Cause-specific Mortality In Men Research Articles

Total and regional fat-to-muscle mass ratio in relation to all-cause and cause-specific mortality in men and women.

Fat-to-muscle mass ratio (FMR) has been considered a potentially useful indicator for assessing disease risk. However, the association between FMR and risk of death remains inconclusive. To investigate the associations of FMR (the whole body, trunk, legs and arms) with all-cause and cause-specific mortality by sex. A total of 337951 participants from the UK Biobank were included. Fat mass and muscle mass were estimated using a bioelectrical impedance assessment device. Cox proportional hazard regression was applied to explore the associations. During a median follow-up of 12.58 years, we recorded 22391 (6.62 %) deaths, of which 4427 were from cardiovascular disease, 11740 from cancer, and 1458 from respiratory disease. We observed associations of different shapes (U-shaped for whole body and trunk, L-shaped for legs, and J-shaped for arms) between FMR and all-cause mortality (P for non-linearity <0.001). Compared with the lowest quintile of whole body and trunk FMR, the all-cause mortality risk was reduced by 12-14% and 7-15% in men and women in quintile 2-4, respectively. The hazard ratio (HR) associated with arm FMR in men and leg FMR in men and women (quintile 5 vs 1) were 1.14 (95% CI 1.05, 1.23), 0.76 (0.71, 0.82), and 0.78 (0.70, 0.88) for all-cause mortality, respectively. The associations between FMR and cause-specific mortality were mostly similar to those for all-cause mortality. Our study revealed significant associations of total and regional FMR with mortality, providing new evidence that FMR may be a potentially useful indicator for assessing mortality risk.

Sex-specific associations between sodium and potassium intake and overall and cause-specific mortality: a large prospective U.S. cohort study, systematic review, and updated meta-analysis of cohort studies

BackgroundThe impact of sodium intake on cardiovascular disease (CVD) health and mortality has been studied for decades, including the well-established association with blood pressure. However, non-linear patterns, dose–response associations, and sex differences in the relationship between sodium and potassium intakes and overall and cause-specific mortality remain to be elucidated and a comprehensive examination is lacking. Our study objective was to determine whether intake of sodium and potassium and the sodium–potassium ratio are associated with overall and cause-specific mortality in men and women.MethodsWe conducted a prospective analysis of 237,036 men and 179,068 women in the National Institutes of Health-AARP Diet and Health Study. Multivariable-adjusted Cox proportional hazard regression models were utilized to calculate hazard ratios. A systematic review and meta-analysis of cohort studies was also conducted.ResultsDuring 6,009,748 person-years of follow-up, there were 77,614 deaths, 49,297 among men and 28,317 among women. Adjusting for other risk factors, we found a significant positive association between higher sodium intake (≥ 2,000 mg/d) and increased overall and CVD mortality (overall mortality, fifth versus lowest quintile, men and women HRs = 1.06 and 1.10, Pnonlinearity < 0.0001; CVD mortality, fifth versus lowest quintile, HRs = 1.07 and 1.21, Pnonlinearity = 0.0002 and 0.01). Higher potassium intake and a lower sodium–potassium ratio were associated with a reduced mortality, with women showing stronger associations (overall mortality, fifth versus lowest quintile, HRs for potassium = 0.96 and 0.82, and HRs for the sodium–potassium ratio = 1.09 and 1.23, for men and women, respectively; Pnonlinearity < 0.05 and both P for interaction ≤ 0.0006). The overall mortality associations with intake of sodium, potassium and the sodium–potassium ratio were generally similar across population risk factor subgroups with the exception that the inverse potassium-mortality association was stronger in men with lower body mass index or fruit consumption (Pinteraction < 0.0004). The updated meta-analysis of cohort studies based on 42 risk estimates, 2,085,904 participants, and 80,085 CVD events yielded very similar results (highest versus lowest sodium categories, pooled relative risk for CVD events = 1.13, 95% CI: 1.06–1.20; Pnonlinearity < 0.001).ConclusionsOur study demonstrates significant positive associations between daily sodium intake (within the range of sodium intake between 2,000 and 7,500 mg/d), the sodium–potassium ratio, and risk of CVD and overall mortality, with women having stronger sodium–potassium ratio-mortality associations than men, and with the meta-analysis providing compelling support for the CVD associations. These data may suggest decreasing sodium intake and increasing potassium intake as means to improve health and longevity, and our data pointing to a sex difference in the potassium-mortality and sodium–potassium ratio-mortality relationships provide additional evidence relevant to current dietary guidelines for the general adult population.Systematic review registrationPROSPERO Identifier: CRD42022331618.

