A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study

Objectives

Emerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea.

Methods

The study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines.

Results

The HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ≤5 hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ≥10 hours (HR, 1.36; 95% CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ≥60 years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ≤5 hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (≤5 and ≥10 hours).

Conclusions

Sleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.     

Smoking and All-Cause Mortality among a Cohort of Urban Transit Operators

This study assesses the contribution of smoking to all-cause mortality among a primarily minority cohort of urban transit operators. Survey and medical exam data, obtained from 1,785 workers (61% African American; 9% female) who participated in the 1983-1985 San Francisco MUNI Health and Safety Study, were matched against state and national death records through 2000. At baseline, approximately 45% of the workers were current smokers, 30% were former smokers, and 25% had never smoked. Covariates were demographic factors (gender, age, race/ethnicity) and alcohol use (average number of drinks per week). There were 198 deaths during the follow-up period. Kaplan-Meier survival analysis indicated that the probability of survival did not differ between former and current smokers, but was significantly lower compared to never smokers (p < 0.001). Data were further analyzed using Cox regression with age, gender, race/ethnicity, years of smoking, and average weekly number of drinks as predictors of mortality. The results showed that years of smoking significantly contributed to mortality (hazard ratio [HR] = 1.023; p < 0.001). Compared to Asian-American transit operators, elevated mortality risk was observed for African-American operators (HR = 2.78, p < 0.01) and white operators (HR = 2.93, p < 0.01). Gender and average weekly number of drinks were not significantly associated with mortality. Although rates of smoking have declined over the past two decades among blue-collar workers, elevated prevalence of former smoking will likely contribute to excess mortality among blue-collar populations.     

Alcohol Consumption and Digestive Cancer Mortality in Koreans: The Kangwha Cohort Study

Background

Alcohol consumption is a known risk factor for cancers of the mouth, esophagus, liver, colon, and breast. In this study, we examined the association between alcohol consumption and digestive cancer mortality in Korean men and women.

Methods

A cohort of 6291 residents of Kangwha County who were aged 55 years or older in March 1985 were followed to 31 December 2005—a period of 20.8 years. We calculated the relative risks of cancer mortality with respect to the amount of alcohol consumed. Cox proportional hazard model was used to adjust for age at entry, smoking, ginseng intake, education status, and pesticide use.

Results

In men, the risks of mortality from esophageal cancer (relative risk [RR], 5.62; 95% confidence interval [CI], 1.45–21.77) and colon cancer (RR, 4.59; 95% CI, 1.10–19.2) were higher among heavy drinkers, as compared with abstainers. The risks of mortality from colon cancer and bile duct cancer rose with increasing alcohol consumption; these trends were positive and statistically significant (P = 0.04 and P = 0.02, respectively). When participants were stratified by type of alcoholic beverage, soju drinkers had higher risks of mortality from esophageal cancer and colon cancer than makkoli drinkers. In women, the risk of digestive cancer mortality was higher among alcohol drinkers than abstainers, but this difference was not statistically significant.

Conclusions

Alcohol consumption increases mortality from esophageal cancer and colon cancer in men.Key words: alcohol consumption, digestive cancer, cohort study, mortality     

青石棉污染区恶性肿瘤死亡率10年回顾队列研究

为了探讨环境低浓度石棉接触对居民恶性肿瘤尤其是肺癌和间皮瘤发生绎大姚县部门青石棉污染区３０岁以上的农村居民进行了１０年回顾性队列调查。队列人数为３３６３人,其中男１５０３人,女１８６０人。对照选用石青石棉污染的该县龙街乡农民和远离该县２３０多公里的禄丰县金山镇农民居民共７６３９人,观察期９年。     

Rationale,design, and profile of the Three-Prefecture Cohort in Japan: A 15-year follow-up

Background

We reutilized the existing Three-Prefecture Cohort to evaluate the relationship between lifestyle factors and the incidence or mortality from non-communicable diseases.

