Combined Population Attributable Risk Research Articles

The contribution of potentially modifiable risk factors to acute ischemic stroke burden - Comparing young and older adults

Stroke is a leading cause of death and disability. In order to estimate the contribution of five modifiable risk factors to acute ischemic stroke (AIS) incidence in Israel, we conducted a case-control study based on first AIS cases aged 21–90 reported to the Israeli National Stroke Registry during 2014–2015, and controls from a national health survey conducted between 2013 and 2015. We calculated the population attributable risk (PAR) of each risk factor and the combined PAR for all risk factors (hypertension, diabetes, current smoking, obesity and hyperlipidemia), in all study population and by subgroups of young adults (age < 55) and older adults (age ≥ 55). The final analysis included 571, 577 and 500 matched pairs for all study population, young adults and older adults, respectively. Among young adults, current smoking and hypertension were the two most contributing risk factors for AIS, accounting for 33.6% (95% CI 27.3–39.9) and 28.9% (95% CI 22.1–35.7) of AIS cases, respectively. Among older adults, hypertension was the single most contributing risk factor for AIS and diabetes was the second most contributing risk factor for AIS, accounting for 64.9% (95% CI 57.3–72.5) and 25.7% (95% CI 17.5–33.9) of AIS cases, respectively. The combined PAR was significantly lower among young adults (PAR = 67.9%), compared with older adults (PAR = 80.7%). The combined PAR for all study population was 80.1% (95% CI 74.0–86.2), indicating that five common and modifiable risk factors explain ~80% of AIS incidence in Israel. Primary prevention strategies targeting these risk factors have the potential to drastically reduce stroke related morbidity and mortality.

Global risk factors of contrast-induced acute kidney injury: systematic review and meta-analysis

Abstract Background Administration of iodinated contrast is common but may be associated with contrast-induced acute kidney injury (CI-AKI), particularly in at-risk patients. There is no recent systematic review of potentially modifiable risk factors. Methods We searched MEDLINE, Embase and the Cochrane Database of Systematic Reviews (to 30 th June 2019) for observational studies assessing risk factors associated with CI-AKI. Twelve potentially modifiable risk factors were finally included in this thematic review and meta-analysis. Random or fixed meta-analysis was performed to derive the adjusted odds ratio (aOR), and the population attributable risk (PAR) was calculated for each risk factor globally and by region. Findings We included 157 studies (2,297,863 participants). The global incidence of CI-AKI was 5.4%. The potentially modifiable risk factors included high contrast volume (PAR 33%), eight cardiovascular risk factors (diuretic use, multivessel coronary artery disease, acute coronary syndrome, hypertension, hypotension, heart failure, reduced left ventricular ejection fraction and intra-aortic balloon pump use) (combined PAR 76.2%) and three noncardiovascular risk factors (renal dysfunction, diabetes mellitus and anaemia) (combined PAR 47.4%) with geographical differences. Bubble chart of the 12 risk factors Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National Science Foundation of China

Global Risk Factors of Contrast-Induced Acute Kidney Injury: Systematic Review and Meta-Analysis

