Is body mass index a risk factor for motor vehicle driver injury? A cohort study with prospective and retrospective outcomes

OBJECTIVE: To investigate the association between risk of motor vehicle driver injury and body mass index (BMI). METHODS: In a cohort study of 10 525 New Zealand men and women, BMI was assessed in 1992-1993 (baseline), and data on deaths and hospitalizations for motor vehicle driver injury were obtained by record linkage to national health databases for the period 1988-1998. Hazard ratios (HR) and CI were estimated by Cox regression. RESULTS: During a mean 10.3 years of follow-up, 139 fatal and non-fatal driver injury cases occurred (85 before baseline and 54 after). A U-shaped association was observed between driver injury risk and BMI, both crudely and after adjustment for covariates, which included age, sex, driving exposure, and alcohol intake (P-values for quadratic trend /=28.7 kg/m(2); HR = 2.00, 95% CI: 1.18-3.39) and lowest (<23.5 kg/m(2); HR = 2.17, 95% CI: 1.27-3.73) quartiles of BMI were twice as likely to have experienced a driver injury during the follow-up period as participants in the reference quartile (25.9-28.6 kg/m(2); HR = 1.00). CONCLUSION: Further research is needed to corroborate or refute the hypothesis that BMI is a risk factor for serious motor vehicle driver injury.     

Dose response of retinol and isotretinoin in the prevention of nonmelanoma skin cancer recurrence

Using data from a randomized, double blind, study of the efficacy of retinol or isotretinoin vs. placebo on recurrence of nonmelanoma skin cancer in high-risk subjects, a reanalysis of the original intent to treat analysis was performed in a dose-response format. Cox proportional hazards models describe the relationship between dose quartiles of isotretinoin and retinol use and time to first occurrence of squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) in crude and adjusted models. Neither the isotretinoin nor retinol models showed any significance at any quartile for reduction in first BCC or SCC occurrence. Crude and adjusted retinol models show a statistically significant increase in risk of developing an SCC in the first quartile, whereas only the crude model shows a statistically significant increase in risk in the first quartile of the isotretinoin model. For retinol and SCC, hazard ratios (HRs) for the first quartile were as follows: HR = 2.92, 95% confidence interval (CI) = 1.67-5.10 crude; HR = 1.95, 95% CI = 1.00-3.80 adjusted. For isotretinoin and SCC, HRs for the first quartile were as follows: HR = 2.38, 95% CI = 1.35-4.19 crude; HR = 1.69, 95% CI = 0.87-3.31 adjusted. Test for trend was not significant in any of the models. These analyses confirm the results of the original intent to treat analyses and raise an interesting question related to the potential for increased risk for patients in the first quartile of retinol dose.     

Dietary intakes of arachidonic acid and alpha-linolenic acid are associated with reduced risk of hip fracture in older adults

PUFA are hypothesized to influence bone health, but longitudinal studies on hip fracture risk are lacking. We examined associations between intakes of PUFA and fish, and hip fracture risk among older adults (n = 904) in the Framingham Osteoporosis Study. Participants (mean age ~75 y at baseline) were followed for incident hip fracture from the time they completed the baseline exam (1988-1989) until December 31, 2005. HR and 95% CI were estimated for energy-adjusted dietary fatty acid exposure variables [(n-3) fatty acids: α-linolenic acid (ALA), EPA, DHA, EPA+DHA; (n-6) fatty acids: linoleic acid, arachidonic acid (AA); and the (n-6):(n-3) ratio] and fish intake categories, adjusting for potential confounders and covariates. Protective associations were observed between intakes of ALA (P-trend = 0.02) and hip fracture risk in a combined sample of women and men and between intakes of AA (P-trend = 0.05) and hip fracture risk in men only. Participants in the highest quartile of ALA intake had a 54% lower risk of hip fracture than those in the lowest quartile (Q4 vs. Q1: HR = 0.46; 95% CI = 0.26-0.83). Men in the highest quartile of AA intake had an 80% lower risk of hip fracture than those in the lowest quartile (Q4 vs. Q1: HR = 0.20; 95% CI = 0.04-0.96). No significant associations were observed among intakes of EPA, DHA, EPA+DHA, or fish. These findings suggest dietary ALA may reduce hip fracture risk in women and men and dietary AA may reduce hip fracture risk in men.     