Drinking Patterns Among Korean Adults: Results of the 2009 Korean Community Health Survey

Objectives

In Korea, the proportion of deaths due to alcohol is estimated at 8.9%, far exceeding the global estimate of 3.8%. Therefore, this study was performed to examine the factors associated with low-risk, moderate-risk, and high-risk drinking patterns in Korean adults and to identify target populations for prevention and control of alcohol-related diseases and deaths.

Methods

We analyzed data from 230 715 Korean adults aged 19 years and older who participated in the 2009 Korean Community Health Survey. Multinomial logistic regression analysis was used to examine associations between socio-demographic and health-related factors and patterns of alcohol use.

Results

A substantially larger proportion of men than women engaged in high risk (21.2% vs. 3.4%) and moderate-risk alcohol use (15.5% vs. 8.2%). In both sexes, moderate- and high-risk uses were associated with younger age, higher income, being currently employed, smoking, being overweight/obese, and good self-rated health.

Conclusions

Given the large proportion of the population that is engaging in moderate- and high-risk drinking and given the social norms that support this behavior, public health policies and campaigns to reduce alcohol consumption targeting the entire population are indicated.     

Association between all-cause mortality and insurance status transition among the elderly population in a rural area in Korea: Kangwha Cohort Study

The study purpose was to examine the association between health insurance transition and all-cause mortality. 3206 residents in Korea who participated in two surveys in 1985 and 1994, were followed-up during 1994–2008. Adjusted hazard ratios (aHR) were calculated using Cox hazard model. Participants were divided into four groups by insurance transition (the “National Health Insurance (NHI)–NHI”, “NHI–Medicaid”, “Medicaid–NHI”, and “Medicaid–Medicaid” groups), where NHI–Medicaid means participants covered by NHI in 1985 but by Medicaid in 1994. For men covered by NHI in 1985, the mortality risk in the NHI–Medicaid was higher (aHR = 1.47) than in the NHI–NHI. For men and women, covered by Medicaid in 1985, aHR was non-significantly lower in the Medicaid–NHI than in the Medicaid–Medicaid. When four groups were analyzed together, men in the Medicaid–Medicaid (aHR = 1.67) and NHI–Medicaid (aHR = 1.46) groups had higher mortality risk than males in the NHI–NHI, whereas no significant difference was observed for females. In conclusion, transition from NHI to Medicaid increases mortality risk, and transition from Medicaid to NHI may mitigate risk, while remaining on Medicaid pose the greatest risk, especially for men. Therefore, policy makers should strengthen coverage for Medicaid. The weak effects of transition from NHI to Medicaid on mortality for women require validation.     

广东省中山市30年全死因与恶性肿瘤死因分析

目的　探讨广东省中山市居民 30年全死因与恶性肿瘤死亡规律。　方法　对 30年中山市居民全死因、恶性肿瘤死亡率、死亡趋势、构成比等指标进行分析。　结果　 30年间中山市居民全死因总死亡率无明显下降 ,而男性恶性肿瘤总死亡率与肺癌等部分病种死亡率明显上升 ;虽然居民死因谱发生了明显变化 ,但心脏病、呼吸系统疾病、脑血管疾病与恶性肿瘤一直是中山市居民 4大主要原因 ,且不同年龄组段主要死因不同。　结论　应进一步加强中山市卫生工作 ,并应根据死亡谱、具体病种死亡率升降趋势、不同年龄组段死亡特征与 90年代主要死因来确定中山市卫生工作重点。     

Cancer Incidence in Korean Vietnam Veterans During 1992-2003: The Korean Veterans Health Study

Objectives

The aim of this study was to investigate the association between Vietnam experience including exposure to military herbicides and cancer incidence in Korean Vietnam War veterans.

Methods

The cancer cases of 185 265 Vietnam veterans from January 1, 1992 to December 31, 2003 were confirmed from the Korea National Cancer Incidence Database. The age-adjusted incidence and standardized incidence ratios (SIRs) were calculated using the male population during 1992 to 2003 as a standard population.

