1
|
Nagel G, Chen J, Jaensch A, Skodda L, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Pershagen G, Rizzuto D, Samoli E, Severi G, Stafoggia M, Tjønneland A, Vermeulen RCH, Wolf K, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O, Weinmayr G. Long-term exposure to air pollution and incidence of gastric and the upper aerodigestive tract cancers in a pooled European cohort: The ELAPSE project. Int J Cancer 2024; 154:1900-1910. [PMID: 38339851 DOI: 10.1002/ijc.34864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
Air pollution has been shown to significantly impact human health including cancer. Gastric and upper aerodigestive tract (UADT) cancers are common and increased risk has been associated with smoking and occupational exposures. However, the association with air pollution remains unclear. We pooled European subcohorts (N = 287,576 participants for gastric and N = 297,406 for UADT analyses) and investigated the association between residential exposure to fine particles (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone in the warm season (O3w) with gastric and UADT cancer. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. During 5,305,133 and 5,434,843 person-years, 872 gastric and 1139 UADT incident cancer cases were observed, respectively. For gastric cancer, we found no association with PM2.5, NO2 and BC while for UADT the hazard ratios (95% confidence interval) were 1.15 (95% CI: 1.00-1.33) per 5 μg/m3 increase in PM2.5, 1.19 (1.08-1.30) per 10 μg/m3 increase in NO2, 1.14 (1.04-1.26) per 0.5 × 10-5 m-1 increase in BC and 0.81 (0.72-0.92) per 10 μg/m3 increase in O3w. We found no association between long-term ambient air pollution exposure and incidence of gastric cancer, while for long-term exposure to PM2.5, NO2 and BC increased incidence of UADT cancer was observed.
Collapse
Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lea Skodda
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate - Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Danish Cancer Institute, Copenhagen, Denmark
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- The Danish Cancer Institute, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| |
Collapse
|
2
|
Finsel J, Rosenbohm A, Peter RS, Bäzner H, Börtlein A, Dempewolf S, Schabet M, Hecht M, Kohler A, Opherk C, Nägele A, Sommer N, Lindner A, Rothenbacher D, Ludolph AC, Nagel G, Lulé DE. Coping as a resource to allow for psychosocial adjustment in fatal disease: results from patients with amyotrophic lateral sclerosis. Front Psychol 2024; 15:1361767. [PMID: 38638511 PMCID: PMC11024296 DOI: 10.3389/fpsyg.2024.1361767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal disorder, which imposes a severe emotional burden on patients. Appropriate coping mechanisms may alleviate this burden and facilitate wellbeing, with social support known to be a successful coping strategy. This observational study aimed to determine the interplay of general coping traits of hope for success and fear of failure, coping behavior of social activity, and patients' wellbeing. Methods In this cross-sectional study, patients with ALS from a clinical-epidemiological registry in Southwestern Germany were interviewed regarding coping traits (achievement-motivated behavior: hope for success and fear of failure), coping behavior of social activity, and psychosocial adjustment, determined using measures of depressiveness, anxiety [both measured by Hospital Anxiety and Depression Scale (HADS)], and quality of life [Anamnestic Comparative Self-Assessment (ACSA)]. Demographics, clinical [ALS Functional Rating Scale revised version (ALSFRS-R)], and survival data were recorded. Results A total of 868 patients [60.70% male patients, mean age: 64.70 (±10.83) years, mean ALSFRS-R: 37.36 ± 7.07] were interviewed. Anxiety in patients was found to be associated with a high fear of failure. In contrast, a generally positive attitude in patients exemplified in high hopes for success was associated with better wellbeing. Finally, coping behavior of social activity explained up to 65% of the variance of depressiveness among the patients with ALS. Conclusion In this study, we present evidence that the wellbeing of patients with ALS is not an immediate fatalistic consequence of physical degradation but rather determined by coping traits and behavior, which may be trained to substantially increase the wellbeing of patients with ALS.
