Excess Relative Risk Research Articles

Opioid analgesic and antidepressant use during pregnancy and the risk of spontaneous preterm birth: A nested case–control study

AbstractBackgroundGiven the high prevalence of both mental health and acute pain conditions during pregnancy, use of antidepressants and analgesic opioids in this period is widespread. Whether single and combined use of these medications is associated with spontaneous preterm birth (sPTB) remains unclear.ObjectivesTo investigate the association between maternal prescription opioid and antidepressant medication exposures for co‐occurring mental health and acute pain management, either alone or in combination, and sPTB.MethodsWe used Tennessee Medicaid data (2007–2019) linked to birth certificates to conduct a nested case–control study among 15‐ to 44‐year‐old pregnant patients with singleton live births. Cases were identified as spontaneous live births between 24 and <37 gestational weeks using a validated birth certificate‐based algorithm. We selected up to 10 controls per case, matched on estimated pregnancy start date and other factors. We identified analgesic opioid and antidepressant pharmacy fills to define medication exposures in the 60 days before index date (case delivery date) and categorised them as unexposed, opioid‐only, antidepressant‐only and combined exposure. We estimated odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression, adjusting for confounders. We assessed the additive interaction between opioids and antidepressants by estimating relative excess risk due to interaction.ResultsWe identified 25,406 eligible cases of sPTB and 225,771 matched controls. Opioid‐only and combined exposures were associated with higher odds of sPTB relative to unexposed (adjusted OR 1.29, 95% CI 1.23, 1.35 and 1.22, 95% CI 1.06, 1.40, respectively), while antidepressant‐only exposure was not (1.04, 95% CI 0.96, 1.12). No additive interaction was identified for combined exposure.ConclusionsExposure to prescription opioids during pregnancy, but not antidepressants, was associated with increased relative odds of sPTB. Co‐exposure to opioids and antidepressants did not elevate the odds of sPTB above what we observed for opioid‐only exposure.

Association and interaction analysis of NLRP3 gene polymorphisms with hypertension risk: a case-control study in China.

The NLRP3 inflammasome, a pivotal mechanism regulating inflammatory responses and featuring the pyrin domain containing 3 (NLRP3) within the NOD-like receptor family, is widely recognized as a central pathogenic factor in cardiovascular diseases. The present study endeavors to delve into the correlation and potential interplay between the rs10754558 polymorphism of NLRP3 and the predisposition to hypertension among the Chinese adult population. All the participants who came from a community in Bengbu, China were investigated by being interviewed with a questionnaire. Overall, 354 paired case-control participants were analyzed. Genomic DNA was extracted from 5ml venous blood using the Tiangen DNA extraction kit. The rs10754558 polymorphism of the NLRP3 gene was genotyped by TaqMan allelic discrimination real-time PCR.The association between the rs10754558 polymorphism and hypertension risk was investigated by a logistic regression analysis. Furthermore, an additive interaction analysis was conducted using related indicators, including the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI). Participants carrying the GG genotype were more likely to develop hypertension than participants carrying the CC genotype (adjusted odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.33-3.52). A significant additive interaction between the NLRP3 polymorphism and obesity status concerning the risk of hypertension was observed, as estimated by all indicators: RERI (1.12, 95% CI: 0.70-1.5), AP (0.34, 95% CI: 0.14-0.53), and SI (1.92, 95% CI: 1.03-3.59). The values of RERI (1.74, 95% CI: 0.37-3.11), AP (0.46, 95% CI: 0.21-0.70), and SI (2.62, 95% CI: 1.18-5.83) showed that a significant interaction between the rs10754558 polymorphism and a family history of hypertension. Our findings indicate a significant association between the NLRP3 rs10754558 polymorphism and the risk of hypertension in Chinese adults. Moreover, a notable additive interaction emerges between NLRP3 polymorphisms and obesity status, further amplifying the risk of hypertension.

Lung cancer mortality attributable to residential radon in Germany.

The radioactive gas radon is one of the most important risk factors for lung cancer after smoking. This article aims to estimate the annual number of lung cancer deaths attributable to residential radon exposure in Germany and its federal states using updated data and an advanced calculation method. Data on lung cancer mortality (2018-2022), smoking behavior (2017), and on the estimated distribution of radon concentration based on a radon residential study (2019-2021) in Germany are used. The risk model employed is derived from the pooled European residential radon study, indicating that excess relative risk for lung cancer increases by 16% per 100 becquerels per cubic meter (Bq/m ) of corrected long-term radon concentration. It is estimated that a total of around 2800 lung cancer deaths per year (95% confidence interval (CI) 900-5100) are attributable to residential radon in Germany. This represents a population attributable fraction of 6.3% (95% CI 2.1-11.4%). Notably, radon-attributable lung cancer deaths occur not only among current (41%) but also significantly among former smokers (41%) and those who have never smoked (19%). The results confirm that radon in homes is an important risk factor for lung cancer, highlighting the need for protective measures against radon for all population groups in Germany.

