Alcohol Consumption and Mortality in the Korean Multi-center Cancer Cohort Study

Objectives

To examine the association between alcohol consumption habit, types of beverages, alcohol consumption quantity, and overall and cancer-specific mortality among Korean adults.

Methods

The alcohol consumption information of a total of 16 320 participants who were 20 years or older from the Korean Multi-center Cancer Cohort were analyzed to examine the association between alcohol consumption habit and mortality (median follow-up of 9.3 years). The Cox proportional hazard model was used to estimate the hazard ratio (HR) of alcohol consumption to mortality adjusting for age, sex, geographic areas, education, smoking status, and body mass index.

Results

Alcohol drinkers showed an increased risk for total mortality compared with never drinkers (HR, 1.72; 95% confidence interval [CI], 1.38 to 2.14 for past drinkers; HR, 1.21; 95% CI, 1.06 to 1.39 for current drinkers), while past drinkers only were associated with higher risk for cancer deaths (HR, 1.84; 95% CI, 1.34 to 2.53). The quantity of alcohol consumed per week showed a J-shaped association with risk of mortality. Relative to light drinkers (0.01 to 90 g/wk), never drinkers and heavy drinkers (>504 g/wk) had an increased risk for all-cause and cancer deaths: (HR, 1.18; 95% CI, 0.96 to 1.45) and (HR, 1.39; 95% CI, 1.05 to 1.83) for all-cause mortality; and (HR, 1.55; 95% CI, 1.15 to 2.11) and (HR, 2.07; 95% CI, 1.39 to 3.09) for all cancer mortality, respectively. Heavy drinkers (>504 g/wk) showed an elevated risk for death from stomach and liver cancers.

Conclusions

The present study supports the existence of a J-shaped association between alcohol consumption quantity and the risk of all-cause and cancer deaths. Heavy drinkers had an increased risk of death from cancer overall and liver and stomach cancer.     

血清胆固醇与癌症死亡率的前瞻性定群研究

对70年代调查测定血清胆固醇等的9021名35~64岁工厂职工平均随访11年。共64人失访、595人死亡,其中癌症263人,原发性肝癌51人。将对象按基线检查时血清胆固醇值的高低分成人数相似的4组。用Log-rank趋势检验法未发现血清胆固醇水平与总的恶性肿瘤死亡的联系,但血清胆固醇值与肝癌存在显著的负相关(P<0.05)。用Cox多变量回归分析表明此负相关独立于其他因素(Z=-2.18, P<0.05),且除去14名死于基线调查三年内的肝癌后,此负相关依然存在。血清胆固醇与慢性肝炎及肝硬化死亡也有类似的负相关。乙肝感染能否缓慢降低血清胆固醇水平,值得进一步探讨。     

Long Sleep Duration Is Associated With Higher Mortality in Older People Independent of Frailty: A 5-Year Cohort Study

ObjectivesAlthough general adult population studies show a U-shaped association between sleep duration and mortality, prolonged rather than short sleep duration was more consistently associated with higher mortality in older populations. Failing health or frailty is a possible mechanism. Thus, we examined the relationship among sleep duration, frailty status, and mortality in an elderly cohort.MethodsA total of 3427 community-living adults 65 years or older were examined for general health, mood, subjective sleep measures (insomnia, napping, sleep apnea, nighttime sleep duration, sleep medications), frailty, and 5-year mortality.ResultsAfter 5 years, 12.9% of men and 4.5% of women had died. Mean nighttime sleep duration was 7.3 hours. Proportion of participants who slept 10 or more hours increased with increasing frailty. Age-adjusted hazard ratio (HR) for 5-year mortality of long nighttime sleep (≥10 hours) was 2.10 (95% confidence interval [CI] 1.33–3.33) in men, and 2.70 (95% CI 0.98–7.46) in women. The HR in men was attenuated (HR 1.75; 95% CI 1.09–2.81) after adjustment for frailty and other covariates, whereas that of women strengthened (HR 2.88; 95% CI 1.01–8.18). Mortality increased sharply with nighttime sleep of 10 hours or more. Nighttime sleep of 10 or more hours (HR 1.75, men; HR 2.88, women) and frailty (HR 2.43, men; HR 2.08, P = .08 in women) were independently associated with 5-year mortality after full adjustment for covariates.ConclusionFrailty and long nighttime sleep duration of 10 or more hours were independently associated with 5-year mortality in older adults.     