Less affluent area of residence and lesser-insured status predict an increased risk of death or myocardial infarction after angiographic diagnosis of coronary disease

PURPOSE: Low socioeconomic status (SES) predicts coronary artery disease (CAD) onset, but its value among patients with CAD is uncertain. Geographic measures (e.g., residential neighborhood) may predict risk, but this requires further evaluation. METHODS: A cohort of 3410 patients with significant, angiographically-defined CAD (> or =1 lesion of > or =70% stenosis) joined a registry during the period between 1993 and 2000 and was followed for 6.7 years (median 3.7 years). A geographic SES measure-residential economic status (RES)-and insurance type were examined for association with mortality or myocardial infarction (MI). RESULTS: In Cox regression adjusting for 17 covariates, lower RES quartile was associated with increased death/MI (p-trend<0.001), death (p-trend=0.001), and MI (p-trend=0.07). First RES quartile (vs. fourth) predicted death/MI (hazard ratio [HR]=1.32, 95% confidence interval [CI]=1.07-1.62, p=0.01) and death (HR=1.46, CI=1.12-1.91, p=0.006), but not MI (HR=1.18, p=0.31). Compared with private insurance, self-pay (HR=1.88, p=0.053), charity care (HR=1.71, p<0.001), and Medicaid (HR=1.43, p=0.24), but not Medicare (HR=0.95, p=0.68), were associated with death/MI. CONCLUSIONS: Both geographic (RES) and economic (insurance) measures of SES independently predicted risk of death/MI in a large population with angiographically-defined CAD. This suggests that SES remains a significant predictor of health outcomes after CAD has developed, and that geographic measures of SES deserve further evaluation.     

Dietary fat intake and the risk of osteoporotic fractures in the elderly

OBJECTIVE: To explore the association between fat intake, serum lipids and the risk of osteoporotic fractures in the elderly. DESIGN: A hospital-based case-control study. SETTING: The study was conducted at a tertiary centre and referral hospital for the province of Jaén (Spain). SUBJECTS: Cases (n=167) were patients aged 65 years or more with a low-energy fracture selected from the population attended at the hospital. Controls (patients without antecedents of any fracture) were 1:1 matched to cases by sex and age (n=167). METHODS: Diet was assessed by a semiquantitative food frequency questionnaire. Serum total cholesterol and high-density lipoprotein (HDL) cholesterol were also measured. RESULTS: Participants in the two upper quartiles of polyunsaturated fat (PUFA) intake showed an increased risk of fracture, with statistically significant differences with respect to the first quartile in the adjusted model (odds ratio (OR)=3.59; 95% confidence interval (CI)=1.06-12.1 and OR=5.88; 95% CI=1.38-25.02); P=0.01 for the trend test). A higher ratio of monounsaturated fat (MUFA) to PUFA was associated with a reduced risk of fracture (OR=0.20; 95% CI=0.07-0.60 for the fourth quartile; P=0.002 for the trend test). The intake of omega-6 fatty acids was associated with an elevated risk of fracture (OR=3.41; 95% CI=1.05-11.15 for the fourth quartile; P=0.01 for the trend test). HDL-cholesterol levels were inversely associated with the risk of fracture (test for trend P=0.03 across quartiles). CONCLUSIONS: PUFA intake was associated with an increased risk of osteoporotic fractures in the elderly, whereas a high ratio of MUFA:PUFA was associated with decreased risk.     

Plasma folate, vitamin B(12), and homocyst(e)ine concentrations in preeclamptic and normotensive Peruvian women