Background: Administration of iodinated contrast is common but may be associated with contrast-induced acute kidney injury (CI-AKI), particularly in at-risk patients. There is no recent systematic review of potentially modifiable risk factors. Methods: We searched MEDLINE, Embase and the Cochrane Database of Systematic Reviews (to 30th June 2019) for observational studies assessing risk factors associated with CI-AKI. Twelve potentially modifiable risk factors were finally included in this thematic review and meta-analysis. Random or fixed meta-analysis was performed to derive the adjusted odds ratio (aOR), and the population attributable risk (PAR) was calculated for each risk factor globally and by region. Findings: We included 157 studies (2,297,863 participants). Most studies had a low risk of bias. The global incidence of CI-AKI was 5.4%. The potentially modifiable risk factors included high contrast volume (PAR 33%), eight cardiovascular risk factors (diuretic use, multivessel coronary artery disease, acute coronary syndrome, hypertension, hypotension, heart failure, reduced left ventricular ejection fraction and intra-aortic balloon pump use) (combined PAR 76.2%) and three noncardiovascular risk factors (renal dysfunction, diabetes mellitus and anaemia) (combined PAR 47.4%) with geographical differences. In Asia, the PAR of high contrast agent volume ranks first with limited data, while diuretic use ranks first in Europe and North America. The PAR of heart failure was higher in Europe, as was renal insufficiency in North America and hypertension in Africa and Latin America. Interpretation: Prevention and treatment strategies targeting these potentially modifiable risk factors or patients with risk factors, especially cardiovascular disorders, may reduce the incidence of CI-AKI and should be evaluated in future studies. Funding Statement: The study is supported by the Science and Technology Planning Project of Guangdong Province (grant no. 2014B070706010), the National Science Foundation of China (grant no. 81670339 and 81970311), and the Beijing Lisheng Cardiovascular Pilot Foundation (grant no. LHJJ201612127). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: (PROSPERO register number: CRD42019121534).

Reducing the Number of People with Dementia Through Primary Prevention in Mozambique, Brazil, and Portugal: An Analysis of Population-Based Data.

Background: Most people with dementia live in low- and middle-income countries and little is known about the potential for reducing these numbers by reducing key risk factors.Objective: To investigate the potential for dementia incidence reduction in Brazil, Mozambique, and Portugal (a culturally related, high-income country).Methods: We replicated previously published methods and based on the relative risks from previous studies, we estimated the population-attributable risk (PAR) of dementia in Mozambique, Brazil, and Portugal for seven modifiable risk factors associated with dementia (low educational attainment, physical inactivity, midlife hypertension, midlife obesity, depression, smoking, and diabetes mellitus). The combined PAR was calculated and adjusted for associations between risk factors. The potential for risk factor reduction was assessed by examining the effect of relative reductions of 10% and 20% per decade for each of the risk factors on projections for dementia cases for each decade until 2050.Results: After adjusting for non-independence of risk factors, 24.4%, 32.3%, and 40.1% of dementia cases could be related to seven potentially modifiable risk factors in Mozambique, Brazil, and Portugal, respectively. Reducing the prevalence of each risk factor by 20% per decade could, by 2050, potentially reduce the prevalence of dementia in Mozambique, Brazil, and Portugal by 12.9%, 16.2%, and 19.5%, respectively.Conclusion: There is a substantial difference between the countries in the percentage of dementia cases that could be attributable to the seven potentially modifiable risk factors. The proportion of cases that could be prevented by 2050 if measures were taken to address these main risk factors was higher in Portugal than in Brazil and Mozambique. Each country or region should consider their unique risk factor profile when developing dementia risk reduction programs.

Differential Impact of Risk Factors on Stroke Occurrence Among Men Versus Women in West Africa.

Background and Purpose- The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods- SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results- Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for stroke with adjusted odds ratios (95% CI) among females versus males, respectively, were hypertension [29.95 (12.49-71.77) versus 16.1 0(9.19-28.19)], dyslipidemia [2.08 (1.42-3.06) versus 1.83 (1.29-2.59)], diabetes mellitus [3.18 (2.11-4.78) versus 2.19 (1.53-3.15)], stress [2.34 (1.48-3.67) versus 1.61 (1.07-2.43)], and low consumption of green leafy vegetables [2.92 (1.89-4.50) versus 2.00 (1.33-3.00)]. However, salt intake and income were significantly different between males and females. Six modifiable factors had a combined population attributable risk of 99.1% (98.3%-99.6%) among females with 9 factors accounting for 97.2% (94.9%-98.7%) among males. Hemorrhagic stroke was more common among males (36.0%) than among females (27.6%), but stroke was less severe among males than females. Conclusions- Overall, risk factors for stroke occurrence are commonly shared by both sexes in West Africa favoring concerted interventions for stroke prevention in the region.