The Effect of Sleep Duration on the Risk of Unintentional Injury in Korean Adults

Objectives

The decrease or increase in sleep duration has recently been recognized as a risk factor for several diseases, including hypertension and obesity. Many studies have explored the relationship of decreased sleep durations and injuries, but few have examined the relationship between increased sleep duration and injury. The objective of this research is to identify the risk for injury associated with both decreased and increased sleep durations.

Methods

Data from the 2010 Community Health Survey were used in this study. We conducted logistic regression with average sleep duration as the independent variable, injury as a dependent variable, and controlling for age, sex, occupation, education, region (cities and provinces), smoking, alcohol use, body mass index, hypertension, diabetes, arthritis, and depression. Seven categories of sleep duration were established: ≤4, 5, 6, 7, 8, 9, and ≥10 hours.

Results

Using 7 hours of sleep as the reference, the adjusted injury risk (odds ratio) for those sleeping a total of ≤4 h/d was 1.53; 1.28 for 5 hours, for 1.11 for 6 hours, 0.98 for 8 hours, 1.12 for 9 hours, and 1.48 for ≥10 hours. The difference in risk was statistically significant for each category except for the 8 and 9 hours. In this study, risk increased as the sleep duration decreased or increased, except for the 8 and 9 hours.

Conclusions

This research found that either a decrease or increase in sleep duration was associated with an increased risk for injury. The concept of proper sleep duration can be evaluated by its associated injury risk.     

Relationship Between Current Sleep Duration and Past Suicidal Ideation or Attempt Among Korean Adolescents

Objectives

To comprehensively examine the relationship between current sleep duration and past suicidal idea or attempt among Korean adolescents.

Methods

Data came from the 2009 Korea Youth Risk Behavior Web-based Survey with 75 066 participants (with the participation rate of 97.6%) in 800 middle and high schools. Binary logistic regression was conducted by gender and depressed mood to identify significant factors for suicidal ideation/attempt. The dependent variable was the log odds of suicidal ideation/attempt, while the independent/control variables were sleep duration and other demographic, socio-economic and health-related factors.

Results

A negative association between sleep duration and suicidal ideation or attempt was weaker for those with depressed mood than for those without such experience in Korea for Year 2009. The odds ratio of suicidal ideation/attempt regarding less than 4 hours of sleep compared to 6 to 7 hours of sleep, was smaller in a group with depressed mood than in a group without such experience, for example, 1.64 (95% confidence interval [CI], 1.29 to 2.08) vs. 2.06 (95% CI, 1.34 to 3.17) for men''s suicidal ideation, 2.50 (95% CI, 1.69 to 3.69) vs. 3.89 (95% CI, 1.74 to 8.66) for men''s suicidal attempt. A negative association between age (or self-rated health) and suicidal ideation/attempt was also weaker for those with depressed mood than for those without such experience in the nation for the year.

Conclusions

There was a negative association between sleep duration and suicidal ideation/attempt in Korea for Year 2009 and this association was weaker for those with depressed mood than for those without such experience. Based on the findings of this study, adolescents'' better mental health and longer, more comfortable sleep might help to prevent their suicidal ideation and attempt in Korea.     

