AA and CA men =< 50 years old. Durham, NC© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e666 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Uhlman More articles by this author Ping Tang More articles by this author Leon Sun More articles by this author Cary Robertson More articles by this author Thomas Polascik More articles by this author David Albala More articles by this author Craig Donatucci More articles by this author Judd Moul More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Reduction in incidence and fatality of out-of-hospital cardiac arrest in females of the reproductive age

The aim of this study was to determine relative risk (RR) of incidence and fatality of out-of-hospital cardiac arrest (OHCA) by gender and oestrogen status. In a prospective, population-based observational study from 1998 through 2007, incidence and neurologically intact 1-month survival after OHCA were compared by gender after grouping: 0-12 years, 13-49 years, and > or =50 years according to menarche and menopause age. Among 26 940 cardiac arrests, there were 11 179 females and 15 701 males. Age-adjusted RR of females for OHCA incidence compared with males was 0.72 [95% confidence interval (CI), 0.58-0.91] in age 0-12 years, 0.39 (95% CI, 0.37-0.43) in age 13-49 years, and 0.54 (95% CI, 0.52-0.55) in age > or =50 years. Females aged 13-49 years had a significantly higher good neurological outcome than males [adjusted odds ratio (OR), 2.00 (95% CI 1.21-3.32)]. This sex difference was larger than that in the other age groups [adjusted OR, 0.82 (95% CI, 0.06-12.02) in age 0-12 years and 1.23 (95% CI, 0.98-1.54) in age > or =50 years]. Reproductive females had a lower incidence and a better outcome of OHCA than females of other ages and males, which might be explained by cardioprotective effects of endogenous oestrogen on OHCA.

Brain lipid metabolism, apolipoprotein E and the pathophysiology of Alzheimer's disease

Brain lipid homoeostasis is critical during neurodevelopment, repair after traumatic brain injury and for the maintenance of efficient neurotransmission. Several neurodegenerative disorders occur as a direct result of neuronal lipid dysfunction and underlying disease processes that are associated with Alzheimer's disease (AD) also appear to be related to an imbalance in brain lipid homeostasis. In support of this latter hypothesis, recent genome wide association studies have confirmed and extended the now widely reproduced association between the epsilon4 allele of the apolipoprotein E gene (APOE) and late onset AD. Even in populations with low APOE epsilon4 allele frequency, gene dosage of APOE epsilon4 increases the age-adjusted relative risk for developing the more common late onset form of AD. A major role for apolipoprotein E (apoE) in the brain is to maintain a constant supply of neuronal lipids for rapid and dynamic membrane synthesis thus ensuring efficient neurotransmitter release and the propagation of action potentials. Additionally, apoE synthesized primarily by glia is critical for the elimination of toxic brain-derived Abeta peptides. In addition to apoE isoform, the overall levels of apoE appear to be important determinants for brain Abeta clearance. Susceptibility to AD in APOE epsilon4 carriers may occur early since brain activity and the accumulation of Abeta in brain parenchyma both appear well in advance of disease onset. Given the pivotal role apoE plays in maintaining neuronal membrane homeostasis, elevating the levels of apoE in brain may be a viable therapeutic strategy for the prevention and/or treatment of AD.

Role of Adiposity and Lifestyle in the Relationship Between Family History of Diabetes and 20-Year Incidence of Type 2 Diabetes in U.S. Women