An Estimate of Attributable Cases of Alzheimer Disease and Vascular Dementia due to Modifiable Risk Factors: The Impact of Primary Prevention in Europe and in Italy

Background: Up to 53.7% of all cases of dementia are assumed to be due to Alzheimer disease (AD), while 15.8% are considered to be due to vascular dementia (VaD). In Europe, about 3 million cases of AD could be due to 7 potentially modifiable risk factors: diabetes, midlife hypertension and/or obesity, physical inactivity, depression, smoking, and low educational level. Aims: To estimate the number of VaD cases in Europe and the number of AD and VaD cases in Italy attributable to these 7 potentially modifiable risk factors. Methods: Assuming the nonindependence of the 7 risk factors, the adjusted combined population attributable risk (PAR) was estimated for AD and VaD. Results: In Europe, adjusted combined PAR was 31.4% for AD and 37.8% for VaD. The total number of attributable cases was 3,033,000 for AD and 873,000 for VaD. In Italy, assuming a 20% reduction of the prevalence of each risk factor, adjusted combined PAR decreased from 45.2 to 38.9% for AD and from 53.1 to 46.6% for VaD, implying a 6.4 and 6.5% reduction in the prevalence of AD and VaD, respectively. Conclusion: A relevant reduction of AD and VaD cases in Europe and Italy could be obtained through primary prevention.

Prestroke Vascular Pathology and the Risk of Recurrent Stroke and Poststroke Dementia.

Improved short-term survival after stroke has necessitated quantifying risk and risk factors of long-term sequelae after stroke (ie, recurrent stroke and dementia). This risk may be influenced by exposure to cardiovascular risk factors before the initial stroke. Within the population-based Rotterdam Study, we determined the long-term risk of recurrent stroke and dementia, and the proportion of recurrent strokes and poststroke dementia cases that are attributable to prestroke cardiovascular risk factors (ie, the population attributable risk). We followed up 1237 patients with first-ever stroke and 4928 stroke-free participants, matched on age, sex, examination round, and stroke date (index date), for the occurrence of stroke or dementia. We calculated incidence rates in both groups and estimated the individual and combined population attributable risk of prestroke cardiovascular risk factors for both outcomes. Beyond 1 year after stroke, patients retained a 3-fold increased risk of recurrent stroke and an almost 2-fold increased risk of dementia compared with people without stroke. In total, 39% (95% confidence interval, 18%-66%) of recurrent strokes and 10% (95% confidence interval, 0%-91%) of poststroke dementia cases were attributable to prestroke cardiovascular risk factors. These percentages were similar for first-ever stroke and dementia in the matched stroke-free population. Long-term risks of recurrent stroke and poststroke dementia remain high and are substantially influenced by prestroke risk factors, emphasizing the need for optimizing primary prevention.

Burden associated with smoking as a suicidal risk factor in an Australian sample of patients with psychosis.

We aim to describe the burden associated with smoking as a risk factor for suicidal behaviors among patients with psychosis. We calculated the Population Attributable Risk (PAR) associated with smoking and other known modifiable risk factors for suicidal behaviors for participants (N=1812) who took part in the Australian Survey of High Impact Psychosis (SHIP). A combined PAR for the seven identified modifiable risk factors was calculated. Smoking contributed to 21% of the suicidal behaviors in this sample; together, the seven factors contributed to 86% of all attempted suicide in this cohort. Smoking may exert a role either directly or indirectly. Evidence indicates that smoking is associated with psychological, biochemical and neurobiological changes that are in turn implicated in smoking. Suicidal behaviors are nevertheless complex behaviors needing multi-faceted approach.

Role of Prestroke Vascular Pathology in Long-Term Prognosis After Stroke: The Rotterdam Study.