Patterns of Recurrence Following Radiation and ADT for Pathologic Lymph Node Positive Prostate Cancer: A Multi-Institutional Study

Retrospective studies have suggested that post-operative radiation therapy (RT) can reduce the risk of cause-specific mortality in men with pathologic nodal involvement (pN1) after radical prostatectomy (RP). We evaluated prognostic factors and patterns of recurrence in patients who received post-operative RT +/- androgen deprivation therapy (ADT) for pN1 disease in a multicentric cohort of 4 academic centers. Data from patients with pN1 prostate cancer after RP who subsequently received RT with short term (< = 6 mo) or long term (>6 mo) ADT were obtained from 4 academic institutions. Patterns of recurrence, biochemical progression free survival (bPFS) and distant metastasis free survival (DMFS) were evaluated. A total of 270 patients with a median follow-up of 48 months were included. Gleason grade group (GG) 2 was present in 20 patients (7.5%), GG 3 in 81 (30%), GG4 in 36 (13.5%), GG5 in 130 (49%) patients. 256 (95%) patients had extracapsular extension, 70% had seminal vesicle invasion, 59% had positive surgical margins, and 66% had a detectable post-operative PSA. The number of positive nodes at surgery were 1 in 59%, 2 in 19% and >2 in 22% of patients. Of the 83 patients that had pre-RT imaging, 46 (55%) had a PET scan (PSMA, or fluciclovine); 25 (30%) of those had lymph nodes detected on imaging prior to RT. Median time from RP to RT was 6 mo (IQR 4.5-9.1 mo). 96% received radiation to both the prostate bed (median dose 68.4Gy) and pelvic lymph nodes (median dose 46Gy). ADT was prescribed short-term (20%) or long-term (68%), while 26 (10%) received no ADT, and 7 (3%) had an unknown duration. Biochemical failure (bF) was observed in 29% of men, with 5% having pelvic nodal failure and 11.5% having distant metastases (majority in bones, followed by paraaortic nodes) at last follow up. Of 59 patients who had normal baseline testosterone levels, 37% recovered their testosterone by last follow-up. The 4-year bRFS was 72% for all patients and was 83% for those with a pre-RT PSA of <0.1 ng/mL, 76% for PSA 0.1-<0.5 ng/mL, 60% for PSA 0.5-2 ng/mL, and 35% for PSA >2 ng/mL. On multivariable analysis, maximum pre-RT PSA ≥0.5 (0.5 to 2.0 vs <0.1 HR = 3.19; >2.0 vs <0.1 HR = 9.00), use of LTADT (HR = 0.47), and percent pN1 (HR = 1.03) were significantly associated with bF. Pre-RT PSA >2 (HR = 4.10), use of LT ADT (HR = 0.33) and percent pN1 (HR = 1.03) were also significantly associated with DM. In pN1 patients, pelvic RT and ADT at low PSA levels is associated with improved oncologic outcomes compared to treatment at higher levels, suggesting that PSA may have prognostic value for pN1 prostate cancer.

Validation of the prostate cancer comorbidity index in predicting cause-specific mortality in men undergoing radical prostatectomy.

Accurate prediction of competing risks of mortality remains a key component of prostate cancer treatment decision-making. We sought to validate the Prostate Cancer Comorbidity Index (PCCI) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP). We sampled 4857 men with prostate cancer treated with RP in the VA from 2000-2018. Risks of OCM, 90-day all-cause mortality (ACM), prostate cancer-specific mortality, metastasis, and biochemical recurrence by PCCI score were assessed using Cox proportional hazards and logistic regression. We compared prediction of 90-day ACM between PCCI and the American Society of Anesthesiology (ASA) score, a validated predictor of short-term mortality. Over median follow-up of 6.7 years (IQR 3.7-10.3), there was a stepwise increase in risk of OCM with higher PCCI score, with hazards (95%CI) of 1.53 (1.14-2.04), 2.11 (1.55-2.88), 2.36 (1.68-3.31), 3.61 (2.61-4.98), and 4.99 (3.58-6.96) for PCCI 1-2, 3-4, 5-6, 7-9, and 10 + (vs. 0), respectively. Projected 10-year cumulative incidence of OCM was 8%, 12%, 16%, 19%, 26%, and 32% for scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+ , respectively. Men with PCCI 7+ had greater odds of 90-day ACM (OR 3.48, 95%CI 1.26-9.63) while men with higher ASA did not. Higher PCCI score was associated with worse cancer outcomes, with the highest categories driving the associations. The PCCI is a robust measure of short- and long-term OCM after RP, validated for use in clinical care and health services research focusing on surgical patient populations.