OBJECTIVETo evaluate to what extent the association between family history of diabetes and risk of type 2 diabetes can be explained by excess adiposity and lifestyle risk factors.RESEARCH DESIGN AND METHODSWe analyzed data from 73,227 women who participated in the Nurses' Health Study cohort. A family history of diabetes was defined as having at least one first-degree family member with diabetes. Lifestyle factors, weight, and height were assessed by using validated questionnaires, and BMI was calculated. The relative risk of type 2 diabetes was estimated using Cox proportional hazards analysis.RESULTSWe documented 5,101 cases of type 2 diabetes during 20 years of follow-up. The age-adjusted relative risk of type 2 diabetes in participants with a family history was 2.27 (95% CI 2.14–2.40) compared with the risk in those without a family history of diabetes. Participants with a family history of diabetes had a higher BMI and were more likely to have a parental history of obesity. BMI explained 21.1% (19.4–22.9) of the association between family history of diabetes and risk of type 2 diabetes. Intakes of red meat, alcohol, and sugar-sweetened beverages explained 1.1% (0.8–1.3), 4.8% (4.3–5.3), and 2.8% (2.4–3.2) of this association, respectively.CONCLUSIONSThese results suggest that excess adiposity and, to a lesser extent, specific dietary habits can explain a substantial part of the association between having a family history of diabetes and risk of type 2 diabetes.

Prostate-specific Antigen–based Risk-adapted Discontinuation of Prostate Cancer Screening in Elderly African American and Caucasian American Men

To evaluate the relationship between initial prostate-specific antigen (PSA) and prostate cancer (PCa) risk in elderly African American (AA) and Caucasian American (CA) men. A total of 408 AA and 1720 CA men whose initial PSA measurement was performed between 75 and 80 years of age were retrieved from Duke Prostate Center database. Patients were stratified by race and initial PSA value. The relative risk (RR) of PCa detection was estimated. The rates of high risk PCa, and death from PCa stratified by initial PSA groups were compared using the chi-square test. The age-adjusted RR of PCa detection in CA men with PSA 3.0-5.9 ng/mL was 1.9-fold higher when compared with that of men with PSA 0.0-2.9 ng/mL (P < .001), but it did not change significantly in AA men (P = .270). PSA 6.0-9.9 ng/mL was associated with age-adjusted RR of PCa 9.3-fold in AA men and 4.1-fold in CA men (both P values < .001). A low rate of high-risk PCa and death from PCa was indicated with PSA < 6.0 ng/mL and < 3.0 ng/mL and follow-up of a maximum of 19.2 years and 17.6 years, respectively, in AA and CA men. AA men with initial PSA < 6.0 ng/mL and CA men with initial PSA < 3.0 ng/mL between 75 and 80 years of age are unlikely to be diagnosed with high risk PCa or death from PCa. It may be safe to discontinue PSA screening in these men.

Characterizing differences in mortality at the low end of the fitness spectrum in individuals with cardiovascular disease

A graded but nonlinear relationship exists between fitness and mortality, with the greatest mortality differences occurring between the least-fit (first, Q1) and the next-least-fit (second, Q2) quintiles of fitness. The purpose of this study was to compare clinical characteristics, exercise test responses, and physical activity (PA) patterns in Q1 versus Q2 in patients with cardiovascular disease (CVD). Observational retrospective study. A total of 5101 patients with a history of CVD underwent clinical treadmill testing and were followed up for 9.1+/-5.5 years. Patients were classified into quintiles of exercise capacity measured in metabolic equivalents. Clinical characteristics, treadmill test results, and recreational PA patterns were compared between Q1 (n = 923) and Q2 (n = 929). Q1 had a nearly two-fold increase in age-adjusted relative risk of cardiovascular mortality compared with Q2 (hazard ratio: 3.79 vs. 2.04, P<0.05; reference: fittest quintile). Q1 patients were older, had more extensive use of medications, and were more likely to have a history of typical angina (35 vs. 28%), myocardial infarction (30 vs. 24%), chronic heart failure (25 vs. 14%), claudication (15 vs. 9%) and stroke (9 vs. 6%) compared with Q2 (all comparisons: P<0.05). Recent and lifetime recreational PA was not different between the two groups. Greater severity of disease in the least-fit versus the next-least-fit quintile likely contributes to but cannot fully explain marked differences in mortality rates in CVD patients. To achieve potential survival benefits, our results suggest that unfit CVD patients should engage in exercise programs of sufficient volume and intensity to improve fitness.

