The fraction of disability pensions attributable to smoking and obesity. Results from a 15-year follow-up study

Objective

The aim of this study was to estimate the fraction of permanent disability pensions among the working population in Denmark that can be attributed to differences in health behaviour.

Methods

A total of 8,287 employees were interviewed regarding health behaviour, work environment and general health. They were followed in a national register on granted disability pensions. Cox regression analysis was performed, and attributable fractions were calculated.

Results

The analysis showed a 48% and 79% risk increase for female heavy and moderate smokers, respectively (attributable fraction 19.7%), and a 74% risk increase for BMI?<?18.5 (attributable fraction 6.1%). Male heavy smokers had a 67% excess risk of disability pension (attributable fraction 15.7%).

Conclusions

Smoking was an independent disability pension predictor regardless of age, work environment factors and baseline general health status. Workplace-based smoking cessation could substantially decrease permanent disability retirement from work.     

Estimating summary measures of health: a structured workbook approach

Background  

Summary measures of health that combine mortality and morbidity into a single indicator are being estimated in the Canadian context for approximately 200 diseases and conditions. To manage the large amount of data and calculations for this many diseases, we have developed a structured workbook system with easy to use tools. We expect this system will be attractive to researchers from other countries or regions of Canada who are interested in estimating the health-adjusted life years (HALYs) lost to premature mortality and year-equivalents lost to reduced functioning, as well as population attributable fractions (PAFs) associated with risk factors. This paper describes the workbook system using cancers as an example, and includes the entire system as a free, downloadable package.     

Fractions of cardiovascular diseases,mental disorders,and musculoskeletal disorders attributable to job strain

Objectives  

The aim of this study was to evaluate fractions of diseases attributable to job strain defined using Karasek’s model among the French working population for cardiovascular diseases (CVD), mental disorders, and musculoskeletal disorders (MSD).     

Indoor Charcoal Smoke and Acute Respiratory Infections in Young Children in the Dominican Republic

The authors investigated the effect of charcoal smoke exposureon risks of acute upper and lower respiratory infection (AURIand ALRI) among children under age 18 months in Santo Domingo,Dominican Republic (1991–1992). Children living in householdsusing charcoal for cooking (exposed, n = 201) were age-matchedto children living in households using propane gas (nonexposed,n = 214) and were followed for 1 year or until 2 years of age.Fuel use and new episodes of AURI and ALRI were ascertainedbiweekly through interviews and medical examinations. Householdindoor-air concentration of respirable particulate matter (RPM)was measured in a sample of follow-up visits. Incidences ofAURI and ALRI were 4.4 and 1.4 episodes/child-year, respectively.After adjustment for other risk factors, exposed children hadno significant increase in risk of AURI but were 1.56 times(95% confidence interval: 1.23, 1.97) more likely to developALRI. RPM concentrations were higher in charcoal-using households(27.9 µg/m³ vs. 17.6 µg/m³), and ALRI risk increasedwith RPM exposure (10-µg/m³ increment: odds ratio = 1.17,95% confidence interval: 1.02, 1.34). Exposure to charcoal smokeincreases the risk of ALRI in young children, an effect thatis probably mediated by RPM. Reducing charcoal smoke exposuremay lower the burden of ALRI among children in this population. air pollution, indoor; biomass; charcoal; Dominican Republic; particulate matter; respiratory tract infections; smoke; wood     

Waist circumference cut-off values for the prediction of cardiovascular risk factors clustering in Chinese school-aged children: a cross-sectional study

Background  

Waist circumference has been identified as a valuable predictor of cardiovascular risk in children. The development of waist circumference percentiles and cut-offs for various ethnic groups are necessary because of differences in body composition. The purpose of this study was to develop waist circumference percentiles for Chinese children and to explore optimal waist circumference cut-off values for predicting cardiovascular risk factors clustering in this population.     

An investigation into the prevalence of dog bites to primary school children in Trinidad

Background  

To estimate the prevalence of dog bites to primary school children between the ages of 8–12 years using a semi-structured interview process. With the increase in the pet population and popularity of dangerous breeds of dog and a high stray dog population combined with a dearth of information on the risk of dog attacks to children in Trinidad, a semi-structured interview process was used to determine risk factors associated with dog attacks.     

