|
1
|
Kedlaya MN, Ramesh A, Hosmane GB, Bhandary R, Sajna HR, Thomas B. Comparative evaluation of serum cotinine levels in chronic periodontitis and chronic obstructive pulmonary disease. J Indian Soc Periodontol 2021; 25:405-410. [PMID: 34667383 PMCID: PMC8452176 DOI: 10.4103/jisp.jisp_546_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 03/14/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022] Open
Abstract
Context: Periodontitis and chronic obstructive pulmonary disease (COPD) are chronic progressive inflammatory conditions. Smoking has been associated with both chronic periodontitis and COPD. Hence, the present study was designed to correlate serum levels of cotinine with the severity of periodontal disease with or without COPD. Settings and Design: A total of eighty patients, twenty healthy individuals, twenty patients with chronic generalized periodontitis without smoking and without COPD, twenty patients who are smokers with chronic periodontitis without COPD and twenty patients who are smokers with chronic periodontitis and COPD in the age range of 43–65 years were selected for the study. Subjects and Methods: Serum cotinine level assessment, smoking history, and periodontal examination were done in all the patients and the data obtained were statistically analyzed. Results: The mean serum cotinine level was highest in smokers with chronic periodontitis and COPD (93.642 ± 14.727) and it differed significantly between the four groups (P < 0.001). There is a significant positive correlation between the number of cigarettes and serum cotinine levels in both groups involving smoking. There was no significant correlation between serum cotinine level and clinical attachment loss in chronic periodontitis smokers with or without COPD. Conclusions: The result of this study indicates that increased smoking with COPD causes a higher chance of progression of periodontal destruction but it is not statistically significant. Furthermore, this study indicates that the assessment of serum cotinine levels is a reliable method to evaluate smoking exposure.
Collapse
Affiliation(s)
- Madhurya Nagaraj Kedlaya
- Department of Periodontology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Amitha Ramesh
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte deemed to be University, Mangalore, Karnataka, India
| | - Giridhar Belur Hosmane
- Department of Pulmonary Medicine, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Rahul Bhandary
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte deemed to be University, Mangalore, Karnataka, India
| | | | - Biju Thomas
- Department of Periodontics, A B Shetty Memorial Institute of Dental Sciences, Nitte deemed to be University, Mangalore, Karnataka, India
| |
Collapse
|
|
2
|
Hovanec J, Weiß T, Koch H, Pesch B, Behrens T, Kendzia B, Arendt M, Dragano N, Moebus S, Schmidt B, Brüning T, Jöckel KH. Smoking and urinary cotinine by socioeconomic status in the Heinz Nixdorf Recall Study. J Epidemiol Community Health 2019; 73:489-495. [DOI: 10.1136/jech-2018-211952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 11/03/2022]
Abstract
BackgroundAssociations of socioeconomic status (SES) and smoking-related diseases depend on uniform validity of self-reported smoking habits in different SES groups. We investigated the influence of SES on validity of self-reported smoking status by means of urinary cotinine.MethodsWe determined total urinary cotinine in the baseline population of the Heinz Nixdorf Recall Study. Participants with cotinine>200 µg/L were potential current smokers. We defined upper and lower 20% of the gender-specific distribution of the International Socio-Economic Index (ISEI) as high and low SES, respectively, else as intermediate. We analysed the association of self-reported smoking status and cotinine by ISEI and additional SES measures, stratified by gender. In self-reported non-smokers, we estimated age-adjusted ORs with 95% CI to detect differences by SES in the validity of self-reported smoking status.ResultsIn 2004 men and 1887 women, 78% and 80%, respectively, reported to be non-smokers. Median cotinine concentrations were 2 µg/L in non-smokers, and 3651 µg/L in male and 3127 µg/L in female smokers. Based on cotinine in non-smokers, 2.0 % of men (n = 32) and 1.8 % of women (n = 27) were potential smokers, with lower proportions in the subgroup of never-smokers (men: 0.7%, women: 0.5%). The validity of self-reported smoking status did not substantially differ by SES. Tendencies for increased underreporting were indicated for women with low ISEI (OR 1.35; 95% CI 0.54 to 3.39) and men in blue-collar jobs (OR 1.39; 95% CI 0.67 to 2.87).ConclusionValidity of self-reported smoking status in this elderly German cohort was high and did not depend on SES.
Collapse
|
|
3
|
Hamling JS, Coombs KJ, Lee PN. Misclassification of smoking habits: An updated review of the literature. World J Meta-Anal 2019; 7:31-50. [DOI: 10.13105/wjma.v7.i2.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 02/06/2023] Open
|
|
4
|
Holtermann A, Gyntelberg F, Bauman A, Jensen MT. Cardiorespiratory fitness, fatness and incident diabetes. Diabetes Res Clin Pract 2017; 134:113-120. [PMID: 28993157 DOI: 10.1016/j.diabres.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023]
Abstract
AIMS Increases in prevalence have led to a diabetes pandemic. Obesity and low cardiorespiratory fitness (CRF) are considered to be central mechanisms. We investigated if the effect of CRF on diabetes risk was equivalent across levels of fatness among healthy men. METHODS In total 4988 middle-aged Caucasian employed men free of cardiovascular disease, diabetes and cancer were included from the Copenhagen Male Study starting in 1970-71. CRF was assessed using a sub-maximal bicycle ergometer test and body mass index (BMI) was measured by height and weight. Their interaction and stratified associations with diabetes incidence were estimated in multivariable Cox-models including conventional risk factors and social class. Diabetes incidence was assessed through a national register. RESULTS During 44 years of follow-up, 518 (10.4%) incident cases of diabetes occurred. In the multi-adjusted model, the obese had a significantly higher risk of diabetes compared to normal weight men (Hazard Ratio (HR):4.89; 95% CI: 3.62-6.61) and CRF was significantly inversely associated with diabetes (HR:0.86; 95% CI: 0.75-0.98 per 10-unit increase in ml/kg/min1 CRF). A significant multi-adjusted interaction between CRF, BMI and diabetes was found (p=0.009). The stratified multi-adjusted analyses on BMI showed a significantly stronger reduced risk of diabetes per 10-unit increase in ml/kg/min1 of CRF among the obese (HR:0.58; CI: 0.38-0.89), but a weaker association among overweight (HR:0.86; CI: 0.71-1.03) and normal weight (HR:0.97; CI: 0.76-1.23). CONCLUSION High CRF has a stronger protective effect on diabetes among obese than among normal weight men, supporting the recommendation of fitness-enhancing physical activity for preventing diabetes among the obese.
Collapse
Affiliation(s)
- Andreas Holtermann
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Finn Gyntelberg
- National Research Centre for the Working Environment, Lersø Parkalle 105, Copenhagen, Denmark; The Copenhagen Male Study, Epidemiological Research Unit, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Adrian Bauman
- Sydney School of Public Health, The University of Sydney, 2006 Sydney, Australia
| | | |
Collapse
|
|
5
|
Jensen MT, Holtermann A, Bay H, Gyntelberg F. Cardiorespiratory fitness and death from cancer: a 42-year follow-up from the Copenhagen Male Study. Br J Sports Med 2016; 51:1364-1369. [DOI: 10.1136/bjsports-2016-096860] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/03/2022]
|
|
6
|
Osler M, Holstein B, Avlund K, Damsgaard MT, Rasmussen NK. Socioeconomic position and smoking behaviour in Danish adults. Scand J Public Health 2016. [DOI: 10.1177/14034948010290010801] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: The associations between smoking and various socioeconomic indicators may have different implications and causes, which may also vary according to sex and birth cohort. This study analyses how two dimensions of socioeconomic position, an individual ( education) and a structural ( occupation) indicator, are associated with ever, current and ex-smoking. Methods: Data on smoking behaviour were collected in five cross-sectional surveys of random samples of the general Danish population aged 20 years or more at intervals between 1982 and 1994. In total, 8,054 men and 8,281 women participated. Logistic regression was used to analyse the infl uence of education and occupation on smoking behaviour controlling for sex and birth cohort. Results: In cohorts born after 1930 ever and current smoking were related to years of school education and current occupation. The prevalences of ever and current smoking were highest among the least educated, unskilled workers, unemployed persons and persons who received welfare benefits. A significant interaction between birth cohort and education indicated that the educational difference in ever and current smoking increased significantly with increasing year of birth. In multivariate analysis controlling for sex and birth cohort, ex-smoking seemed to be more strongly associated with education than occupation .Those with 12 or more years of school education had twice as high a chance of being ex-smokers as those with 7 years of school or less. Conclusion: Smoking behaviour is strongly associated with both individual and structural indicators of socioeconomic position in Danish adults in all cohorts except for those born before 1930.
Collapse
Affiliation(s)
- Merete Osler
- Institute of Public Health, University of Copenhagen, M.Osler socmed.ku.dk, The Copenhagen County Centre for Preventive Medicine, Glostrup University Hospital, Denmark
| | | | - Kirsten Avlund
- Institute of Public Health, University of Copenhagen, The Copenhagen County Centre for Preventive Medicine, Glostrup University Hospital, Denmark
| | | | | |
Collapse
|
|
7
|
Guo H, Sa Z. Socioeconomic differentials in smoking duration among adult male smokers in China: result from the 2006 China Health and Nutrition Survey. PLoS One 2015; 10:e0117354. [PMID: 25575097 PMCID: PMC4289072 DOI: 10.1371/journal.pone.0117354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/21/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A smoker's risk of diseases and death from smoking is closely related to his/her smoking duration. But little is known about the average length of smoking and the association between smoking duration and socio-economic status (SES) among Chinese smokers. METHODS A sample of male ever smokers (N = 2,637) aged 18+ years was drawn from the 2006 China Health and Nutrition Survey to examine the average length of smoking and socioeconomic differentials in smoking duration. Kaplan-Meier analysis was used to obtain median smoking duration. Log-logistic regression models were employed to estimate the relative duration of smoking, adjusted for demographic characteristics, smoking history, and health status. RESULTS Results showed that Chinese male ever smokers aged 18 years and older had a median duration of smoking of 58 years (95% CI: 56-61). Male ever smokers with a lower status job (i.e. farmers, manual and skilled workers, service workers, and office staff) had a significantly longer duration of smoking than those with a professional or administrative job after adjusted for demographic characteristics, smoking history, and health status. Individuals who earned the lowest income and who had no education or were being illiterate smoked for 11% and 14% longer, respectively, relative to those who had the highest income or who had college or above education. CONCLUSION The findings demonstrated the problem of long smoking duration and a pattern of social disparities in smoking duration among Chinese male smokers. Social disparities in smoking behavior may exacerbate the already existing social inequalities in health. Thus, policies and interventions to promote smoking cessation should pay more attention to disadvantaged social groups.