Collapse
Affiliation(s)
- Julia Finsel
- Department of Neurology, Ulm University, Ulm, Germany
| | | | - Raphael S. Peter
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Hansjörg Bäzner
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Axel Börtlein
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Silke Dempewolf
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Schabet
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Hecht
- Department of Neurology, Klinikum Kaufbeuren, Kliniken Oberallgäu-Kaufbeuren, Kaufbeuren, Germany
| | - Andreas Kohler
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Christian Opherk
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Andrea Nägele
- Department of Neurology, Christophsbad Göppingen, Göppingen, Germany
| | - Norbert Sommer
- Department of Neurology, Christophsbad Göppingen, Göppingen, Germany
| | - Alfred Lindner
- Department of Neurology, Marienhospital Stuttgart, Stuttgart, Germany
| | | | - Albert C. Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm Site, Ulm, Germany
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | |
Collapse
|
3
|
Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, Ahmed SA, Ajami M, Aji B, Akara EM, Akbarialiabad H, Akinosoglou K, Akinyemiju T, Akkaif MA, Akyirem S, Al Hamad H, Al Hasan SM, Alahdab F, Alalalmeh SO, Alalwan TA, Al-Aly Z, Alam K, Alam M, Alam N, Al-amer RM, Alanezi FM, Alanzi TM, Al-Azzam S, Albakri A, Albashtawy M, AlBataineh MT, Alcalde-Rabanal JE, Aldawsari KA, Aldhaleei WA, Aldridge RW, Alema HB, Alemayohu MA, Alemi S, Alemu YM, Al-Gheethi AAS, Alhabib KF, Alhalaiqa FAN, Al-Hanawi MK, Ali A, Ali A, Ali L, Ali MU, Ali R, Ali S, Ali SSS, Alicandro G, Alif SM, Alikhani R, Alimohamadi Y, Aliyi AA, Aljasir MAM, Aljunid SM, Alla F, Allebeck P, Al-Marwani S, Al-Maweri SAA, Almazan JU, Al-Mekhlafi HM, Almidani L, Almidani O, Alomari MA, Al-Omari B, Alonso J, Alqahtani JS, Alqalyoobi S, Alqutaibi AY, Al-Sabah SK, Altaany Z, Altaf A, Al-Tawfiq JA, Altirkawi KA, Aluh DO, Alvis-Guzman N, Alwafi H, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amare AT, Amegbor PM, Ameyaw EK, Amin TT, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Ancuceanu R, Anderlini D, Anderson DB, Andrade PP, Andrei CL, Andrei T, Angus C, Anil A, Anil S, Anoushiravani A, Ansari H, Ansariadi A, Ansari-Moghaddam A, Antony CM, Antriyandarti E, Anvari D, Anvari S, Anwar S, Anwar SL, Anwer R, Anyasodor AE, Aqeel M, Arab JP, Arabloo J, Arafat M, Aravkin AY, Areda D, Aremu A, Aremu O, Ariffin H, Arkew M, Armocida B, Arndt MB, Ärnlöv J, Arooj M, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Asaad M, Asadi-Lari M, Asgedom AA, Asghariahmadabad M, Asghari-Jafarabadi M, Ashraf M, Aslani A, Astell-Burt T, Athar M, Athari SS, Atinafu BTT, Atlaw HW, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Ausloos M, Avan A, Awedew AF, Aweke AM, Ayala Quintanilla BP, Ayatollahi H, Ayuso-Mateos JL, Ayyoubzadeh SM, Azadnajafabad S, Azevedo RMS, Azzam AY, B DB, Babu AS, Badar M, Badiye AD, Baghdadi S, Bagheri N, Bagherieh S, Bah S, Bahadorikhalili S, Bahmanziari N, Bai R, Baig AA, Baker JL, Bako AT, Bakshi RK, Balakrishnan S, Balasubramanian