The authors measured maternal third trimester plasma folate, vitamin B(12), and homocyst(e)ine concentrations among 125 women with preeclampsia and 179 normotensive women in Lima, Peru (1997-1998), to determine whether these analytes were associated with the occurrence of preeclampsia. Logistic regression procedures were used to calculate maximum likelihood estimates of odds ratios and 95% confidence intervals. Relative to women in the upper quartile of the control distribution of maternal plasma folate concentrations, women with values in the lowest quartile experienced a 1.6-fold increased risk of preeclampsia (odds ratio = 1.6; 95% confidence interval: 0.8, 3.2). There was no evidence of an increased risk of preeclampsia associated with low plasma vitamin B(12) concentrations. The unadjusted relative risk of preeclampsia increased across successively higher quartiles of plasma homocyst(e)ine level (odds ratios were 1.0, 1.0, 1.5, and 2.9, respectively, with the lowest quartile used as the referent; p for linear trend = 0.0004). After adjustment for maternal age, parity, gestational age, use of prenatal vitamins, whether the pregnancy had been planned, and educational attainment, the relative risk between extreme quartiles was 4.0 (95% confidence interval: 1.8, 8.9). These findings are consistent with earlier reports suggesting that hyperhomocyst(e)inemia in pregnancy may be a risk factor for preeclampsia.     

Predicting cause-specific mortality of older men living in the veterans home by handgrip strength and walking speed: a 3-year, prospective cohort study in Taiwan

ObjectiveTo determine prognostic value of handgrip strength (HGS) and walking speed (WS) in predicting the cause-specific mortality for older men.DesignProspective cohort study.SettingBanciao Veterans Care Home.Participants558 residents aged 75 years and older.MeasurementsAnthropometric data, lifestyle factors, comorbid conditions, biomarkers, HGS, and WS at recruitment; all-cause and cause-specific mortality at 3 years after recruitment.ResultsDuring the study period, 99 participants died and the baseline HGS and WS were significantly lower than survivors (P both <.001). Cox survival analysis showed that subjects with slowest quartile of WS were at significantly higher risk of all-cause mortality and cardiovascular mortality (hazard ratio [HR] 3.55, 95% confidence interval [CI] 1.69–7.43; HR 11.55, 95% CI 2.30–58.04, respectively), whereas the lowest quartile of HGS significantly predicted a higher risk of infection-related death (HR 5.53, 95% CI 1.09–28.09). Participants in the high-risk status with slowest quartile for WS but not those in the high-risk status with weakest quartile for HGS had similar high risk of all-cause mortality with the group with combined high-risk status (HR 2.96, 95% CI 1.68–5.23; HR 2.58, 95% CI 1.45–4.60, respectively) compared with the participants without high-risk status (reference group).ConclusionsSlow WS predicted all-cause and cardiovascular mortality, whereas weak HGS predicted a higher risk of infection-related death among elderly, institutionalized men in Taiwan. Combining HGS with WS simultaneously had no better prognostic value than using WS only in predicting all-cause mortality.     

Preconception B-vitamin and homocysteine status, conception, and early pregnancy loss

Maternal vitamin status contributes to clinical spontaneous abortion, but the role of B-vitamin and homocysteine status in subclinical early pregnancy loss is unknown. Three-hundred sixty-four textile workers from Anqing, China, who conceived at least once during prospective observation (1996-1998), provided daily urine specimens for up to 1 year, and urinary human chorionic gonadotropin was assayed to detect conception and early pregnancy loss. Homocysteine, folate, and vitamins B6 and B12 were measured in preconception plasma. Relative to women in the lowest quartile of vitamin B6, those in the third and fourth quartiles had higher adjusted proportional hazard ratios of conception (hazard ratio (HR)=2.2, 95% confidence interval (CI): 1.3, 3.4; HR=1.6, 95% CI: 1.1, 2.3, respectively), and the adjusted odds ratio for early pregnancy loss in conceptive cycles was lower in the fourth quartile (odds ratio=0.5, 95% CI: 0.3, 1.0). Women with sufficient vitamin B6 had a higher adjusted hazard ratio of conception (HR=1.4, 95% CI: 1.1, 1.9) and a lower adjusted odds ratio of early pregnancy loss in conceptive cycles (odds ratio=0.7, 95% CI: 0.4, 1.1) than did women with vitamin B6 deficiency. Poor vitamin B6 status appears to decrease the probability of conception and to contribute to the risk of early pregnancy loss in this population.     