Collapse
Affiliation(s)
- Hong Guo
- Independent Researcher, Beijing, China
| | - Zhihong Sa
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| |
Collapse
|
|
8
|
Kulik MC, Eikemo TA, Regidor E, Menvielle G, Mackenbach JP. Does the pattern of educational inequalities in smoking in Western Europe depend on the choice of survey? Int J Public Health 2014; 59:587-97. [DOI: 10.1007/s00038-014-0560-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 04/07/2014] [Accepted: 04/23/2014] [Indexed: 11/24/2022] Open
|
|
9
|
Ferrario MM, Veronesi G, Chambless LE, Tunstall-Pedoe H, Kuulasmaa K, Salomaa V, Borglykke A, Hart N, Söderberg S, Cesana G. The contribution of educational class in improving accuracy of cardiovascular risk prediction across European regions: The MORGAM Project Cohort Component. Heart 2014; 100:1179-87. [PMID: 24794139 DOI: 10.1136/heartjnl-2013-304664] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess whether educational class, an index of socioeconomic position, improves the accuracy of the SCORE cardiovascular disease (CVD) risk prediction equation. METHODS In a pooled analysis of 68 455 40-64-year-old men and women, free from coronary heart disease at baseline, from 47 prospective population-based cohorts from Nordic countries (Finland, Denmark, Sweden), the UK (Northern Ireland, Scotland), Central Europe (France, Germany, Italy) and Eastern Europe (Lithuania, Poland) and Russia, we assessed improvements in discrimination and in risk classification (net reclassification improvement (NRI)) when education was added to models including the SCORE risk equation. RESULTS The lowest educational class was associated with higher CVD mortality in men (pooled age-adjusted HR=1.64, 95% CI 1.42 to 1.90) and women (HR=1.31, 1.02 to 1.68). In men, the HRs ranged from 1.3 (Central Europe) to 2.1 (Eastern Europe and Russia). After adjustment for the SCORE risk, the association remained statistically significant overall, in the UK and Eastern Europe and Russia. Education significantly improved discrimination in all European regions and classification in Nordic countries (clinical NRI=5.3%) and in Eastern Europe and Russia (NRI=24.7%). In women, after SCORE risk adjustment, the association was not statistically significant, but the reduced number of deaths plays a major role, and the addition of education led to improvements in discrimination and classification in the Nordic countries only. CONCLUSIONS We recommend the inclusion of education in SCORE CVD risk equation in men, particularly in Nordic and East European countries, to improve social equity in primary prevention. Weaker evidence for women warrants the need for further investigations.
Collapse
Affiliation(s)
- Marco M Ferrario
- Dipartimento di Medicina Clinica e Sperimentale, Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy
| | - Giovanni Veronesi
- Dipartimento di Medicina Clinica e Sperimentale, Centro Ricerche EPIMED-Epidemiologia e Medicina Preventiva, Università degli Studi dell'Insubria, Varese, Italy
| | - Lloyd E Chambless
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, UK
| | - Kari Kuulasmaa
- Department of Chronic Disease Prevention, THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- Department of Chronic Disease Prevention, THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Anders Borglykke
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Nigel Hart
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Cardiology and Heart Centre, Umeå University, Umeå, Sweden
| | - Giancarlo Cesana
- Centro Studi e Ricerche in Sanità Pubblica (CESP), Università degli Studi di Milano-Bicocca, Monza, Italy
| | | |
Collapse
|
|
10
|
Bosdriesz JR, Mehmedovic S, Witvliet MI, Kunst AE. Socioeconomic inequalities in smoking in low and mid income countries: positive gradients among women? Int J Equity Health 2014; 13:14. [PMID: 24502335 PMCID: PMC3922442 DOI: 10.1186/1475-9276-13-14] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 01/19/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In Southern Europe, smoking among older women was more prevalent among the high educated than the lower educated, we call this a positive gradient. This is dominant in the early stages of the smoking epidemic model, later replaced by a negative gradient. The aim of this study is to assess if a positive gradient in smoking can also be observed in low and middle income countries in other regions of the world. METHODS We used data of the World Health Survey from 49 countries and a total of 233,917 respondents. Multilevel logistic regression was used to model associations between individual level smoking and both individual level and country level determinants. We stratified results by education, occupation, sex and generation (younger vs. older than 45). Countries were grouped based on GDP and region. RESULTS In Eastern Europe and the Eastern Mediterranean, we observed a positive gradient in smoking among older women and a negative gradient among younger women. In Sub-Saharan Africa and Latin America no clear gradient was observed: inequalities were relatively small. In South-East Asia and East Asia a strong negative gradient was observed. Among men, no positive gradients were observed, and like women the strongest negative gradients were seen in South-East Asia and East Asia. CONCLUSIONS A positive socio-economic gradient in smoking was found among older women in two regions, but not among younger women. But contrary to predictions derived from the smoking epidemic model, from a worldwide perspective the positive gradients are the exception rather than the rule.
Collapse
Affiliation(s)
- Jizzo R Bosdriesz
- Department of Public Health, Academic Medical Centre -University of Amsterdam, Amsterdam, The Netherlands
| | - Selma Mehmedovic
- Department of Public Health, Academic Medical Centre -University of Amsterdam, Amsterdam, The Netherlands
| | - Margot I Witvliet
- Department of Public Health, Academic Medical Centre -University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre -University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
|
11
|
Socioeconomic inequalities in current daily smoking in five Turkish regions. Int J Public Health 2013; 59:251-60. [DOI: 10.1007/s00038-013-0476-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 04/08/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022] Open
|
|
12
|
Gorini G, Carreras G, Allara E, Faggiano F. Decennial trends of social differences in smoking habits in Italy: a 30-year update. Cancer Causes Control 2013; 24:1385-91. [PMID: 23639993 DOI: 10.1007/s10552-013-0218-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/24/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To update educational inequalities in smoking in Italy up to 2009, with an in-depth analysis of female prevalence. METHODS Data from 15 national health surveys (1980, 1983, 1986-1987, 1990, 1994, 1999-2003, 2005-2009) were analyzed. The overall sample size was representative of the population older than 25 years of age (3,300,000 men and 3,620,000 women). Main measures smoking prevalence rates standardized to the 2,000 European population, prevalence ratios by educational level (high: university degree or high school diploma; low: primary or middle school diploma), area (north, center, south and islands), and age-group (25-44, 45-59, >=60 years). Trends in tobacco prevalence were also analyzed with a multivariate approach using the negative binomial distribution. RESULTS Although male prevalence steadily declined of about 2% annually from 56.1% in 1980 to 30.2% in 2009, educational inequalities slightly widened, recording in 2009 a 53% higher prevalence in men with low educational level compared to graduates. Even though female prevalence stalled around 18% in the last three decades, this was the result of opposite trends by educational group. In fact, highly educated women, with the highest prevalence during 1980s, decreased their tobacco use, determining a reversal similar to men in educational inequalities in smoking. This reversal occurred from the 1980s onwards with a time gradient starting from north to south and from younger to older women. CONCLUSION To achieve a fairer reduction in smoking habits, tobacco control policies focusing on lower social groups are needed.
Collapse
Affiliation(s)
- Giuseppe Gorini
- Environmental and Occupational Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence, Italy.
| | | | | | | |
Collapse
|
|
13
|
Jensen MT, Suadicani P, Hein HO, Gyntelberg F. Elevated resting heart rate, physical fitness and all-cause mortality: a 16-year follow-up in the Copenhagen Male Study. Heart 2013; 99:882-7. [PMID: 23595657 PMCID: PMC3664385 DOI: 10.1136/heartjnl-2012-303375] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To examine whether elevated resting heart rate (RHR) is an independent risk factor for mortality or a mere marker of physical fitness (VO2Max). Methods This was a prospective cohort study: the Copenhagen Male Study, a longitudinal study of healthy middle-aged employed men. Subjects with sinus rhythm and without known cardiovascular disease or diabetes were included. RHR was assessed from a resting ECG at study visit in 1985–1986. VO2Max was determined by the Åstrand bicycle ergometer test in 1970–1971. Subjects were classified into categories according to level of RHR. Associations with mortality were studied in multivariate Cox models adjusted for physical fitness, leisure-time physical activity and conventional cardiovascular risk factors. Results 2798 subjects were followed for 16 years. 1082 deaths occurred. RHR was inversely related to physical fitness (p<0.001). Overall, increasing RHR was highly associated with mortality in a graded manner after adjusting for physical fitness, leisure-time physical activity and other cardiovascular risk factors. Compared to men with RHR ≤50, those with RHR >90 had an HR (95% CI) of 3.06 (1.97 to 4.75). With RHR as a continuous variable, risk of mortality increased with 16% (10–22) per 10 beats per minute (bpm). There was a borderline interaction with smoking (p=0.07); risk per 10 bpm increase in RHR was 20% (12–27) in smokers, and 14% (4–24) in non-smokers. Conclusions Elevated RHR is a risk factor for mortality independent of physical fitness, leisure-time physical activity and other major cardiovascular risk factors.