M, Baltatu OC, Bam K, Banach M, Bandyopadhyay S, Banik PC, Bansal H, Bansal K, Barbic F, Barchitta M, Bardhan M, Bardideh E, Barker-Collo SL, Bärnighausen TW, Barone-Adesi F, Barqawi HJ, Barrero LH, Barrow A, Barteit S, Barua L, Basharat Z, Bashiri A, Basiru A, Baskaran P, Basnyat B, Bassat Q, Basso JD, Basting AVL, Basu S, Batra K, Baune BT, Bayati M, Bayileyegn NS, Beaney T, Bedi N, Beghi M, Behboudi E, Behera P, Behnoush AH, Behzadifar M, Beiranvand M, Bejarano Ramirez DF, Béjot Y, Belay SA, Belete CM, Bell ML, Bello MB, Bello OO, Belo L, Beloukas A, Bender RG, Bensenor IM, Beran A, Berezvai Z, Berhie AY, Berice BN, Bernstein RS, Bertolacci GJ, Bettencourt PJG, Beyene KA, Bhagat DS, Bhagavathula AS, Bhala N, Bhalla A, Bhandari D, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhardwaj PV, Bhargava A, Bhaskar S, Bhat V, Bhatti GK, Bhatti JS, Bhatti MS, Bhatti R, Bhutta ZA, Bikbov B, Bishai JD, Bisignano C, Bisulli F, Biswas A, Biswas B, Bitaraf S, Bitew BD, Bitra VR, Bjørge T, Boachie MK, Boampong MS, Bobirca AV, Bodolica V, Bodunrin AO, Bogale EK, Bogale KA, Bohlouli S, Bolarinwa OA, Boloor A, Bonakdar Hashemi M, Bonny A, Bora K, Bora Basara B, Borhany H, Borzutzky A, Bouaoud S, Boustany A, Boxe C, Boyko EJ, Brady OJ, Braithwaite D, Brant LC, Brauer M, Brazinova A, Brazo-Sayavera J, Breitborde NJK, Breitner S, Brenner H, Briko AN, Briko NI, Britton G, Brown J, Brugha T, Bulamu NB, Bulto LN, Buonsenso D, Burns RA, Busse R, Bustanji Y, Butt NS, Butt ZA, Caetano dos Santos FL, Calina D, Cámera LA, Campos LA, Campos-Nonato IR, Cao C, Cao Y, Capodici A, Cárdenas R, Carr S, Carreras G, Carrero JJ, Carugno A, Carvalheiro CG, Carvalho F, Carvalho M, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Catalá-López F, Catapano AL, Cattaruzza MS, Cederroth CR, Cegolon L, Cembranel F, Cenderadewi M, Cercy KM, Cerin E, Cevik M, Chadwick J, Chahine Y, Chakraborty C, Chakraborty PA, Chan JSK, Chan RNC, Chandika RM, Chandrasekar EK, Chang CK, Chang JC, Chanie GS, Charalampous P, Chattu VK, Chaturvedi P, Chatzimavridou-Grigoriadou V, Chaurasia A, Chen AW, Chen AT, Chen CS, Chen H, Chen MX, Chen S, Cheng CY, Cheng ETW, Cherbuin N, Cheru WA, Chien JH, Chimed-Ochir O, Chimoriya R, Ching PR, Chirinos-Caceres JL, Chitheer A, Cho WCS, Chong B, Chopra H, Choudhari SG, Chowdhury R, Christopher DJ, Chukwu IS, Chung E, Chung E, Chung E, Chung SC, Chutiyami M, Cindi Z, Cioffi I, Claassens MM, Claro RM, Coberly K, Cogen RM, Columbus A, Comfort H, Conde J, Cortese S, Cortesi PA, Costa VM, Costanzo S, Cousin E, Couto RAS, Cowden RG, Cramer KM, Criqui MH, Cruz-Martins N, Cuadra-Hernández SM, Culbreth GT, Cullen P, Cunningham M, Curado MP, Dadana S, Dadras O, Dai S, Dai X, Dai Z, Dalli LL, Damiani G, Darega Gela J, Das JK, Das S, Das S, Dascalu AM, Dash NR, Dashti M, Dastiridou A, Davey G, Dávila-Cervantes CA, Davis Weaver N, Davletov K, De Leo D, de Luca K, Debele AT, Debopadhaya S, Degenhardt L, Dehghan A, Deitesfeld L, Del Bo' C, Delgado-Enciso I, Demessa BH, Demetriades AK, Deng K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert Bain L, Erkhembayar R, Esezobor CI, Eshrati B, Eskandarieh S, Espinosa-Montero J, Esubalew H, Etaee