Dietary glycemic index, glycemic load, and cause-specific mortality: two population-based prospective cohort studies.

Epidemiological studies on the relationship between dietary glycemic index (GI), glycemic load (GL) and all-cause and cause-specific mortality yielded conflict results. We aimed to assess these associations in Chinese. We conducted this study based on two prospective cohort studies in Shanghai. Dietary information was collected using validated cohort-specific food frequency questionnaires. We used Cox regression model to estimate the hazard ratios (HR) for mortality associated with GI and GL. After median follow-up periods of 12.8 years for 59,770 men and 18.2 years for 74,735 women, 8,711 deaths in men and 10,501 deaths in women were documented. After we controlled the potential confounders, dietary GI, GL, and carbohydrate intake were associated with a higher risk of cardiovascular disease (CVD) mortality (P values for trend = 0.025, 0.001, and 0.001). Dietary GI was associated with lower risk of total and cause-specific mortality in men in the second quartile (Q) (all-cause mortality: HR Q2 vs. Q1 = 0.89, 95%CI: 0.84, 0.95). Dietary GL was associated with lower risk of cancer mortality but higher risk of CVD mortality in men. In women, dietary GI was associated with mortality due to all-cause (HRMax Q4 vs. Q1 = 1.10, 95%CI: 1.04, 1.06), cancer (HRMax Q4 vs. Q1 = 1.12, 95%CI: 1.02, 1.23), and CVD (HRMax Q4 vs. Q1 = 1.10, 95%CI: 1.00, 1.22). The present study indicates that diet with higher GI and GL was associated with an increased risk of CVD mortality in Chinese adults. The association may vary for men and women, which need further investigating in other Asian populations.

Serum Testosterone is Inversely and Sex Hormone-binding Globulin is Directly Associated with All-cause Mortality in Men

Serum testosterone concentrations decline with age, while serum sex hormone-binding globulin (SHBG) concentrations increase. To analyze associations of baseline serum testosterone and SHBG concentrations, and calculated free testosterone (cFT) values, with all-cause and cause-specific mortality in men. The UK Biobank prospective cohort study of community-dwelling men aged 40-69 years old, followed for 11 years. All-cause, atherosclerotic cardiovascular disease (CVD) and cancer-related mortality. Cox proportional hazards regression was performed, adjusting for age, waist circumference, medical conditions, and other covariates. Models for testosterone included SHBG and vice versa. In a complete case analysis of 149 436 men with 10 053 deaths (1925 CVD and 4927 cancer-related), men with lower testosterone had a higher mortality rate from any cause (lowest vs highest quintile, Q1 vs Q5, fully-adjusted hazard ratio [HR] = 1.14, 95% confidence interval [CI] = 1.06-1.22, overall trend P < 0.001), and cancer (HR = 1.20, CI = 1.09-1.33, P < 0.001), with no association for CVD deaths. Similar results were seen for cFT. Men with lower SHBG had a lower mortality rate from any cause (Q1 vs Q5, HR = 0.68, CI = 0.63-0.73, P < 0.001), CVD (HR = 0.70, CI = 0.59-0.83, P < 0.001), and cancer (HR = 0.80, CI = 0.72-0.89, P < 0.001). A multiply imputed dataset (N = 208 425, 15 914 deaths, 3128 CVD-related and 7468 cancer-related) and analysis excluding deaths within the first 2 years (9261, 1734, and 4534 events) yielded similar results. Lower serum testosterone is independently associated with higher all-cause and cancer-related, but not CVD-related, mortality in middle-aged to older men. Lower SHBG is independently associated with lower all-cause, CVD-related, and cancer-related mortality. Confirmation and determination of causality requires mechanistic studies and prospective trials.