Abstract 4118183: Anxiety disorder, depression and coronary artery disease: associations and modification by genetic susceptibility

Background: Associations of anxiety disorder and depression with coronary artery disease (CAD) are heterogeneous between populations. Research questions: How does genetic susceptibility to CAD alter the associations between anxiety and depression and incident CAD? Aims: To investigate how genetic susceptibility to CAD alters the associations of anxiety and depression with incident CAD, comparing and combining anxiety and depression. Methods: This is a prospective cohort study using UK Biobank. Diagnoses of anxiety disorder and depression before the baseline assessment were ascertained through linked hospital admission data. Incident CAD was ascertained through hospital admission and death certificate data after baseline. CAD polygenic risk score (PRS) was obtained from CARDIoGRAMplus4 and categorised into low, intermediate, and high. Cox proportional hazard models were used to examine associations between anxiety and depression and CAD. The product term of PRS and these mental health conditions, and the relative excess risk due to interaction (RERI), were used to investigate the presence of multiplicative and additive interactions, respectively. Results: Our study included 288,152 participants of whom 54.4% were female, with a mean age of 56.4 years. Both anxiety disorder (HR: 2.24, 95% CI: 1.86–2.70) and depression (HR: 2.04, 95% CI: 1.80–2.32) were associated with CAD after adjusting for sociodemographic confounders. There was an addictive interaction between depression and PRS (RERI: 0.86; 95% CI: 0.06–1.65) such that the association between depression and CAD was strongest among those with a high PRS whilst there was no such evidence for anxiety disorder. Anxiety only (HR 1.69, 95% 1.17–2.45), depression only (HR 2.01, 95% CI 1.62–2.49) and concomitant anxiety and depression (HR 3.51, 95% CI 2.26–5.45) were associated with CAD even among people with a low PRS. Lifestyle mediators attenuated all these associations across PRS categories. Conclusions: CAD genetic susceptibility might partly contribute to the clustering of depression and CAD but does not provide a full explanation, nor does it explain the association between anxiety disorder and CAD. Therefore, other mechanisms should be explored.

Chronic bronchitis and bronchial asthma: the impact of chronic occupational radiation exposure on incidence and mortality of Mayak nuclear workers.

The information about the radiation risk of non-cancer respiratory diseases is inconsistent and mainly corresponds to mortality. Previously, an increased risk of chronic bronchitis incidence was demonstrated in the cohort of workers employed at the first Russian nuclear facility Mayak Production Association who had been chronically exposed to gamma rays (externally) and to alpha-active plutonium aerosols (internally). Within this retrospective study, we performed analyses of incidence of and mortality from chronic bronchitis and bronchial asthma using improved estimates of radiation doses provided by the "Mayak Worker Dosimetry System (MWDS) - 2013". The cohort included 22,377 individuals hired in 1948-1982, and its follow-up was extended by 10 years (to the end of 2018). The excess relative risk of chronic bronchitis incidence per unit radiation dose (ERR/Gy) and the 95% confidence interval (95% CI) were: with the 0-year lag ERR/Gy=0.07 (95% CI -0.01, 0.17) for gamma exposure and ERR/Gy=0.36 (95% CI 0.13, 0.68) for alpha exposure; with the 10-year lag ERR/Gy=0.15 (95% CI 0.04, 0.30) for gamma exposure and ERR/Gy=0.54 (95% CI 0.19, 1.03) for alpha exposure. The chronic bronchitis mortality risk was significantly associated with internal alpha exposure only for certain worker categories: ERR/Gy=4.08 (95% CI 0.59, 14.3) in males; ERR/Gy=7.10 (95% CI 0.31, 70.44) in former smokers; ERR/Gy=7.94 (95% CI 1.71, 30.2) in workers with the smoking index above 20 pack×years. No association was observed in the chronic bronchitis mortality risk with external gamma exposure. No strong evidence was observed for the impact of gamma and alpha exposure on risk of mortality from chronic bronchitis. The study confirmed the significant positive linear association of the chronic bronchitis incidence risk with gamma and alpha radiation doses from occupational chronic external and internal exposure. However, the estimates of ERR/Gy of alpha particles from internal exposure appeared to be almost 2.4-3 times lower than those based on the MWDS-2008. The observed inconsistency requires further clarification. As for bronchial asthma in Mayak workers, no association was demonstrated in the incidence and mortality risks with occupational gamma and alpha radiation exposure.

