A population-based study of environmental hazards in the homes of older persons

OBJECTIVES: This study sought to estimate the population-based prevalence of environmental hazards in the homes of older persons and to determine whether the prevalence of these hazards differs by housing type or by level of disability in terms of activities of daily living (ADLs). METHODS: An environmental assessment was completed in the homes of 1000 persons 72 years and older. Weighted prevalence rates were calculated for each of the potential hazards and subsequently compared among subgroups of participants characterized by housing type and level of ADL disability. RESULTS: Overall, the prevalence of most environmental hazards was high. Two or more hazards were found in 59% of bathrooms and in 23% to 42% of the other rooms. Nearly all homes had at least 2 potential hazards. Although age-restricted housing was less hazardous than community housing, older persons who were disabled were no less likely to be exposed to environmental hazards than older persons who were nondisabled. CONCLUSIONS: Environmental hazards are common in the homes of community-living older persons.     

Psychotropic drug use among persons with mental distress symptoms: a population-based study in Norway

AIMS: To explore psychotropic drug use in the general population and in particular among non-institutionalized persons with mental distress symptoms. METHODS: A total of 14,139 women and 11,665 men participating in the Oslo Health Study or the Oppland/Hedmark Study 2000-2001 submitted a self-administered questionnaire on health status and drug use, lifestyle, and socioeconomic factors. Respondents using antidepressants, hypnotics, and/or anxiolytics during the last four weeks were defined as users. A high Hopkins Symptoms Checklist-10 score indicated mental distress. The 15% with the highest score in each gender and age group (adults: 30/40/45 years; elderly: 60 years) were studied. RESULTS: The prevalence of antidepressant use among those with mental distress was, for women: adults 21%; elderly 30%; and for men, adults 15%; elderly 15%. These figures were nearly four times higher than in the general population. Not participating in the labour market was the main factor associated with use of antidepressants for subjects with mental distress: adult women (odds ratio (OR) 3.5; 95% confidence interval (CI) 2.5-5.0); elderly women (OR 5.2; CI 2.7-10.2); adult men (OR 4.7; CI 3.0-7.3); and elderly men (OR 2.9; CI 1.4-6.0). Use of analgesics was the main factor associated with use of anxiolytics/hypnotics: adult women (OR 2.4; CI 1.7-3.4); elderly women (OR 2.3; CI 1.4-3.8); adult men (OR 2.1; CI 1.3-3.3); and elderly men (OR 3.4; CI 1.9-6.0). CONCLUSIONS: Among individuals with mental distress, not participating in the labour market and regular use of analgesics were the main factors associated with use of psychotropics in both genders regardless of age.     

First-trimester maternal alcohol consumption and the risk of infant oral clefts in Norway: a population-based case-control study

Although alcohol is a recognized teratogen, evidence is limited on alcohol intake and oral cleft risk. The authors examined the association between maternal alcohol consumption and oral clefts in a national, population-based case-control study of infants born in 1996-2001 in Norway. Participants were 377 infants with cleft lip with or without cleft palate, 196 with cleft palate only, and 763 controls. Mothers reported first-trimester alcohol consumption in self-administered questionnaires completed within a few months after delivery. Logistic regression was used to calculate odds ratios and 95% confidence intervals, adjusting for confounders. Compared with nondrinkers, women who reported binge-level drinking (>or=5 drinks per sitting) were more likely to have an infant with cleft lip with or without cleft palate (odds ratio = 2.2, 95% confidence interval: 1.1, 4.2) and cleft palate only (odds ratio = 2.6, 95% confidence interval: 1.2, 5.6). Odds ratios were higher among women who binged on three or more occasions: odds ratio = 3.2 for cleft lip with or without cleft palate (95% confidence interval: 1.0, 10.2) and odds ratio = 3.0 for cleft palate only (95% confidence interval: 0.7, 13.0). Maternal binge-level drinking may increase the risk of infant clefts.     