Collapse
Affiliation(s)
- Magnus Thorsten Jensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
| | | | | | | |
Collapse
|
|
14
|
Federico B, Mackenbach JP, Eikemo TA, Kunst AE. Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group. Addiction 2012; 107:1677-86. [PMID: 22360495 DOI: 10.1111/j.1360-0443.2012.03853.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To estimate the immediate as well as the longer-term impact of the 2005 smoke-free law on smoking prevalence, cessation and intensity both in the overall population and separately by educational level. DESIGN Interrupted time-series analyses of 11 cross-sectional nationally representative surveys. SETTING Italy, 1999-2010. PARTICIPANTS Adults aged 20-64 years. MEASUREMENTS For each year we computed the prevalence of current smoking, the quit ratio and the mean number of cigarettes smoked per day. All measures were standardized by age. Segmented linear regression analyses were performed for each smoking variable separately by sex. FINDINGS Among males, smoking prevalence decreased by 2.6% (P = 0.002) and smoking cessation increased by 3.3% (P = 0.006) shortly after the ban, but both measures tended to return to pre-ban values in the following years. This occurred among both highly and low-educated males. Among low-educated females, the ban was followed by a 1.6% decrease (P = 0.120) in smoking prevalence and a 4.5% increase in quit ratios (P < 0.001). However, these favourable trends reversed over the following years. Among highly educated females, trends in smoking prevalence and cessation were not altered by the ban. Among both males and females, long-term trends in the daily number of cigarettes, which were already declining well before the implementation of the policy, changed to a minor extent. CONCLUSION The impact of the Italian smoke-free policy on smoking and inequalities in smoking was short-term. Smoke-free policies may not achieve the secondary effect of reducing smoking prevalence in the long term, and they may have limited effects on inequalities in smoking.
Collapse
Affiliation(s)
- Bruno Federico
- Department of Health and Sport Sciences, University of Cassino, Cassino, Italy.
| | | | | | | |
Collapse
|
|
15
|
Généreux M, Roy M, Montpetit C, Azzou SAK, Gratton J. Regional surveillance of social and geographic inequalities in smoking: the case of Montréal, Canada. Health Place 2011; 18:240-9. [PMID: 22019850 DOI: 10.1016/j.healthplace.2011.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 07/08/2011] [Accepted: 09/22/2011] [Indexed: 11/30/2022]
Abstract
Surveillance of social inequalities in health is a platform for action. We examined the trends in smoking behaviours (current and ever smoking, quit ratios) according to education and place of residence and we quantified the observed inequalities. Data were from repeated cross-sectional surveys (2003-2009) of Montreal (Canada) residents ≥15 years (n=12,053). Trends in smoking behaviours according to education were measured with logistic and log-binomial regressions. Spatial distribution of smoking behaviours across local areas was assessed with Morans' Index. Observed inequalities were quantified with prevalence ratio and difference, population attributable risk, and slope index of inequality. Results showed that ever smoking rose among low-educated individuals. Among their high-educated fellow-citizens, current smoking decreased and quit ratios increased. Adverse smoking behaviours (current and ever smoking) were clustered in south-central areas. We conclude that smoking inequalities in Montreal are growing. We thus encourage a closer monitoring of smoking social differentials.
Collapse
Affiliation(s)
- Mélissa Généreux
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.
| | | | | | | | | |
Collapse
|
|
16
|
Suadicani P, Hein HO, Gyntelberg F. High Salt Intake and Risk of Chronic Bronchitis: The Copenhagen Male Study—A 10-Year Followup. ACTA ACUST UNITED AC 2011. [DOI: 10.5402/2011/257979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. The role of salt intake as a risk factor for asthma, bronchial hyperresponsiveness, and other bronchial symptoms has been addressed in a number of studies. Collectively, these studies indicate an increased risk of bronchial symptoms with high consumption of salt, but the issue remains controversial. We tested prospectively the hypothesis that salt intake would be an independent risk factor for chronic bronchitis (CB). Design. A 10-year prospective study of 2,183 men aged 46 to 65 years without any relevant lung symptoms at baseline. Main Outcome. Chronic bronchitis. Results. During the 10-year followup, the overall incidence of CB was 7.1% among men without any relevant lung symptoms at baseline. In a multiple logistic regression analysis, controlling for age, smoking habits, occupational dust exposure, alcohol use, and social class, the odds ratio associated with self-assessed high salt preference (reported by 24%) was 1.6 (1.1–2.4). Interpretation. The results suggest that salt restriction may prevent chronic bronchitis.
Collapse
Affiliation(s)
- Poul Suadicani
- The Copenhagen Male Study, Epidemiological Research Unit, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Hans Ole Hein
- The Copenhagen Male Study, Epidemiological Research Unit, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
- Research Centre for Prevention and Health, Glostrup University Hospital, Copenhagen, Denmark
| | - Finn Gyntelberg
- The Copenhagen Male Study, Epidemiological Research Unit, Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| |
Collapse
|
|
17
|
Gyntelberg F, Hein HO, Suadicani P. Determinants of obesity among men with the lewis double-negative blood group: a genetic marker of obesity-the Copenhagen Male Study. Metab Syndr Relat Disord 2010; 9:99-103. [PMID: 21117959 DOI: 10.1089/met.2010.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Middle-aged and elderly men with the Lewis blood group phenotype Le(a-b-), have a two-fold higher prevalence of obesity than others. We investigated if the association could be ascribed to differences in lifestyle, or if obesity determinants had a different impact in this group. METHOD This was a cross-sectional study of 3,290 men aged 53-74 years with a mean of 63 years drawn from the Copenhagen Male Study. The main outcome measure was prevalence of obesity [body mass index (BMI) ≥30 (kg/m(2))]. RESULTS Among men with the Le(a-b-) phenotype (n = 315), the prevalence of obesity was 15.6%; it was 8.1% among men with other phenotypes (n = 2,975, p < 0.001). Obesity-related life style habits did not differ between Le(a-b-) and other men. In multiple logistic regression analyses, the role of obesity covariates was conspicuously different between men with the Le(a-b-) phenotype and men with other Lewis phenotypes. However, among Le(a-b-) men, a much stronger inverse association was found between high coffee consumption (>7 cups/day vs. less) and obesity, and between lacking fat avoidance and obesity; the odds ratio [95% confidence interval (CI)] for high coffee consumption was 0.2(0.1-0.7) and for avoidance of fatty foods 2.0(1.04-3.7). The association of obesity with leisure time physical activity, smoking, alcohol use, use of sugar in hot beverages, and tea consumption, did not differ between Le(a-b-) men and others. CONCLUSIONS Our findings suggests a gene-environment interaction between lifestyle and obesity. Because some ethnic groups have up to 40% with the Le(a-b-) phenotype, the above observations may be of significant public health interest.
Collapse
Affiliation(s)
- Finn Gyntelberg
- Bispebjerg Hospital, University of Copenhagen, Epidemiological Research Unit, Department of Occupational and Environmental Medicine, Copenhagen, Denmark.
| | | | | |
Collapse
|
|
18
|
Antihypertensive Treatment, High Triglycerides, and Low High-Density Lipoprotein Cholesterol and Risk of Ischemic Heart Disease Mortality: A 16-Year Follow-Up in the Copenhagen Male Study. Metab Syndr Relat Disord 2010; 8:215-22. [DOI: 10.1089/met.2009.0072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
|
19
|
Chapman B, Fiscella K, Duberstein P, Kawachi I. Education and smoking: confounding or effect modification by phenotypic personality traits? Ann Behav Med 2009; 38:237-48. [PMID: 20049661 PMCID: PMC2820130 DOI: 10.1007/s12160-009-9142-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Little is known about whether educational gradients in smoking patterns can be explained by financial measures of socioeconomic status (SES) and/or personality traits. PURPOSE To assess whether the relationship of education to (1) never smoking and (2) having quit smoking would be confounded by financial measures of SES or by personality; whether lower Neuroticism and higher Conscientiousness would be associated with having abstained from or quit smoking; and whether education effects were modified by personality. METHOD Using data from the Midlife Development in the US National Survey, 2,429 individuals were classified as current (n = 695), former (n = 999), or never (n = 735) smokers. Multinomial logistic regressions examined study questions. RESULTS Greater education was strongly associated with both never and former smoking, with no confounding by financial status and personality. Never smoking was associated with lower Openness and higher Conscientiousness, while have quit was associated with higher Neuroticism. Education interacted additively with Conscientiousness to increase and with Openness to decrease the probability of never smoking. CONCLUSIONS Education and personality should be considered unconfounded smoking risks in epidemiologic and clinical studies. Educational associations with smoking may vary by personality dispositions, and prevention and intervention programs should consider both sets of factors.
Collapse
Affiliation(s)
- Benjamin Chapman
- Laboratory of Personality and Development, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden, Rochester, NY 14642, USA.
| | | | | | | |
Collapse
|
|
20
|
Suadicani P, Hein HO, von Eyben FE, Gyntelberg F. Metabolic and lifestyle predictors of ischemic heart disease and all-cause mortality among normal weight, overweight, and obese men: a 16-year follow-up in the Copenhagen Male Study. Metab Syndr Relat Disord 2009; 7:97-104. [PMID: 19032035 DOI: 10.1089/met.2008.0041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The aim of this study was to identify metabolic and lifestyle risk factors for ischemic heart disease (IHD) and all-cause mortality (ACM) among normal weight, overweight, and obese men. METHODS This was a 16-year follow up of 2982 men 53 to 75 years without overt cardiovascular disease. POTENTIAL RISK FACTORS: These were blood pressure, diabetes, fasting serum triglycerides (TGs) and high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glucosuria, cancer, body mass index (BMI), alcohol, tobacco, leisure-time physical activity, social class, and age. MAIN OUTCOME This was to determine mortality during 16 years of follow-up. RESULTS A total of 194 men (6.5%) died due to IHD and 1184 (39.8%) from all causes. All lifestyle factors and clinical/metabolic risk factors were associated with BMI, positively or negatively. Risk of IHD and ACM increased gradually from the normal weight (BMI 20.0-25.0) to higher BMI groups. With respect to IHD, compared to normal weight men, obese men (BMI > or = 30.0) had an age-adjusted hazard ratio (HR) (95%CI) of 1.67(1.04-2.68); adjusted for potential confounders HR was 0.99 (0.59-1.66); corresponding estimates for ACM were 1.21 (0.98-1.49) and 0.86 (0.68-1.09). High TG (>1.70 mmol/L) was an independent risk factor for IHD mortality only among men with BMI < or = 27.5 kg/m(2); low HDL-C (< or =1.03 mmol/L) was an independent risk factor for IHD mortality only among men with BMI > 27.5 kg/m(2). Cumulative smoking and type 2 diabetes/glucosuria were the strongest risk factors of ACM among men with a BMI < or = 27.5 as well as men with a BMI > 27.5. CONCLUSION The importance of risk factors for IHD mortality, in particular serum TG and serum HDL-C, depends on BMI.