F, Fabin N, Fadaka AO, Fagbamigbe AF, Fahim A, Fahimi S, Fakhri-Demeshghieh A, Falzone L, Fareed M, Farinha CSES, Faris MEM, Faris PS, Faro A, Fasanmi AO, Fatehizadeh A, Fattahi H, Fauk NK, Fazeli P, Feigin VL, Feizkhah A, Fekadu G, Feng X, Fereshtehnejad SM, Feroze AH, Ferrante D, Ferrari AJ, Ferreira N, Fetensa G, Feyisa BR, Filip I, Fischer F, Flavel J, Flood D, Florin BT, Foigt NA, Folayan MO, Fomenkov AA, Foroutan B, Foroutan M, Forthun I, Fortuna D, Foschi M, Fowobaje KR, Francis KL, Franklin RC, Freitas A, Friedman J, Friedman SD, Fukumoto T, Fuller JE, Fux B, Gaal PA, Gadanya MA, Gaidhane AM, Gaihre S, Gakidou E, Galali Y, Galles NC, Gallus S, Ganbat M, Gandhi AP, Ganesan B, Ganiyani MA, Garcia-Gordillo MA, Gardner WM, Garg J, Garg N, Gautam RK, Gbadamosi SO, Gebi TG, Gebregergis MW, Gebrehiwot M, Gebremeskel TG, Georgescu SR, Getachew T, Gething PW, Getie M, Ghadiri K, Ghahramani S, Ghailan KY, Ghasemi MR, Ghasempour Dabaghi G, Ghasemzadeh A, Ghashghaee A, Ghassemi F, Ghazy RM, Ghimire A, Ghoba S, Gholamalizadeh M, Gholamian A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golchin A, Goldust M, Golechha M, Goleij P, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Goulart BNG, Goyal A, Grada A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Guimarães RA, Gulati S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gurmessa L, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadei M, Hadi NR, Haep N, Hafezi-Nejad N, Hailu A, Haj-Mirzaian A, Halboub ES, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hamilton EB, Han C, Han Q, Hanif A, Hanifi N, Hankey GJ, Hanna F, Hannan MA, Haque MN, Harapan H, Hargono A, Haro JM, Hasaballah AI, Hasan I, Hasan MT, Hasani H, Hasanian M, Hashi A, Hasnain MS, Hassan I, Hassanipour S, Hassankhani H, Haubold J, Havmoeller RJ, Hay SI, He J, Hebert JJ, Hegazi OE, Heidari G, Heidari M, Heidari-Foroozan M, Helfer B, Hendrie D, Herrera-Serna BY, Herteliu C, Hesami H, Hezam K, Hill CL, Hiraike Y, Holla R, Horita N, Hossain MM, Hossain S, Hosseini MS, Hosseinzadeh H, Hosseinzadeh M, Hosseinzadeh Adli A, Hostiuc M, Hostiuc S, Hsairi M, Hsieh VCR, Hsu RL, Hu C, Huang J, Hultström M, Humayun A, Hundie TG, Hussain J, Hussain MA, Hussein NR, Hussien FM, Huynh HH, Hwang BF, Ibitoye SE, Ibrahim KS, Iftikhar PM, Ijo D, Ikiroma AI, Ikuta KS, Ikwegbue PC, Ilesanmi OS, Ilic IM, Ilic MD, Imam MT, Immurana M, Inamdar S, Indriasih E, Iqhrammullah M, Iradukunda A, Iregbu KC, Islam MR, Islam SMS, Islami F, Ismail F, Ismail NE, Iso H, Isola G, Iwagami M, Iwu CCD, Iyamu IO, Iyer M, J LM, Jaafari J, Jacob L, Jacobsen KH, Jadidi-Niaragh F, Jafarinia M, Jafarzadeh A, Jaggi K, Jahankhani K, Jahanmehr N, Jahrami H, Jain N, Jairoun AA, Jaiswal A, Jamshidi E, Janko MM, Jatau AI, Javadov S, Javaheri T, Jayapal SK, Jayaram S, Jebai R, Jee SH, Jeganathan J, Jha AK, Jha RP, Jiang H, Jin Y, Johnson O, Jokar M, Jonas JB, Joo T, Joseph A, Joseph N, Joshua CE, Joshy G, Jozwiak JJ, Jürisson M, K V, Kaambwa B, Kabir A, Kabir Z, Kadashetti V, Kadir DH, Kalani R, Kalankesh LR, Kalankesh LR, Kaliyadan F, Kalra S, Kamal VK, Kamarajah SK, Kamath R, Kamiab Z, Kamyari N, Kanagasabai T, Kanchan T, Kandel