肿瘤死亡率与年龄、时间和出生队列关系的定量分析

肿瘤死亡率与年龄、时间和出生队列之间存在一定的数函关系。作者以一个监测点１９７０－１９８９年宫颈癌和胃癌的资料进行了上述分析，结果与观察的危险因素变动情况相符合。     

The Role of Cognitive Impairment,Physical Disability,and Chronic Conditions in the Association of Sleep Duration With All-Cause Mortality Among Very Old Adults

ObjectiveThis study aimed to examine the relationship between sleep duration and all-cause mortality, and to assess the role of cognitive impairment, physical disability, and chronic conditions on this association among very old adults.DesignA prospective cohort study.Setting and ParticipantsWithin the Chinese Longitudinal Healthy Longevity Surveys, 17,637 oldest-old aged 80-105 years were followed up to 10 years (2005- 2014).MeasuresData on sleep duration at baseline were based on self-report and were categorized as short (<7 hour), moderate (7-9 hours), and long sleep (>9 hours). Information on cognitive function using the Mini-Mental State Examination (MMSE), physical disability using Activities of Daily Living (ADL), and chronic conditions including diabetes, heart disease, stroke, asthma, and cancer were collected at baseline based on a structured questionnaire. Information about vital status was ascertained and confirmed by a close family member or village doctor of the participant during the follow-up. Data were analyzed using Cox proportional hazards models, with adjustment for potential confounders.ResultsDuring the follow-up of 10 years, 11,067 (62.7%) participants died. The multivariate-adjusted hazard ratios (HRs) with 95% confidence interval (CI) for mortality were 1.03 (0.98-1.09) for short sleep and 1.13 (1.08-1.18) for long sleep compared with moderate sleep duration. In stratified analysis by cognitive impairment, physical disability, and chronic conditions, the risk of morality was present only among people with MMSE scores ≤24 but did not differ much when stratified by physical disability and chronic conditions. There was a statistically significant interaction between long sleep and cognitive impairment on mortality (P for interaction = .002).Conclusions and ImplicationsLong sleep duration is associated with higher risk of mortality in very old adults independently of health conditions. Cognitive impairment may enhance this association. These findings suggest that health practitioners and families should be aware of the potential adverse prognosis associated with long sleep.     

天津市农村人群体质指数与脑卒中发病关系的前瞻性队列研究

目的探讨天津市农村人群体质指数(BMI)与脑卒中发病的关系。方法以整群随机抽样的方法,于1991年9月在天津市蓟县某镇选取6个自然村15岁及以上常住人口4796人为基线研究对象,进行流行病学问卷调查,测量血压、身高、体重。用前瞻性队列研究的方法,每年随访队列人群的脑卒中事件,并进行全死因登记,至2009年9月共随访18年。分析不同BMI水平脑卒中发病的相对危险度(RR)。结果脑卒中发病与BMI水平明显有关,与正常体重组比较,体重过低组、超重组、肥胖组发生出血性卒中的RR值分别为2.7,1.9和3.5,缺血性卒中的发病危险在超重组和肥胖组明显增加,RR值分别为1.4和2.4;60岁以下人群体重过低组出血性卒中的发病风险最高(RR=10);60岁以上人群仅显示肥胖组有较高的缺血性卒中发病危险。结论农村肥胖人群有较高的脑卒中发病风险,特别是60岁以下人群,体重过低者易患出血性卒中。     

Sleep Duration and the Risk of Dementia: A Systematic Review and Meta-analysis of Prospective Cohort Studies