Collapse
Affiliation(s)
- Poul Suadicani
- Copenhagen Male Study, Epidemiologic Research Unit, Copenhagen University Hospital, Denmark.
| | | | | | | |
Collapse
|
|
21
|
Menvielle G, Boshuizen H, Kunst AE, Dalton SO, Vineis P, Bergmann MM, Hermann S, Ferrari P, Raaschou-Nielsen O, Tjønneland A, Kaaks R, Linseisen J, Kosti M, Trichopoulou A, Dilis V, Palli D, Krogh V, Panico S, Tumino R, Büchner FL, van Gils CH, Peeters PHM, Braaten T, Gram IT, Lund E, Rodriguez L, Agudo A, Sánchez MJ, Tormo MJ, Ardanaz E, Manjer J, Wirfält E, Hallmans G, Rasmuson T, Bingham S, Khaw KT, Allen N, Key T, Boffetta P, Duell EJ, Slimani N, Gallo V, Riboli E, Bueno-de-Mesquita HB. The role of smoking and diet in explaining educational inequalities in lung cancer incidence. J Natl Cancer Inst 2009; 101:321-30. [PMID: 19244178 PMCID: PMC2852413 DOI: 10.1093/jnci/djn513] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. METHODS To investigate the role of smoking in these inequalities, we used data from 391,251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. RESULTS During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII(men) = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100,000 person-years for lowest vs highest education level; RII(women) = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100,000 person-years) decreased after adjustment for smoking but remained statistically significant (RII(men) = 2.29, 95% CI = 1.75 to 3.01; RII(women) = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs < 1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. CONCLUSION Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.
Collapse
Affiliation(s)
- Gwenn Menvielle
- The National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
22
|
Tehranifar P, Liao Y, Ferris JS, Terry MB. Life course socioeconomic conditions, passive tobacco exposures and cigarette smoking in a multiethnic birth cohort of U.S. women. Cancer Causes Control 2009; 20:867-76. [PMID: 19238563 DOI: 10.1007/s10552-009-9307-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
Low socioeconomic status (SES) and exposure to passive tobacco smoke are associated with increased risk of smoking in adults, but the influences of these factors in earlier life periods on adult smoking behavior are not well understood. We investigated the relationship of SES and passive tobacco exposure over the lifecourse with adult smoking status in a multiethnic cohort of U.S. women (n = 262, average age = 41.8), using prospective data on maternal smoking during pregnancy and childhood SES, and follow-up data on current smoking, adult SES and household tobacco exposure. Low adolescent and adult SES consistently increased the risk of current smoking, but most associations were not statistically significant in multivariable models. Blue collar parental occupation at birth increased the risk of smoking, particularly for current smoking relative to former smoking (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.2-5.9). After adjusting for SES, current and former smokers were more likely than never smokers to have exposures to prenatal tobacco (OR = 4.4, 95% CI = 2.1-9.4 and OR = 2.0, 95% CI = 1.0-4.2, respectively) and adult household tobacco (OR = 2.7, 95% CI = 1.3-5.8 and OR = 2.4, 95% CI = 1.2-4.8, respectively). Our results show that early life conditions have enduring influences on women's smoking behavior in middle adulthood, even after considering similar types of conditions in later life periods.
Collapse
Affiliation(s)
- Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, 7th Floor, New York, NY 10032, USA.
| | | | | | | |
Collapse
|
|
23
|
Gyntelberg F, Hein HO, Suadicani P. Sugar in coffee or tea and risk of obesity: A neglected issue. Int J Food Sci Nutr 2009; 60 Suppl 3:56-64. [PMID: 19194815 DOI: 10.1080/09637480802668471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM In the Copenhagen Male Study sugar intake in coffee or tea is inversely associated with obesity. We analyzed the association of sugar intake with obesity among men with and without lifestyle factors indicating health awareness. METHODS A cross-sectional study of 3,290 men aged 53-75 years including information about smoking, alcohol, physical activity, tea and coffee use, avoidance of fatty food, social class, self-assessed health, and family obesity. RESULTS Overall, 291 men (8.8%) were obese, body mass index > or =30. Among men using sugar in coffee or tea (36%), the prevalence was 6.2%; among others, 10.3% (odds ratio [95% confidence interval]=0.6 [0.4-0.8]). An inverse association between use of sugar in hot beverages and prevalence of obesity was consistent in subgroups, and most pronounced among the least health-conscious [odds ratio [95% confidence interval]=0.4 [0.2-0.8]). INTERPRETATION The results indicate a weight-controlling or reducing effect of small amounts of sucrose ingested several times a day.
Collapse
Affiliation(s)
- Finn Gyntelberg
- The Copenhagen Male Study, Clinic of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | | |
Collapse
|
|
24
|
Connor Gorber S, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009; 11:12-24. [PMID: 19246437 DOI: 10.1093/ntr/ntn010] [Citation(s) in RCA: 786] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Smoking is a leading cause of premature mortality and preventable morbidity. Surveillance is most often based on self-reported data, but studies have shown that self-reports tend to underestimate smoking status. METHODS This study systematically reviewed the literature to measure the concordance between self-reported smoking status and smoking status determined through measures of cotinine in biological fluids. Four electronic databases were searched to identify observational and experimental studies on adult populations over the age of 18 years. RESULTS Searching identified 67 studies that met the eligibility criteria and examined the relationship between self-reported smoking and smoking confirmed by cotinine measurement. Overall, the data show trends of underestimation when smoking prevalence is based on self-report and varying sensitivity levels for self-reported estimates depending on the population studied and the medium in which the biological sample is measured. Sensitivity values were consistently higher when cotinine was measured in saliva instead of urine or blood. Meta-analysis was not appropriate because of the substantial heterogeneity among the cutpoints used to define smokers and the poor reporting on outcomes of interest. DISCUSSION Further research in this field would benefit from the standardization of cutpoints to define current smokers and the implementation of standard reporting guidelines to enhance comparability across studies. Accurate estimation of smoking status is important as data from population studies such as those included in this review are used to generate regional and national estimates of smoking status and in turn are used to allocate resources and set health priorities.
Collapse
Affiliation(s)
- Sarah Connor Gorber
- Health Measures Analysis Section, Health Information and Research Division, Statistics Canada, 24th Floor R.H. Coats Building, 100 Tunney's Pasture Driveway, Ottawa, ON, Canada K1A 0T6.
| | | | | | | | | |
Collapse
|
|
25
|
Lin YS, Wu DM, Chu NF, Lai HR, Shi ZP, Chen HI. Factors associated with cigarette smoking among young military conscripts in taiwan. J Chin Med Assoc 2008; 71:559-65. [PMID: 19015053 DOI: 10.1016/s1726-4901(08)70169-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify the most important risk factors that influence cigarette smoking among young adult military conscripts in Taiwan. METHODS A cross-sectional survey was conducted among young conscripts (19-25 years old) in Taiwan from August to December 2001. A total of 3,569 conscripts who had served more than 1 month in the military were chosen. Information regarding cigarette smoking and other factors was collected using a standard structured questionnaire. RESULTS Subjects whose lifestyles included betel-nut chewing (OR, 16.81; 95% CI, 11.35-25.91) and alcohol drinking (OR, 2.11; 95% CI, 1.54-2.90) were more likely to smoke compared to subjects without these adverse behaviors. Subjects whose education stopped at junior high school or before were more likely to smoke compared to those with a university degree (OR, 5.36; 95% CI, 3.77-7.69). Subjects who had a higher proportion of peers who smoked were more likely to smoke compared to those with no peers who smoked (OR, 3.16; 95% CI, 2.42-4.15). Subjects whose parents and peers approved of smoking were also at a higher risk for smoking compared with those whose parents and peers disapproved (father's approval---OR, 3.28 and 95% CI, 2.02-5.43; mother's approval---OR, 3.11 and 95% CI, 1.47-7.12; peer approval---OR, 2.27 and 95% CI, 1.60-3.22). CONCLUSION From this study, we found that education level, betel-nut chewing, alcohol intake, smoking behavior of peers, and the attitudes of parents and peers toward smoking are all associated with the risk of a young adult conscripts becoming a habitual cigarette smoker. These results provide insight for targeting critical risk factors in helping these individuals control or cease their cigarette smoking habit in the future.
Collapse
Affiliation(s)
- Yaoh-Shiang Lin
- Department of Otolaryngology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | | | | | | | | | | |
Collapse
|
|
26
|
Wine intake, ABO phenotype, and risk of ischemic heart disease and all-cause mortality: the Copenhagen Male Study--a 16-year follow-up. Alcohol 2008; 42:575-82. [PMID: 18789630 DOI: 10.1016/j.alcohol.2008.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 04/23/2008] [Accepted: 05/07/2008] [Indexed: 11/23/2022]
Abstract
The association of alcohol intake with ischemic heart disease (IHD) and all-cause mortality may depend on ABO phenotype. We tested this hypothesis in a 16-year follow-up of 3,022 Caucasian men aged 53-74 years without overt cardiovascular disease. Potential risk factors and confounders included were ABO phenotypes, alcohol intake (wine, beer, and spirits), tobacco smoking history, leisure-time physical activity, social class, and age. During 16 years, 1985-1986 to end of 2001, 197 subjects (6.5%) died due to IHD, and 1,204 (39.8%) from all causes. Among non-O phenotypes (A, B, and AB) significantly fewer men who died due to IHD were wine consumers, 43.9% versus 55.7%, P<.01; with respect to all-cause mortality corresponding figures were 47.0% versus 60.1%, P<.001. No difference was found among men with phenotype O. Among men with phenotype A, compared to alcohol abstainers, in Cox analysis, the hazard ratio (HR) (95% confidence limit) for men drinking up to 8 beverages/wk was 0.5 (0.3-1.02), and among men consuming >8 beverages/wk (the highest quintile) the HR was 0.3 (0.2-0.8), P<.01. Among men with phenotype O, the association of wine intake with IHD mortality was slightly and not significantly U-shaped. The difference in the predictive role of wine intake between phenotype O and phenotype A men was supported in a statistical test for interaction. A similar association was found for all-cause mortality. The results suggest that the effect of wine intake on IHD and all-cause mortality among middle-aged and elderly men may depend on ABO phenotypes.