Mortality inequalities by occupational status and type of job in men and women: results from the Rome Longitudinal Study

ObjectivesSocioeconomic inequalities have a strong impact on population health all over the world. Occupational status is a powerful determinant of health in rich societies. We aimed at investigating the association between occupation and mortality in a large metropolitan study.DesignCohort study.SettingRome, capital of Italy.ParticipantsWe used the Rome Longitudinal Study, the administrative cohort of residents in Rome at the 2001 general census, followed until 2015. We selected residents aged 15–65 years at baseline. For each subject, we had information on sex, age and occupation (occupational status and type of job) according to the Italian General Census recognition.Main outcome measuresWe investigated all-cause, cancer, cardiovascular and accidental mortality, major causes of death in the working-age population. We used Cox proportional hazards models to investigate the association between occupation and all-cause and cause-specific mortality in men and women.ResultsWe selected 1 466 726 subjects (52.1% women). 42 715 men and 29 915 women died during the follow-up. In men, 47.8% of deaths were due to cancer, 26.7% to cardiovascular causes and 6.4% to accidents, whereas in women 57.8% of deaths were due to cancer, 19.3% to cardiovascular causes and 3.5% to accidents. We found an association between occupational variables and mortality, more evident in men than in women. Compared with employed, unemployed had a higher risk of mortality for all causes with an HR=1.99 (95% CI 1.92 to 2.06) in men and an HR=1.49 (95% CI 1.39 to 1.60) in women. Compared with high-qualified non-manual workers, non-specialised manual workers had a higher mortality risk (HR=1.68, 95% CI 1.59 to 1.77 and HR=1.30, 95% CI 1.20 to 1.40, for men and women, respectively).ConclusionsThis study shows the importance of occupational variables as social health determinants and provides evidence for policy-makers on the necessity of integrated and preventive policies aimed at improving the safety of the living and the working environment.

0457 Insomnia and Cause-Specific Mortality in Men and Women

Abstract Introduction The association of insomnia with an increased risk of mortality has remained inconsistent across studies, which contrasts with accumulating evidence linking this prevalent and chronic sleep disorder with cardiovascular, cerebrovascular, oncologic, and psychiatric morbidity. The higher prevalence of insomnia in women compared to men may be an important contributor to the different survival rates reported in large, population-based studies. Methods The Penn State Adult Cohort is a random, general population sample of 1,741 adults (48.8±13.6y, 52.2% women) who were studied in the sleep laboratory and followed-up for their cause of death up to December 31, 2018. Insomnia was defined as a chronic complaint lasting at least 1 year (n=199). We assessed the risk of all-cause mortality (n=664) and the two most common causes of death: cardiovascular/cerebrovascular (n=275) and cancer (n=161). Cox proportional hazard models adjusted for age, race, sex, education, smoking, alcohol, BMI, AHI, cognitive impairment, mental health problems and physical health problems, including hypertension, diabetes, heart disease, stroke and cancer at baseline. Results The risk of all-cause mortality associated with insomnia was significantly increased in men (HR=1.84, 95%CI=1.18-2.87) but not in women (HR=0.80, 95%CI=0.57-1.13; p for sex-interaction&amp;lt;0.01). Insomnia was significantly associated with an increased risk of cardiovascular/cerebrovascular mortality in men (HR=2.11, 95%CI=1.14-3.99), but not in women (HR=0.98, 95%CI=0.59-1.63; p for sex-interaction=0.06). Insomnia was not significantly associated with an increased risk of cancer mortality either in men (HR=1.41, 95% CI=0.56-3.56) or in women (HR=0.90, 95% CI=0.45-1.80), after adjusting for hypertension, diabetes, heart disease, stroke and cancer at baseline. Conclusion Men with chronic insomnia are at an increased risk of mortality, particularly that of cardiovascular/cerebrovascular origin. There is a need for translational studies focused on sex-differences that can disentangle the biological and behavioral mechanisms underlying women’s resilience. Support American Heart Association (14SDG19830018), National Institutes of Health (R01HL51931, R01HL40916)

Sex hormone-binding globulin, androgens and mortality: the KORA-F4 cohort study.

ObjectiveSex hormone-binding globulin (SHBG) and androgens have been associated with mortality in women and men, but controversy still exists. Our objective was to investigate associations of SHBG and androgens with all-cause and cause-specific mortality in men and women.Design1006 men and 709 peri- and postmenopausal women (age range: 45–82 years) from the German population-based KORA F4 cohort study were followed-up for a median of 8.7 years.MethodsSHBG was measured with an immunoassay, total testosterone (TT) and dihydrotestosterone (DHT) with mass-spectrometry in serum samples and we calculated free testosterone (cFT). To assess associations between SHBG and androgen levels and mortality, we calculated hazard ratios (HRs) with 95% CIs using Cox proportional-hazards models.ResultsIn the cohort, 128 men (12.7%) and 70 women (9.9%) died. In women, we observed positive associations of SHBG with all-cause (HR: 1.54, 95% CI: 1.16–2.04) and with other disease-related mortality (HR: 1.86, 95% CI: 1.08–3.20) and for DHT with all-cause mortality (HR: 1.32, 95% CI: 1.00–1.73). In men, we found a positive association of SHBG (HR: 1.24 95% CI: 1.00–1.54) and inverse associations of TT (HR: 0.87, 95% CI: 0.77–0.97) and cFT (HR: 0.84, 95% CI: 0.73–0.97) with all-cause mortality. No other associations were found for cause-specific mortality.ConclusionsHigher SHBG levels were associated with increased risk of all-cause mortality in men and women. Lower TT and cFT levels in men and higher DHT levels in women were associated with increased risk of all-cause mortality. Future, well-powered population-based studies should further investigate cause-specific mortality risk.