Attributable risk of carpal tunnel syndrome in the general population: implications for intervention programs in the workplace

Carpal tunnel syndrome (CTS) represents one of the most significant and costly health problems occurring in the working population. An estimation of the potential impact of CTS prevention programs in the workplace would be useful for public policy. The aim of this study was to assess the work-related population-attributable fraction (PAF) of CTS in industrial sectors and occupational categories at high risk of CTS in the general population. All cases of CTS occurring in patients living in a French region were included prospectively between 2002-2004. Using a mailed questionnaire, we gathered medical and occupational history from 815 women and 320 men. We calculated the age-adjusted relative risks and PAF of CTS in relation to industrial sectors and occupational categories. The PAF for women was higher in lower-grade, white-collar workers (24%, 95% CI 19-29) than blue-collar workers (19%, 95% CI 15-22). The PAF was higher for the service industries sector (16%, 95% CI 8-22) than manufacturing (10%, 95% CI 7-13) or agricultural (5%, 95% CI 3-7) sectors. The PAF was high for men in blue-collar workers (50%, 95% CI 41-57) and in the construction (13%, 95% CI 9-18) and manufacturing industries (17%, 95% CI 10-23). The study suggested that 5-50% of CTS cases might be avoided in the whole population if totally effective intervention programs were implemented in specific occupational categories or industrial sectors.

Anthropometric assessment of abdominal obesity and coronary heart disease risk in men: the PRIME study

Objective:Waist-to-height ratio is an anthropometric indicator of abdominal obesity that accounts for stature. Earlier studies have reported marked associations between the waist-to-height ratio and cardiovascular risk factors. The goal of...

Neighborhood Socioeconomic Status and Homicides Among Children in Urban Canada

We sought to determine the influence of neighborhood income on homicides among children living in urban Canada. Homicides among children <15 years of age living in any of Canada's census metropolitan areas in 1996, 1997, or 1998 were identified on the basis of vital statistics death registration data, by using International Classification of Diseases, Ninth Revision codes. Deaths were assigned to census tracts through postal codes, and the tracts were then assigned to neighborhood income quintiles on the basis of the proportions of the population below the Statistics Canada low-income cutoff values. Census population counts and intercensal population interpolations were used to estimate person-years at risk for rate calculations. Interquintile rate ratios and 95% confidence intervals were calculated. Poisson regression was used to model the effects of neighborhood income quintiles on homicide rates, after adjustment for age. During the 3-year study period, there were 87 homicides among children <15 years of age in Canada's census metropolitan areas (0.82 cases per 100,000; not statistically different according to gender). The age-adjusted relative risks for the lowest versus highest neighborhood income quintiles were 2.95 for all children <15 years of age and 3.39 for children <5 years of age. Effective child homicide-prevention strategies should be focused on children <5 years of age living in low-income areas.

Comparison of metabolic syndrome with glucose measurement for prediction of type 2 diabetes: The Isfahan Diabetes Prevention Study

Aims The aim of this study was to compare the ability of the metabolic syndrome (MetS) and fasting and 2-h glucose to predict progression to diabetes in non-diabetic first-degree relatives (FDRs) of patients with type 2 diabetes. Methods A total of 706 non-diabetics FDR 20–70 years old in 2003–2005 were followed through 2008 for the occurrence of type 2 diabetes mellitus. At baseline and through follow-ups, participants undergo a standard 75 g 2-h oral glucose tolerance test. MetS was defined by NCEP-ATP III. Results The fasting and 2-h glucose values were better predictors of progression to diabetes than MetS. Compared to participants without MetS, the age-adjusted relative risk (RRs) of diabetes was similar for participants with MetS (1.09 (95% CI 0.92, 1.29)). The age-adjusted relative risk of diabetes among those with impaired glucose tolerance (IGT) and MetS was 1.89 (95% CI 1.47, 2.42) and among those with IGT but without MetS was 1.59 (95% CI 1.32, 1.91). Areas under the receiver operating characteristic curves were 0.789 for fasting and 0.760 for 2-h glucose versus 0.595 for number of metabolic abnormalities ( P < 0.001). Conclusions These data indicate that fasting or 2-h glucose during the OGTT may be more effective and efficient than MetS in predicting progression to diabetes.