Collapse
|
|
27
|
Occupational Organic Solvent Exposure, Smoking, and Prevalence of Chronic Bronchitis–An Epidemiological Study of 3387 Men. J Occup Environ Med 2008; 50:730-5. [DOI: 10.1097/jom.0b013e31817e9140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
|
28
|
Virtanen M, Kivimäki M, Kouvonen A, Elovainio M, Linna A, Oksanen T, Vahtera J. Average household income, crime, and smoking behaviour in a local area: The Finnish 10-Town study. Soc Sci Med 2007; 64:1904-13. [PMID: 17324492 DOI: 10.1016/j.socscimed.2007.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Indexed: 10/23/2022]
Abstract
Social environments, like neighbourhoods, are increasingly recognised as determinants of health. While several studies have reported an association of low neighbourhood socio-economic status with morbidity, mortality and health risk behaviour, little is known of the health effects of neighbourhood crime rates. Using the ongoing 10-Town study in Finland, we examined the relations of average household income and crime rate measured at the local area level, with smoking status and intensity by linking census data of local area characteristics from 181 postal zip codes to survey responses to smoking behaviour in a cohort of 23,008 municipal employees. Gender-stratified multilevel analyses adjusted for age and individual occupational status revealed an association between low local area income rate and current smoking. High local area crime rate was also associated with current smoking. Both local area characteristics were strongly associated with smoking intensity. Among ever-smokers, being an ex-smoker was less likely among residents in areas with low average household income and a high crime rate. In the fully adjusted model, the association between local area income and smoking behaviour among women was substantially explained by the area-level crime rate. This study extends our knowledge of potential pathways through which social environmental factors may affect health.
Collapse
Affiliation(s)
- Marianna Virtanen
- Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, Helsinki FIN 00250, Finland.
| | | | | | | | | | | | | |
Collapse
|
|
29
|
van Lenthe FJ, Martikainen P, Mackenbach JP. Neighbourhood inequalities in health and health-related behaviour: Results of selective migration? Health Place 2007; 13:123-37. [PMID: 16386937 DOI: 10.1016/j.healthplace.2005.09.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 07/08/2005] [Accepted: 07/19/2005] [Indexed: 10/25/2022]
Abstract
We hypothesised that neighbourhood inequalities in health and health-related behaviour are due to selective migration between neighbourhoods. Ten-year follow-up data of 25-74-year-old participants in a Dutch city (Eindhoven) showed an increased probability of both upward and downward migration in 25-34-year-old participants, and in single and divorced participants. Women and those highly educated showed an increased probability of upward migration from the most deprived neighbourhoods; lower educated showed an increased probability of moving downwards. Adjusted for these factors, health and health-related behaviour were weakly associated with migration. Over 10 years of follow-up, selective migration will hardly contribute to neighbourhood inequalities in health and health-related behaviour.
Collapse
Affiliation(s)
- Frank J van Lenthe
- Department of Public Health, Erasmus Medical Centre Rotterdam, 3000 DR Rotterdam, The Netherlands.
| | | | | |
Collapse
|
|
30
|
van Lenthe FJ, Mackenbach JP. Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors. J Epidemiol Community Health 2006; 60:699-705. [PMID: 16840760 PMCID: PMC2588087 DOI: 10.1136/jech.2005.043851] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the association between physical neighbourhood stressors and smoking, and the contribution of these stressors to neighbourhood and individual socioeconomic inequalities in smoking. METHODS Data were analysed of participants of the baseline measurement of the Dutch GLOBE study (1991), aged 20 years and older, who lived in 79 neighbourhoods of the city of Eindhoven (n = 9062). The neighbourhood socioeconomic environment was assessed from aggregated self reported information of participants' education and occupation level, and employment status. Neighbourhood stressors included were the physical quality (decay), required police attention, noise pollution from traffic, and population density in neighbourhoods. Current smokers were distinguished from previous and never smokers. RESULTS Compared with those living in the most advantaged neighbourhoods, residents living in the socioeconomically most disadvantaged neighbourhoods were more likely to smoke (adjusted for age, sex, education, occupation, and employment status) (OR = 1.24, 95% CI 1.05 to 1.46). An increase in a summary neighbourhood stressor score was associated with smoking, independently of the neighbourhood socioeconomic environment (OR = 1.57, 95% CI 1.11 to 2.21, in the neighbourhoods with the highest stress score). Adjustment for the score substantially reduced the odds ratio for living in the socioeconomic most disadvantaged neighbourhoods (OR = 1.03, 95% CI 0.84 to 1.28, for those in the most disadvantaged neighbourhoods). Neighbourhood stressors contributed 10% to the increased probability of smoking in the lowest educated persons. CONCLUSIONS Physical neighbourhood stressors are related to smoking and contribute substantially to neighbourhood inequalities in smoking over and above individual level characteristics.
Collapse
Affiliation(s)
- Frank J van Lenthe
- Department of Public Health, Erasmus Medical Centre Rotterdam, Netherlands.
| | | |
Collapse
|
|
31
|
Federico B, Costa G, Kunst AE. Educational inequalities in initiation, cessation, and prevalence of smoking among 3 Italian birth cohorts. Am J Public Health 2006; 97:838-45. [PMID: 16809593 PMCID: PMC1854860 DOI: 10.2105/ajph.2005.067082] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined socioeconomic inequalities in initiation and cessation rates of smoking and the resultant inequality in smoking prevalence among 3 consecutive Italian birth cohorts. METHODS We used data from the 1999-2000 Italian National Health Interview Survey, which included 28958 men and 29769 women who were born between 1940 and 1969. The association between smoking variables and level of education was assessed with logistic regression and life table analyses. RESULTS Inequalities in the lifetime prevalence of smoking increased across the 3 birth cohorts in Italy. At age 40, lower-educated persons in the youngest cohort reported on average 1 to 5 years of additional exposure to regular smoking compared with higher-educated persons. Inequalities in smoking prevalence increased among both men and women because of widening inequalities in initiation rates. Among women, growing inequalities in cessation rates also played a role. CONCLUSIONS The relative contribution of initiation and cessation to socioeconomic inequalities in smoking rates varied by both gender and birth cohort. For the youngest birth cohort, policies that address inequalities in smoking should focus on both initiation and cessation.
Collapse
Affiliation(s)
- Bruno Federico
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
| | | | | |
Collapse
|
|
32
|
Suadicani P, OleHein H, Gyntelberg F. Lifestyle, social class, and obesity-the Copenhagen Male Study. ACTA ACUST UNITED AC 2005; 12:236-42. [PMID: 15942422 DOI: 10.1097/00149831-200506000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE With the implicit purpose of identifying relevant intervention targets, the aim of the study was to test if lifestyle factors associated with obesity are unevenly distributed across social groups, and whether an uneven distribution of such factors may contribute to the explanation of social differences in obesity. DESIGN Cross-sectional study of 3290 men aged 53-75 years (mean=63) carried out in 1985-1986 using in addition, data from a previous baseline established in 1970-1971. Information about lifestyle factors was obtained from a questionnaire validated during an interview. Potential risk factors were smoking history, alcohol consumption, leisure time physical activity (LTPA), and from the 1985-1986 study only: consumption of tea and coffee, use of sugar in tea or coffee, and avoidance of fat in foods. The clinical examination included measurements of height and weight. Obesity was defined as a body mass index > or =30 (BMI=kg/m2). Based on information about education and job profile the men were subdivided into five social classes. RESULTS Overall, 291 men (8.8%) were obese. The lower the social class the higher the proportion of obese men: in social classes I and II, 4.5% (of 953), social class III, 9.1% (of 636), social class IV, 11.1% (of 1353), and social class V, 11.6% (of 346), P<0.001 (trend test). Leisure time physical activity, alcohol consumption, smoking habits, use of sugar in hot beverages, and consumption of coffee and tea, were all significantly associated with obesity, either positively or negatively, and even significantly associated with social class. Based on these lifestyle factors it was possible to discriminate subgroups with highly different prevalences of obesity. Despite this, adjustment for identified obesity covariates in a multiple logistic regression analysis did in no way explain the association of social class with obesity. CONCLUSION Lifestyle factors in concert strongly associated with obesity are unevenly distributed across social classes, yet incapable of explaining the higher prevalence of obesity in lower social classes.
Collapse
Affiliation(s)
- Poul Suadicani
- The Copenhagen Male Study, Epidemiological Research Unit, Clinic of Environmental and Occupational Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
| | | | | |
Collapse
|
|
33
|
Huisman M, Kunst AE, Mackenbach JP. Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control 2005; 14:106-13. [PMID: 15791020 PMCID: PMC1748002 DOI: 10.1136/tc.2004.008573] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine those groups who are at increased risk of smoking related diseases, we assessed in which male and female generations smoking was more prevalent among lower educated groups than among the higher educated, in 11 European countries. DESIGN Cross sectional analysis of data on smoking, covering the year 1998, from a social survey designed for all member states of the European Union. SUBJECTS Higher and lower educated men and women aged 16 years and older from 11 member states of the European Union. OUTCOME MEASURES Age standardised prevalence rates by education and prevalence odds ratios of current and ever daily smoking comparing lower educated groups with higher educated groups. RESULTS A north-south gradient in educational inequalities in current and ever daily smoking was observed for women older than 24 years, showing larger inequalities in the northern countries. Such a gradient was not observed for men. A disadvantage for the lower educated in terms of smoking generally occurred later among women than among men. Indications of inequalities in smoking in the age group 16-24 years were observed for all countries, with the exception of women from Greece and Portugal. CONCLUSIONS Preventing and reducing smoking among lower educated subgroups should be a priority of policies aiming to reduce inequalities in health in Europe. If steps are not taken to control tobacco use among the lower educated groups specifically, inequalities in lung cancer and other smoking related diseases should be anticipated in all populations of the European Union, and both sexes.