Mortality after stroke remains high for years, mostly because of cardiovascular causes. Given that cardiovascular pathology plays an important role in causing the initial stroke, such prestroke pathology might also influence the prognosis after stroke. Within the population-based Rotterdam Study, we examined the proportion of deaths after stroke that are attributable to pre-existent cardiovascular risk factors before stroke (the population attributable risk). We examined 1237 patients with first-ever stroke and 4928 stroke-free participants (between 1990 and 2012), matched on age, sex, examination round, and stroke date (index date). Cardiovascular risk factors measured on ≈4 years before index date were used as determinants. Participants were continuously followed up for mortality (≈6 years) after the index date. We calculated separate and combined population attributable risk of hypertension, total cholesterol, high-density lipoprotein-cholesterol, body mass index, diabetes mellitus, smoking, transient ischemic attack, and atrial fibrillation. Nine hundred and nineteen patients with stroke and 2654 stroke-free participants died. The combined population attributable risk in patients with stroke was 27% (95% confidence interval, 14%-45%) and in stroke-free participants was 19% (95% confidence interval, 12%-29%). Population attributable risks of diabetes mellitus, smoking, and atrial fibrillation were higher in patients with stroke than in the reference group because of a higher prevalence of risk factors. In addition, people with atrial fibrillation and stroke had a higher hazard ratio for death than those with only atrial fibrillation. One quarter of deaths after stroke could theoretically be prevented with rigorous cardiovascular prevention and treatment, but this should preferably start before stroke occurrence. In addition, research into factors explaining the remaining deaths needs to be encouraged.

Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics

ObjectivesStudies examining cervicitis aetiology and prevalence lack comparability due to varying criteria for cervicitis. We aimed to outline cervicitis associations and suggest a best case definition.MethodsA cross-sectional study of 558...

The potential for prevention of dementia across two decades: the prospective, population-based Rotterdam Study.

BackgroundCardiovascular factors and low education are important risk factors of dementia. We provide contemporary estimates of the proportion of dementia cases that could be prevented if modifiable risk factors were eliminated, i.e., population attributable risk (PAR). Furthermore, we studied whether the PAR has changed across the last two decades.MethodsWe included 7,003 participants of the original cohort (starting in 1990) and 2,953 participants of the extended cohort (starting in 2000) of the Rotterdam Study. Both cohorts were followed for dementia until ten years after baseline. We calculated the PAR of overweight, hypertension, diabetes mellitus, cholesterol, smoking, and education. Additionally, we assessed the PAR of stroke, coronary heart disease, heart failure, and atrial fibrillation. We calculated the PAR for each risk factor separately and the combined PAR taking into account the interaction of risk factors.ResultsDuring 57,996 person-years, 624 participants of the original cohort developed dementia, and during 26,177 person-years, 145 participants of the extended cohort developed dementia. The combined PAR in the original cohort was 0.23 (95 % CI, 0.05–0.62). The PAR in the extended cohort was slightly higher at 0.30 (95 % CI, 0.06–0.76). The combined PAR including cardiovascular diseases was 0.25 (95 % CI, 0.07–0.62) in the original cohort and 0.33 (95 % CI, 0.07–0.77) in the extended cohort.ConclusionsA substantial part of dementia cases could be prevented if modifiable risk factors would be eliminated. Although prevention and treatment options of cardiovascular risk factors and diseases have improved, the preventive potential for dementia has not declined over the last two decades.

Potential for primary prevention of Alzheimer's disease: an analysis of population-based data

