Using data from five U.S. cohort studies, the authors estimate that 17% of excess mortality among smokers is due to diseases not already established as caused by smoking; for example, renal failure, ...infections, and intestinal ischemia could potentially be linked to smoking.
The 2014 Surgeon General’s report estimates that cigarette smoking causes more than 480,000 deaths each year in the United States.
1
This widely cited estimate of the mortality burden of smoking may be an underestimate, because it considers deaths only from the 21 diseases that have been formally established as caused by smoking (12 types of cancer, 6 categories of cardiovascular disease, diabetes, chronic obstructive pulmonary disease COPD, and pneumonia including influenza). Associations between smoking and the 30 most common causes of death in the United Kingdom in the Million Women Study suggest that the excess mortality observed among current smokers . . .
CONTEXT Physical activity can reduce the risk of hip fractures in older women,
although the required type and duration of activity have not been determined.
Walking is the most common activity among ...older adults, and evidence suggests
that it can increase femoral bone density and reduce fracture risk. OBJECTIVE To assess the relationship of walking, leisure-time activity, and risk
of hip fracture among postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS Prospective analysis begun in 1986 with 12 years of follow-up in the
Nurses' Health Study cohort of registered nurses within 11 US states. A total
of 61 200 postmenopausal women (aged 40-77 years and 98% white) without
diagnosis of cancer, heart disease, stroke, or osteoporosis at baseline. MAIN OUTCOME MEASURES Incident hip fracture resulting from low or moderate trauma, analyzed
by intensity and duration of leisure-time activity and by time spent walking,
sitting, and standing, measured at baseline and updated throughout follow-up. RESULTS From 1986 to 1998, 415 incident hip fracture cases were identified.
After controlling for age, body mass index, use of postmenopausal hormones,
smoking, and dietary intakes in proportional hazards models, risk of hip fracture
was lowered by 6% (95% confidence interval CI, 4%-9%; P<.001) for each increase of 3 metabolic equivalent (MET)–hours
per week of activity (equivalent to 1 h/wk of walking at an average pace).
Active women with at least 24 MET-h/wk had a 55% lower risk of hip fracture
(relative risk RR, 0.45; 95% CI, 0.32-0.63) compared with sedentary women
with less than 3 MET-h/wk. Even women with a lower risk of hip fracture due
to higher body weight experienced a further reduction in risk with higher
levels of activity. Risk of hip fracture decreased linearly with increasing
level of activity among women not taking postmenopausal hormones (P<.001), but not among women taking hormones (P = .24). Among women who did no other exercise, walking for at least
4 h/wk was associated with a 41% lower risk of hip fracture (RR, 0.59; 95%
CI, 0.37-0.94) compared with less than 1 h/wk. More time spent standing was
also independently associated with lower risks. CONCLUSION Moderate levels of activity, including walking, are associated with
substantially lower risk of hip fracture in postmenopausal women.
OBJECTIVE:To report long-term health outcomes and mortality after oophorectomy or ovarian conservation.
METHODS:We conducted a prospective, observational study of 29,380 women participants of the ...Nurses’ Health Study who had a hysterectomy for benign disease; 16,345 (55.6%) had hysterectomy with bilateral oophorectomy, and 13,035 (44.4%) had hysterectomy with ovarian conservation. We evaluated incident events or death due to coronary heart disease (CHD), stroke, breast cancer, ovarian cancer, lung cancer, colorectal cancer, total cancers, hip fracture, pulmonary embolus, and death from all causes.
RESULTS:Over 24 years of follow-up, for women with hysterectomy and bilateral oophorectomy compared with ovarian conservation, the multivariable hazard ratios (HRs) were 1.12 (95% confidence interval CI 1.03–1.21) for total mortality, 1.17 (95% CI 1.02–1.35) for fatal plus nonfatal CHD, and 1.14 (95% CI 0.98–1.33) for stroke. Although the risks of breast (HR 0.75, 95% CI 0.68–0.84), ovarian (HR 0.04, 95% CI 0.01–0.09, number needed to treat=220), and total cancers (HR 0.90, 95% CI 0.84–0.96) decreased after oophorectomy, lung cancer incidence (HR=1.26, 95% CI 1.02–1.56, number needed to harm=190), and total cancer mortality (HR=1.17, 95% CI 1.04–1.32) increased. For those never having used estrogen therapy, bilateral oophorectomy before age 50 years was associated with an increased risk of all-cause mortality, CHD, and stroke. With an approximate 35-year life span after surgery, one additional death would be expected for every nine oophorectomies performed.
CONCLUSION:Compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with a decreased risk of breast and ovarian cancer but an increased risk of all-cause mortality, fatal and nonfatal coronary heart disease, and lung cancer. In no analysis or age group was oophorectomy associated with increased survival.