Collapse
Affiliation(s)
- M Huisman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
| | | | | |
Collapse
|
|
34
|
Abstract
BACKGROUND We have previously found a quite strong interplay between occupational airborne pollutants, ABO phenotypes, and risk of ischaemic heart disease (IHD), with long-term exposure being associated with a significantly increased risk among men with phenotype O, and not among men with other ABO phenotypes. We suggested that the biological pathway could be a stronger systemic inflammatory response in men with blood group O. Several inflammatory mediators likely to increase the risk of IHD have recently been linked also to obesity, suggesting that long-term exposure to airborne pollutants might play a role in the aetiology of obesity. Accordingly, we tested the hypothesis that long-term occupational exposure to airborne pollutants would be more strongly associated with obesity in men with phenotype O than in men with other ABO phenotypes. DESIGN Cross-sectional exposure-response study taking into account potential confounders. SETTING The Copenhagen Male Study. SUBJECTS A total of 3290 men aged 53-74 y. MAIN OUTCOME MEASURE Prevalence of obesity (BMI > or =30 (kg/m2)). RESULTS Overall, no differences were found in the prevalence of obesity between men with the O phenotype (n=1399) and men with other phenotypes (n=1891), 8.6 and 9.0%. However, only among men with the O phenotype was long-term occupational exposure (at least 5 y of frequent exposure) to various respirable airborne pollutants: dust, asbestos, soldering fumes, welding fumes, organic solvents, fumes from lacquer, paint or varnish, toxic components, breath irritants, stench or strongly smelling products, and irritants (other than breath irritants or contagious components) associated with an increased prevalence of obesity. Statistically, the strongest univariate associations were found for asbestos exposure, welding fumes, and breath irritants. Odds ratios (95% confidence limits) for these factors were 3.7 (1.8-7.6), 2.7 (1.6-4.4), and 2.6 (1.5-4.4), respectively. This particular relationship of airborne exposures with obesity in men with phenotype O was supported in multivariate analysis including interaction terms and taking into account a number of potential confounders. In contrast, no gene-environment interactions with obesity were found with respect to ABO phenotypes and a number of nonrespirable exposures. CONCLUSION The finding of a quite strong interplay between long-term exposure to airborne pollutants, ABO phenotypes, and risk of obesity may open up new possibilities for clarifying mechanisms underlying the global obesity epidemic.
Collapse
Affiliation(s)
- P Suadicani
- The Copenhagen Male Study, Epidemiological Research Unit, Clinic of Environmental and Occupational Medicine, Bispebjerg University Hospital, Copenhagen, NV, Denmark.
| | | | | |
Collapse
|
|
35
|
Laaksonen M, Rahkonen O, Karvonen S, Lahelma E. Socioeconomic status and smoking: analysing inequalities with multiple indicators. Eur J Public Health 2005; 15:262-9. [PMID: 15755781 DOI: 10.1093/eurpub/cki115] [Citation(s) in RCA: 223] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Socioeconomic differences in smoking have been well established. While previous studies have mostly relied on one socioeconomic indicator at a time, this study examined socioeconomic differences in smoking by using several indicators that reflect different dimensions of socioeconomic position. DATA AND METHODS Data derive from Helsinki Health Study baseline surveys conducted among the employees of the City of Helsinki in 2000 and 2001. The data include 6243 respondents aged 40-60 years (response rate 68%). Six socioeconomic indicators were used: education, occupational status, household income per consumption unit, housing tenure, economic difficulties and economic satisfaction. Their associations with current smoking were examined by fitting sequential logistic regression models. RESULTS All socioeconomic indicators were strongly associated with smoking among both men and women. When the indicators were examined simultaneously their associations with smoking attenuated, especially when education and occupational status were considered together, and when income and housing tenure were introduced into the models already containing education and occupational status. After mutual adjustment for all socioeconomic indicators, housing tenure and economic satisfaction remained associated with smoking in men. In women, all indicators except income and economic difficulties were inversely associated with smoking after adjustments. CONCLUSIONS Smoking was associated with structural, material as well as perceived dimensions of socioeconomic disadvantage. Attempts to reduce smoking among the socioeconomically disadvantaged need to target several dimensions of socioeconomic position.
Collapse
Affiliation(s)
- Mikko Laaksonen
- Department of Public Health, University of Helsinki, Helsinki, Finland.
| | | | | | | |
Collapse
|
|
36
|
van Oort FVA, van Lenthe FJ, Mackenbach JP. Cooccurrence of lifestyle risk factors and the explanation of education inequalities in mortality: results from the GLOBE study. Prev Med 2004; 39:1126-34. [PMID: 15539046 DOI: 10.1016/j.ypmed.2004.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND To investigate whether the cooccurrence of two lifestyle risk factors (smoking, excessive alcohol consumption, physical inactivity in leisure time) has an additional contribution to the explanation of education inequalities in mortality, over and above the contribution of single risk factors. METHODS Prospective cohort study, 1991-1998, in the South East of the Netherlands. Participants were 16,980 men and women aged 15-74 years at baseline. RESULTS Education differences in the cooccurrence of risk factors were of a similar magnitude as education inequalities seen for single risk factors. A significant (P = 0.04) interaction effect on mortality was found between smoking and physical inactivity. Adjustment for both smoking and inactivity reduced the mortality hazard ratio of the lowest level of education by 30% (from 1.66 to 1.46). Further adjustment for the interaction between the two risk factors did not change the hazard ratio significantly. CONCLUSION The cooccurrence of lifestyle risk factors did not provide any additional contribution to the explanation of education inequalities in mortality, over and above that of single risk factors. However, because risk factors tend to cooccur and have a higher prevalence among lower-educated people, it is still useful to focus interventions on more than one risk factor.
Collapse
Affiliation(s)
- F V A van Oort
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | | | | |
Collapse
|
|
37
|
Grundy E, Sloggett A. Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances. Soc Sci Med 2003; 56:935-47. [PMID: 12593868 DOI: 10.1016/s0277-9536(02)00093-x] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Older people now constitute the majority of those with health problems in developed countries so an understanding of health variations in later life is increasingly important. In this paper, we use data from three rounds of the Health Survey for England, a large nationally representative sample, to analyse variations in the health of adults aged 65-84 by indicators of attributes acquired in childhood and young adulthood, termed personal capital; and by current social resources and current socio-economic circumstances, while controlling for smoking behaviour and age. We used six indicators of health status in the analysis, four based on self-reports and two based on nurse collected data, which we hypothesised would identify different dimensions of health. Results showed that socio-economic indicators, particularly receipt of income support (a marker of poverty) were most consistently associated with raised odds of poor health outcomes. Associations between marital status and health were in some cases not in the expected direction. This may reflect bias arising from exclusion of the institutional population (although among those under 85 the proportion in institutions is very low) but merits further investigation, especially as the marital status composition of the older population is changing. Analysis of deviance showed that social resources (marital status and social support) had the greatest effect on the indicator of psychological health (GHQ) and also contributed significantly to variation in self-rated health, but among women not to variation in taking three or more medicines and among men not to self-reported long-standing illnesses. Smoking, in contrast, was much more strongly associated with these indicators than with self-rated health. These results are consistent with the view that self-rated health may provide a holistic indicator of health in the sense of well-being, whereas measures such as taking prescribed medications may be more indicative of specific morbidities. The results emphasise again the need to consider both socio-economic and socio-psychological influences on later life health.
Collapse
Affiliation(s)
- Emily Grundy
- Centre for Population Studies, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, WC1B 3DP, London, UK.
| | | |
Collapse
|
|
38
|
Tydén P, Hansen O, Engström G, Hedblad B, Janzon L. Myocardial infarction in an urban population: worse long term prognosis for patients from less affluent residential areas. J Epidemiol Community Health 2002; 56:785-90. [PMID: 12239206 PMCID: PMC1732015 DOI: 10.1136/jech.56.10.785] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVE The objective in this follow up study from the Malmö myocardial infarction register has been to assess whether long term survival following discharge after first myocardial infarction has any relation with the socioeconomic environment and to assess to what extent intra-urban differences in mortality from ischaemic heart disease can be accounted for by covariance with long term survival following discharge after acute myocardial infarction. DESIGN Register based surveillance study. SETTING Seventeen residential areas in the city of Malmö, Sweden. PARTICIPANTS The cohort contains all 2931 male and 2083 female patients with myocardial infarction who were discharged for the first time between 1986-95 from Malmö University Hospital. MAIN RESULTS During the on average 4.9 years of follow up 55% of the patients died. The sex adjusted and age adjusted all cause mortality rate/1000 patient years ranged between residential areas from 85.5 to 163.6. The area specific relative risk of death after discharge was associated with a low socioeconomic score, r=-0.56, p=0.018. Major risk factors for cardiovascular disease were more prevalent in areas with low socioeconomic score and low rates of survival. Of the intra-urban differences in mortality from ischaemic heart disease, 41% could be accounted for by differences with regard to the survival rate after discharge. CONCLUSIONS The results are compatible with the hypothesis that the socioeconomic environment plays an important part in the survival rate of patients with myocardial infarction. To assess the preventive potential, the extent to which socioeconomic circumstances covary with severity of disease, respectively with the use and compliance with secondary preventive measures, needs to be evaluated.
Collapse
Affiliation(s)
- P Tydén
- Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden.
| | | | | | | | | |
Collapse
|
|
39
|
Droomers M, Schrijvers CTM, Mackenbach JP. Why do lower educated people continue smoking? Explanations from the longitudinal GLOBE study. Health Psychol 2002; 21:263-72. [PMID: 12027032 DOI: 10.1037/0278-6133.21.3.263] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes the effect of educational level on the decision to continue smoking among 1,354 initially smoking participants (age > or = 20 years) in the Dutch GLOBE study. The effect of education on continued smoking was explained from baseline information (1991) on smoking characteristics, individual characteristics, and environmental factors. Smoking status was reassessed after 6.5 years. Lower educated smokers more often continued smoking (odds ratio 2.09). Poor perceived health and earlier smoking initiation in lower educated groups were main predictors of educational differences in smoking maintenance. Educational differences in chronic illness, perceived control, neuroticism, and emotional support also contributed to the explanation of educational differences in continued smoking. These results have important implications for intervention programs and policy.
