A high body mass index (BMI) has been associated with increased risk of several cancers; however, whether BMI is related to a larger number of cancers than currently recognized is unclear. Moreover, ...whether waist circumference (WC) is more strongly associated with specific cancers than BMI is not well established. We aimed to investigate the associations between BMI and 26 cancers accounting for non-linearity and residual confounding by smoking status as well as to compare cancer risk estimates between BMI and WC.
Prospective cohort study with population-based electronic health records from Catalonia, Spain. We included 3,658,417 adults aged ≥ 18 years and free of cancer at baseline between 2006 and 2017. Our main outcome measures were cause-specific hazard ratios (HRs) with 99% confidence intervals (CIs) for incident cancer at 26 anatomical sites.
After a median follow-up time of 8.3 years, 202,837 participants were diagnosed with cancer. A higher BMI was positively associated with risk of nine cancers (corpus uteri, kidney, gallbladder, thyroid, colorectal, breast post-menopausal, multiple myeloma, leukemia, non-Hodgkin lymphoma) and was positively associated with three additional cancers among never smokers (head and neck, brain and central nervous system, Hodgkin lymphoma). The respective HRs (per 5 kg/m
increment) ranged from 1.04 (99%CI 1.01 to 1.08) for non-Hodgkin lymphoma to 1.49 (1.45 to 1.53) for corpus uteri cancer. While BMI was negatively associated to five cancer types in the linear analyses of the overall population, accounting for non-linearity revealed that BMI was associated to prostate cancer in a U-shaped manner and to head and neck, esophagus, larynx, and trachea, bronchus and lung cancers in an L-shaped fashion, suggesting that low BMIs are an approximation of heavy smoking. Of the 291,305 participants with a WC measurement, 27,837 were diagnosed with cancer. The 99%CIs of the BMI and WC point estimates (per 1 standard deviation increment) overlapped for all cancers.
In this large Southern European study, a higher BMI was associated with increased risk of twelve cancers, including four hematological and head and neck (only among never smokers) cancers. Furthermore, BMI and WC showed comparable estimates of cancer risk associated with adiposity.
Ambient air pollution may play a role in childhood obesity development, but evidence is scarce, and the modifying role of socioeconomic status (SES) is unclear. We aimed to examine the association ...between exposure to air pollution during early childhood and subsequent risk of developing overweight and obesity, and to evaluate whether SES is a modifier of this association.
This longitudinal study included 416,955 children identified as normal weight between 2-5 years old and registered in an electronic primary healthcare record between 2006 and 2016 in Catalonia (Spain). Children were followed-up until they developed overweight or obesity, reached 15 years of age, died, transferred out, or end of study period (31/12/2018). Overweight and obesity were defined following the WHO reference obtained from height and weight measures. We estimated annual residential census levels of nitrogen dioxide (NO
) and particulate matter <10 μm (PM
), <2.5 μm (PM
), and 2.5-10 μm (PM
) at study entry. We estimated the risk of developing overweight and obesity per interquartile range increase in air pollution exposure with Cox proportional hazard models.
A total of 142,590 (34.2%) children developed overweight or obesity. Increased exposure to NO
, PM
, and PM
was associated with a 2-3% increased risk of developing overweight and obesity (hazard ratio HR per 21.8 μg/m
NO
= 1.03 95% CI: 1.02-1.04; HR per 6.4 μg/m
PM
= 1.02 95% CI: 1.02-1.03; HR per 4.6 µg/m
PM
= 1.02, 95% CI: 1.01-1.02). For all air pollutants, associations were stronger among children living in most compared to least deprived areas.
This study suggests that early life exposure to air pollution may be associated with a small increase in the risk of developing overweight and obesity in childhood, and that this association may be exacerbated in the most deprived areas. Even these small associations are of potential global health importance because air pollution exposure is widespread and the long-term health consequences of childhood obesity are clear.
The association between air pollution and green spaces with breast cancer risk stratified by menopausal status has not been frequently investigated despite its importance given the different impact ...of risk factors on breast cancer risk depending on menopausal status.
To study the association between air pollution, green spaces and pre and postmenopausal breast cancer risk.