LEVEL OF EVIDENCE:II
Objective
Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular disease. However, prospective population‐based data addressing this association have been ...lacking.
Methods
We conducted a prospective cohort study among 119,332 women participating in the Nurses' Health Study who were free of cardiovascular disease and SLE at baseline in 1976. Incident SLE was confirmed by medical record review. Cardiovascular events included fatal and nonfatal myocardial infarction, stroke, coronary artery bypass grafting, and angioplasty. The relative risk (RR) of cardiovascular events among participants with SLE as compared with those without SLE was estimated using Cox proportional hazards models.
Results
Over 28 years of followup (2.9 million person‐years), 8,169 cardiovascular events occurred and 148 women developed incident SLE. The mean age at SLE diagnosis was 52.6 years, and 20 participants with SLE developed a subsequent cardiovascular event. After adjusting for potential confounding factors, including age, race, cardiovascular risk factors, and medication use, the RR of a cardiovascular event in women with SLE compared with those without SLE was 2.26 (95% confidence interval 95% CI 1.45–3.52). When end points were analyzed separately, the RR for coronary heart disease was 2.25 (95% CI 1.37–3.69) and the RR for stroke was 2.29 (95% CI 0.85–6.15).
Conclusion
In this prospective population‐based study, we found a statistically significant >2‐fold increased risk of cardiovascular disease among participants with SLE. The risk was not as high as has been previously reported, which may have been due to the relatively high age at diagnosis of SLE in this cohort.
Purpose Higher urine calcium is a common feature of calcium nephrolithiasis and may be associated with lower bone mineral density in individuals with kidney stones. However previous population based ...studies of kidney stones and the risk of bone fracture demonstrate conflicting results. We examined independent associations between a history of kidney stones and incident fracture. Materials and Methods We performed prospective studies using data from the Nurses' Health Study of 107,001 women with 32 years of followup and the Health Professionals Follow-up Study of 50,982 men with 26 years of followup. We excluded premenopausal women, men younger than 45 years and individuals who reported osteoporosis at baseline. Study outcomes were incident wrist (distal radius) or incident hip (proximal femur) fracture due to low or moderate trauma. Cox proportional hazards regression was used to adjust for multiple factors, including age, race, body mass index, thiazide use, supplemental calcium and dietary intakes. Results There were 4,940 wrist and 2,391 hip fractures in women, and 862 wrist and 747 hip fractures in men. All fractures were incident. The multivariable adjusted relative risk of incident wrist fracture in participants with a history of kidney stones compared to participants without kidney stones was 1.18 (95% CI 1.04–1.34) in women and 1.21 (95% CI 1.00–1.47) in men. The pooled multivariable adjusted relative risk of wrist fracture was 1.20 (95% CI 1.08–1.33). The multivariable adjusted relative risk of incident hip fracture in participants with kidney stones was 0.96 (95% CI 0.80–1.14) in women and 0.92 (95% CI 0.74–1.14) in men. The pooled multivariable adjusted relative risk of hip fracture was 0.94 (95% CI 0.82–1.08). Conclusions Nephrolithiasis is associated with a significantly higher risk of incident wrist but not hip fracture in women and men.
Epidemiological and other evidence suggests that vitamin D may be protective against several chronic diseases. Assessing vitamin D status in epidemiological studies, however, is challenging given ...finite resources and limitations of commonly used approaches. Using multivariable linear regression, we derived predicted 25-hydroxyvitamin D (25(OH)D) scores based on known determinants of circulating 25(OH)D, including age, race, UV-B radiation flux at residence, dietary and supplementary vitamin D intakes, BMI, physical activity, alcohol intake, post-menopausal hormone use (women only) and season of blood draw, in three nationwide cohorts: the Nurses' Health Study, Nurses' Health Study II and the Health Professionals Follow-up Study. The model r2 for each cohort ranged from 0·25 to 0·33. We validated the prediction models in independent samples of participants from these studies. Mean measured 25(OH)D levels rose with increasing decile of predicted 25(OH)D score, such that the differences in mean measured 25(OH)D between the extreme deciles of predicted 25(OH)D were in the range 8·7–12·3 ng/ml. Substituting predicted 25(OH)D scores for measured 25(OH)D in a previously published case–control analysis of colorectal cancer yielded similar effect estimates with OR of approximately 0·8 for a 10 ng/ml difference in either plasma or predicted 25(OH)D. We conclude that these data provide reasonable evidence that a predicted 25(OH)D score is an acceptable marker for ranking individuals by long-term vitamin D status and may be particularly useful in research settings where biomarkers are not available for the majority of a study population.