Health Risk Appraisal Models for Mass Screening for Esophageal and Pharyngeal Cancer: An Endoscopic Follow-up Study of Cancer-Free Japanese Men

To assess the performance of our health risk appraisal (HRA) models for screening individuals at high risk of esophageal/pharyngeal squamous cell carcinoma (EPSCC). Based on the results of our previous case-control study, we invented HRA models that enable screening for EPSCC cases in Japanese men with high sensitivity and specificity based on either their aldehyde dehydrogenase-2 genotype (HRA-G model) or alcohol flushing (HRA-F model) and drinking, smoking, and dietary habits. Follow-up endoscopy combined with esophageal iodine staining (median follow-up period: 5.0 years) was done on 404 Japanese men (50-78 years) who were registered as cancer-free controls in the previous study. The follow-up endoscopy resulted in a diagnosis of 6 esophageal SCC (T(is) in 5 and T(1) in 1), 1 hypopharyngeal SCC (T(2)), and 1 oropharyngeal SCC (T(2)). Seven and 6 of the 8 EPSCC cases were in the top 10% risk group at baseline according to the HRA-G and HRA-F models, respectively. The EPSCC detection rates per 100 person-years in the top 10% risk groups by the HRA-G and HRA-F models were 4.38 (95% confidence interval, 1.76-9.01) and 3.48 (95% confidence interval, 1.28-7.58), respectively. Their age-adjusted relative risk was 95.1- and 26.3-fold, respectively (P < 0.0001), higher than in the bottom 90% risk groups. The high detection rates for EPSCC in the top 10% risk group of this preliminary follow-up study were in good agreement with those predicted by the HRA models and thus encouraged the screening based on our HRA models in larger populations of Japanese men.

La mortalidad evitable y no evitable: distribución geográfica en áreas pequeñas de España (1990–2001)

Objective Comparison of mortality amenable to medical intervention (avoidable mortality) in small geographical areas provides a useful tool to analyse quality of health care services. Currently there are no studies that analyse avoidable mortality by geographical distribution in small areas for the whole of Spain. The aim of this study is to describe the geographical distribution of avoidable and non-avoidable mortality in small areas in Spain by sex for the period 1990–2001. Methods The 2.218 small areas considered consisted of municipalities or aggregated municipalities in the entirety of the Spanish territory. Avoidable deaths were analysed for the period 1990–2001. Empirical Bayes model-based estimates of age-adjusted relative risk were displayed in small-area maps for each group of causes of death by sex. Results There is an heterogeneous geographical distribution of avoidable mortality for both sexes. Areas with greater mortality are located in the south and northwest of Spain. Especially for hypertension, cerebrovascular disease and ischaemic heart disease in men there is a clear aggregation of deaths in these areas. Geographical distribution of non avoidable mortality in both sexes is similar to that described for these three causes. Conclusions Geographical study of avoidable mortality in small areas for the whole of Spain permits the identification of areas with elevated mortality. Further research is necessary to clarify those factors related to avoidable mortality distribution.