Acute Lower Respiratory Infection in Childhood and Household Fuel Use in Bhaktapur,Nepal

Background: Globally, solid fuels are used by about 3 billion people for cooking. These fuels have been associated with many health effects, including acute lower respiratory infection (ALRI) in young children. Nepal has a high prevalence of use of biomass for cooking and heating.Objective: This case–control study was conducted among a population in the Bhaktapur municipality, Nepal, to investigate the relationship of cookfuel type to ALRI in young children.Methods: Cases with ALRI and age-matched controls were enrolled from an open cohort of children 2–35 months old, under active monthly surveillance for ALRI. A questionnaire was used to obtain information on family characteristics, including household cooking and heating appliances and fuels. The main analysis was carried out using conditional logistic regression. Population-attributable fractions (PAF) for stove types were calculated.Results: A total of 917 children (452 cases and 465 controls) were recruited into the study. Relative to use of electricity for cooking, ALRI was increased in association with any use of biomass stoves [odds ratio (OR) = 1.93; 95% CI: 1.24, 2.98], kerosene stoves (OR = 1.87; 95% CI: 1.24, 2.83), and gas stoves (OR = 1.62; 95% CI: 1.05, 2.50). Use of wood, kerosene, or coal heating was also associated with ALRI (OR = 1.45; 95% CI: 0.97, 2.14), compared with no heating or electricity or gas heating. PAFs for ALRI were 18.0% (95% CI: 8.1, 26.9%) and 18.7% (95% CI: 8.4%–27.8%), for biomass and kerosene stoves, respectively.Conclusions: The study supports previous reports indicating that use of biomass as a household fuel is a risk factor for ALRI, and provides new evidence that use of kerosene for cooking may also be a risk factor for ALRI in young children.     

A Population‐based Study of Perinatal Infection Risk in Women with and without Systemic Lupus Erythematosus and their Infants

Background

Increased risk of adverse birth outcomes is well described in women with systemic lupus erythematosus (SLE), but risk of maternal or infant infection in the peripartum period has not been well studied. We conducted a population‐based cohort study of infection risk in women with and without SLE and their infants.

Methods

Linked birth‐hospital discharge data identified 1297 deliveries to women with SLE and a 4:1 comparison cohort of deliveries to women without SLE in Washington State, 1987–2013. Maternal and infant infections during the first 30 days after delivery were identified. Relative risks (RR) and 95% confidence intervals (CI) were estimated.

Results

Women with SLE were 1.7 times more likely (95% CI 1.4, 2.0) to have an infection during the birth hospitalisation and more likely to receive antibiotics during labour (RR 1.3, 95% CI 1.1, 1.5), though there was no increased risk of chorioamnionitis in women with SLE. Infants of women with SLE had an increased risk for an infection during the birth hospitalisation (RR 2.2, 95% CI 1.3, 3.5), although the size of the difference was smaller when adjusted for gestational age (RR 1.4, 95% CI 0.9, 2.1). Risks of neonatal infection, sepsis, receipt of antibiotics, and admission to neonatal intensive care were also increased, and were also attenuated after adjustment for gestational age.

Conclusions

Women with SLE have an increased risk of peripartum infections and antibiotic exposure. Their neonates have a greater likelihood of infection, much of which is attributable to preterm birth.     

Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y

OBJECTIVES: To determine whether subclinical vitamin D deficiency in Indian children under 5 y of age is a risk factor for severe acute lower respiratory infection (ALRI). DESIGN: A hospital-based case-control study. SETTING: Sanjeevani Paediatrics Hospital, a private hospital in Indapur, India. PARTICIPANTS: A total of 150 children including 80 cases and 70 controls, aged 2-60 months, were enrolled. Case definition of severe ALRI as given by the World Health Organization was used for cases. Controls were healthy children attending outpatients' service for immunization. MAIN OUTCOME MEASURE: Association of serum 25-hydroxyvitamin D3 (25OHD3) with severe ALRI, controlling for demographic and other potential risk factors. RESULTS: Serum 25OHD3 increased with age. Factors significantly associated with decreased risk of severe ALRI in univariate analysis were: exclusive breastfeeding in the first 4 months (cases 35/78 (45%), controls 41/64 (64%); P=0.02); introduction of other dietary liquids than milk only after 6 months (cases 46/70 (66%), controls 31/66 (47%); P=0.03); use of liquid petroleum cooking fuel (cases 32/80 (40%), controls 40/70 (57%); P=0.04); infant not covered in swaddling cloths when exposed to sunlight before crawling (cases 11/52 (21%), controls 25/54 (46%); P=0.006); and serum 25OHD3>22.5 nmol/l (cases 16/80 (20%), controls 48/70 (69%); P<0.001). In multivariate analysis, factors associated with significantly lower odds ratio for having severe ALRI were: serum 25OHD3>22.5 nmol/l (OR: 0.09; 95% CI 0.03-0.24; P<0.001) and exclusive breastfeeding in the first 4 months of life (OR 0.42; 95% CI 0.18-0.99; P=0.046) with age and height/age as significant covariates. CONCLUSION: Subclinical vitamin D deficiency and nonexclusive breastfeeding in the first 4 months of life were significant risk factors for severe ALRI in Indian children.     

Ambient particulate air pollution and acute lower respiratory infections: a systematic review and implications for estimating the global burden of disease

Acute lower respiratory infections (ALRI) account for nearly one fifth of mortality in young children worldwide and have been associated with exposures to indoor and outdoor sources of combustion-derived air pollution. A systematic review was conducted to identify relevant articles on air pollution and ALRI in children. Using a Bayesian approach to meta-analysis, a summary estimate of 1.12 (1.03, 1.30) increased risk in ALRI occurrence per 10 μg/m³ increase in annual average PM_2.5 concentration was derived from the longer-term (subchronic and chronic) effects studies. This analysis strengthens the evidence for a causal relationship between exposure to PM_2.5 and the occurrence of ALRI and provides a basis for estimating the global attributable burden of mortality due to ALRI that is not influenced by the wide variation in regional case fatality rates. Most studies, however, have been conducted in settings with relatively low levels of PM_2.5. Extrapolating their results to other, more polluted, regions will require a model that is informed by evidence from studies of the effects on ALRI of exposure to PM_2.5 from other combustion sources, such as secondhand smoke and household solid fuel use.     

Smoking-attributable morbidity: acute care hospital diagnoses and days of treatment in Canada, 2002

Background  

Smoking is one of the most important risk factors for burden of disease. Our objective was to estimate the number of hospital diagnoses and days of treatment attributable to smoking for Canada, 2002.     

Children admitted to hospital following unintentional injury: perspectives of health service providers in Aotearoa/New Zealand

Background  

Unintentional injuries are the leading cause of death and hospitalisation among New Zealand children, with indigenous Māori and ethnic minority Pacific children significantly over represented in these statistics. International research has shown that many children hospitalised for injury, as well as their families experience high levels of stress, and ethnic disparities in the quality of trauma care are not uncommon. The research on which this paper is based sought to identify key issues and concerns for New Zealand's multi-ethnic community following hospitalisation for childhood injury in order to inform efforts to improve the quality of trauma services. This paper reports on service providers' perspectives complementing previously published research on the experiences of families of injured children.     

The fraction of long-term sickness absence attributable to work environmental factors: prospective results from the Danish Work Environment Cohort Study

Objective

To examine the fraction of long‐term sickness absence periods attributable to physical and psychosocial work environmental risk factors.

Method

A random population sample was followed for 18 months in a national register of social transfer payments. Mutually adjusted hazard ratios for onset of long‐term sickness absence and aetiological fractions were computed.

Results

After mutual adjustment, no significant effect of psychosocial work environment factors remained. In men, 23% and 28% of long‐term sickness absence were attributable to working mainly standing or squatting, and lifting or carrying loads, respectively. In women, 27% of long‐term sickness absence was attributable to bending or twisting of the neck or back.