H, Kanmanthareddy AR, Kanmiki EW, Kanmodi KK, Kannan S S, Kansal SK, Kantar RS, Kapoor N, Karajizadeh M, Karanth SD, Karasneh RA, Karaye IM, Karch A, Karim A, Karimi SE, Karimi Behnagh A, Kashoo FZ, Kasnazani QHA, Kasraei H, Kassebaum NJ, Kassel MB, Kauppila JH, Kaur N, Kawakami N, Kayode GA, Kazemi F, Kazemian S, Kazmi TH, Kebebew GM, Kebede AD, Kebede F, Keflie TS, Keiyoro PN, Keller C, Kelly JT, Kempen JH, Kerr JA, Kesse-Guyot E, Khajuria H, Khalaji A, Khalid N, Khalil AA, Khalilian A, Khamesipour F, Khan A, Khan A, Khan G, Khan I, Khan IA, Khan MN, Khan M, Khan MJ, Khan MAB, Khan ZA, Khan suheb MZ, Khanmohammadi S, Khatab K, Khatami F, Khatatbeh H, Khatatbeh MM, Khavandegar A, Khayat Kashani HR, Khidri FF, Khodadoust E, Khorgamphar M, Khormali M, Khorrami Z, Khosravi A, Khosravi MA, Kifle ZD, Kim G, Kim J, Kim K, Kim MS, Kim YJ, Kimokoti RW, Kinzel KE, Kisa A, Kisa S, Klu D, Knudsen AKS, Kocarnik JM, Kochhar S, Kocsis T, Koh DSQ, Kolahi AA, Kolves K, Kompani F, Koren G, Kosen S, Kostev K, Koul PA, Koulmane Laxminarayana SL, Krishan K, Krishna H, Krishna V, Krishnamoorthy V, Krishnamoorthy Y, Krohn KJ, Kuate Defo B, Kucuk Bicer B, Kuddus MA, Kuddus M, Kuitunen I, Kulimbet M, Kulkarni V, Kumar A, Kumar A, Kumar H, Kumar M, Kumar R, Kumari M, Kumie FT, Kundu S, Kurmi OP, Kusnali A, Kusuma D, Kwarteng A, Kyriopoulos I, Kyu HH, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lagat AK, Lager ACJ, Lahmar A, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lam H, Lám J, Landrum KR, Lanfranchi F, Lang JJ, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lassi ZS, Latief K, Latifinaibin K, Lauriola P, Le NHH, Le TTT, Le TDT, Ledda C, Ledesma JR, Lee M, Lee PH, Lee SW, Lee SWH, Lee WC, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Ligade VS, Likaka ATM, Lim LL, Lim SS, Lindstrom M, Linehan C, Liu C, Liu G, Liu J, Liu R, Liu S, Liu X, Liu X, Llanaj E, Loftus MJ, López-Bueno R, Lopukhov PD, Loreche AM, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma ZF, Maass KL, Machairas N, Machoy M, Madadizadeh F, Madsen C, Madureira-Carvalho ÁM, Maghazachi AA, Maharaj SB, Mahjoub S, Mahmoud MA, Mahmoudi A, Mahmoudi E, Mahmoudi R, Majeed A, Makhdoom IF, Malakan Rad E, Maled V, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Mansouri P, Mansournia MA, Mantovani LG, Maqsood S, Marasini BP, Marateb HR, Maravilla JC, Marconi AM, Mardi P, Marino M, Marjani A, Martinez G, Martinez-Guerra BA, Martinez-Piedra R, Martini D, Martini S, Martins-Melo FR, Martorell M, Marx W, Maryam S, Marzo RR, Masaka A, Masrie A, Mathieson S, Mathioudakis AG, Mathur MR, Mattumpuram J, Matzopoulos R, Maude RJ, Maugeri A, Maulik PK, Mayeli M, Mazaheri M, Mazidi M, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail SM, Mechili EA, Medina JRC, Mediratta RP, Meena JK, Mehra R, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Meles GG, Mendez-Lopez MAM, Mendoza W, Menezes RG, Mengist B, Mentis AFA, Meo SA, Meresa HA, Meretoja A, Meretoja TJ, Mersha AM, Mesfin BA, Mestrovic T, Mettananda KCD, Mettananda S, Meylakhs P, Mhlanga A, Mhlanga L, Mi T, Miazgowski T, Micha G, Michalek IM, Miller TR, Mills EJ, Minh LHN, Mini GK, Mir Mohammad Sadeghi