Influence of air pollution on the nonaccidental death before and after the outbreak of COVID-19

BackgroundDuring the COVID-19 pandemic, non-therapeutic interventions (NPIs), such as traffic restrictions, work stoppages, and school suspensions, have led to a sharp decline in the concentration of air pollutants in the epidemic sites. However, few studies focused on the impact of air pollutant changes on the risk of nonaccidental death.MethodWe selected Yancheng City, China, as the study site and applied a Generalized Additive Model (GAM) based on the quasi-Poisson distribution to evaluate the impact of atmospheric pollutants exposure on the nonaccidental death of local residents. The time span of this study was set from January 1, 2013, to December 21, 2022, that is, before and after the outbreak of COVID-19.ResultsThe concentration of some air pollutants has greatly varied after the outbreak of COVID-19, with a significant decline for PM2.5 (− 43.4%), PM10 (− 38.5%), SO2 (− 62.9%), and NO2 (− 22.6%), but an increase for O3 (+ 4.3%). Comparative analysis showed that PM2.5 contributed to an increased risk of nonaccidental death after the outbreak of COVID-19. With an increase in PM2.5 by 10 µg/m³, the excess relative risks (ER) of nonaccidental death of residents increased by 1.01% (95%CI: 0.19%,1.84%). The stratified analysis revealed that air pollutants impacted nonaccidental deaths in both men and women before the outbreak of COVID-19. After the outbreak of COVID-19, PM10 had a significant effect on male nonaccidental deaths. The concentrations of PM2.5, PM10, and SO2 increased by 10 µg/m³, the ER of PM2.5, PM10, and SO2 on female nonaccidental death increased by 1.52% (0.38%,2.67%), 0.58% (0.02%,1.13%), and 15.09% (5.73%,25.28%), respectively. Before the outbreak of COVID-19, five air pollutants had an impact on the death of residents from cardiovascular disease (CVD). After the outbreak of COVID-19, only PM10 significantly affected the death risk of CVD. In addition, we discovered that PM2.5, PM10, and SO2 significantly impacted the risk of death due to respiratory diseases before and after the outbreak of COVID-19.ConclusionsAir pollutants have different effects on nonaccidental deaths before and after the COVID-19 outbreak. A decrease in air pollutant concentration due to the NPIs for COVID-19 had a significant effect on the reduction of the risk of nonaccidental death.

A note on potential gains in precision of radiation risk estimates from joint analysis.

In estimating radiation-related risk of cancer and other diseases based on the RERF Life Span Study (LSS), joint analyses can be performed where multiple health outcome endpoints are combined in the same model, allowing some parameters to be estimated in common among all endpoints with possible increase in precision of radiation risk and other model parameter estimates. Using as a basis excess relative risk (ERR) and excess absolute risk (EAR) models of the type commonly used in analysis of LSS data at RERF, we use maximum likelihood theory to compute the asymptotic relative standard error of endpoint-specific radiation effect and other parameter estimates using joint analyses as compared to traditional independent analysis. We show that some gains in precision of endpoint-specific radiation risk parameter estimates can be achieved by sharing effect modifier and other model parameters, but only small or negligible gains in precision are achieved for endpoint-specific background modifying or effect modifying parameters when other model parameters are shared. The magnitude of the precision gain for radiation risk estimates depends on the number of endpoints, the baseline incidence rate of the endpoint, and the type of model being used.

COVID-19 vaccination modified the effect of nirmatrelvir-ritonavir on post-acute mortality and rehospitalization: a retrospective cohort study.