Impacts of educational level and employment status on mortality for Japanese women and men: the Jichi Medical School cohort study

The objective of this study was to examine educational levels and employment status as independent determinants of overall and cause-specific mortality in a Japanese population. Participants were 4,301 men and 6,780 women in a multi-center community-based prospective study, and data of the baseline survey was collected between 1992 and 1995. The participants were followed up until December 31, 2002 (the average follow-up period was 9.17 years). Early termination of education was associated with an increased risk of mortality from all causes for both men and women. This tendency was more prominent in women aged 59 and younger (hazard ratio (HR) = 3.82, 95% confidence interval (CI): 1.18–12.34), after adjusting for confounding factors using the Cox proportional hazard models. Similar trends were shown for men; specifically, cardiovascular disease mortality for all men was increased by early termination of education (HR = 2.97, 95% CI: 1.17–7.52) compared to later termination. For employment status, unemployed men showed increased mortality from all causes compared to white-collar workers (HR = 1.51, 95% CI: 1.00–2.28). Female farmers and forestry workers showed reduced mortality from all causes compared to white-collar workers (HR = 0.55, 95% CI: 0.33–0.93). Male farmers and forestry workers also showed reduced mortality from cardiovascular diseases compared to white-collar workers (HR = 0.34, 95% CI: 0.14–0.82). Educational level and employment status may affect mortality for Japanese women and men.Funding: The Foundation for the Development of the Community, Tochigi, Japan.     

The effect of body mass index and weight change on epithelial ovarian cancer survival in younger women: a long-term follow-up study

Abstract Objective: The objective of this study was to assess the relationship between body mass index (BMI) and epithelial ovarian cancer survival among young women. Methods: We conducted a cohort analysis of 425 women aged 20-54 years with incident epithelial ovarian cancer enrolled during 1980-1982 in Cancer and Steroid Hormone (CASH), a population-based, case-control study. Participants' vital status was ascertained though linkage with the Surveillance, Epidemiology and End Results (SEER) program. Using Cox proportional hazards models, we estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between survival and usual adult BMI, BMI at age 18, and weight change from age 18 to adult. Results: During a follow-up of up to 17 years, 215 women died. Compared to women with an adult BMI in the lowest quartile (<20.7), women in the second (20.8-22.5), third (22.6-24.9), and fourth (≥25.0) quartiles were not at increased risk for death (HR 1.2, 95% CI 0.8-1.8; HR 1.1, 95% CI 0.7-1.6; and HR 0.9, 95% CI 0.6-1.4, respectively) (p trend=0.6). Similarly, neither age 18 BMI nor weight change were associated with ovarian cancer survival. Conclusions: Although elevated BMI is associated with increased ovarian cancer risk among young women, we found no evidence of its association with ovarian cancer survival in this population.     

Temporary employment and risk of overall and cause-specific mortality

The number of nonpermanent employees is rising, but mortality in this group has received little attention. The authors examined the associations between temporary employment and all-cause and cause-specific mortality. Longitudinal data from 10 towns in Finland related to 26,592 men and 65,759 women, of whom 1,332 died between 1990 and 2001. Cox proportional hazards models adjusted for age, occupational status, salary, and change in occupational title showed that overall mortality was 1.2-1.6 times higher among male and female temporary employees compared with permanent employees. Temporary employment was associated with increased deaths from alcohol-related causes (hazard ratio (HR) = 2.0, 95% confidence interval (CI): 1.4, 2.9 for men; HR = 1.7, 95% CI: 1.1, 2.5 for women) and, for men, smoking-related cancer (HR = 2.8, 95% CI: 1.3, 6.0). Corresponding risks were greater for the unemployed. Moving from temporary to permanent employment was associated with a lower risk of death than remaining continuously in permanent employment (HR = 0.7, 95% CI: 0.5, 0.9 for men and women combined). These findings suggest that the conventional research practice of treating the employed as a single group may attenuate the associations between employment status and mortality.     