P, Mirica A, Mirijello A, Mirrakhimov EM, Mirutse MK, Mirzaei M, Misganaw A, Mishra A, Misra S, Mitchell PB, Mithra P, Mittal C, Mobayen M, Moberg ME, Mohamadkhani A, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadi S, Mohammadian-Hafshejani A, Mohammadifard N, Mohammed H, Mohammed H, Mohammed M, Mohammed S, Mohammed S, Mohan V, Mojiri-Forushani H, Mokari A, Mokdad AH, Molinaro S, Molokhia M, Momtazmanesh S, Monasta L, Mondello S, Moni MA, Moodi Ghalibaf A, Moradi M, Moradi Y, Moradi-Lakeh M, Moradzadeh M, Moraga P, Morawska L, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosser JF, Motappa R, Mougin V, Mouodi S, Mousavi P, Mousavi SE, Mousavi Khaneghah A, Mpolya EA, Mrejen M, Mubarik S, Muccioli L, Mueller UO, Mughal F, Mukherjee S, Mulita F, Munjal K, Murillo-Zamora E, Musaigwa F, Musallam KM, Mustafa A, Mustafa G, Muthupandian S, Muthusamy R, Muzaffar M, Myung W, Nagarajan AJ, Nagel G, Naghavi P, Naheed A, Naik GR, Naik G, Nainu F, Nair S, Najmuldeen HHR, Nakhostin Ansari N, Nangia V, Naqvi AA, Narasimha Swamy S, Narayana AI, Nargus S, Nascimento BR, Nascimento GG, Nasehi S, Nashwan AJ, Natto ZS, Nauman J, Naveed M, Nayak BP, Nayak VC, Nazri-Panjaki A, Ndejjo R, Nduaguba SO, Negash H, Negoi I, Negoi RI, Negru SM, Nejadghaderi SA, Nejjari C, Nena E, Nepal S, Ng M, Nggada HA, Nguefack-Tsague G, Ngunjiri JW, Nguyen AH, Nguyen DH, Nguyen HTH, Nguyen PT, Nguyen VT, Niazi RK, Nielsen KR, Nigatu YT, Nikolouzakis TK, Nikoobar A, Nikoomanesh F, Nikpoor AR, Ningrum DNA, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Noreen M, Noroozi N, Norrving B, Noubiap JJ, Novotney A, Nri-Ezedi CA, Ntaios G, Ntsekhe M, Nuñez-Samudio V, Nurrika D, Nutor JJ, Oancea B, Obamiro KO, Oboh MA, Odetokun IA, Odogwu NM, O'Donnell MJ, Oduro MS, Ofakunrin AOD, Ogunkoya A, Oguntade AS, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olaiya MT, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Olusanya JO, Oluwafemi YD, Omar HA, Omar Bali A, Omer GL, Ondayo MA, Ong S, Onwujekwe OE, Onyedibe KI, Ordak M, Orisakwe OE, Orish VN, Ortega-Altamirano DV, Ortiz A, Osman WMS, Ostroff SM, Osuagwu UL, Otoiu A, Otstavnov N, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, Ozten Y, P A MP, Padron-Monedero A, Padubidri JR, Pal PK, Palicz T, Palladino C, Palladino R, Palma-Alvarez RF, Pan F, Pan HF, Pana A, Panda P, Panda-Jonas S, Pandi-Perumal SR, Pangaribuan HU, Panos GD, Panos LD, Pantazopoulos I, Pantea Stoian AM, Papadopoulou P, Parikh RR, Park S, Parthasarathi A, Pashaei A, Pasovic M, Passera R, Pasupula DK, Patel HM, Patel J, Patel SK, Patil S, Patoulias D, Patthipati VS, Paudel U, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Pensato U, Pepito VCF, Peprah EK, Peprah P, Perdigão J, Pereira M, Peres MFP, Perianayagam A, Perico N, Pestell RG, Pesudovs K, Petermann-Rocha FE, Petri WA, Pham HT, Philip AK, Phillips MR, Pierannunzio D, Pigeolet M, Pigott DM, Pilgrim T, Piracha ZZ, Piradov MA, Pirouzpanah S, Plakkal N, Plotnikov E, Podder V, Poddighe D, Polinder S, Polkinghorne KR, Poluru R, Ponkilainen VT, Porru F, Postma MJ, Poudel GR, Pourshams A, Pourtaheri N, Prada SI, Pradhan PMS, Prakasham TN, Prasad M, Prashant