Recent estimates suggesting that over half of Alzheimer's disease burden worldwide might be attributed to potentially modifiable risk factors do not take into account risk-factor non-independence. We aimed to provide specific estimates of preventive potential by accounting for the association between risk factors. Using relative risks from existing meta-analyses, we estimated the population-attributable risk (PAR) of Alzheimer's disease worldwide and in the USA, Europe, and the UK for seven potentially modifiable risk factors that have consistent evidence of an association with the disease (diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, and low educational attainment). The combined PAR associated with the risk factors was calculated using data from the Health Survey for England 2006 to estimate and adjust for the association between risk factors. The potential of risk factor reduction was assessed by examining the combined effect of relative reductions of 10% and 20% per decade for each of the seven risk factors on projections for Alzheimer's disease cases to 2050. Worldwide, the highest estimated PAR was for low educational attainment (19·1%, 95% CI 12·3-25·6). The highest estimated PAR was for physical inactivity in the USA (21·0%, 95% CI 5·8-36·6), Europe (20·3%, 5·6-35·6), and the UK (21·8%, 6·1-37·7). Assuming independence, the combined worldwide PAR for the seven risk factors was 49·4% (95% CI 25·7-68·4), which equates to 16·8 million attributable cases (95% CI 8·7-23·2 million) of 33·9 million cases. However, after adjustment for the association between the risk factors, the estimate reduced to 28·2% (95% CI 14·2-41·5), which equates to 9·6 million attributable cases (95% CI 4·8-14·1 million) of 33·9 million cases. Combined PAR estimates were about 30% for the USA, Europe, and the UK. Assuming a causal relation and intervention at the correct age for prevention, relative reductions of 10% per decade in the prevalence of each of the seven risk factors could reduce the prevalence of Alzheimer's disease in 2050 by 8·3% worldwide. After accounting for non-independence between risk factors, around a third of Alzheimer's diseases cases worldwide might be attributable to potentially modifiable risk factors. Alzheimer's disease incidence might be reduced through improved access to education and use of effective methods targeted at reducing the prevalence of vascular risk factors (eg, physical inactivity, smoking, midlife hypertension, midlife obesity, and diabetes) and depression. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough.

Maternal and neonatal profile of late-preterm survivors in a poorly resourced country

Objective. To determine maternal indicators and adverse perinatal outcomes among late-preterm infants during birth hospitalization in a low-income country.Methods. Cross-sectional study of late-preterm and term survivors in a tertiary maternity hospital in southwest Nigeria using multivariable logistic regression analysis and population attributable risk (PAR) percentage. Adjusted odds ratios (OR) and 95% confidence intervals (CI) of significant factors are stated.Results. Of 4176 infants enrolled, 731 (17.5%) were late preterm and 3445 (82.5%) were full-term. Late-preterm delivery was independently associated with mothers who were unmarried (OR: 1.71, CI: 1.06–2.75), lacked formal education (OR: 1.75, CI: 1.06–2.89), human immunodeficiency virus positive (OR: 1.61, CI: 1.17–2.20), with hypertensive disorders (OR: 3.07, CI: 2.32–4.08), antepartum hemorrhage (OR: 3.66, CI: 1.97–6.84), and were unlikely to have induced labor (OR: 0.010, CI: 0.01–0.69). Hypertensive disorders and antepartum hemorrhage had a combined PAR of 48.4%. Infants born late preterm were more likely to have low 5-min Apgar scores (OR: 1.70, CI: 1.01–2.83), sepsis (OR: 1.62, CI: 1.05–2.50), hyperbilirubinemia (OR: 1.56, CI: 1.05–2.33), admission into special care baby unit (OR: 1.85, CI: 1.38–2.48), and nonexclusive breast-feeding (OR: 1.49, CI: 1.49, CI: 1.18–1.89).Conclusions. These findings suggest that late-preterm infants in low-resource settings are at risk of severe morbidity and suboptimal feeding. Education and close monitoring of high-risk mothers are warranted to prevent avoidable late-preterm delivery and facilitate the proactive management of unavoidable late-preterm births.