Predictors of first nonfatal occupational injury following employment in a Brazilian steelworks

OBJECTIVES: This study investigated the influence of sociodemographic and occupational factors on the risk of 1st injury among Brazilian steelworkers. METHODS: Workers 1st employed between 1 January 1977 and 31 December 1985 and still employed on 1 December 1983 were followed from the date of hire until 30 October 1992. Occupational injuries were ascertained from a database. Kaplan-Meier curves for time to 1st injury were calculated for the total cohort and for different subgroups. A multivariate analysis of risk factors for 1st injury was carried out using the Cox proportional hazards regression model. RESULTS: Forty-one percent of the workers had > or = 1 occupational injuries, and 39% of 1st injuries occurred in the 1st year of employment. Lacerations, contusions, penetration by foreign bodies, bums, sprains, and fractures constituted the main diagnostic groups. Injuries to the hands, eyes, feet, arms, and legs dominated. Over 5% of the injured workers were on temporary disability leave (cumulative total 10,660 days). The probability for an occupational injury was 16% for the 1st year, rising to 25% in the 2nd year. The risk of nonfatal injury was highest for laborers [hazard ratio (HR) 1.76, 95% confidence interval (95% CI) 1.35-2.29] and employees in the steel mill (HR 1.40, 95% CI 1.21-1.63), and inversely related to worker age and educational level. The risk of injury decreased significantly with calendar period of employment. CONCLUSIONS: Substantial reductions in nonfatal injuries may reflect changes in work organization, increased automation, and improved safety standards. Knowledge of predictors of work-related injury may contribute to injury prevention strategies, especially among newly employed workers.     

Socioeconomic Status and Injury in a Cohort of Saskatchewan Farmers

Purpose: To estimate the strength of relationships between socioeconomic status and injury in a large Canadian farm population. Methods: We conducted a prospective cohort study of 4,769 people from 2,043 farms in Saskatchewan, Canada. Participants reported socioeconomic exposures in 2007 and were followed for the occurrence of injury through 2009 (27 months). The relative hazards of time to first injury according to baseline socioeconomic status were estimated via Cox proportional hazards models. Findings: Risks for injury were not consistent with inverse socioeconomic gradients (adjusted HR 1.07; 95% CI: 0.76 to 1.51 for high vs low economic worry; adjusted HR 1.72; 95% CI: 1.23 to 2.42 for completed university education vs less than high school). Strong increases in the relative hazard for time to first injury were identified for longer work hours on the farm. Conclusions: Socioeconomic factors have been cited as important risk factors for injury on farms. However, our findings suggest that interventions aimed at the prevention of farm injury are better focused on operational factors that increase risk, rather than economic factors per se.     

Population-based case-control study of amyotrophic lateral sclerosis in western Washington State. II. Diet

The association of nutrient intake with the risk of amyotrophic lateral sclerosis (ALS) was investigated in a population-based case-control study conducted in three counties of western Washington State from 1990 to 1994. Incident ALS cases (n = 161) were identified and individually matched on age and gender to population controls (n = 321). A self-administered food frequency questionnaire was used to assess nutrient intake. Conditional logistic regression analysis was used to compute odds ratios adjusted for education, smoking, and total energy intake. The authors found that dietary fat intake was associated with an increased risk of ALS (highest vs. lowest quartile, fiber-adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI): 0.9, 8.0; p for trend = 0.06), while dietary fiber intake was associated with a decreased risk of ALS (highest vs. lowest quartile, fat-adjusted OR = 0.3, 95% CI: 0.1, 0.7; p for trend = 0.02). Glutamate intake was associated with an increased risk of ALS (adjusted OR for highest vs. lowest quartile = 3.2, 95% CI: 1.2, 8.0; p for trend < 0.02). Consumption of antioxidant vitamins from diet or supplement sources did not alter the risk. The positive association with glutamate intake is consistent with the etiologic theory that implicates glutamate excitotoxicity in the pathogenesis of ALS, whereas the associations with fat and fiber intake warrant further study and biologic explanation.     

Prospective study of diet and pancreatic cancer in male smokers

There have been few prospective studies relating diet to pancreatic cancer, with most having fewer than 100 cases and only one examining dietary nutrients. The authors prospectively examined dietary factors hypothesized to be associated with exocrine pancreatic cancer in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort in Finland. Of the 27,111 male smokers aged 50-69 years with complete dietary information, as ascertained from a self-administered dietary history questionnaire given at baseline (1985-1988), 163 developed pancreatic cancer from 1985 through November 1997. Cox proportional hazards models were used to estimate smoking- and age-adjusted hazard ratios and 95% confidence intervals. Energy-adjusted butter consumption and saturated fat intake were positively associated with pancreatic cancer (highest quintile vs. lowest: hazard ratio (HR) = 1.40, 95% confidence interval (CI): 0.87, 2.25 (p trend = 0.04), and HR = 1.60, 95% CI: 0.96, 2.64 (p trend = 0.02), respectively). Energy intake and energy-adjusted carbohydrate intake were inversely associated with the disease (highest quintile vs. lowest: HR = 0.62, 95% CI: 0.36, 1.07 (p trend = 0.05), and HR = 0.62, 95% CI: 0.37, 1.03 (p trend = 0.02), respectively). These results support the hypothesis that a high intake of saturated fat may increase the risk of pancreatic cancer in smokers, while greater intakes of energy and carbohydrate may reduce the risk.     