ObjectiveEpidemiologic studies have reported inconsistent findings about the association between sleep duration and the risk of dementia. We aimed to clarify this association by method of meta-analysis.DesignSystematic review and meta-analysis of prospective cohort studies.Setting and participantsCommunity or clinical settings. Participants included patients with dementia or Alzheimer's disease and the general population.MeasuresWe systematically searched the PubMed, EMBASE, and Web of Science for prospective cohort studies investigating the association between sleep duration and all-cause dementia or Alzheimer's disease (AD). Generic inverse-variance method was used to combine the outcomes with a random effects model for the association between sleep duration (short or long vs normal) and all-cause dementia or AD.ResultsWe identified 7 studies for all-cause dementia and 6 studies for AD. Pooled analyses showed that long sleep duration was associated with a 77% increased risk of all-cause dementia [hazard ratio (HR) = 1.77, 95% confidence interval (CI) = 1.32-2.37] and a 63% increased risk of AD (HR = 1.63, 95% CI = 1.24-2.13). Short sleep duration was not statistically associated with an increased risk of all-cause dementia (HR = 1.20, 95% CI = 0.91-1.59) or AD (HR = 1.18, 95% CI = 0.91-1.54).Conclusions and implicationsOnly long sleep duration is significantly associated with an increased risk of all-dementia and AD. Future studies are needed to better understand the mechanisms underlying this association.     

十二家橡胶厂肿瘤死亡的回顾性队列研究

在17865名橡胶工人中进行了肿瘤死亡回顾性队列研究,观察期为1967年1月1日至1988年12月31日,以我国1988年41个城市的死亡资料为参照。队列成员分归8类27个工种。结果是(1)男女恶性肿瘤均居死因首位;(2)消化系统癌较突出,特别是胃癌在5个工种类SMR均显著超高,肝癌与食管癌在少数工种显著超高;(3)呼吸系统癌中男女吸烟者肺癌明显超出,吸烟与职业两因素呈相加作用,鼻咽癌在男女个别工种吸烟者超高;(4)膀胱癌超高仅见于硫化工吸烟者;(5)成型工白血病超高;(6)胃癌及肝癌主要在专业工作初始年龄小于20岁或30岁人群中超高;(7)炼胶、硫化、配料及非轮胎混合是问题较多的工种。 本文详细讨论了职业癌调查中工种划分及队列成员工种归属的方法及原则,并提出了独到见解。     

Duration of pregnancy in relation to seafood intake during early and mid pregnancy: prospective cohort

We examined the association between exposure to seafood intake during two periods of pregnancy on the one hand and risks of preterm delivery and postterm delivery on the other. In a prospective cohort of 8729 pregnant Danish women, we assessed frequency of fish meals during the first and second trimester of pregnancy by questionnaires completed around gestation weeks 16 and 30, respectively. When fish intake was based solely on intake reported for the early period of pregnancy, mean gestation length was shorter by 3.91 (95% CI: 2.24–5.58) days and odds of preterm delivery were increased 2.38 (1.23–4.61) times in those who never consumed fish (n = 308) vs. those who consumed both fish as main meal and fish in sandwiches at least once per week (n = 785). These measures were similar when fish intake was based solely on intake reported for mid-pregnancy. In the subgroup of women reporting same intake in the two trimesters, those who never consumed fish (n = 165) had 8.57 (5.46–11.7) days shorter mean gestation and 19.6 (2.32–165) times increased odds of preterm delivery, compared to high fish consumers (n = 127); odds of elective and postterm delivery were reduced by a factor 0.33 (0.11–1.02) and 0.34 (0.12–0.95), respectively, in zero fish consumers. All analyses were adjusted for potential confounding by factors such as maternal smoking, height, and prepregnant weight. We conclude that never consuming fish in the first two trimesters of pregnancy was an extremely strong risk factor for preterm delivery but was also associated with reduced risks of elective delivery and postterm delivery.     

基于分位数回归的睡眠时长对卒中发病风险的影响研究

目的 分析睡眠时长对卒中发病风险的影响以及在不同风险人群中的影响效应.方法 利用中国营养与健康调查2015年数据,通过WLS回归和分位数回归分析睡眠时长对卒中发病风险的影响.结果 共纳入研究对象9566人,WLS回归显示睡眠时长不足和过多会分别增加2.7％和2.4％的卒中发病风险;分位数回归显示随着分位数的提高,睡眠时...     