Results

The age-adjusted overall cancer incidence per 100 000 person-years was 455.3 in Vietnam veterans. The overall cancer incidence was slightly yet significantly lower in veterans (SIR, 0.97; 95% confidence interval, 0.95 to 0.99) than in the general population. The overall cancer incidence in enlisted soldiers was not lower (SIR, 1.00), whereas that in officers was significantly lower (SIR, 0.87) than in the general population. The incidences of prostate cancer and T-cell lymphoma in all veterans, and lung cancer and bladder cancer in enlisted soldiers, and colon cancer and kidney cancer in non-commissioned officers, and colon cancer, kidney cancer, and prostate cancer in officers, were higher than in the general population. The SIR for overall cancer among Vietnam veterans rose from 0.92 for 1992-1997 to 0.99 for 1998-2003.

Conclusions

The overall cancer incidence in Vietnam veterans was not higher than in the general male population. Vietnam veterans and military rank subcohorts experienced a higher incidence of several cancers, including prostate cancer, T-cell lymphoma, lung cancer, bladder cancer, kidney cancer, and colon cancer than the general population. The SIR for overall cancer increased over time in Vietnam veterans.     

2001年北京地区癌症死亡预测

利用长期进行的恶性肿瘤登记报告资料，对北京地区１９８０－１９９１年恶性肿瘤死亡率变化进行了动态分析，找出时间序列变化的规律，利用灰色系统理论模型对北京地区２００１年癌症流行趋势做出预测，为癌症预防下控制策略、措施的研究提供科学依据。     

低年级大学生饮酒行为研究

对８７１名汉族低年级大学生的饮酒状况进行研究，结果表明，男生饮酒率为９２．７％，女生饮酒率为７２．９％。男女生的饮酒行为类型和饮酒种类等差异均有非常显著性（Ｐ＜０．０００１），不同专业的男生饮酒行为差异也有显著。男生饮酒行为还受对学业的担心以及朋友和父亲的饮酒行为的影响。     

江西省农村地区中老年女性宫颈癌队列研究

目的研究导致江西省农村地区女性宫颈癌高发的危险因素,为宫颈癌的防治及流行病学和病因学研究提供科学依据。方法从1995年6月1日至2002年12月31日,对江西省4个地区20 050名≥40岁农村女性居民进行了队列研究。应用非条件Logistic回归进行统计学分析。结果随访期间有1 146人死亡,78人患宫颈癌。结果表明,宫颈癌的发生与妇科疾病、闭经与否、心情、睡眠时间有统计学意义(P<0.05),比值比(OR)分别为35.534,0.359,2.116,0.598。结论妇科疾病是导致江西农村地区女性宫颈癌高发的主要危险因素,因此,宫颈癌预防重点应放在妇科感染的预防与控制上。     

Alcohol Consumption and Mortality: The Khon Kaen Cohort Study,Thailand

Background

The prevalence of alcohol consumption among Thais is high, around 30%. We quantified the relationship between alcohol drinking and mortality in a rural population in the most populous region of Thailand.

Methods

The data were from the Khon Kaen Cohort Study. About 24 000 Thai adults were enrolled between 1990 and 2001, and follow-up for vital status continued until March 16, 2012. Mortality data were obtained from the Bureau of Policy and Strategy, Ministry of the Interior, Thailand. A Cox proportional hazards model was used to analyze the association between alcohol drinking and death, controlling for age, education level, and smoking, and floating absolute risk was used to estimate the 95% confidence intervals of hazard ratios.

Results

In total, 18 457 participants (5829 men and 12 628 women) were recruited, of whom 3155 died (1375 men and 1780 women) during a median follow-up period of 13.6 years. Although alcohol drinking was common (64% of men and 25% of women), the amounts consumed were very low (average, 4.3 g/day in men and 0.8 g/day in women). As compared with never drinkers, mortality risk was lower among current drinkers and higher among ex-drinkers. Current drinking was not associated with mortality from cancer or diseases of the circulatory system, although ex-drinkers appeared to have a higher risk of death from the latter.