While previous research examined coronavirus disease 2019 (COVID-19) antiviral-vaccine interactions through exploratory subgroup analysis, none specifically designed for examining this interaction or its impact on post-acute outcomes. This study examined the interaction between nirmatrelvir-ritonavir and complete COVID-19 vaccination on reducing the risk of post-acute outcomes among COVID-19 patients. We followed COVID-19 patients hospitalized between 11 March 2022 and 10 October 2023, until 31 October 2023 in Hong Kong. Exposure groups were based on nirmatrelvir-ritonavir usage and vaccination status (fully or not fully vaccinated). Post-acute death and all-cause rehospitalization were the study outcomes. Propensity score weighting was applied to balance covariates among exposure groups, including age, sex, Charlson Comorbidity Index, and concomitant treatments. Multiplicative and additive interactions between nirmatrelvir-ritonavir and vaccination status were assessed. A total of 50,438 COVID-19 patients were included in this study and arranged into four exposure groups. Significant additive interaction on post-acute rehospitalization was observed (relative excess risk, 0.10; 95% CI, 0.02-0.19; p-value, 0.018; attributable proportion, 0.07; 95% CI, 0.01-0.12; p-value, 0.017; synergy index, 1.26; 95% CI, 1.02-1.55; p-value, 0.032). The interaction on post-acute mortality was marginally significant. In the subgroup analysis, the interaction effect is more pronounced in older adults, female, and CoronaVac recipients. In conclusion, our study demonstrated an additive interaction between nirmatrelvir-ritonavir and complete vaccination on post-acute outcomes, suggesting greater long-term benefits of the antiviral for fully vaccinated individuals compared to not fully vaccinated patients.

Windows of susceptibility and joint effects of prenatal and postnatal ambient air pollution and temperature exposure on asthma and wheeze in Mexican children

IntroductionPrenatal and early-life exposure to air pollution and extreme temperatures are associated with childhood asthma and wheeze. However, potential windows of susceptibility and their sex-specific and interactive effects have not been fully elucidated. We aimed to identify critical windows of susceptibility and evaluate sex-specific effects in these associations, and evaluate exposure interactions. MethodsWe analyzed data from 468 mother–child pairs enrolled in the PROGRESS birth cohort in Mexico City. Daily residential levels of PM2.5, NO2, and temperature were generated from our validated spatiotemporally resolved models from conception to age 4 years. Childhood asthma and wheeze outcomes were collected at 4–6 and 7–8 years. Distributed lag nonlinear models (DLNMs) were used to identify susceptible windows for prenatal weekly-specific and postnatal monthly-specific associations of air pollution and temperature with respiratory outcomes adjusting for covariates. To evaluate sex-specific effects, DLNMs were stratified. Joint effects were assessed using relative excess risk due to interaction and attributable proportion. ResultsMid-gestation was a critical window for both PM2.5 (weeks 20–28, cumulative OR: 1.18 [95% CI: 1.01, 1.37]; weeks 19–26, cumulative OR: 1.18 [95% CI: 1.02, 1.36]) and NO2 (weeks 18–25, cumulative OR: 1.16 [95% CI: 1.02, 1.31]) exposure, associated with higher odds of wheeze. Postnatal exposure to PM2.5 and NO2 during the first year of life was also linked to higher odds of wheeze. The warmer and colder temperatures showed mixed effects on respiratory outcomes. We observed a synergistic interaction between high PM2.5 and high temperature exposure during the first year of life, associated with higher odds of current wheeze. The associations of prenatal air pollution and temperature exposure with respiratory outcomes were more pronounced in males. ConclusionsEarly-life air pollution exposure contributes to the development of childhood asthma and wheeze, while exposure to temperature showed mixed associations with respiratory outcomes.

Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality among patients who are immunocompromised with COVID-19 in Hong Kong: a retrospective cohort study

The effect of nirmatrelvir-ritonavir on post-COVID-19 outcomes for individuals who are immunocompromised is understudied. We aimed to examine the association of nirmatrelvir-ritonavir with post-acute sequelae and mortality among patients who are immunocompromised and admitted to hospital with COVID-19. We did a retrospective cohort study using territory-wide electronic health records from the Hong Kong Hospital Authority and Hong Kong Department of Health. Eligible patients were adults aged 18 years or older who tested positive for SARS-CoV-2 during the study period (March 11, 2022, to Nov 9, 2023) and were admitted to hospital with COVID-19. Four exposure groups were formed based on immune status (immunocompromised or immunocompetent) and nirmatrelvir-ritonavir status (yes or no). The primary outcome was post-acute inpatient death, starting from 21 days after the positive RT-PCR date. Standardised mortality ratio weighting with doubly robust adjustment was applied to control for confounders. Cox models were used to estimate hazard ratios (HRs) for the outcomes. Between March 11, 2022, and Nov 9, 2023, there were 89 772 individuals with positive RT-PCR tests, of whom 39 923 met eligibility criteria and were included in the study cohort. 19 914 (49·9%) of 39 923 patients were female, 20 009 (50·1%) were male and the median age was 75·0 years (IQR 63·0-85·0). 846 (38·2%) of 2217 patients who were immunocompromised and 14 586 (38·7%) of 37 706 patients who were immunocompetent were prescribed nirmatrelvir-ritonavir. Among the patients who were immunocompromised, those patients who received nirmatrelvir-ritonavir had significantly lower risk of post-acute inpatient death (HR 0·58, 95% CI 0·45-0·74; p<0·0001) and hospitalisation for acute respiratory distress syndrome (0·43, 0·20-0·90; p=0·024) than those who did not. A significant negative interaction was found between immune status and nirmatrelvir-ritonavir on post-acute all-cause hospitalisation (relative excess risk due to interaction -0·84, 95% CI -1·30 to -0·37; p=0·0004). Nirmatrelvir-ritonavir was associated with reduced risk of post-acute inpatient death among patients who were immunocompromised and admitted to hospital with COVID-19. However, the effectiveness of nirmatrelvir-ritonavir on post-acute hospitalisation outcomes was less pronounced in patients who were immunocompromised than in patients who were immunocompetent. Health and Medical Research Fund, Research Grants Council theme-based research schemes, and Research Grants Council Collaborative Research Fund.