心脏手术后医院感染经济损失的前瞻性队列研究

目的评估心脏手术患者发生医院感染所造成的经济学损失。方法采用前瞻性队列研究方法 ,依据是否发生医院感染,将2306例接受心脏手术的患者分为感染组和未感染组,比较两组的住院日和医疗费用。结果感染组患者的中位住院天数为46.76d,医疗总费用、药费、检查费和治疗费分别为246788.83、79732.39、10704.31、38299.33元,均明显高于未感染组的81073.14、13150.75、2760.74、5808.43元,差异有统计学意义(P0.01)。结论医院感染可延长心脏手术患者的住院时间,增加其医疗费用,应当采取有效措施控制医院感染。     

妊娠早期睡眠质量对妊娠期糖尿病发病风险影响的前瞻性队列研究

目的 分析孕妇妊娠早期睡眠质量对妊娠期糖尿病(gestational diabetes mellitus,GDM)发病风险的影响.方法 于2018年8—12月选取武汉市妇幼保健院产科门诊903例孕妇作为研究对象,采用结构问卷和匹兹堡睡眠质量指数量表(Pittsburg sleep quality index,PSQI)...     

Leisure Activities and All-Cause Mortality Among the Chinese Oldest-Old Population: A Prospective Community-Based Cohort Study

ObjectiveTo investigate associations between leisure activities, examining each activity separately and in combination, and all-cause mortality among the Chinese oldest-old (≥80 years) population.DesignProspective cohort study.SettingCommunity-living, the oldest-old from 22 provinces in China.ParticipantsWe included 30,070 Chinese individuals aged ≥80 years (mean age: 92.7 years) from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2014.MeasurementsCox proportional hazards models were used to estimate relationships between leisure activities and all-cause mortality, adjusting for covariates including sociodemographic and lifestyle factors, self-reported medical history, and other potential confounders.ResultsDuring 110,278 person-years of follow-up, 23,661 deaths were documented. Participants who engaged in watching TV or listening to the radio, playing cards or mah-jong, reading books or newspapers, gardening, keeping domestic animals or pets, or attending religious activities “almost every day” had a significantly lower mortality risk (adjusted hazard ratios ranged from 0.82 to 0.89; P < .01 for all) than did participants who “never” engaged in those activities. Furthermore, engagement in multiple leisure activities was associated with a reduced risk of all-cause mortality (P for the trend < .001).Conclusions and implicationsFrequent participation in leisure activities might help decrease the risk of death in the Chinese oldest-old population. This finding has important implications for public health policy and encourages the incorporation of a broad range of leisure activities into the daily lives of oldest-old individuals.     

睡眠时间和2型糖尿病患者死亡风险的前瞻性队列研究

目的 探讨2型糖尿病人群中睡眠时间和全死因死亡风险的关联。方法 以江苏省常熟市、淮安市清河区和淮安区纳入国家基本公共卫生服务管理的17 452名2型糖尿病患者作为观察队列。利用Cox比例风险模型计算不同睡眠时间人群随访期间的全死因死亡风险比（HR）值及其95% CI，并按照性别、年龄、生活方式因素进行分层分析。结果 研究人群累计随访67 912人年，平均随访4年，随访期间糖尿病患者死亡1 057人。以睡眠时间7 h/d为参照，调整混杂因素后，睡眠时间≤ 6、8、9和≥ 10 h/d发生死亡的HR值（95% CI）分别为1.14（0.94~1.37）、1.10（0.91~1.32）、1.33（1.05~1.70）和1.52（1.24~1.87）。分层分析显示结果和全人群结果相似，睡眠时间过长与糖尿病患者死亡风险有统计学关联，但未见睡眠时间不足与糖尿病患者死亡风险有统计学关联。结论 睡眠时间过长可增加2型糖尿病患者死亡风险。     

Association of Dietary Fiber Intake with All-Cause Mortality and Cardiovascular Disease Mortality: A 10-Year Prospective Cohort Study