Conclusions

The leading causes of mortality were not associated with current alcohol drinking at the low consumption levels observed in this population.Key words: alcohol consumption, mortality, health behaviour, rural population     

Alcohol Consumption by Women Before and During Pregnancy

Objectives To determine the prevalence, patterns, and predictors of alcohol consumption prior to and during various intervals of pregnancy in the U.S. Methods Alcohol-related, pregnancy-related, and demographic data were derived from computer-assisted telephone interviews with 4,088 randomly selected control mothers from the National Birth Defects Prevention Study who delivered live born infants without birth defects during 1997–2002. Alcohol consumption rates and crude and adjusted odds ratios (OR) were calculated. Results 30.3% of all women reported drinking alcohol at some time during pregnancy, of which 8.3% reported binge drinking (4+ drinks on one occasion). Drinking rates declined considerably after the first month of pregnancy, during which 22.5% of women reported drinking, although 2.7% of women reported drinking during all trimesters of pregnancy and 7.9% reported drinking during the 3rd trimester. Pre-pregnancy binge drinking was a strong predictor of both drinking during pregnancy (adjusted OR = 8.52, 95% CI = 6.67–10.88) and binge drinking during pregnancy (adjusted OR = 36.02, 95% CI = 24.63–52.69). Other characteristics associated with both any drinking and binge drinking during pregnancy were non-Hispanic white race/ethnicity, cigarette smoking during pregnancy, and having an unintended pregnancy. Conclusions Our study revealed that drinking during pregnancy is fairly common, three times the levels reported in surveys that ask only about drinking during the month before the survey. Women who binge drink before pregnancy are at particular risk for drinking after becoming pregnant. Sexually active women of childbearing ages who drink alcohol should be advised to use reliable methods to prevent pregnancy, plan their pregnancies, and stop drinking before becoming pregnant. Findings were presented as posters at the following meetings  (i) The 2nd International Conference on Fetal Alcohol Spectrum Disorder, March 7-10, 2007, Victoria, British Columbia, Canada; (ii) The Texas Birth Defects Research Symposium, April 19, 2006, Austin, Texas; (iii) The 9th Annual Meeting of the National Birth Defects Prevention Network, January 30-Feb 1, 2006, Arlington, Virginia; (iv) The Centers for Birth Defects Research and Prevention Partners Meeting, November 16, 2005, Washington, DC     

Adherence to the Mediterranean Diet and Overall Cancer Incidence: The Netherlands Cohort Study

BackgroundMediterranean diet adherence has been associated with reduced risks of various cancer types. However, prospective findings for overall cancer risk are inconclusive.ObjectiveThe aim of this study was to examine sex-specific relations of Mediterranean diet adherence with overall cancer risk.DesignThis analysis was conducted as part of the prospective Netherlands Cohort Study. Baseline data on diet and other cancer risk factors were collected using a self-administered questionnaire. Participants were followed up for cancer incidence for 20.3 years through record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry. The alternate Mediterranean diet score without alcohol was the principal measure of Mediterranean diet adherence.Participants/settingThe study population consisted of 120,852 inhabitants of the Netherlands, who were aged 55 to 69 years in September 1986.Main outcome measureThe primary outcome was overall cancer incidence.Statistical analyses performedCox regression analyses (case-cohort design) were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of Mediterranean diet adherence with incidence of cancer (subgroups). In total, 12,184 male and 7,071 female subjects with cancer had complete data on potential confounders and were eligible for inclusion in the Cox models.ResultsMiddle compared with low Mediterranean diet adherence (alternate Mediterranean diet score without alcohol) was significantly associated with a reduced overall cancer risk in women (HR [95% CI]: 0.85 [0.75-0.97]). Decreased HR estimates for the highest Mediterranean diet adherence category and per 2-point increase in score were also observed, but did not reach statistical significance in multivariable-adjusted analyses. In men, there was no evidence of an association for overall cancer risk (HR_{per 2-point increment} [95% CI]: 1.02 [0.95-1.10]). Results for cancer subgroups, defined by relations with tobacco smoking, obesity, and alcohol consumption, were largely similar to the overall findings. Model fits diminished when alcohol was included in the Mediterranean diet score.ConclusionsMediterranean diet adherence was not associated with overall cancer risk in male participants of the prospective Netherlands Cohort Study. HR estimates in women pointed in the inverse direction, but lost statistical significance after full adjustment for confounding in most cases.     