Coffee or Tea? A prospective cohort study on the associations of coffee and tea intake with overall and cause-specific mortality in men versus women

Coffee and tea intake have been associated with reduced mortality, but no studies have investigated possible substitution effects. The relationship of mortality with coffee, tea, and substituting coffee with tea was investigated in the Netherlands Cohort Study. In 1986, 120,852 men and women aged 55–69 years provided information on dietary and lifestyle habits. Mortality follow-up until 1996 consisted of linkage to Statistics Netherlands. Multivariate case-cohort analyses were based on 8665 deaths and 3166 subcohort members with complete data on coffee, tea and confounders. Higher coffee intake was significantly, nonlinearly related to lower overall and cause-specific mortality in women. In men, coffee was significantly positively related to cancer and cardiovascular mortality, and inversely to respiratory and other causes of death. Tea intake was significantly, nonlinearly related to lower overall, cancer and cardiovascular mortality in men, but showed no association with mortality in women. In substitution analyses, increasing the proportion tea (replacing coffee with tea) was significantly and nonlinearly related to lower overall, cancer and cardiovascular mortality in men, but in women higher tea proportions were positively associated with overall mortality (and most causes of death). This study suggests that for men, compared to exclusive coffee drinkers, those drinking 30–50% tea showed the lowest mortality; any tea drinking seemed better than only coffee. For women, those who drank exclusively coffee or drinking up to 40% tea had the lowest mortality, but those drinking higher percentages of tea were at increased mortality risk [HR = 1.41 (95% CI 1.01–1.99) for 80–100% tea compared to exclusive coffee drinkers].

Cause-Specific Mortality in Male US Veterans With Rheumatoid Arthritis.

There has been limited investigation into cause-specific mortality and the associated risk factors in men with rheumatoid arthritis (RA). We investigated all-cause and cause-specific mortality in men with RA, examining determinants of survival. Men from a longitudinal RA registry were followed from enrollment until death or through 2013. Vital status and cause of death were determined using the National Death Index. Crude mortality rates and standardized mortality ratios (SMRs) were calculated for all-cause, cardiovascular disease (CVD), cancer, and respiratory mortality. Associations with all-cause and cause-specific mortality were examined using multivariable Cox proportional hazards and competing-risks regression. There were 1,652 men with RA and 332 deaths. The leading causes of death were CVD (31.6%; SMR 1.77 [95% confidence interval (95% CI) 1.46-2.14]), cancer (22.9%; SMR 1.50 [95% CI 1.20-1.89]), and respiratory disease (15.1%; SMR 2.90 [95% CI 2.20-3.83]). Factors associated with all-cause mortality included older age, white race, smoking, low body weight, comorbidity, disease activity, and prednisone use. Rheumatoid factor concentration and nodules were associated with CVD mortality. There were no associations of methotrexate or biologic agent use with all-cause or cause-specific mortality. Men in this RA cohort experienced increased all-cause and cause-specific mortality, with a 3-fold risk of respiratory-related deaths compared to age-matched men in the general population. Further studies are needed in order to examine whether interventions targeting potentially modifiable correlates of mortality might lead to improved long-term survival in men with RA.

Increased risk of fatal infections in women starting peritoneal dialysis.