Mortality risk associated with disability: a population-based record linkage study

Objectives. We assessed the association between mortality and disability and quantified the effect of disability-associated risk factors.Methods. We linked data from cross-sectional health surveys in the Netherlands to the population registry to create a large data set comprising baseline covariates and an indicator of death. We used Cox regression models to estimate the hazard ratio of disability on mortality.Results. Among men, the unadjusted hazard ratio for activities of daily living, mobility, or mild disability defined by the Organization for Economic Co-operation and Development at age 55 years was 7.85 (95% confidence interval [CI] = 4.36, 14.13), 5.21 (95% CI = 3.19, 8.51), and 1.87 (95% CI = 1.58, 2.22), respectively. People with disability in activities of daily living and mobility had a 10-year shorter life expectancy than nondisabled people had, of which 6 years could be explained by differences in lifestyle, sociodemographics, and major chronic diseases.Conclusions. Disabled people face a higher mortality risk than nondisabled people do. Although the difference can be explained by diseases and other risk factors for those with mild disability, we cannot rule out that more severe disabilities have an independent effect on mortality.Population aging is associated with an increase in the number of people who are disabled. This increase presents a challenge for society because elderly persons disabled in 1 or more domains of life are hospitalized more often,¹ need more medical and long-term care,^2–5 and face a higher risk of death than nondisabled persons do.^6–13Disablement refers to the impact that chronic and acute conditions have on people''s ability to perform tasks necessary for daily living and normal social functioning.¹⁴ In a broader context, the disablement process is described as a causal chain in which the progression of disease leads to functional limitations, loss of mobility, and eventually to inability to perform activities of daily living (ADLs).^14–17 Empirical studies have found numerous risk factors associated with disablement. These factors are usually seen as risks that increase the chance of developing a disability. The major underlying causes are (acute and progressive) chronic diseases,¹⁸ but other risk factors including sociodemographic factors (e.g., age, gender,¹⁹ socioeconomic status²⁰), behavioral factors (e.g., smoking),²¹ nutrition,²² physical activity,²³ comorbidity,¹⁸ self-rated health,²⁴ and cognitive impairment²⁵ are also associated with incident disability.Disability is most often assessed in cross-sectional studies without information on mortality. The few longitudinal studies that have been conducted tend to emphasize incident disability rather than the trajectory of disability following onset because of lack of statistical power.²⁶ Thus, although the onset of disability has been extensively researched, there has been far less investigation into the mortality risk associated with disability. In previous studies, the study populations were often limited to specific disease groups^9,12 or based on small sample sizes with few control variables.^{6–8,10,11,13} Moreover, the focus was often on other determinants of mortality rather than on disability. Nonetheless, disability has been found to be an independent predictor of death after adjustment for heart disease,⁹ depressive symptoms,¹⁰ physical activity,¹¹ socioeconomic status,¹³ or health status.¹⁰ However, no study has assessed the extent to which the relationship between disability and mortality can be explained by risk factors known to be associated with disablement. Assessment of this relationship may enhance understanding of the public health aspects of aging. If disability is found to be independently associated with mortality, developing strategies to prevent disability would not only increase disability-free life expectancy but also total life expectancy.We assessed the association between mortality and 3 disability measures reflecting different levels of disability severity. The linking of cross-sectional health surveys to municipal health registries in the Netherlands permitted the compilation of a large time-to-event data set with covariates measured at baseline.²⁷ We quantified the magnitude of the association between disability and mortality, unadjusted and adjusted for groups of risk factors. These risk factors included distal and proximal risk factors that may influence the speed of disablement.^28–31 We used hazard ratios (HRs) and life expectancy to summarize the association between disability and mortality.     

Cancer incidence among Icelandic deck officers in a population-based study

OBJECTIVES: The aim of this study was to define the cancer pattern in an Icelandic cohort of deck officers while indirectly controlling for their smoking habits. METHODS: A cohort of 3874 male deck officers was followed from 1966 to 1998. It was record-linked by the deck officers' personal identification numbers to population-based registers containing each person's vital and emigration status and cancer diagnosis. Standardized incidence ratios (SIR) were calculated for all cancers and different cancer sites in relation to different lag times and years of birth. Information on smoking habits was obtained by from a questionnaire administered to a sample of the cohort (N=728). RESULTS: In the total cohort 436 cancers were observed, equal to the expected 436 [SIR 1.0, 95% confidence interval (95% CI) 0.9-1.1], and a significantly increased risk of soft-tissue sarcoma (SIR 2.7, 95% CI 1.2-5.1) was found together with a decreased risk of testis cancer (SIR 0.0, 95% CI .. -0.7) and urinary bladder cancer (SIR 0.5, 95% CI 0.3-0.8). The deck officers' smoking habits were similar to those found in a sample of the general population. The predictive value was 1.11 for lung cancer CONCLUSIONS: An increased incidence of soft-tissue sarcoma was found among deck officers. This increase resembles that previously found for Swedish deck officers, and it warrants further study.     