Conclusions

Physical work environment exposures explained between 10% and 30% of long‐term sickness absence. The potential for reducing long‐term sickness absence is substantial.Long‐term sickness absence is a major public health problem.¹ In previous studies we identified five psychosocial and four physical work environment factors that were independent risk factors of long‐term sickness absence.^2,3 The psychosocial risk factors associated with long‐term sickness absence were the demands of hiding emotions and emotional demands for men, and management quality, role conflicts, and reward among women.² In both genders, the physical work environment risk factors associated with long‐term sickness absence were extreme bending or twisting of the neck or back, working mainly standing or squatting, lifting or carrying loads, and pushing or pulling loads.³In the present study, the relative contribution of these risk factors, and thus the potential for reducing long‐term sickness absence, is studied by computation of aetiological fractions.⁴     

The Economic Burden of Cancers Attributable to Metabolic Syndrome in Korea

Objectives:

Metabolic syndrome is an important etiologic factor in the development of certain types of cancers. The economic cost of the treatment of cancer has been steadily increasing. We therefore estimated the economic burden of cancers attributable to metabolic syndrome in Korea.

Methods:

We reviewed metabolic syndrome-related cancers and relative risk and then calculated population attributable fractions. We analyzed insurance claims data for metabolic syndrome-related cancers in 2012 in order to estimate the direct costs associated with these cancers, including hospitalization, outpatient visits, transportation costs, and caregivers’ costs as well as indirect costs such as loss of productivity due to cancer treatment and premature death.

Results:

In 2012, 18 070 patients in Korea had cancers attributable to metabolic syndrome. The economic burden was USD 199.8 million and the direct and indirect costs were USD 124.5 million and USD 75.3 million, respectively.

Conclusions:

We estimated the economic burden of cancers attributable to metabolic syndrome in Korea and the efforts are necessary to reduce this burden.     

Vaccination status and sequence of vaccinations as risk factors for hospitalisation among outpatients in a high mortality country

Background

Most developing countries are implementing the WHO immunisation programme. Although vaccines reach most children, many modifications of the recommended schedule are observed in practice. We investigated the association between vaccination status and risk of hospitalisation in Guinea-Bissau.

Methods

From May 2003 to May 2004, all consultations of children less than five years of age at the outpatient clinic of the paediatric ward at the national hospital in Bissau were registered. For each consultation, information was collected about the child's name, sex, age and socio-cultural conditions, as well as diagnosis and whether the child was hospitalised. Information about vaccinations was also registered from the child's vaccination card. We analysed the association between vaccination status and risk of hospitalisation in age intervals according to the pre-dominant vaccines. We particularly emphasised the comparison of those who had received the recommended vaccination for the age groups and those who were delayed and only had the previous vaccinations. We also examined those who had received the vaccines out of sequence.

Results

Information about vaccinations was available for 11,949 outpatient children of whom 2219 (19%) were hospitalised. Among children less than 3 months of age, unvaccinated children compared to BCG children had as expected a higher risk of hospitalisation; controlled for important determinants of hospitalisation, the hospitalisation risk ratio (HRR) was 1.99 (95% CI 1.37-2.89). In contrast, there was no difference in the HRR for children aged 1 ½ -8 months who were delayed and had only received BCG compared to those who as recommended had received diphtheria-tetanus-pertussis (DTP) vaccine after BCG (HRR = 1.10 (0.77-1.59)). In the age interval 9-17 months of age, children who were delayed and had only received DTP had significantly higher risk of hospitalisation compared with children who as recommended had measles vaccine (MV) as the most recent vaccination (HRR = 1.39 (1.16-1.66)). Having received DTP after MV (HRR = 1.60 (1.15-2.24)) or MV and DTP simultaneously (HRR = 1.51 (1.16-1.97)) was also associated with higher risk than MV only as most recent vaccination. In contrast, the children aged 18-59 months who as recommended had received a DTP booster after MV did not have lower risk of hospitalisations compared with children who were delayed and had received only MV (RR = 0.90 (0.75-1.07)). After 9 months of age, there was a significant difference in the female-male HRR for children who had MV (HRR = 0.85 (0.72-1.00)) or DTP (HRR = 1.08 (0.96-1.22)) as most recent vaccination (p = 0.02, test of interaction).