Collapse
Affiliation(s)
- Mariël Droomers
- Department of Public Health, Erasmus University Rotterdam, The Netherlands.
| | | | | |
Collapse
|
|
40
|
Vartiainen E, Seppälä T, Lillsunde P, Puska P. Validation of self reported smoking by serum cotinine measurement in a community-based study. J Epidemiol Community Health 2002; 56:167-70. [PMID: 11854334 PMCID: PMC1732104 DOI: 10.1136/jech.56.3.167] [Citation(s) in RCA: 395] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE The validity of self reported smoking in population surveys remains an important question. An associated question is what would be the value of measuring serum cotinine concentrations in such surveys to obtain validated smoking data. DESIGN Cross sectional analysis of data on self reported smoking and serum cotinine among a random population sample of 5846 persons aged 25 to 64 years, who participated in the FINRISK-92 survey. MAIN RESULTS Among self reported regular smokers, 97.2% of men and 94.9% of women had a cotinine concentration of 10 ng/ml or higher in serum. Of those participants who reported to have smoked at any time during their life but not during the previous month, 6.3% of men and 5.2% of women had a serum cotinine concentration of at least 10 ng/ml. Among never smokers 2.5% of men and 2.7% of women had detectable level of cotinine in their serum. The validity of self reporting was similar among subjects from different areas, ages, and socioeconomic groups. CONCLUSIONS In a sample of the general population in Finland the validity of self reported smoking is high, and most of the few self reported non-smokers who had cotinine in their serum had only low or moderate levels.
Collapse
Affiliation(s)
- E Vartiainen
- National Public Health Institute, Helsinki, Finland.
| | | | | | | |
Collapse
|
|
41
|
Suadicani P, Hein HO, Meyer HW, Gyntelberg F. Exposure to cold and draught, alcohol consumption, and the NS-phenotype are associated with chronic bronchitis: an epidemiological investigation of 3387 men aged 53-75 years: the Copenhagen Male Study. Occup Environ Med 2001; 58:160-4. [PMID: 11171928 PMCID: PMC1740108 DOI: 10.1136/oem.58.3.160] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study was performed to estimate the strength of association between chronic bronchitis and lifetime exposure to occupational factors, current lifestyle, and the NS-phenotype in the MNS blood group among middle aged and elderly men. METHODS The study was carried out within the frameworks of the Copenhagen Male Study. Of 3387 men 3331 men with a mean age of 63 (range 53-75) years could be classified by prevalence of chronic bronchitis. As well as the completion of a large questionnaire on health, lifestyle, and working conditions, all participants had a thorough examination, including measurements of height and weight and blood pressure and a venous blood sample was taken for the measurement of serum cotinine and MNS typing; 16.5% of the men had the NS-phenotype. Chronic bronchitis was defined as cough and phlegm lasting 3 months or more for at least 2 years; 14.6% had chronic bronchitis. RESULTS Smoking and smoke inhalation were the factors most strongly associated with prevalence of chronic bronchitis. There were three major new findings: (a) long term (>5 years) occupational exposure to cold and draught was associated with a significantly increased prevalence of chronic bronchitis; compared with others, and adjusted for confounders, the odds ratio (OR) with 95% confidence interval (95% CI) was 1.4 (1.1 to 1.7), p=0.004; (b) a significant J shaped association existed between alcohol use and bronchitis, p<0.001, with the lowest prevalence found among moderate users; (c) a significant gene by environment association existed between smoking and the NS-phenotype in the MNS blood group; only among smokers was the NS-phenotype associated with a significantly decreased risk of chronic bronchitis, OR 0.67 (0.47-0.97), p=0.02. Other well known associations between dust, fumes, and even exposure to solvents and bronchitis were confirmed. CONCLUSION The results emphasise the multifactorial nature of chronic bronchitis, and show some hitherto unrecognised associations between cold and draught exposure, alcohol consumption, and the NS-phenotype and chronic bronchitis.
Collapse
Affiliation(s)
- P Suadicani
- H:S Bispebjerg Hospital, University of Copenhagen, Epidemiological Research Unit, Clinic of Occupational and Environmental Medicine, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
| | | | | | | |
Collapse
|
|
42
|
Hein HO, Suadicani P, Gyntelberg F. Lewis phenotypes, leisure time physical activity, and risk of ischaemic heart disease: an 11 year follow up in the Copenhagen male study. Heart 2001; 85:159-64. [PMID: 11156665 PMCID: PMC1729618 DOI: 10.1136/heart.85.2.159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To test the hypothesis that the predictive value for risk of fatal ischaemic heart disease associated with Lewis phenotypes depends on the level of leisure time physical activity. DESIGN Prospective study controlling for alcohol, tobacco, serum cotinine, blood pressure, body mass index, serum lipids, work related physical activity, and social class. SETTING The Copenhagen male study, Denmark. SUBJECTS 2826 white men aged 53-75 years without overt cardiovascular disease; 266 (9.4%) had the Le(a-b-) phenotype. MAIN OUTCOME MEASURE Incidence of death from ischaemic heart disease during 11 years. RESULTS 107 men died of ischaemic heart disease. Among men with a low level of leisure time physical activity (</= 4 hours/week moderate or </= 2 hours/week more vigorous activity), being Le(a-b-) was associated with an increased risk of having a fatal ischaemic heart disease event compared with men with other Lewis phenotypes (relative risk (RR) 2.7, 95% confidence interval (CI) 1.4 to 5.2; p < 0.01). Among men with a high level of leisure time physical activity, the RR associated with being Le(a-b-) was 1. 3 (95% CI 0.5 to 3.1; NS). Compared with all other alternatives tested, being Le(a-b-) and having a low level of leisure time physical activity was associated with an RR of 3.2 (95% CI 1.7 to 5. 8; p < 0.001). As a point estimate and adjusted for confounding variables, among men with low leisure time physical activity the attributable risk associated with Le(a-b-) was 12%-that is, assuming that all sedentary men had phenotypes other than Le(a-b-), 12% of all fatal ischaemic heart disease events would not have occurred. The corresponding point estimate among those more active was 2%. CONCLUSIONS The excess risk of fatal ischaemic heart disease in middle aged and elderly men with the Le(a-b-) phenotype is strongly modified by leisure time physical activity. Public health and clinical implications may be important in populations with a predominantly sedentary lifestyle and in a high proportion of men with the Le(a-b-) phenotype.
Collapse
Affiliation(s)
- H O Hein
- The Copenhagen Male Study, Epidemiological Research Unit, Copenhagen University Hospital, 23 Bispebjerg Bakke, DK-2400 Copenhagen NV, Denmark.
| | | | | |
Collapse
|
|
43
|
Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. High triglycerides and low HDL cholesterol and blood pressure and risk of ischemic heart disease. Hypertension 2000; 36:226-32. [PMID: 10948082 DOI: 10.1161/01.hyp.36.2.226] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Treatment of high blood pressure (BP) has not produced the expected reduction in risk of ischemic heart disease (IHD). Subjects with high BP often have the metabolic syndrome X, an aggregation of abnormalities in glucose and lipid metabolism. We tested the hypothesis that the BP level would be less predictive of risk of IHD in those with high triglycerides (TG) and low HDL cholesterol (HDL-C), the characteristic dyslipidemia in the metabolic syndrome than in those without. Baseline measurements of fasting lipids, systolic BP (SBP), diastolic BP (DBP), and other risk factors were obtained in 2906 men, age 53 to 74 years, free of overt cardiovascular disease. High TG/low HDL-C was defined as TG >1.59 mmol/L and HDL-C <1.18 mmol/L. Within an 8-year period, 229 men developed IHD. In men with high TG/low HDL-C, the incidence of IHD according to SBP (<120, 120 to 140, >140 mm Hg) was 12.5%, 12.9%, and 10.0% (P=NS), respectively, and according to DBP, the incidence of IHD was (<75, 75 to 90, >90 mm Hg) 13.7%, 10.6%, and 13.7% (P=NS), respectively. The corresponding figures for other men were 5.2%, 8. 0%, and 9.7% for SBP (P<0.001), and 6.1%, 7.5%, and 9.9% for DBP (P<0.03). In conclusion, the BP level did not predict the risk of IHD in those with high TG/low HDL-C. This finding may explain the reason lowering BP has not produced the expected reduction in IHD.
Collapse
Affiliation(s)
- J Jeppesen
- Copenhagen Male Study, Epidemiological Research Unit, Copenhagen University Hospital, Denmark
| | | | | | | |
Collapse
|
|
44
|
Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grötvedt L, Helmert U, Lahelma E, Lundberg O, Matheson J, Mielck A, Rasmussen NK, Regidor E, do Rosário-Giraldes M, Spuhler T, Mackenbach JP. Educational differences in smoking: international comparison. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1102-7. [PMID: 10775217 PMCID: PMC27351 DOI: 10.1136/bmj.320.7242.1102] [Citation(s) in RCA: 400] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate international variations in smoking associated with educational level. DESIGN International comparison of national health, or similar, surveys. SUBJECTS Men and women aged 20 to 44 years and 45 to 74 years. SETTING 12 European countries, around 1990. MAIN OUTCOME MEASURES Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. RESULTS In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. CONCLUSIONS These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.