Cigarette smoking has been associated with rheumatoid arthritis (RA), but the importance of smoking intensity, duration, and time since quitting, and whether the risk is primarily for rheumatoid ...factor (RF) seropositive versus seronegative RA are still unclear.
We conducted a prospective analysis of smoking and the risk of RA among 103,818 women in the Nurses’ Health Study. A total of 680 RA cases, diagnosed from 1976 and 2002, were confirmed using a questionnaire and medical record review. Sixty percent were RF positive. Cox proportional hazards models calculated the relative risks (RRs) of RA with smoking, adjusting for reproductive and lifestyle factors.
The RR of RA was significantly elevated among current (RR 1.43 95% confidence interval 1.16-1.75) and past smokers (RR 1.47 95% confidence interval 1.23-1.76), compared with never smokers. The risk of RA was significantly elevated with 10 pack-years or more of smoking and increased linearly with increasing pack-years (
P trend <.01). A greater number of daily cigarettes and longer duration of smoking were associated with increased risk. The effect of smoking was much stronger among RF-positive cases than among RF-negative cases. The risk remained elevated in past smokers until 20 years or more after cessation.
In this large cohort, past and current cigarette smoking were related to the development of RA, in particular seropositive RA. Both smoking intensity and duration were directly related to risk, with prolonged increased risk after cessation.
Although a number of studies showed a lower risk of hip fractures with high-quality diets, few of them were conducted in the United States.
This prospective analysis examined the association between ...several diet quality indexes and risk of hip fractures in US men and women.
This is a prospective cohort study.
The participants were 74,446 postmenopausal women from the Nurses’ Health Study and 36,602 men aged 50 years and older from the Health Professionals Follow-Up Study in the United States.
Hip fractures were self-reported on biennial questionnaires between 1980-2012 in women, and between 1986-2012 in men.
Diet was assessed every 4 years with a validated food frequency questionnaire. Relative risks were computed for hip fracture by quintiles of the Alternate Mediterranean Diet score (aMed), the Alternate Healthy Eating Index-2010 (AHEI-2010), and the Dietary Approaches to Stop Hypertension score using Cox proportional hazards models, adjusting for potential confounders.
Two thousand one hundred forty-three incident hip fractures in women and 603 in men were reported during follow-up. A significant inverse trend was observed with the cumulative AHEI-2010 score in women (relative risk comparing extreme quintiles 0.87, 95% CI 0.75 to 1.00; P for trend=0.02). There was also a suggestion of an inverse association with the Dietary Approaches to Stop Hypertension score (P for trend=0.03). In addition, significant inverse trends were observed between all three diet quality scores and hip fractures in women younger than age 75 years but not older women. There was no clear association between diet quality indexes and hip fracture in men.
Higher AHEI-2010 scores were associated with a lower risk of hip fractures in US women. The inverse associations with diet quality may be more apparent among those younger than age 75 years.
Lung Cancer Incidence in Never Smokers WAKELEE, Heather A; CHANG, Ellen T; WEST, Dee W ...
Journal of clinical oncology,
02/2007, Letnik:
25, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. ...However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited.
We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study; Health Professionals Follow-Up Study; California Teachers Study; Multiethnic Cohort Study; Swedish Lung Cancer Register in the Uppsala/Orebro region; and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study.
Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers.
Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.
Better information on lung cancer occurrence in lifelong nonsmokers is needed to understand gender and racial disparities and to examine how factors other than active smoking influence risk in ...different time periods and geographic regions.
We pooled information on lung cancer incidence and/or death rates among self-reported never-smokers from 13 large cohort studies, representing over 630,000 and 1.8 million persons for incidence and mortality, respectively. We also abstracted population-based data for women from 22 cancer registries and ten countries in time periods and geographic regions where few women smoked. Our main findings were: (1) Men had higher death rates from lung cancer than women in all age and racial groups studied; (2) male and female incidence rates were similar when standardized across all ages 40+ y, albeit with some variation by age; (3) African Americans and Asians living in Korea and Japan (but not in the US) had higher death rates from lung cancer than individuals of European descent; (4) no temporal trends were seen when comparing incidence and death rates among US women age 40-69 y during the 1930s to contemporary populations where few women smoke, or in temporal comparisons of never-smokers in two large American Cancer Society cohorts from 1959 to 2004; and (5) lung cancer incidence rates were higher and more variable among women in East Asia than in other geographic areas with low female smoking.
These comprehensive analyses support claims that the death rate from lung cancer among never-smokers is higher in men than in women, and in African Americans and Asians residing in Asia than in individuals of European descent, but contradict assertions that risk is increasing or that women have a higher incidence rate than men. Further research is needed on the high and variable lung cancer rates among women in Pacific Rim countries.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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