We conducted a population-based cohort study using electronic primary care records in Catalonia. We included women aged 17–85 years free of cancer at study entry between 2009 and 2017. Our exposures were particulate matter <2.5 μm (PM2.5) & <10 μm (PM10), nitrogen dioxide (NO2), normalized difference vegetation index (NDVI), and percentage of green spaces estimated at the census tract level. Breast cancer was identified with ICD-10 code C50. We estimated cause-specific hazard ratios (HR) for the relationship between each individual exposure and pre and postmenopausal breast cancer risk, using linear and non-linear models.
Of the 1,054,180 pre and 744,658 postmenopausal women followed for a median of 10 years, 6,126 and 17,858 developed breast cancer, respectively. Among premenopausal women, only very high levels of PM10 (≥46 μg/m3) were associated with increased cancer risk (compared to lower levels) in non-linear models. Among postmenopausal women, an interquartile range increase in PM2.5 (HR:1.03; 95%CI:1.01–1.04), PM10 (1.03; 1.01–1.05), and NO2 (1.05; 1.02–1.08) were associated with higher cancer risk. NDVI was negatively associated with decreased cancer risk only among postmenopausal women who did not change residence during follow-up (0.84; 0.71–0.99) or who were followed for at least three years (0.82; 0.69–0.98).
Living in areas with high concentrations of PM2.5, PM10, and NO2 increases breast cancer risk in postmenopausal women while long-term exposure to green spaces may decrease this risk. Only very high concentrations of PM10 increase breast cancer risk in premenopausal women.
•High levels of PM and NO2 increase breast cancer risk in postmenopausal women.•Very high concentrations of PM10 increase breast cancer risk in premenopausal women.•Long-term exposure to green spaces may decrease breast cancer risk in older women.•We used survival models with restricted cubic splines to investigate associations.
We aimed to evaluate the feasibility of an online self-sampling pilot intervention for HIV testing addressed to gay, bisexual, and other men who have sex with men (GBMSM) and trans women (TW) users ...of dating apps in Spain. The website
https://www.testate.org/
was designed to offer self-sampling kits for HIV testing and online consultation of the results. It was advertised on gay dating apps. Participants requested the delivery of a saliva self-sampling kit by mail and a postage-paid envelope to send the sample to the reference laboratory. An anonymous acceptability survey was conducted. The cascade of care was estimated. From November 2018 to December 2021, 4623 individual users ordered self-sampling kits, 3097 returned an oral fluid sample to the reference laboratory (67.5% return rate). 87 reactive results were detected. 76 were confirmed to be HIV-positive, we estimated an HIV prevalence of 2.45% (95% CI 1.9–3.0%). 100% of those referred to specialized care are in treatment. 45.8% of participants took more than one test. 23 incident cases were detected among repeat testers, of which 20 were confirmed. The estimated incidence was 1.00 confirmed case per 100 individual-years of follow-up. 98.01% of participants would recommend it to a friend. The most identified advantages were convenience and privacy. We demonstrated that the online offer of oral self-sampling kits for HIV detection and reporting results online among GBMSM and TW users of dating apps is feasible. The intervention counted with a high acceptability and high efficacy (in terms of reactivity, confirmation and linkage to care rates).
Our aims were: (1) to characterize gay, bisexual and other men who have sex with men (GBMSM) and transgender (TG) populations using internet-based self-sampling services in the TESTATE project or ...attending community-based STI/HIV voluntary counselling and testing (CBVCT) services as alternative strategies to formal HIV testing within the Spanish national health system, and (2) to identify factors associated with repeat use of the same screening strategy from November 2018 to December 2021. Demographic, health, and behavioral characteristics of users using complementary strategies were analyzed. We developed a cross-sectional study, with descriptive analysis, HIV cascade, and a multivariate logistic model to identify factors associated with participants' repeated use of the same screening strategy. We included 9939 users, of whom 94.1% were GBMSM (n = 9348) and 5.9% TG (n = 580), with a high representation of migrants. Reactive results were 3.4% (n = 340), with 3.0% in GBMSM (n = 277/9348) and 10.7% in TG (n = 63/591). 