Although cardiovascular disease (CVD) is an important cause of morbidity and mortality in patients with end-stage renal disease, non-CVD causes account for more than 50% of total deaths. We previously showed that, compared with men, women starting dialysis-- both hemodialysis and peritoneal dialysis (PD)--have higher non-CVD mortality rates. Here, we evaluate sex-specific outcomes in a large cohort of incident PD patients. Incident de novo PD patients from the Andalusian SICATA Registry for 1999 - 2010, with follow-up until 31 December 2010 or up to 5 years, were investigated for fatal outcomes. Causes of death were extracted from medical records. The analysis used traditional and competing-risk Cox models for all-cause and cause-specific mortality in men and women, correcting in the competing-risk models for the events of kidney transplantation and transfer to hemodialysis. A total of 1458 patients (57% men; mean overall age: 55.3 ± 17.0 years) initiated PD in Andalusia during the study period. During follow-up, 350 deaths, 355 renal transplantation procedures, and 331 transfers to hemodialysis were recorded. Vascular disease and diabetic nephropathy were the most frequent causes of kidney failure in men; other causes were more common in women. In the traditional Cox model, both sexes showed a similar all-cause mortality risk [crude hazard ratio (HR): 0.90; 95% confidence interval (CI): 0.72 to 1.12]. However, with respect to specific causes of death, women showed a borderline lower risk of both CVD (crude HR: 0.71; 95% CI: 0.50 to 0.99) and non-CVD mortality from other than infection (crude HR: 0.81; 95% CI: 0.57 to 1.15). In contrast, the risk of death from infection was almost doubled in women compared with men (crude HR: 1.92; 95% CI: 1.15 to 3.20), a finding that held true after multivariate adjustment for age, primary renal disease, period of inclusion, and initial PD modality (adjusted HR: 1.76; 95% CI: 1.03 to 3.01). This result was confirmed even taking into consideration the competing events of kidney transplantation and transfer to hemodialysis. Compared with men starting PD, women starting PD are at higher risk of mortality from infection. More stringent screening measures and corrective efforts in women might be indicated.

Treatment with curative intent and survival in men with high‐risk prostate cancer. A population‐based study of 11 380 men with serum PSA level 20–100 ng/mL

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: There are two randomized controlled trials showing that radiotherapy can be beneficial for men with locally advanced prostate cancer. The present study confirms the importance of curative treatment for men with high-risk prostate cancer. To investigate the influence of curative treatment on cause-specific mortality in men diagnosed with prostate cancer (PCa) with serum prostate-specific antigen (PSA) levels between 20 and 100 ng/mL. Patients with PCa (T1-4, N0/N1/NX, M0/MX), PSA 20-100 ng/mL and age ≤75 years were identified in the National Prostate Cancer Register of Sweden. Data on co-morbidity diagnoses were obtained from the National Patient Register and cause of death from the Cause of Death Register. Following adjustment for age at diagnosis, co-morbidity burden, Gleason score, T-category, PSA level and cause-specific mortality in relation to treatment were estimated using Cox regression analysis. A total of 11 380 men were diagnosed with PCa between 1996 and 2008 and fulfilled the inclusion criteria. The cumulative 10-year PCa-specific mortality was 36% for patients receiving only palliative treatment and 13% for those treated with curative intent. For the 8462 (74%) patients with PSA levels from 20 to 50 ng/mL at diagnosis, the hazard ratio for death from PCa was 0.23 (95% confidence interval 0.19-0.27) for those treated with curative intent compared with those given palliative treatment after adjusting for age, co-morbidity, T category, PSA level and Gleason score. The corresponding hazard ratio was 0.22 (95% confidence interval 0.17-0.30) for patients with PSA levels from 51 to 100 ng/mL. Treatment with curative intent for men with high-risk PCa was associated with reduced cause-specific mortality and should be considered even when serum PSA exceeds 20 ng/mL.

Abstract P359: Dietary Patterns and Risk of All-Cause and Cause-Specific Mortality in Chinese Men and Women: The Singapore Chinese Health Study