Retinopathy of prematurity: risk factors in a prospective population-based study

A prospective study of risk factors for retinopathy of prematurity (ROP) in all very low birthweight (less than 1500 g) infants born in New Zealand in 1986 is reported. Of 413 liveborn infants admitted to neonatal units, 338 (81.2%) survived to be discharged home. Of surviving infants, 313 (93%) were examined by indirect ophthalmoscopy, as were eight infants who died before discharge. Sixty-nine infants (21.5% of 321) had acute retinopathy. On multiple logistic regression analysis, three variables made statistically significant independent contributions to the risk of any acute retinopathy; gestational age (P less than 0.0001), principal hospital caring for the infant (P less than 0.01) and treatment with indomethacin (P less than 0.01). Only two variables, gestational age (P less than 0.0001) and hospital (P less than 0.01), made significant contributions to the risk of stage 2 or more ROP. For both categories of ROP, timing of the examination also had a statistically significant effect (P less than 0.001). After adjustment for other significant predictor variables, it was estimated that approximately 70% of infants of less than 26 weeks' gestation were at risk of ROP and nearly 50% of stage 2 or more ROP, in comparison with less than 2% of infants of 32 weeks' gestation or more; infants treated with indomethacin were over 1.5 times more likely to have ROP than infants not so treated. Failure to enforce uniform timing of examination was the most serious defect in the study; only 205 (64%) of the 321 infants were examined at the recommended time. However, reanalysis of the model with information limited to these 205 infants yielded similar risk factors. The incidence of ROP, both observed (P less than 0.05) and adjusted for other significant variables in the regression model (P less than 0.01) was lowest in the two largest level III hospitals. These hospitals also had the best survival rates after adjustment for birthweight, gestation and gender (P less than 0.01). We speculate that the larger level III units obtained better results because their size and experience enabled them to provide a better overall quality of care.     

Suicide risk in relation to level of urbanicity--a population-based linkage study

BACKGROUND: The extent to which the high suicide rate in urban areas is influenced by exposures to risk factors for suicide other than urbanicity remains unknown. This population-based study aims to investigate suicide risk in relation to the level of urbanicity in the context of other factors, and to study the risk variation in a sex, age, and calendar year perspective. METHODS: The study is a nested case-control study comprising 21 169 suicides and 423 128 population controls matched for age and sex. Personal data on place of residence, socioeconomic status and psychiatric history were retrieved from various Danish longitudinal registers. Data were analysed with conditional logistic regression. RESULTS: This study confirms that people living in more urbanized areas are at a higher risk of suicide than their counterparts in less urbanized areas. However, this excess risk is largely eliminated when adjusted for personal marital, income, and ethnic differences; it is even reversed when further adjusted for psychiatric status. Moreover, the impact of urbanicity on suicide risk differs significantly by sex and across age. Urban living reduces suicide risk significantly among men, especially young men, but increases the risk among women, especially women aged 24-35 or >65 years. In addition, during 1981-1997, the suicide risk associated with urbanicity remained rather constant among women, whereas it dropped significantly among men, a trend that seemingly gained strength during the last part of this period. CONCLUSIONS: Suicide risk associated with urbanicity varies significantly by sex and age groups and recent years have seen a decline in the urban-rural disparities among men. The increased risk in urban areas can largely be explained by the effects of marital status, ethnics, income, and psychiatric status.     

Tobacco habits and risk of lung, oropharyngeal and oral cavity cancer: a population-based case-control study in Bhopal, India

BACKGROUND: Tobacco habits in India are unique and vary in different regions. Few studies, and none from central India, have reported on type of tobacco used and risk of the most common cancer types in India. We conducted a population-based case-control study to evaluate the risk of tobacco particularly bidi smoking and tobacco quid chewing on the most common cancer sites among males in Bhopal. METHODS: In all, 163 lung, 247 oropharyngeal and 148 oral cavity cancer cases from the Population-Based Cancer Registry records and 260 controls randomly selected from a tobacco survey conducted in the Bhopal population formed the study population. RESULTS: A significant risk of bidi and cigarette smoking with a dose-response relationship was observed for lung and oropharyngeal cancer. Tobacco quid chewing showed no risk for lung, marginally increased risk for oropharyngeal and about a sixfold increased risk for oral cavity cancer. Population-attributable risk per cent (PARP) was observed to be 82.7% and 71.6% for smokers for the development of lung and oropharyngeal cancer, while the same was found to be 66.1% for tobacco chewers for the development of oral cavity cancer. CONCLUSIONS: These data provide strong evidence that smoking bidi is even more hazardous than cigarette smoking in the development of lung and oropharyngeal cancer. An intervention study to prevent the use of tobacco will be useful in this population as it also underwent gas exposure due to a chemical accident in 1984.     