73.8% (n = 251) were confirmed HIV positive and 76.7% (n = 194) were linked to health services. Users repeated the online screening strategy more than CBVCT (44.3% vs. 31.8%), but TG population used face-to-face community services more (8.4% vs. 0.6%). Factors influencing the repetition of the online self-sampling strategy included older age, non-migrant status, and recent HIV testing. In the CBVCT strategy, factors included older age, TG identity, non-migrant status, condom use during the last sexual encounter, and recent HIV testing. In conclusion, both CBVCT and online-requested self-sampling at home are important alternatives to the health system for the provision of HIV testing to GBMSM and TG.Our aims were: (1) to characterize gay, bisexual and other men who have sex with men (GBMSM) and transgender (TG) populations using internet-based self-sampling services in the TESTATE project or attending community-based STI/HIV voluntary counselling and testing (CBVCT) services as alternative strategies to formal HIV testing within the Spanish national health system, and (2) to identify factors associated with repeat use of the same screening strategy from November 2018 to December 2021. Demographic, health, and behavioral characteristics of users using complementary strategies were analyzed. We developed a cross-sectional study, with descriptive analysis, HIV cascade, and a multivariate logistic model to identify factors associated with participants' repeated use of the same screening strategy. We included 9939 users, of whom 94.1% were GBMSM (n = 9348) and 5.9% TG (n = 580), with a high representation of migrants. Reactive results were 3.4% (n = 340), with 3.0% in GBMSM (n = 277/9348) and 10.7% in TG (n = 63/591). 73.8% (n = 251) were confirmed HIV positive and 76.7% (n = 194) were linked to health services. Users repeated the online screening strategy more than CBVCT (44.3% vs. 31.8%), but TG population used face-to-face community services more (8.4% vs. 0.6%). Factors influencing the repetition of the online self-sampling strategy included older age, non-migrant status, and recent HIV testing. In the CBVCT strategy, factors included older age, TG identity, non-migrant status, condom use during the last sexual encounter, and recent HIV testing. In conclusion, both CBVCT and online-requested self-sampling at home are important alternatives to the health system for the provision of HIV testing to GBMSM and TG.
We aimed to assess the feasibility of TESTA'T COVID strategy among healthcare and education professionals.in Spain during the peak of the 6th wave caused by Omicron variant. Kits were ordered online ...and sent by mail, participants answered an online acceptability/usability survey and uploaded the picture of results. 492 participants ordered a test, 304 uploaded the picture (61.8%). Eighteen positive cases were detected (5.9%). 92.2% were satisfied/very satisfied with the intervention; and 92.5% found performing the test easy/very easy. We demonstrated that implementing online COVID-19 self-testing in schools and healthcare settings in Spain is feasible.
Purpose
Hydrochlorothiazide (HCTZ) use has been linked to skin cancer in northern European countries. We assessed the association between HCTZ exposure and risk of malignant melanoma (MM) and ...keratinocyte carcinoma (KC) in a European Mediterranean population.
Methods
Two parallel nested case‐control studies were conducted in Spain using two electronic primary healthcare databases, each one providing data on both exposure and outcomes: SIDIAP and BIFAP. Cancer cases were matched to 10 controls by age and gender through risk‐set sampling. The ORs and 95% CI for MM and KC associated with previous HCTZ use were estimated using conditional logistic regression. In BIFAP, KC cases were further identified as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).
Results
In adjusted analyses, both ever and cumulative high (≥50,000 mg) use of HCTZ were associated with an increased risk of KC. The risk estimates for high use were 1.30 (1.26–1.34) in SIDIAP and 1.20 (1.12–1.30) in BIFAP, with a lower risk for BCC (1.11 1.02–1.21) than for SCC (1.71 1.45–2.02). A dose–response relationship was observed between cumulative doses of HCTZ and KC risk. Inconsistent results were found for high use of HCTZ and risk of MM: 1.25 (1.09–1.43) in SIDIAP and 0.85 (0.64–1.13) in BIFAP.
Conclusions
In this European Mediterranean population, a high cumulative use of HCTZ was related to an increased risk of KC with a clear dose–response pattern.
Abstract
Objectives
Joint replacement due to end-stage OA has been linked to incidence of several cancers. We aimed to estimate the association between newly diagnosed knee and hip OA and incidence ...of nine common cancer types.
Methods
We identified persons with incident knee or hip OA, aged ≥40 years, between 2009 and 2015 in the SIDIAP database in Catalonia, Spain. We matched up to three OA-free controls on age, sex and general practitioner. We followed participants from 1 year after OA diagnosis until migration, death, end of study at 31 December 2017 or incident cancer of: stomach, colorectal, liver, pancreas, lung, skin, breast, prostate and bladder. We used flexible parametric survival models, adjusted for confounders. Estimates were corrected for misclassification using probabilistic bias analysis.