Over the last half century dietary composition has been shown to have a clear role in the development of cardiovascular disease (CVD) and other conditions. Yet, research is limited on overall dietary patterns in relation to all-cause and cause-specific mortality, especially in non-western populations. We aimed to empirically derive dietary patterns and examine their association with all-cause and cause-specific mortality in men and women aged 45-74 enrolled in the Singapore Chinese Health Study from 1993 - 1998. We excluded those with a history of cancer, CVD and diabetes, as well as extreme caloric intakes, leaving 52,584 participants. Participants were followed through December 31, 2009 and 8,359 deaths were identified. Follow-up for mortality is considered virtually complete due to linkage with the national birth and death registry. Included in the baseline assessment was a 165-item food frequency questionnaire specifically developed for and validated in the study population. Two major dietary patterns were identified using principal components analysis; a vegetable, fruit, and soy rich pattern (VFS) and a dim sum and meat rich pattern (DSM). Pattern scores for each participant were calculated and examined with risk of mortality using Cox regression. The VFS dietary pattern with higher intake of vegetables, fruits, and soy foods was inversely associated with risk of death from CVD, cancer, respiratory diseases, and all-causes. The DSM dietary pattern with higher intake of dim sum, meat and processed meat, sweetened foods and beverages and fried foods was associated with a significantly increased risk of death from all causes as well as cause-specific deaths. There was no evidence these results differed by age, sex, education, smoking status, physical activity or BMI. These findings suggest population level shifts towards a more traditional and prudent dietary pattern would have significant impact on not only CVD mortality rates, but also mortality from cancer, respiratory diseases, and possibly other causes. Hazard ratios and 95% confidence intervals of mortality due to cardiovascular disease, cancer, respiratory, and all causes in Chinese men and women according to quintile of dietary pattern score Vegetable, fruit, and soy rich pattern Q1 Q2 Q3 Q4 Q5 Type of Death HR (95% CI) HR (95% CI) HR (95% CI) HR (95% CI) P Trend All Cause 1.0 0.88 (0.83-0.93) 0.79 (0.74-0.85) 0.79 (0.74-0.85) 0.75 (0.70-0.81) &amp;#60;0.0001 CVD 1.0 0.86 (0.77-0.95) 0.73 (0.64-0.82) 0.78 (0.69-0.88) 0.67 (0.58-0.77) &amp;#60;0.0001 Cancer 1.0 0.96 (0.86-1.06) 0.87 (0.78-0.96) 0.88 (0.79-0.99) 0.84 (0.74-0.95) 0.001 Respiratory 1.0 0.74 (0.63-0.87) 0.75 (0.64-0.89) 0.68 (0.56-0.81) 0.66 (0.54-0.80) &amp;#60;0.0001 Dim sum and meat rich pattern Type of Death Q1 Q2 Q3 Q4 Q5 P Trend All Cause 1.0 0.98 (0.92-1.04) 1.03 (0.96-1.10) 1.06 (0.99-1.14) 1.16 (1.07-1.26) &amp;#60;0.0001 CVD 1.0 0.99 (0.88-1.11) 1.04 (0.92-1.17) 1.10 (0.97-1.25) 1.23 (1.06-1.42) 0.003 Cancer 1.0 0.97 (0.87-1.08) 1.00 (0.90-1.12) 1.09 (0.98-1.23) 1.14 (1.00-1.29) 0.01 Respiratory 1.0 1.04 (0.88-1.22) 1.06 (0.89-1.26) 0.88 (0.72-1.06) 1.21 (0.99-1.49) 0.23 -Models adjusted for age, sex, dialect, education, marital status, smoking, physical activity, sleep, BMI and energy intake. -Definition of outcomes: CVD (ICD-9 =394-459, N=2,626), Cancer (ICD-9=140-239, N=3,279), Respiratory (e.g. Influenza, pneumonia, COPD) (ICD-9=480-488, 490-96, N=1,289)

Relationships of Suicide Ideation with Cause-Specific Mortality in a Longitudinal Study of South Koreans

Using 7-year mortality follow-up data (n = 341) from the 1998 National Health and Nutrition Examination Surveys of South Korean individuals (N = 5,414), the authors found that survey participants with suicide ideation were at increased risk of suicide mortality during the follow-up period compared with those without suicide ideation. The cause-specific analyses showed that, in men, suicide ideation was significantly associated with mortality due to cardiovascular disease, external causes, and other causes. However, there was no significant association between suicide ideation and cause-specific mortality in women. The relationship between suicide ideation and cause-specific mortality in men was not fully explained by baseline health status, socioeconomic status, health behavior, or psychosocial factors.

Relationship between prostate cancer mortality and number of unfavourable risk factors in men treated with definitive brachytherapy