Variation in the prevention of cardiovascular risk factors. A population-based study

BACKGROUND: Published studies on clinical practice variability have mainly focussed on variability in the rates of hospitalization and surgical procedures. The objective of this study was to evaluate variability in the measurement of cholesterolemia and blood pressure in four professional groups and in the general population. METHODS: A cross-sectional survey was performed by mail in the city of Valencia (Spain). Five population groups were selected: physicians, nurses, lawyers, architects and the general population. The sample was obtained by random sampling of each group. RESULTS: Of all the questionnaires returned, only those returned by individuals surveyed (1,755) and their partners (1,296) were used (total: 3,050). The frequency of preventive cholesterolemia measurement was greater among nurses (55.7%) and physicians (54.1%) than among architects (38.9%), lawyers (38.2%) and the general population (35.1%). The frequency of preventive blood pressure measurement was also greater among physicians (47.7%) and nurses (42.2%) followed by architects (39.4%) and lawyers (38.8%) and was lower among the general population (32.2%). After adjusting by sex, age group, marital status, level of education, and employment, only lawyers (RR = 0.79; 95% CI, 0.6-0.9) and architects (RR = 0.77; 95% CI, 0.68-0.88) showed a significantly lower probability of determining cholesterol levels than physicians (basal category) and nurses (RR = 1.05; 95% CI, 0.93-1.18). The general population showed the lowest probability of measuring blood pressure (RR = 0.8; 95% CI, 0.65-0.97), although the differences were statistically significant only when compared with physicians. CONCLUSIONS: Preventive practices should be increased among groups in which they are less frequently performed until they are performed with the same frequency as among physicians and nurses. Efforts should be directed to increasing cardiovascular prevention programs in health centers.     

Cancer patients' awareness about their diagnosis: a population-based study

BACKGROUND: The aim of the study was to evaluate Norwegian cancer patients' awareness of their prior cancer diagnosis in a general population-based study. METHODS: A cross-sectional population-based study of cancer patients' responses to the index question: 'Do you have or have you had cancer?' was carried out. We assessed correctness of the response in relation to cancer site, date of diagnosis, marital status, age and education. Smoking was chosen as a marker of health awareness. A total of 65,330 persons participated in the Nord-Tr?ndelag Health Survey (HUNT-II), performed in 1995-1997. The database of HUNT-II was merged with the Cancer Registry of Norway (CRN), thus identifying each of the 2983 (4 percent) participants with an invasive cancer diagnosis. RESULTS: Excluding basal cell epithelioma, a total of 20 percent of the patients denied their prior cancer diagnosis. This group consisted mainly of men (54 percent) and those who were diagnosed as very young or as elderly. More smokers than non-smokers were unaware of their prior malignancy (24 percent versus 20 percent). CONCLUSIONS: A 20 percent rate of patients who denied their former malignancy is surprisingly and unacceptably high. Disclosure of a cancer diagnosis should help the patient to develop increased health awareness. It should enable a person to report his or her former cancer diagnosis when necessary.     

A method for spatial analysis of risk in a population-based case-control study

Spatial distributions of disease occurrence and risk have traditionally served as a tool for identifying exposures of public health concern. Current software for manipulating geographic data (GIS) now allows many kinds of analyses not feasible before. This paper presents a method for producing a "picture" of disease risks based on residential history data from a population based case-control study. We illustrate the method using geographically coded data on individual-level risk factors, such as age and smoking, from a cancer study of the Upper Cape Cod region of Massachusetts for 1983-1986. Our results show the association between lung cancer and residential location as an indicator of exposure. Crude and adjusted odds ratios were estimated by adaptive rate stabilization and mapped using kriging as an interpolation method to examine the risk of lung cancer in the region. The crude and adjusted surfaces for various smoothing parameters were compared to identify areas of increased lung cancer not explained by standard risk factors. Such spatial patterns of disease risk may provide clues to exposures of importance or confirm associations with previously suspected exposures.     