Interaction of serum uric acid with overweight on hypertension: findings from the China Health and Nutrition Survey

BackgroundBoth serum uric acid (SUA) levels and body mass index (BMI) are recognized as important risk factors for hypertension. The current study aimed to investigate the interaction effects between SUA levels and overweight (defined as BMI ≥ 24 kg/m2 in Chinese) on the incidence of hypertension among Chinese adults.Methods1124 hypertensive participants and 7283 non-hypertensive participants, extracted from the China Health and Nutrition Survey (CHNS), were analyzed. Participants were categorized based on their SUA levels and BMI, to investigate the interaction effects between SUA levels and overweight on hypertension.ResultsIn comparison with the reference group (BMI < 24 kg/m2 and in the 1st quintile of SUA), multivariable adjusted analysis demonstrated that the odds ratio (OR) (95% confidence interval, 95% CI) of hypertension for participants with overweight alone was 2.18 (1.41–3.37); for elevated SUA levels alone, the ORs (95% CIs) were 1.57 (1.08–2.30), 1.84 (1.24–2.74), 2.21 (1.47–3.32), and 2.48 (1.55–3.96) across SUA quintiles; and for the combined effect of higher SUA levels and overweight, the ORs (95% CIs) were 3.25 (2.19–4.82), 3.73 (2.51–5.55), 5.17 (3.42–7.80), and 6.21 (4.01–9.60). The relative excess risk due to interaction (RERI) was 3.26 (1.43–5.09) at the 5th quintile of SUA, indicating the presence of additive interaction between overweight and SUA levels on hypertension.ConclusionInteraction between SUA levels and overweight on hypertension exists specifically at the highest quintile (Q5, > 6.39 mg/dL) of SUA among Chinese adults. Therefore, strategies to lower SUA levels could be considered as a potential approach to mitigate hypertension risk in overweight individuals within this specific subgroup.

Circulating fatty acids, genetic susceptibility and hypertension: a prospective cohort study.

Combining genetic risk factors and plasma fatty acids (FAs) can be used as an effective method of precision medicine to prevent hypertension risk. A total of 195,250 participants in the UK Biobank cohort were included in this study from 2006-2010. Polygenic risk scores (PRSs) were calculated for hypertension using single-nucleotide polymorphisms (SNPs). Concentrations of plasma FAs, including polyunsaturated fatty acids (PUFAs), monounsaturated fatty acids (MUFAs) and saturated fatty acids (SFAs), were tested by nuclear magnetic resonance. The Cox model was used to test for the main effects of PRS, different plasma FAs and their joint effects on hypertension. Relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP) were used to test the additive interaction. Plasma PUFAs, n-3 PUFAs, MUFAs and SFAs were related to the risk of hypertension (PUFAs: HR, 0.878; 95% CI, 0.868-0.888; MUFAs: HR, 1.13; 95% CI, 1.123-1.150; SFAs: HR, 1.086; 95% CI, 1.074-1.098; n-3 PUFAs: HR, 0.984; 95% CI, 0.973-0.995). Moreover, an additive interaction was found between PRS and plasma FAs, which could contribute to an approximately 10-18% risk of hypertension, and the associations between high plasma MUFAs and a high PRS of hypertension were the strongest positive [RERI: 0.178 (95% CI: 0.062, 0.294), AP: 0.079 (95% CI: 0.027, 0.130)]. Increased plasma MUFAs or SFAs and decreased plasma PUFAs or n-3 PUFAs were associated with hypertension risk, especially among people at high genetic risk.