Alcohol drinking and colorectal cancer: A population-based prospective cohort study in China

Study objective: To asses the association between alcohol consumption and the risk of colorectal cancer (CRC) in the Chinese population. Design: A population-based prospective cohort study was initiated from the colorectal cancer screening population in Jiashan County in 1989–1990. The drinking habits of individuals were investigated with demographic information. Setting: A cohort study was followed-up from 1st May 1990 to 1st January 2001 and censored at the date of diagnosis of CRC, at death from any causes, or at 1st January 2001, whichever came first, and the person-time was computed. Participants: Two hundred and forty two CRC patients were diagnosed during the study period and 64,100 individuals finished the follow-up. Results: The distribution of sex, smoking status, occupation, education level and marital status were all significantly different among different drinking habits at baseline. When the above factors were adjusted, no significant association was observed between alcohol consumption and the risk of CRC. Exclusion of individuals diagnosed cancer less than 1 year after the examination date did not alter the strength of an alcohol–CRC relationship. Further analysis in sex strata also did not show a significant relationship. Conclusions: Alcohol drinking may not be associated with a higher risk of CRC in the Chinese population.This revised was published online in April 2005. In the previous version the article category was missing.     

国内吸烟、饮酒与缺血性脑卒中关系的Meta分析

目的探讨吸烟、饮酒与缺血性脑卒中的关系.方法应用Meta分析方法对检索到的国内10个吸烟、饮酒与缺血性脑卒中关系的研究结果进行定量综合分析,一致性检验后,应用随机效应模型(D-L法)计算,合并比值比(OR)及其95%的可信区间(95% CI).结果吸烟、饮酒的合并OR(95% CI)分别为2.01(1.41～2.85)和2.36(1.87～2.98).吸烟、饮酒高危人群缺血性脑卒中的病因分值为50.25%和57.63%,一般人群归因危险百分比为26.66%和34.83%.结论吸烟、饮酒是我国缺血性脑卒中的重要危险因素,开展人群戒烟限酒干预是缺血性脑卒中病因预防的一项重要措施.     

甲醛接触工人肿瘤死亡流行病学

采用回顾性队列死亡率研究方法,凡1977年12月31日前在5家脲醛和/或酚醛树脂生产工厂工作满一年以上的工人进入队列,失访率低于5%。观察至1987年12月31日止接触组(1316人男性813人,人年19400)。男性接触组全肿瘤,肺癌、肝癌、胃癌、膀胱癌队列。具统计学意义的超额死亡,男性接触者为全肿瘤,脑瘤、肺癌、胃癌和膀胱癌,女性为全肿瘤,肺癌和肝癌。超额死亡危险随接触工龄延长而增加,三例鼻癌均发生于接触组,工龄在10以上。纠正了吸烟因素后,接触组死亡率高于对照组。     

中国石棉接触人员癌症死亡队列研究的Meta分析

目的以M eta分析探讨单纯接触温石棉人员癌症是否高发。方法凡满足明确是中国石棉接触人员且为癌症死亡率队列研究的资料均被纳入研究对象,以直接法与随机效应模型法计算主要部位癌症标准化死亡比(SMR)及其95%可信区间(CI),计算Q统计量与Z值检验研究结果异质性及其来源。结果共有13个队列符合入选标准,平均间皮瘤死亡百分比为0.62%,全死因、全癌亡、肺癌的M eta-SMR显著上升(分别为1.51、1.96、4.54),单纯接触温石棉人员肺癌的M eta-SMR也显著上升(4.39),消化系统、喉、乳腺和生殖泌尿系统等其他部位癌症的M eta-SMR未见显著上升。结论单纯温石棉暴露能使作业人员肺癌、间皮瘤显著高发,与其他部位癌症无病因联系。