Fat, Protein, and Meat Consumption and Renal Cell Cancer Risk: A Pooled Analysis of 13 Prospective Studies

Results of several case-control studies suggest that high consumption of meat (all meat, red meat, or processed meat) is associated with an increased risk of renal cell cancer, but only a few prospective studies have examined the associations of intakes of meat, fat, and protein with renal cell cancer. We conducted a pooled analysis of 13 prospective studies that included 530,469 women and 244,483 men and had follow-up times of up to 7-20 years to examine associations between meat, fat, and protein intakes and the risk of renal cell cancer. All participants had completed a validated food frequency questionnaire at study entry. Using the primary data from each study, we calculated the study-specific relative risks (RRs) for renal cell cancer by using Cox proportional hazards models and then pooled these RRs by using a random-effects model. All statistical tests were two-sided. A total of 1,478 incident cases of renal cell cancer were identified (709 in women and 769 in men). We observed statistically significant positive associations or trends in pooled age-adjusted models for intakes of total fat, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, total protein, and animal protein. However, these associations were attenuated and no longer statistically significant after adjusting for body mass index, fruit and vegetable intake, and alcohol intake. For example, the pooled age-adjusted RR of renal cell cancer for the highest vs the lowest quintile of intake for total fat was 1.30 (95% confidence interval [CI] = 1.08 to 1.56; P(trend) = .001) and for total protein was 1.17 (95% CI = 0.99 to 1.38; P(trend) = .02). By comparison, the pooled multivariable RR for the highest vs the lowest quintile of total fat intake was 1.10 (95% CI = 0.92 to 1.32; P(trend) = .31) and of total protein intake was 1.06 (95% CI = 0.89 to 1.26; P(trend) = .37). Intakes of red meat, processed meat, poultry, or seafood were not associated with the risk of renal cell cancer. Intakes of fat and protein or their subtypes, red meat, processed meat, poultry, and seafood are not associated with risk of renal cell cancer.

Abstract 3194: Clinical Characteristics And Physical Activity Patterns Among The Least-fit And The Next-least-fit Quintile Of Individuals With Cardiovascular Disease

A graded non-linear relationship exists between fitness and all-cause mortality with the most remarkable difference in mortality rates observed between the least-fit (first, Q1) and the next-least-fit (second, Q2) quintile of fitness. The purpose of this study was to compare clinical characteristics, exercise test responses and physical activity patterns in Q1 versus Q2 in individuals with cardiovascular disease (CVD). A total of 5101 consecutive patients referred for clinical exercise testing from 1987 to 2006 were followed for a mean (±SD) of 9.1±5.5 years. All subjects had a history of CVD and/or abnormal exercise test results. Subjects were classified into quintiles of exercise capacity measured in metabolic equivalents (METs) and the first 2 quintiles were compared (Q1: METs &lt;4.2 (n=923); Q2: METs 4.3–5.9 (n=929)). In a subset (n=655), recreational physical activity was assessed using a questionnaire. Q1 had an almost 2-fold increase in age-adjusted relative risk of mortality compared to Q2 (cardiovascular mortality: HR (95% CI): 3.79 (1.73, 8.29) vs. 2.04 (1.9, 4.6), p&lt;0.05; reference group: fittest subjects (Q5, METs &gt;10.0)). Q1 were older (67±9 vs. 64±10 years, p&lt;0.001), had more extensive use of medications and were more likely to have a history of typical angina (35% vs. 28%, p&lt;0.004), myocardial infarction (30% vs. 24%, p=0.003), chronic heart failure (25% vs. 14%, p&lt;0.001), claudication (15% vs. 9%, p&lt;0.001) and stroke (9% vs. 6%, p=0.027) compared to Q2. Prevalence of dyslipidemia, current smoking rates, treatment with ACE-inhibitors, statins and diuretics, and exercise test responses were lower in Q1 versus Q2. Recent (1263±1783 kcal/week vs. 1566±2161 kcal/week, p=0.22) and lifetime (1323±1847 kcal/week vs. 1619±1830 kcal/week, p=0.23) recreational physical activity were not different between the groups. Marked differences in mortality rates between the least-fit and the next-least-fit quintiles appear to be due to a greater severity of disease and comorbidities rather than differences in physical activity patterns. These findings suggest that higher levels of fitness are required to improve survival in individuals with CVD.