Interactive effects of outdoor fine particulate matter and metabolic, behavioural, and psychosocial risk factors on cardiovascular disease: analysis of the PURE-China cohort study

Abstract Background Long-term PM2.5 exposure has been associated with an elevated risk of cardiovascular disease (CVD) and its associated risk factors.[1–4] There is a paucity of studies investigating the interactive effects of PM2.5 exposure and a comprehensive list of risk factors including metabolic, behavioural, and psychosocial risk factors on CVD risk.[5] Purpose This study aims to examine the interactive effects of PM2.5 exposure and metabolic, behavioural, and psychosocial risk factors on incident CVD. Methods The Prospective Urban Rural Epidemiology (PURE)-China cohort study is a population-based cohort study recruiting participants aged 35–70 years from 115 communities in 12 provinces of China between 2005 and 2009, and followed up until August 31, 2021.[6] Participants’ metabolic, behavioural, and psychosocial risk factor information was recorded. PM2.5 concentrations were extracted from a 1x1 km2 global model.[7,8] For this analysis, we included participants aged 35–70 years at baseline without a history of CVD, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (CVD deaths, myocardial infarction, stroke, and heart failure). Additive interaction was measured by relative excess risk due to interaction (RERI), the proportion of disease attributable to interaction (AP), and the synergy index (SI).[9,10] To comply with the additive interaction method, we classified concentrations of PM2.5 into low and high levels by the median of 3-year average PM2.5 concentration (45.7 μg/m3, IQR: 33.7-74). Cox proportional hazard models were used to assess the associations of metabolic, behavioural, and psychosocial risk factors on incident CVD by PM2.5 concentrations. Results The PURE-China study recruited 47 931 participants, of which 39 329 are eligible for this analysis. During the median follow-up period of 11.9 years (IQR: 9.6-12.6), 1462 and 2155 major CVD events had occurred in the low and high PM2.5 group respectively. There was a synergistic interaction between PM2.5 and the systolic blood pressure (SBP) for CVD: RERI: 0.363, 95% CI: 0.196-0.531; AP: 0.098, 95% CI: 0.081-0.115; SI: 1.155, 95% CI: 1.132-1.177; high LDL cholesterol: RERI: 0.219, 0.003-0.436; AP: 0.135, 0.008-0.263; SI: 1.549, 0.947-2.533. A significant synergistic interaction was also identified between PM2.5 and household air pollution (RERI: 0.457, 0.292-0.622; AP: 0.277, 0.184-0.37; SI: 3.362, 1.409-8.019). Interactions between PM2.5 and low grip strength on CVD were significantly synergistic, but antagonistic between PM2.5 and low physical activity (RERI: -0.248, -0.485--0.012; AP: -0.174, -0.349-0.001; SI: 0.633, 0.412-0.971). Conclusion Addictive interaction was between PM2.5 and SBP, high LDL cholesterol, household air pollution, low grip strength and low physical activity on incident CVD, indicating the benefit of coordinated control strategies for metabolic, physical, and environmental risk factors for the prevention of CVD.

Interaction between alcohol intake and employment status changes on mortality among young workers

Abstract Background To investigate the impact of changes in employment status and their interaction with alcohol consumption on health outcomes among young workers. This study aims to explore how employment fluctuations, periodic unemployment, and economic activity levels influence the health of economically active individuals, focusing particularly on the synergistic effects that these employment changes may have when combined with alcohol consumption. Methods We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. The study included individuals aged 25-44 years who underwent health check-ups between 2009 and 2010. We categorized changes in employment status into three groups: continuously employed, economically active with employment fluctuations, and periodically unemployed. We estimated adjusted hazard ratios and 95% confidence intervals using multivariable Cox proportional hazard models to assess the impact of changes in employment status on the risk of all-cause mortality. The relative excess risk due to interaction, a widely accepted indicator of additive interaction, was used to assess the interaction between alcohol consumption and changes in employment status. Results Changes in employment status significantly increased the risk of all-cause mortality in both men and women in the economically active with employment fluctuations and periodically unemployed groups compared with the continuously employed group. The synergistic effect of alcohol consumption and changes in employment status on the risk of all-cause mortality was significant only among men. Conclusions The findings of this study indicate that changes in employment status, particularly when combined with alcohol consumption, significantly affect all-cause mortality among young workers. Key messages • Employment status fluctuations combined with alcohol consumption significantly increase all-cause mortality risks among young workers, especially men. • This study emphasizes the urgent need for targeted interventions that address the combined impact of employment and lifestyle factors on public health.