Results
We included 117 750 persons with knee OA and matched 309 913 persons without, with mean (s.d.) age of 67.5 (11.1) years and 63% women. The hip cohort consisted of 39 133 persons with hip OA and 116 713 controls. For most of the included cancers, the hazard ratios (HRs) were close to 1. The HR of lung cancer for knee OA exposure was 0.80 (95% CI: 0.71, 0.89) and attenuated to 0.98 (0.76, 1.27) in non-smokers. The hazard of colorectal cancer was lower in persons with both knee and hip OA by 10–20%.
Conclusions
Knee and hip OA are not associated with studied incident cancers, apart from lower risk of colorectal cancer. The often-reported protective association of knee OA with lung cancer is explained by residual confounding.
Urban environments are characterized by multiple exposures that may influence body mass index (BMI) growth in early life. Previous studies are few, with inconsistent results and no evaluation of ...simultaneous exposures. Thus, this study aimed to assess the associations between exposure to air pollution, green spaces and built environment characteristics, and BMI growth trajectories from 0 to 5 years. This longitudinal study used data from an electronic primary care health record database in Catalonia (Spain), including 79,992 children born between January 01, 2011 and December 31, 2012 in urban areas and followed until 5 years of age. Height and weight were measured frequently during childhood and BMI (kg/m2) was calculated. Urban exposures were estimated at census tract level and included: air pollution (nitrogen dioxide (NO2), particulate matter <10 μm (PM10) and <2.5 μm (PM2.5)), green spaces (Normalized Difference Vegetation Index (NDVI) and % green space) and built environment (population density, street connectivity, land use mix, walkability index). Individual BMI trajectories were estimated using linear spline multilevel models with several knot points. In single exposure models, NO2, PM10, PM2.5, and population density were associated with small increases in BMI growth (e.g. β per IQR PM10 increase = 0.023 kg/m2, 95%CI: 0.013, 0.033), and NDVI, % of green spaces and land use mix with small reductions in BMI growth (e.g. β per IQR % green spaces increase = −0.015 kg/m2, 95%CI: −0.026, −0.005). These associations were strongest during the first two months of life. In multiple exposure models, most associations were attenuated, with only those for PM10 and land use mix remaining statistically significant. This large longitudinal study suggests that early life exposure to air pollution, green space and built environment characteristics may be associated with small changes in BMI growth trajectories during the first years of life, and that it is important to account for multiple exposures in urban settings.
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•Large longitudinal study evaluating multiple urban exposures.•Air pollution, green spaces and built environment were associated with small changes in early life BMI trajectories.•Associations were strongest during the first two month of life.•Important to take into account multiple exposures in urban settings.
Association of type 2 diabetes mellitus (T2D) with subsequent Parkinson's disease (PD) has supported the link between glucose metabolism and PD. We assessed the risk of PD not only in T2D but also in ...prediabetes.
We conducted a retrospective cohort study of the population attended in primary care centres of the Catalan Health Institute in Catalonia between 2006 and 2018. The data were obtained from the Information System for Research in Primary Care (SIDIAP). We created a cohort of T2D and prediabetes patients (HbA1c ≥ 5.7–6.4% without antidiabetic drugs or previous T2D diagnosis) and compared to a reference cohort. The outcome was PD diagnosis and we excluded PD before or during the first year of follow-up. We used multivariate Cox regression models to calculate hazard ratios (HR) and 95% confidence intervals (95%CI). We excluded subjects with atypical and secondary parkinsonisms.
The exposed cohorts comprised of 281.153 patients with T2D and 266.379 with prediabetes and a reference cohort of 2.556.928 subjects. T2D and prediabetes were associated with higher risk of PD (HRadjusted 1.19, 95%CI 1.13–1.25, and 1.07, 1.00–1.14; respectively). In analyses stratified by sex, prediabetes was only associated with PD risk in women (1.12, 1.03–1.22 vs. 1.01, 0.99–1.10 in men). When analysis was stratified by age, T2D and prediabetes were associated with a greater PD risk both in women (2.36, 1.96–2.84 and 2.10, 1.70–2.59 respectively) and men (1.74, 1.52–2.00 and 1.90, 1.57–2.30 respectively) below 65 years-old.
We report for the first time that prediabetes increases the odds of subsequent PD and replicate the association with established T2D. Both associations predominate in women and young individuals.
•Besides type-2-diabetes, prediabetes also increases the risk of Parkinson's disease .•The increased risk of both associations was greater in women and young individuals.
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