Collapse
Affiliation(s)
- A E Cavelaars
- Department of Public Health, Erasmus University, 3000 DR Rotterdam, Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
45
|
Osler M, Gerdes LU, Davidsen M, Brønnum-Hansen H, Madsen M, Jørgensen T, Schroll M. Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982-1992. J Epidemiol Community Health 2000; 54:108-13. [PMID: 10715743 PMCID: PMC1731611 DOI: 10.1136/jech.54.2.108] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE The decline in cardiovascular mortality in Denmark during the 1980s has been greatest in the highest socioeconomic groups of the population. This study examines whether the increased social inequality in cardiovascular mortality has been accompanied by a different trend in cardiovascular risk factors in different educational groups. DESIGN Data from three cross sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92, were analysed to estimate trends in biological (weight, height, body mass index, blood pressure, and serum lipids) and behavioural (smoking, physical activity during leisure, and eating habits) risk factors in relation to educational status. SETTING County of Copenhagen, Denmark. PARTICIPANTS 6695 Danish men and women of ages 30, 40, 50, and 60 years. MAIN RESULTS The prevalence of smoking and heavy smoking decreased during the study but only in the most educated groups. In fact, the prevalence of heavy smoking increased in the least educated women. There was no significant interaction for the remaining biological and behavioural risk factors between time of examination and educational level, indicating that the trend was the same in the different educational groups. However, a summary index based on seven cardiovascular risk factors improved, and this development was only seen in the most educated men and women. CONCLUSION The difference between educational groups in prevalence of smoking increased during the 1980s, and this accounted for widening of an existing social difference in the total cardiovascular risk.
Collapse
Affiliation(s)
- M Osler
- Danish Institute of Clinical Epidemiology, Copenhagen O, Denmark
| | | | | | | | | | | | | |
Collapse
|
|
46
|
Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ. The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review. Am J Prev Med 1999; 17:211-29. [PMID: 10987638 DOI: 10.1016/s0749-3797(99)00069-0] [Citation(s) in RCA: 263] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population. METHOD A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month. RESULTS Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data. CONCLUSIONS This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.
Collapse
Affiliation(s)
- S A Newell
- New South Wales Cancer Council Cancer Education Research Program, Wallsend, Australia
| | | | | | | |
Collapse
|
|
47
|
Laatikainen T, Vartiainen E, Puska P. Comparing smoking and smoking cessation process in the Republic of Karelia, Russia and North Karelia, Finland. J Epidemiol Community Health 1999; 53:528-34. [PMID: 10562876 PMCID: PMC1756967 DOI: 10.1136/jech.53.9.528] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE The aims of this study were to assess and validate self reported smoking prevalence and to assess smoking cessation related process variables in the Republic of Karelia, Russia and in North Karelia, Finland. DESIGN Comparative population surveys of random population samples from both areas in spring 1992. The study included a self administered questionnaire, physical measurements and laboratory tests. The validity of self reported smoking prevalence was assessed by serum cotinine analyses. SETTING The district of Pitkäranta in the Republic of Karelia, Russia and province of North Karelia, Finland. PARTICIPANTS The study population was a 25 to 64 year old population in both areas. A stratified random sample of 1000 people in Pitkäranta and 2000 people in North Karelia was drawn from the population registers. In Pitkäranta 380 men and 455 women, and in North Karelia 673 men and 803 women, participated in the survey. RESULTS The self reported prevalence rates of daily smoking in Pitkäranta were 65% among men and 10% among women. In North Karelia the respective rates were 29% and 13%. Women in Pitkäranta greatly underreported their smoking status, which was assessed by comparing the self reported data to the serum cotinine measurements. The smoking prevalence among women in Pitkäranta would rise from 10% to 21% if all participants with high cotinine values would be regarded as smokers. Compared with smokers in North Karelia, a higher percentage of smokers in Pitkäranta expressed their wish to quit and believed that they would succeed. However, on average they had fewer previous smoking cessation attempts than smokers in North Karelia. In addition, the health personnel in North Karelia were more active in advising smokers to quit. CONCLUSIONS High smoking prevalence among men in Pitkäranta obviously contributes much to the high premature death rate in the Republic of Karelia. There is considerable underreporting of smoking in Pitkäranta, especially among women, which is probably attributable to the cultural unacceptability of female smoking in Russia. The common wish to quit, few previous cessation attempts and much lower rates of ex smokers, together with less smoking cessation counselling from health personnel, need to be considered in tailoring antismoking interventions in the area.
Collapse
Affiliation(s)
- T Laatikainen
- National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland
| | | | | |
Collapse
|
|
48
|
Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. Triglyceride concentration and ischemic heart disease: an eight-year follow-up in the Copenhagen Male Study. Circulation 1998; 97:1029-36. [PMID: 9531248 DOI: 10.1161/01.cir.97.11.1029] [Citation(s) in RCA: 443] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of triglycerides as a risk factor of ischemic heart disease (IHD) remains controversial. For the present study, we examined the relation between fasting triglycerides and risk of IHD in the Copenhagen Male Study. METHODS AND RESULTS Baseline measurements of fasting lipids and other IHD risk factors were obtained for 2906 white men (age range, 53 to 74 years) who were initially free of overt cardiovascular disease. During an 8-year follow-up period, 229 men had a first IHD event. Crude cumulative incidence rates of IHD were 4.6% for the lowest, 7.7% for the middle, and 11.5% for the highest third of triglyceride levels (P for trend <.001). Compared with the lowest third level and adjusted for age, body mass index, alcohol, smoking, physical activity, hypertension, non-insulin-dependent diabetes mellitus, social class, and LDL and HDL cholesterol, relative risks of IHD (95% confidence interval) were 1.5 (1.0 to 2.3; P=.05) and 2.2 (1.4 to 3.4; P<.001) for the middle and highest third of triglyceride levels, respectively. When triglyceride levels were stratified by HDL cholesterol levels (triglyceride third multiplied by HDL cholesterol third), a clear gradient of risk of IHD was found with increasing triglyceride levels within each level of HDL cholesterol, including high HDL cholesterol level, which are thought to provide protection against IHD. CONCLUSIONS In middle-aged and elderly white men, a high level of fasting triglycerides is a strong risk factor of IHD independent of other major risk factors, including HDL cholesterol.
Collapse
Affiliation(s)
- J Jeppesen
- Copenhagen Male Study, Epidemiology Research Unit, Copenhagen University Hospital, Denmark
| | | | | | | |
Collapse
|
|
49
|
Jeppesen J, Hein HO, Suadicani P, Gyntelberg F. Relation of high TG-low HDL cholesterol and LDL cholesterol to the incidence of ischemic heart disease. An 8-year follow-up in the Copenhagen Male Study. Arterioscler Thromb Vasc Biol 1997; 17:1114-20. [PMID: 9194762 DOI: 10.1161/01.atv.17.6.1114] [Citation(s) in RCA: 185] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
High triglyceride (TG) and low HDL cholesterol (HDL-C) is the characteristic dyslipidemia seen in insulin-resistant subjects. We examined the role of this dyslipidemia as a risk factor of ischemic heart disease (IHD) compared with that of high LDL cholesterol (LDL-C) in the Copenhagen Male Study. In total 2910 white men, aged 53 to 74 years, free of cardiovascular disease at baseline, were subdivided into four groups on the basis of fasting concentrations of serum TG, HDL-C, and LDL-C. "High TG-low HDL-C" was defined as belonging to both the highest third of TG and the lowest third of HDL-C; this group encompassed one fifth of the population. "High LDL-C" was defined as belonging to the highest fifth of LDL-C. A control group was defined as not belonging to either of these two groups. "Combined dyslipidemia" was defined as belonging to both dyslipidemic groups. Age-adjusted incidence of IHD during 8 years of follow-up was 11.4% in high TG-low HDL-C, 8.2% in high LDL-C, 6.6% in the control group, and 17.5% in combined dyslipidemia. Compared with the control group, relative risks of IHD (95% confidence interval), adjusted for potentially confounding factors or covariates (age, body mass index, alcohol consumption, physical activity, non-insulin-dependent diabetes, hypertension, smoking, and social class), were 1.5 (1.0-2.1), P < .05; 1.3 (0.9-2.0), P = .16; and 2.4 (1.5-4.0), P < .01, in the three dyslipidemic groups, respectively. In conclusion, the present results showed that high TG-low HDL-C, the characteristic dyslipidemia seen in insulin-resistant subjects, was at least as powerful a predictor of IHD as isolated high LDL-C. The results suggest that efforts to prevent IHD should include intervention against high TG-low HDL-C, and not just against hypercholesterolemia.
Collapse
Affiliation(s)
- J Jeppesen
- Copenhagen Male Study, Epidemiological Research Unit, Rigshopitalet, State University Hospital, Denmark
| | | | | | | |
Collapse
|
|
50
|
Suadicani P, Hein HO, Gyntelberg F. Adverse effects on risk of ischaemic heart disease of adding sugar to hot beverages in hypertensives using diuretics. A six year follow-up in the Copenhagen Male Study. Blood Press 1996; 5:91-7. [PMID: 8860097 DOI: 10.3109/08037059609062114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Non insulin dependent diabetes mellitus (NIDDM) and essential hypertension (EH) are two of several manifestations of the insulin resistance syndrome. Although subjects with NIDDM and subjects with EH share a common defect in carbohydrate metabolism, only diabetics are advised to avoid sugar. We tested the theory that an adverse effect of diuretics treatment in men with EH with respect to risk of ischaemic heart disease (IHD) would depend on the intake of dietary sugar using sugar in hot beverages as a marker. The cohort consisted of 2,899 men from the Copenhagen Male Study aged 53-74 years (mean 63) who were without overt cardiovascular disease. Potential confounders were: age, alcohol,smoking, physical activity, body mass index, blood pressure, fasting lipids, cotinine, NIDDM,and social class. A total of 340 men took antihypertensives; 211 took diuretics (95% thiazides and related agents), and 129 used other antihypertensives. During 6 years, 179 men (6.2%) had a first IHD event. Among the 340 men taking antihypertensives, the incidence rate was 11%. Diuretics use was associated with a high risk of IHD in hypertensive men with a relatively high intake of dietary sugar; the cumulative incidence rate was 22%; in diuretics treated men with a low intake of sugar, the rate was 7%. After controlling for potential confounders, relative risk (95% ci.) was 3.1(1.3-7.6), p = 001. Among the 129 men who took other forms of antihypertensive drugs, the IHD incidence rate was 8%, and independent of the intake of sugar. The results indicate that the risk of IHD in hypertensives using diuretics is associated with intake of dietary sugar, which may explain at least some of the discouraging effects of antihypertensive agents on the reduction of risk of IHD.
Collapse
Affiliation(s)
- P Suadicani
- Epidemiological Research Unit, Clinic of Occupational Medicine, Righospitalet, State University Hospital, Copenhagen, Denmark
| | | | | |
Collapse
|