Intergenerational Transmission of Overweight and Obesity among Preschool Children in Sweden

Abstract Background Child overweight including obesity (OWOB) has quadrupled globally, since 1975. It affects a third of European children and even higher rates persist among expectant parents. Parental pre-pregnancy body mass index (BMI) and health behaviours are known to influence offspring health. Thus, this study aimed to investigate the link between parental and children’s OWOB, alongside parental socio-economic and other factors. Methods This is a population-based repeated cross-sectional study utilized data from the Salut Programme in Västerbotten, Sweden, and Swedish national registers, including 5,937 of 3-year-olds and their parents. Logistic regression analyses were used to examine the association of child BMI with prenatal BMI and other factors. Further, the Relative Excess Risk due to Interaction (RERI) arising from the interplay between parent’s OWOB status in relation to their children’s OWOB was calculated. Results OWOB prevalence rates for 3-year-olds, expectant mothers, and their partners were 15.1%, 29.1%, and 53.5%, respectively. Both parent’s OWOB significantly affected children’s BMI (with strongest association for mothers). The Relative Excess Risk due to interaction (RERI) was positive for children’s OWOB if both parents were obese, showing an additive interaction effect of individual parental obesity status. The odds for a child to be OWOB was 2.88 (1.83-4.43) if both parents were obese compared to if none of them were obese. Conclusions OWOB among preschool children remain an important public health concern in Sweden. Based on the study findings, Sweden’s regional and national public health initiatives should prioritize targeting parental overweight and obesity as a key strategy to reduce the burden of OWOB among children. Furthermore, the resemblance of these results with comparable studies across the world, emphasizing the importance of initiating interventions with parents before pregnancy or even earlier. Key messages • Parental combined obesity status significantly increase the odds of childhood overweight and obesity. • The importance of initiating interventions with parents before pregnancy for better health outcomes related to child BMI.

Socioeconomic status and cardiovascular mortality in over 170,000 cancer survivors: a population-based cohort study

Abstract Background Cardiovascular health is acknowledged as a crucial concern among cancer survivors. Purpose We designed the current study to explore the relationship between socioeconomic status (SES) and cardiovascular disease (CVD) outcomes in cancer survivors. Methods Using the National Health Insurance Service-National Health Examinee database, we identified cancer survivors diagnosed and surviving beyond 5 years post-diagnosis. SES was assessed based on insurance premiums and classified into 5 groups. The primary outcome was death from any CVD. Results This study analyzed 170,555 individuals (mean age 60.7 ± 11.9 years, 57.8% female). A gradual increase in risk was observed across SES groups: adjusted hazard ratios (95% confidence intervals) for overall CVD mortality were 1.20 (1.09-1.33), 1.37 (1.23-1.54), 1.38 (1.24-1.54), and 2.42 (1.48-3.96) for the second, third, and fourth quartile, and medical aid group (the lowest SES group) compared to the highest SES group, respectively. The medical aid group with hypertension exhibited a 3.4-fold higher risk of CVD mortality compared to the highest SES group without hypertension. The relative excess risk due to interaction between medical aid and hypertension was 1.30, and the synergy index was 1.62. Conclusions Low SES and hypertension are both linked to a higher risk of CVD mortality. The present study suggests that low SES, particularly the lowest SES group, synergistically interacts with hypertension, amplifying the risk of CVD mortality.

Independent and joint associations of urinary potassium excretion with cardiovascular death: a national population-based cohort study

Abstract Background Elevated potassium excretion is associated with lower blood pressure, as well as reduced risks of cardiovascular disease (CVD) death. However, the impact of varied sodium levels on this association remains a topic of debate, and the mediators of this association besides blood pressure remain uncertain. Purpose To examine the joint association of potassium and sodium with CVD mortality risk, and to identify potential mediating factors of this association. Methods Based on the ChinaHEART (China Health Evaluation And risk Reduction through nationwide Teamwork) project, participants aged 35-75 from 239 sites across all 31 provinces in the mainland of China were recruited from November 2014 to December 2022. We collected spot urine samples from participants and estimated 24-hour sodium and potassium excretion using the Kawasaki formula. Death records were captured through data linkage with the National Mortality Surveillance System and Vital Registration. Multiple regressions were used to analyze the association between potassium excretion and CVD death, as well as to examine the addictive interaction of potassium and sodium. Results This study included 270,991 participants with a mean age of 55.8±9.8 years, and 60.5% of them were female. The mean potassium excretion was 54.36±12.58 mmol/d , which was higher in males and people living in the north. Findings revealed a positive correlation between low urinary potassium levels and CVD death , and the lowest adjusted hazard rate for CVD mortality was 0.65 (95% CI: 0.58-0.73) in the group with the highest potassium excretion (i.e. ≥64.27 mmol/d) compared with the reference group (&amp;lt;43.79 mmol/d), after adjusting for sociodemographic characteristics, medical histories, and lifestyles. Age modified the association between potassium excretion and risk of CVD death (P for interaction=0.031). In addition to systolic blood pressure (16.6%), heart rate (2.2%) also served as the significant mediator between urinary potassium excretion and CVD death. The relative excess risk of interaction (RERI) of lower potassium excretion and lower sodium was significantly positive (RERI=0.22, 95% CI: 0.02-0.42), which implied the synergy effect. Conclusion Potassium intake in the Chinese population is evidently lower than the guideline recommendations, and increasing potassium intake, especially in the population aged &amp;lt;65 years, may reduce the risk and burden of cardiovascular and other diseases. Moreover, when sodium intake is insufficient, supplementation with both sodium and potassium salt can achieve greater health benefits.Graphic abstract