Plasma concentrations of polychlorinated biphenyls and the risk of breast cancer: a congener-specific analysis

Some reports indicate that exposure to specific polychlorinated biphenyl (PCB) congeners is related to breast cancer risk. The authors recruited participants in a case-control study from October 1994 to March 1997 to assess the relation between breast cancer risk and concentrations of 14 PCB congeners measured in plasma lipids by high-resolution gas chromatography. Participants were incident cases of breast cancer (n = 314) and controls (n = 523) from the Quebec City region (Canada). Compared with controls, cases had significantly higher concentrations of PCB 99 (p = 0.02), PCB 118 (p = 0.03), and PCB 156 (p = 0.006). Associations were found between breast cancer risk and either PCB 118 (odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.01, 2.53; fourth vs. first quartile) or PCB 156 (OR = 1.80, 95% CI: 1.11, 2.94; fourth vs. first quartile) concentration. Breast cancer risk was also associated with a total concentration of the three mono-ortho-substituted congeners 105, 118, and 156 expressed as 2,3,7,8-tetrachlorodibenzo-p-dioxin toxic equivalents (OR = 2.02, 95% CI: 1.24, 3.28; fourth vs. first quartile). These results suggest that exposure to dioxin-like PCBs increases breast cancer risk. Alternatively, the results may be explained by differences between cases and controls regarding metabolic pathways involved in the biotransformation of both mono-ortho PCBs and estrogens.     

Occupational exposures and ovarian cancer in textile workers

BACKGROUND: Occupational risk factors for ovarian cancer have been investigated only to a limited extent. We conducted a case-cohort study to examine associations between occupational exposures and ovarian cancer in the textile industry. METHODS: We compared 261 incident ovarian cancer cases diagnosed between 1989 and 1998 with an age-stratified reference subcohort (n = 3199) from a cohort of 267,400 textile workers in Shanghai, China. Occupational exposures were assessed by job-exposure matrices designed for the textile industry, and estimates of quantitative cotton dust and endotoxin. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) with Cox proportional hazards modeling adapted for the case-cohort design. RESULTS: A decreased risk of ovarian cancer was associated with ever having worked in cotton manufacturing production (HR = 0.7; 95% CI = 0.4-1.0). An increased risk was associated with ever having worked in textile finishing (2.1; 0.9-5.0). We found an increasing risk of ovarian cancer associated with cumulative exposure to silica dust (for <10 years exposure, HR = 6.8 [CI = 0.6-76]; for > or =10 years, 5.6 [1.3-23.6]), although these results are based on only 8 exposed subcohort women (0.3%) and 4 cases (1.3%). We also detected inverse risk gradients for cumulative exposures to endotoxin when exposures were lagged by 20 years (in highest quartile, HR = 0.6 [CI = 0.4-1.1]). CONCLUSION: Silica dust may increase the risk of ovarian cancer, and cotton dust and endotoxin may reduce risk.     

Body size and risk for colorectal cancers showing BRAF mutations or microsatellite instability: a pooled analysis