To explore whether the number of unfavourable pretreatment risk factors predicts cause-specific mortality in men treated with prostate brachytherapy. Between April 1995 and March 2006, 739 patients were treated who had at least one of the following adverse risk factors: pretreatment prostate-specific antigen (PSA) level of >10 ng/mL, a Gleason score of > or =7, clinical stage > or =T2b, or a PSA velocity (PSAV) of >2 ng/mL/year. Supplemental external beam radiotherapy (EBRT) was delivered to 464 (62.8%) men and 301 (40.7%) received androgen deprivation therapy (ADT). Of men with more than two risk factors, 87% received EBRT and 62% received ADT. The biochemical progression-free survival (bPFS), cause-specific survival (CSS) and overall survival for all patients were 95.0%, 97.9% and 70.0% at 12 years. Men with three or four risk factors had a prostate cancer-specific mortality (PCSM) at 12 years of 5.3%, vs 1.7% for men with one or two risk factors (P= 0.006). When 'percentage of positive biopsy cores >50%' replaced PSAV as a risk factor, men with two or more risk factors had a PCSM of 8.9%, vs 1.0% for men with one or two risk factors (P= 0.001). There was no difference in all-cause mortality between the groups in either analysis. Multimodal brachytherapy results in high rates of bPFS and CSS, even for men with several unfavourable risk factors. Men with two or more unfavourable risk factors had a slightly greater risk of PCSM and no difference in all-cause mortality. The presence of three or four unfavourable intermediate-risk factors does not appear to clearly identify a group that requires further treatment intensification, although the percentage of positive cores might be more predictive than PSAV.

Errors in Tables in: Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women: The United Kingdom Health and Lifestyle Survey

Errors in Tables in: Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women: The United Kingdom Health and Lifestyle Survey

Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women

Physical activity, diet, smoking, and alcohol consumption have been shown to be related to mortality. We examined prospectively the individual and combined influence of these risk factors on total and cause-specific mortality. The prospective cohort study included 4886 individuals at least 18 years old from a United Kingdom-wide population in 1984 to 1985. A health behavior score was calculated, allocating 1 point for each poor behavior: smoking; fruits and vegetables consumed less than 3 times daily; less than 2 hours physical activity per week; and weekly consumption of more than 14 units of alcohol (in women) and more than 21 units (in men) (range of points, 0-4). We examined the relationship between health behaviors and mortality using Cox models and compared it with the mortality risk associated with aging. During a mean follow-up period of 20 years, 1080 participants died, 431 from cardiovascular diseases, 318 from cancer, and 331 from other causes. Adjusted hazard ratios and 95% confidence intervals (CIs) for total mortality associated with 1, 2, 3, and 4 poor health behaviors compared with those with none were 1.85 (95% CI, 1.28-2.68), 2.23 (95% CI, 1.55-3.20), 2.76 (95% CI, 1.91-3.99), and 3.49 (95% CI, 2.31-5.26), respectively (P value for trend, <.001). The effect of combined health behaviors was strongest for other deaths and weakest for cancer mortality. Those with 4 compared with those with no poor health behaviors had an all-cause mortality risk equivalent to being 12 years older. The combined effect of poor health behaviors on mortality was substantial, indicating that modest, but sustained, improvements to diet and lifestyle could have significant public health benefits.

Relationship between Prostate Cancer Mortality and Number of Unfavorable Risk Factors following Brachytherapy

Purpose: To explore whether the number of unfavorable pretreatment risk factors predicts for cause-specific mortality in men treated with prostate brachytherapy. Specifically, does the presence of multiple unfavorable risk factors (pre-treatment PSA velocity, pre-treatment PSA, Gleason score, clinical stage, % positive biopsies) in men treated with primary brachytherapy harbor the same prognosis as those treated with external beam radiation therapy or radical prostatectomy.

The Short-Form Six-Dimension utility index predicted mortality in the European Prospective Investigation into Cancer-Norfolk prospective population-based study

Objective To examine the relationship between the Short-Form Six-Dimension (SF-6D) and mortality. Study Design and Setting Participants were 17,736 men and women aged 40–79 years at baseline who lived in Norfolk, UK, and had no known cardiovascular disease or cancer, and completed the anglicized Short-Form 36 (SF-36)-item during 1996–2000 in the European Prospective Investigation into Cancer-Norfolk prospective population study. The SF-36 data were converted to SF-6D. The relationship between SF-6D and all-cause and cause-specific mortality were examined. Results One thousand and seventy deaths occurred during a total of 115,255 person years of follow-up (mean 6.5 years). Lower SF-6D was associated with increased risk of all-cause mortality in men and women. A decrease of 1 standard deviation (0.12 point) in SF-6D was associated with a 35% increase in all-cause mortality (hazards ratio = 1.35; 95% CI: 1.26, 1.45) after controlling for age, gender, body mass index, systolic blood pressure, cholesterol, diabetes, smoking, and social class. Similar results were observed for cardiovascular, cancer, and other causes of deaths. Conclusion Poor health utility measured by the SF-6D predicted increased risk of all-cause and cause-specific mortality in men and women. The present study provides the first evidence of the sensitivity of the SF-6D in predicting mortality in an apparently healthy population.