Synergistic effect of periodontitis and C-reactive protein levels on mortality: NHANES 2001-2004.

Periodontitis is associated with elevated C-reactive protein (CRP) levels. Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers.

Age and sex differences in the association of dental visits with inadequate oral health and multimorbidity: Findings from the Canadian Longitudinal Study on Aging (CLSA)

BackgroundDental attendance is important for the prevention, diagnosis, and treatment of oral diseases. In this study, we aimed to assess the extent of the association between dental visits, inadequate oral health, and multimorbidity (MM), and whether this association differs by age and sex.MethodsWe conducted a cross-sectional analysis of the first follow-up wave (2018) of the Canadian Longitudinal Study on Aging (CLSA). Poor self-reported oral health (SROH), oral health problems, and edentulism were used to indicate inadequate oral health. MM was defined as having 2 or more chronic conditions out of cancer, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental illnesses. Dental visiting was determined as the number of visits to a dental professional within the past 12 months. Covariates included socioeconomic, behavioural factors, and the availability of dental insurance. We constructed multivariable Poisson and logistic regression models with interactions terms and estimated the relative excess risk due to interaction prevalence ratio (RERIPR) to assess the effect measure modification of age and sex on the associations of interest. We conducted sensitivity analyses and estimated E-values for unmeasured confounding.ResultsIn this sample (n = 44,815), dental visiting was inversely associated with inadequate oral health and MM in adjusted models, reducing the odds/prevalence of poor SROH (OR 0.41, 95% CI 0.34, 0.51), oral health problems (PR 0.89, 95% CI 0.79, 0.94), edentulism (OR 0.10, 95% CI 0.06, 0.15), and MM (PR 0.86, 95% CI 0.79, 0.92). These associations were stronger in older age and females.ConclusionDental visiting may contribute to better oral health and reduced chronic diseases in the middle-aged and older population. Our findings suggest the need for age and sex-specific targeted interventions to optimize oral and overall health.

The combined effects of heatwaves, air pollution and greenery on the risk of frailty: a national cohort study

The associations between heatwaves and frailty, as well as the joint effects of heatwaves with air pollution and greenery, are currently unknown. This study leverages data from the China Health and Retirement Longitudinal Study (CHARLS), which collected information from 6,400 older adults between 2011 and 2018. Our outcome variable was frailty, as measured by the frailty index (FI > 0.21). Heatwaves were defined based on maximum temperature, incorporating four thresholds (≥ 97.5%, 97.5%, 92.5%, and 90%) and three durations (≥ 2, 3, and 4 days). These variables were considered as time-varying variables, representing the one-year exposure preceding survival events. Fine particulate matter (PM2.5) and greenery (normalized difference vegetation index (NDVI)) were utilized as indicators of air pollution and greenery exposure, respectively, and were treated as time-varying indicators concurrent with heatwaves.Time-varying Cox proportional hazards models were employed to assess the independent effects, as well as the multiplicative and additive interactions of heatwaves, air pollution, and greenery on the risk of frailty. These effects were quantified using hazard ratios (HRs), a traditional product term representing the ratio of HRs, and the relative excess risk due to interaction (RERI). Our findings indicate that heatwaves are associated with an increased risk of frailty, with HRs ranging from 1.035 (95% CI: 1.006–1.064) to 1.063 (95% CI: 1.028–1.101). We observed both a positive multiplicative interaction (HRs > 1) and an additive interaction (RERI > 0) between high level PM2.5 concentration, lack of greenery, and heatwaves. This study reveals that the combined effects exacerbate the adverse impact of heatwaves on the risk of frailty. Moreover, the combined effects of heatwaves, air pollution, and greenery exposure on frailty risk vary across age, gender, and educational attainment.