Imputation of sequence variants for identification of genetic risks for Parkinson's disease: a meta-analysis of genome-wide association studies

Genome-wide association studies (GWAS) for Parkinson's disease have linked two loci (MAPT and SNCA) to risk of Parkinson's disease. We aimed to identify novel risk loci for Parkinson's disease. We did a meta-analysis of datasets from five Parkinson's disease GWAS from the USA and Europe to identify loci associated with Parkinson's disease (discovery phase). We then did replication analyses of significantly associated loci in an independent sample series. Estimates of population-attributable risk were calculated from estimates from the discovery and replication phases combined, and risk-profile estimates for loci identified in the discovery phase were calculated. The discovery phase consisted of 5333 case and 12 019 control samples, with genotyped and imputed data at 7 689 524 SNPs. The replication phase consisted of 7053 case and 9007 control samples. We identified 11 loci that surpassed the threshold for genome-wide significance (p<5×10(-8)). Six were previously identified loci (MAPT, SNCA, HLA-DRB5, BST1, GAK and LRRK2) and five were newly identified loci (ACMSD, STK39, MCCC1/LAMP3, SYT11, and CCDC62/HIP1R). The combined population-attributable risk was 60·3% (95% CI 43·7-69·3). In the risk-profile analysis, the odds ratio in the highest quintile of disease risk was 2·51 (95% CI 2·23-2·83) compared with 1·00 in the lowest quintile of disease risk. These data provide an insight into the genetics of Parkinson's disease and the molecular cause of the disease and could provide future targets for therapies. Wellcome Trust, National Institute on Aging, and US Department of Defense.

Assessment of Factors Influencing Morale in the Elderly

BackgroundWe examined the relationship between morale measured by the Philadelphia Geriatric Morale Scale (PGC) and disability, social support, religiosity, and personality traits. Instruments predicting morale were then tested against PGC domains.MethodsThe study utilized a cross-sectional survey with a multistage cluster sampling design. Instruments used were disability (disease burden; WHO Disability Score-II, WHODAS-II), social support (Duke Social Support Scale, DUSOCS; Lubben Social Network Scale, LSNS-6; Medical Outcomes Study Social Support Survey, MOS-SSS), religiosity (Revised Intrinsic-Extrinsic Religious Orientation Scale, I/E-R), and personality (Ten-Item Personality Inventory, TIPI). These were plotted as bar charts against PGC, resolved with one-way ANOVA and Kruskal-Wallis tests, then corrected for multiple comparisons. This process was repeated with PGC domains. Contribution of factors was modeled using population attributable risk (PAR) and odds ratios. Effect of confounders such as gender, age, and ethnicity were checked using binary logistic regression.ResultsAll instruments showed clear relationships with PGC, with WHODAS-II and DUSOCS performing well (ANOVA p<0.001). For PGC domains, attitude toward aging and lonely dissatisfaction trended together, while agitation did not. PAR, odds ratios, and Exp(β) were disability (WHODAS-II: 28.5%, 3.8, 2.8), social support (DUSOCS: 28.0%, 3.4, 2.2), religiosity (I/E-R: 21.6%, 3.2, 2.1), and personality (TIPI: 27.9%, 3.6, 2.4). Combined PAR was 70.9%.ConclusionsDisability, social support, religiosity, and personality strongly influence morale in the elderly. WHODAS-II and DUSOCS perform best in measuring disability and social support respectively.

Could Recent Decreases in Breast Cancer Incidence Really Be Due to Lower HRT Use? Trends in Attributable Risk for Modifiable Breast Cancer Risk Factors in Canadian Women

Objectives: Recent downward trends in breast cancer incidence have been attributed to declining use of hormone replacement therapy (HRT). To determine whether this is a credible conclusion, this study calculated population attributable risk (PAR) for HRT and other modifiable breast cancer risk factors. Methods: PAR calculation needs both the prevalence of a risk factor, and the relative risk (RR) for breast cancer incidence for that risk factor. Prevalences were calculated for Canadian women, aged 50-69, participating in the National Population Health Survey, 1994-2006. RR were derived from published research: 1.4 for HRT use, 1.4 for excessive alcohol use, 1.15 for physical inactivity, 1.25 for smoking, 1.4 for BMI over 30 kg/m2. Trends for PAR were calculated for the risk factors separately, as well as combined. Age-adjusted breast cancer incidence rates were calculated for Canadian women aged 50-69 for the years 1994-2004. Results: Between 1998 and 2004, PAR for HRT decreased by 50%. PAR for other risk factors showed only small changes, and the combined PAR decreased by 18.6%. Age-adjusted breast cancer incidence for women aged 50-69 peaked in 2000 at 330.0/100,000, then dropped by 17.2% by 2004. Conclusion: Patterns of PAR for HRT use in Canada are consistent with the noticeable decrease in breast cancer incidence observed for women of the same age group. Combining PAR for all risk factors indicated that changes in HRT use overpowered any trends of other risk factors. The combined PAR suggest that alterations in lifestyle could have considerable impact on breast cancer incidence. Key words: Breast cancer incidence; population attributable risk; hormone replacement therapy; alcohol; physical activity; obesity