Conclusion

Following the recommended vaccination schedule for BCG and MV is associated with a reduced risk of hospitalisation but this is not the case for DTP and booster DTP. Receiving DTP simultaneously with MV or after MV is associated with increased risk of hospitalisation. Vaccines have sex-differential effects on the risk of hospitalisation.     

Hospitalisation among immigrants in Italy

Background  

Immigration is increasing in Italy. In 2003, 2.6 million foreign citizens lived in the country; 52% were men and the majority were young adults who migrated for work. The purpose of this study was to investigate differences in hospitalisation between immigrants and the resident population during the year 2000 in the Lazio region.     

Selecting participants that raise a clinical trial's population attributable fraction can increase the treatment effect within the trial and reduce the required sample size

Background

Detection of modest but worthwhile treatment effects in randomized controlled trials (RCTs) demands trials of large sample size. Approaches to decreasing required size of RCTs while maintaining power are needed.

Objective

The epidemiological concept of population attributable fraction (AF_p) was applied to the population selected for an RCT to assess its role in determining the size of treatment effect and the required sample size. The additional effect of efficacy of treatment specifically among participants at risk for attributable target events (relative risk reduction_{at risk} [RRR_{at risk}]) was also examined.

Results

A model is described which accounts for size of treatment effect in an RCT based on AF_p and RRR_{at risk}: RRR_trial = (AF_p) (RRR_at risk). The increase in RRR_trial resulting from raising AF_p exceeds that possible under the traditional high risk/high response approach to trial design and allows a reduction in required trial sample size. AF_p can be estimated from studies of causation that determine both risk and attributable risk (AR) associated with specific risk factors.

Conclusion

Larger treatment effects within RCTs are enabled by choosing a target outcome having a specific cause and selecting participants at specific risk for that outcome. Using information about phenotypic and genetic predictors of AR may increase our capacity to select trial populations having high AF_p.     

An analysis of risk factors of non-fatal drowning among children in rural areas of Guangdong Province,China: a case-control study

Background  

Drowning is a major cause of morbidity and mortality for children, yet non-fatal drowning remains poorly understood. The aim of this study was to explore potential modifiable risk factors of non-fatal drowning among children in rural areas of China.     

Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors

Background  

Measles is a highly contagious infectious disease with a significant public health impact especially among displaced populations due to their characteristic mass population displacement, high population density in camps and low measles vaccination coverage among children. While the fatality rate in stable populations is generally around 2%, evidence shows that it is usually high among populations displaced by disasters. In recent years, refugees and internally displaced persons have been increasing. Our study aims to define the epidemiological characteristics and risk factors associated with measles outbreaks in displaced populations.     

Mortality following the Haitian earthquake of 2010: a stratified cluster survey

Background

The estimated gap in life expectancy (LE) between Indigenous and non-Indigenous Australians was 12 years for men and 10 years for women, whereas the Northern Territory Indigenous LE gap was at least 50% greater than the national figures. This study aims to explain the Indigenous LE gap by common modifiable risk factors.

Methods

This study covered the period from 1986 to 2005. Unit record death data from the Northern Territory were used to assess the differences in LE at birth between the Indigenous and non-Indigenous populations by socioeconomic disadvantage, smoking, alcohol abuse, obesity, pollution, and intimate partner violence. The population attributable fractions were applied to estimate the numbers of deaths associated with the selected risks. The standard life table and cause decomposition technique was used to examine the individual and joint effects on health inequality.

Results

The findings from this study indicate that among the selected risk factors, socioeconomic disadvantage was the leading health risk and accounted for one-third to one-half of the Indigenous LE gap. A combination of all six selected risks explained over 60% of the Indigenous LE gap.

Conclusions

Improving socioeconomic status, smoking cessation, and overweight reduction are critical to closing the Indigenous LE gap. This paper presents a useful way to explain the impact of risk factors of health inequalities, and suggests that reducing poverty should be placed squarely at the centre of the strategies to close the Indigenous LE gap.