BACKGROUND: How body size influences risk of molecular subtypes of colorectal cancer (CRC) is unclear. We investigated whether measures of anthropometry differentially influence risk of tumours according to BRAF c.1799T>A p.V600E mutation (BRAF) and microsatellite instability (MSI) status. METHODS: Data from The Netherlands Cohort Study (n?=?120?852) and Melbourne Collaborative Cohort Study (n?=?40?514) were pooled and included 734 and 717 colorectal cancer cases from each study, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) for body mass index (BMI), waist measurement and height were calculated and compared for subtypes defined by BRAF mutation and MSI status, measured from archival tissue. RESULTS: Results were consistent between studies. When pooled, BMI modelled in 5?kg/m(2) increments was positively associated with BRAF wild-type (HR: 1.16, 95% CI: 1.08-1.26) and MS-stable tumours (HR: 1.15, 95% CI: 1.06-1.24). Waist measurement was also associated with BRAF wild-type (highest vs lowest quartile, HR: 1.59, 95% CI: 1.33-1.90) and MS-stable tumours (highest vs lowest quartile HR: 1.68, 95% CI: 1.31-2.15). The HRs for BRAF mutation tumours and MSI tumours were smaller and non-significant, but differences between the HRs by tumour subtypes were not significant. Height, modelled per 5-cm increase, was positively associated with BRAF wild-type and BRAF mutation tumours, but the HR was greater for tumours with a BRAF mutation than BRAF wild-type (HR: 1.23, 95% CI: 1.11-1.37, P(heterogeneity)?=?0.03). Similar associations were observed with respect to height and MSI tumours (HR: 1.26, 95% CI: 1.13-1.40, P(heterogeneity)?=?0.02). CONCLUSIONS: Generally, overweight increases the risk of CRC. Taller individuals have an increased risk of developing a tumour with a BRAF mutation or MSI.     

Socioeconomic status, status inconsistency and risk of ischaemic heart disease: a prospective study among members of a statutory health insurance company

BACKGROUND: Inconsistency in social status and its impact on health have been a focus of research 30-40 years ago. Yet, there is little recent information on it's association with ischaemic heart disease (IHD) morbidity and IHD is still defined as one of the major health problems in socioeconomically developed societies. METHODS: A secondary analysis of prospective historical data from 68 805 male and female members of a statutory German health insurance company aged 25-65 years was conducted. Data included information on sociodemographic variables, social status indicators (education, occupational grade and income) and hospital admissions because of IHD. RESULTS: Findings from Cox regression analysis showed an increased risk for IHD in the group with the highest educational level, whereas the lowest occupational and income groups had the highest hazard ratio (HR). Further analysis revealed that after adjustment for income status inconsistency (defined by the combination of higher educational level with lower occupational status) accounts for increased risk of IHD (HR for men, 3.14 and for women, 3.63). An association of similar strength was observed regarding high education/low income in women (HR 3.53). The combination of low education with high income reduced the risk among men (HR 0.29). No respective findings were observed concerning occupational group and income. CONCLUSIONS: Status inconsistency is associated with the risk of IHD as well as single traditional indicators of socioeconomic position. Information on status inconsistency should be measured in addition to single indicators of socioeconomic status to achieve a more appropriate estimation of the risk of IHD.     

Occupational history and exposure and the risk of adult leukemia in Shanghai

PURPOSE: Evaluation of the association of selected occupational exposures with leukemia risk. METHODS: Population-based case-control study of 486 leukemia subjects and 502 healthy controls residing in Shanghai from 1987 to 1989. Adjusted odds ratios (OR) were calculated for the association between occupational factors and leukemia risk. RESULTS: Significant increase in leukemia risk was observed in chemical manufacturing industry workers (OR=3.1, 95% CI=1.0-9.8). Increased risks for leukemia were observed from self-reported exposures to benzene (OR=1.7, 95% CI=1.1-2.6), radioactive materials (OR=3.7, 95% CI=1.3-10.2), synthetic fiber dust (OR=2.0, 95% CI=1.2-3.5), and toluene (OR=1.6, 95% CI=1.0-2.5). Dose-response relations of leukemia risk was observed with the duration of exposure to benzene (OR=3.3, 95% CI=1.6-6.9 for >or=15 years exposure; p for trend<0.01), radioactive materials (OR=5.2, 95% CI=1.1-24.7 for >or=15 years exposure; p for trend=0.02), paints (OR=2.3, 95% CI=1.2-4.7 for >or=15 years exposure; p for trend=0.09), and toluene (OR=2.9, 95% CI=1.3-6.7 for >or=15 years exposure; p for trend=0.02). CONCLUSIONS: Adult leukemia risk may be associated with working in the chemical industry, and exposure to benzene, synthetic fiber dust, radioactive materials, and toluene in the study population.