Although previous studies have established that dietary fiber (DF) intake reduces the total cardiovascular disease (CVD) mortality in general populations, limited studies have been conducted in individuals with pre-existing chronic conditions, especially in Asian countries. We aimed to investigate the association of DF intake with all-cause and CVD mortality in the general population and in the subpopulation with hypertension, diabetes, and dyslipidemia. We examined the relationship between DF intake and all-cause and CVD mortality using the Korean genome and epidemiology study. Diet was assessed using a food-frequency questionnaire at baseline. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CIs) after adjusting for confounders. During the mean 10.1 years of follow-up, higher DF intake was significantly associated with a lower risk of all-cause mortality after adjusting for confounders (HR and 95% CIs for Q5 vs. Q1: 0.84 (0.76–0.93); p < 0.001). DF intake was inversely associated with a lower risk of CVD mortality after adjusting for the same confounders (HR and 95% CIs for Q5 vs. Q1: 0.61 (0.47–0.78); p < 0.001). Total DF intake was inversely associated with all-cause and CVD mortality in middle-aged and older adults.     

Lower Dietary Calcium Intake is Associated with a Higher Risk of Mortality in Korean Adults

BackgroundCalcium, one of the most abundant minerals in the human body, has a pivotal role in human physiology. However, only a few studies have examined the association of dietary calcium intake with mortality in a population with low calcium intake.ObjectiveThe aim of this study was to examine the association of dietary calcium intake with risk of all-cause and cause-specific mortality among Korean adults with low calcium intake.DesignThis study was a prospective cohort study.Participants/settingThe analysis was conducted using data from 44,327 eligible Korean adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey 2007-2015. Dietary calcium intake was assessed using 1-day 24-hour recall data.Main outcome measuresThe main outcomes of this study were mortality from all causes, cancer, cardiovascular disease, respiratory disease, and all other causes combined. The outcome was ascertained through linkage to the death registry compiled by Statistics Korea with the use of the resident registration number.Statistical analyses performedWeighted Cox proportional hazard models were used to estimate the hazard ratios and 95% CIs of the all-cause and cause-specific mortality according to dietary calcium intake.ResultsDuring a mean follow-up of 7.28 person-years, 1,889 deaths were ascertained. After multivariable adjustment, the hazard ratios for all-cause mortality for the second quintile to the highest quintile of dietary calcium intake, respectively, compared with the first quintile were 0.86 (95% CI 0.73 to 1.00), 0.82 (95% CI 0.69 to 0.98), 0.85 (95% CI 0.69 to 1.03), and 0.78 (95% CI 0.64 to 0.96) (P for trend from the lowest to the highest quintile = .04). There were no statistically significant associations between dietary calcium intake and risk of mortality from cancer, cardiovascular, or respiratory disease.ConclusionsIn this large prospective cohort study of Korean adults, lower dietary calcium intake was associated with a higher risk of all-cause mortality.     

Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: The Multiethnic Cohort Study

Objective

To explore an independent association between self-reported sleep duration and cause-specific mortality.

Methods

Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii.

Results

Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9 year follow-up. Shorter (≤ 5 h/day) and longer (≥ 9 h/day) sleepers of both sexes (vs. 7 h/day) had an increased risk of all-cause and cardiovascular disease (CVD) mortality, but not of cancer mortality. Multivariable hazard ratios for CVD mortality were 1.13 (95% CI 1.00–1.28) for ≤ 5 h/day and 1.22 (95% CI 1.09–1.35) for ≥ 9 h/day among men; and 1.20 (95% CI 1.05–1.36) for ≤ 5 h/day and 1.29 (95% CI 1.13–1.47) for ≥ 9 h/day among women. This risk pattern was not heterogeneous across specific causes of CVD death among men (P_hetero 0.53) or among women (P_hetero 0.72). The U-shape association for all-cause and CVD mortality was observed in all five ethnic groups included in the study and by subgroups of age, smoking status, and body mass index.

Conclusion

Insufficient or excessive amounts of sleep were associated with increased risk of mortality from CVD and other diseases in a multiethnic population.