Determination of a gene and environment risk model for age-related macular degeneration

Background/aimsWe have recently identified an association between age-related macular degeneration (AMD) and genetic variants in the serpin peptidase inhibitor, clade G, member 1 (SERPING1) gene. In the current study we...

Risk of Type 2 Diabetes Attributable to C-Reactive Protein and Other Risk Factors

To calculate the population-attributable risk (PAR) of C-reactive protein (CRP) and other risk factors for type 2 diabetes. The Rotterdam Study is a population-based, prospective follow-up study among 7,983 participants aged > or = 55 years. Risk factors including serum CRP were determined at baseline. Participants with diabetes at baseline were excluded, and the cohort was followed for a mean of 10.8 years. The hazard ratio (HR) and PAR for diabetes were computed for all studied risk factors. Serum CRP > 1 mg/l (HR 1.67, PAR 0.33), BMI > 25 kg/m2 (HR 2.51, PAR 0.51), waist circumference > 102 for men and > 88 cm for women (HR 1.36, PAR 0.14), current smoking (HR 1.16, PAR 0.03), age > 65 years (HR 1.35, PAR 0.15), and family history of diabetes (HR 1.87, PAR 0.16) were related to diabetes and contributed to the risk of the disease. Serum CRP was a greater contributor to the risk of diabetes in women than in men (PAR values of 0.37 vs. 0.28, respectively). Age and current smoking PARs were not statistically significantly contributing to the risk of diabetes in women. Combined PAR was 0.80 (95% CI 0.74-0.85) for all six studied risk factors and 0.71 (0.64-0.78) for modifiable risk factors (serum CRP, BMI, waist circumference, and current smoking). High CRP is one of the major contributors to the risk of type 2 diabetes. The contribution of modifiable risk factors to the risk of diabetes is considerable.

Relative and Attributable Risk for Cervical Cancer: A Comparative Study in the United States and Italy

The attributable risk for invasive cervical cancer in the US and Italian populations has been estimated in relation to main 'aetiological' factors (number of sexual partners, age at first intercourse, parity, oral contraceptive use and smoking) and history of Pap smear using data from two case-control studies conducted in the US (466 cases and 788 controls) and Italy (528 cases and 456 controls). The risk of cervical cancer increased in both studies with multiple sexual partners, decreasing age at first intercourse, higher parity, oral contraceptive use and smoking. Levels of exposure to various risk factors were markedly different in the two countries (ie number of sexual partners, frequency of oral contraceptive use and smoking were greater in the US). Multiple Pap smears and a short interval since last Pap smear strongly reduced risk of cervical cancer in both populations, although screening was much more widespread in the US study population, with only 9% of controls reporting no previous smear versus 38% of the Italian control series. The combined population attributable risk for the five 'aetiological' risk factors was slightly greater in the US study (76%) than in the Italian one (69%), chiefly because of a higher prevalence of exposure to sexual factors in US study women. A substantially larger proportion of Italian cases were due in part to deficiency in screening (46% in US and 84% in Italy). Thus, further inclusion of the effect of screening programmes (number of Pap smears and time since last Pap) led to an overall proportion of cases attributable to the examined risk factors of 87% in the US and 95% in Italy.