Childbearing and the risk of scleroderma: a population-based study in Sweden

This study examined associations between childbearing and risk of scleroderma by using national population-based registry data from Sweden. Women with a discharge diagnosis of scleroderma from 1964 to 1999 (n = 2,149) were identified in the Swedish Inpatient Register. These cases were matched by year and month of birth and region of residence to as many as five controls obtained from the Multi-Generation Register. Pregnancy history (number of births, age at each birth) was restricted to births before the first scleroderma-related hospitalization for cases and the corresponding age for their matched controls. Risk estimates, measured by the odds ratio and 95% confidence interval, were obtained by using conditional logistic regression. Nulliparity was associated with an increased risk of scleroderma (odds ratio = 1.37, 95% confidence interval: 1.22, 1.55). Risk decreased with increasing number of births. Similar results were found when analyses were limited to births up to 2 years or up to 5 years before hospitalization. Among parous women, younger age at first birth was associated with an increased risk of scleroderma. The association between lower parity and increased risk of scleroderma could reflect subfecundity caused by scleroderma before disease became clinically evident, possible common causes of infertility and scleroderma, or a protective effect of pregnancy through an unknown mechanism.     

Maternal cigarette smoking and oral clefts: a population-based study.

Analyses of 1984 data from the Maryland Birth Defects Reporting and Information System indicate that mothers of infants with oral clefts (cleft lip with or without cleft palate; and cleft palate) smoked more during pregnancy than mothers of infants with other defects (odds ratio OR of 2.56 and 2.39, respectively). There was a dose-response relation between the daily amount smoked and the risk of clefting. Adjustment for available confounding variables did not account for the association between smoking and oral clefts.     

尿石症危险因素人群病例对照研究

目的 探索尿石症发病的危险因素，为人群预防提供依据。方法 选取深圳市尿石症现况调查发现的334例患者为病例组，721名健康者为对照组，进行尿石症危险因素人群病例对照研究；采用非条件logistic回归对34个变量进行分析，采用Falconer回归法估算遗传变。结果 尿石症病例组和对照组配比条件均衡可比，单因素logistic回归分析共有17个变量有统计学意义，但最终进入模型的因素有10个，其中4个变量为尿石症发病危险因素，OR值大小依次为既往泌尿系慢性炎症史（OR＝4.09,95%CI:1.38-12.14)，一级亲属尿石症史（OR＝2.61,95%CI:1.70-4.01)和多食动物蛋白质（OR＝2．14，95％CI：1．71－2．69），暴露日照时间长（OR＝1．39，95％CI：1．16－1．66）；而较高文化程度（OR＝0．46，95％CI：0．29－0．73），日引水量多（OR＝0．59，95％CI：0．48－0．72），饮果汁（OR＝0．41，95％CI：0．18－0．94），多食奶及奶制品（OR＝0．82，95％CI：0．68－0．99），多食蔬菜（OR＝0．70，95％CI：0．55－0．91）和多食水果（OR＝0．78，95％CI：0．64－0．94）6个变量为尿石症发病的保护因素。一级亲属尿石症患病率病例组高于对照组，尿石症分离比为0．0109，95％CI：0．0050－0．0168，一级亲属尿石症的遗传度为28．48％，男，女分别为32．06％和24．60％。结论 尿石症主要受饮食习惯影响，尿石症家族史和社会经济状况也与发病有关。     

Differences in risk estimations from a hospital and a population-based case-control study

A hospital-based and population-based case-control study of cervical cancer (in situ and invasive) was conducted in urban Utah to determine if methods of respondent selection affect estimates of risk for variables thought to be associated with the disease. Population cases (N = 409) and cases from two large hospitals (N = 124) were identified through the Utah Cancer Registry. Population-based controls (N = 379) were identified through random-digit dialing; hospital-based controls (N = 150) with gynaecological disorders other than cancers and elective abortions were chosen from the same hospitals as the cases for the hospital study. Both control groups were frequency matched to cases by age. Approximately 79% of the identified cases and 85% of the selected controls completed interviews conducted in their homes. Most risk estimates were lower in the hospital-based study because of the more case-like attributes of this group. Stratified analysis for social class led to adjusted risk estimates which were lower than the unadjusted risk estimates for the population-based study, but not for the hospital-based study. The close social class matching in the hospital-based study seems to have led to concurrent overmatching on other risk factors since many of these are closely related to social class. Findings are discussed in terms of implications for case-control study design.