A, Prates EJS, Prieto Alhambra D, PRISCILLA TINA, Pritchett N, Purohit BM, Puvvula J, Qasim NH, Qattea I, Qazi AS, Qian G, Qiu S, Qureshi MF, Rabiee Rad M, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi Shahraki H, Rafferty Q, Raggi A, Raghav PR, Raheem N, Rahim F, Rahim MJ, Rahimi-Movaghar V, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmanian V, Rajaa S, Rajput P, Rakovac I, Ramasamy SK, Ramazanu S, Rana K, Ranabhat CL, Rancic N, Rane A, Rao CR, Rao IR, Rao M, Rao SJ, Rasali DP, Rasella D, Rashedi S, Rashedi V, Rashidi MM, Rasouli-Saravani A, Rasul A, Rathnaiah Babu G, Rauniyar SK, Ravangard R, Ravikumar N, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Rawlley B, Raza RZ, Razo C, Redwan EMM, Rehman FU, Reifels L, Reiner Jr RC, Remuzzi G, Reyes LF, Rezaei M, Rezaei N, Rezaei N, Rezaeian M, Rhee TG, Riaz MA, Ribeiro ALP, Rickard J, Riva HR, Robinson-Oden HE, Rodrigues CF, Rodrigues M, Roever L, Rogowski ELB, Rohloff P, Romadlon DS, Romero-Rodríguez E, Romoli M, Ronfani L, Roshandel G, Roth GA, Rout HS, Roy N, Roy P, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, Rwegerera GM, Rynkiewicz A, S N C, Saad AMA, Saadatian Z, Saber K, Saber-Ayad MM, SaberiKamarposhti M, Sabour S, Sacco S, Sachdev PS, Sachdeva R, Saddik B, Saddler A, Sadee BA, Sadeghi E, Sadeghi E, Sadeghian F, Saeb MR, Saeed U, Safaeinejad F, Safi SZ, Sagar R, Saghazadeh A, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahoo U, Sahu M, Saif Z, Sajid MR, Sakshaug JW, Salam N, Salamati P, Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samargandy S, Samodra YL, Samy AM, Sanabria J, Sanna F, Santomauro DF, Santos IS, Santric-Milicevic MM, Sao Jose BP, Sarasmita MA, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarkar T, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Satpathy M, Sayeed A, Sayeed MA, Saylan M, Sayyah M, Scarmeas N, Schaarschmidt BM, Schlaich MP, Schlee W, Schmidt MI, Schneider IJC, Schuermans A, Schumacher AE, Schutte AE, Schwarzinger M, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Senapati S, Senthilkumaran S, Sepanlou SG, Serban D, Sethi Y, Sha F, Shabany M, Shafaat A, Shafie M, Shah NS, Shah PA, Shah SM, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahsavari HR, Shahwan MJ, Shaikh A, Shaikh MA, Shakeri A, Shalash AS, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma R, Sharma S, Sharma U, Sharma V, Shastry RP, Shavandi A, Shayan M, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shetty A, Shetty BSK, Shetty PH, Shi P, Shibuya K, Shiferaw D, Shigematsu M, Shin MJ, Shin YH, Shiri R, Shirkoohi R, Shitaye NA, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shokraneh F, Shokri A, Shool S, Shorofi SA, Shrestha S, Shuval K, Siddig EE, Silva JP, Silva LMLR, Silva S, Simpson CR, Singal A, Singh A, Singh BB, Singh G, Singh J, Singh NP, Singh P, Singh S, Sinha DN, Sinto R, Siraj MS, Sirota SB, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Socea B, Sokhan A, Solanki R, Solanki S, Soleimani H, Soliman SSM, Song S, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Spearman S, Sreeramareddy CT, Srivastava VK, Stanaway JD, Stanikzai MH, Stark BA, Starnes JR, Starodubova AV, Stein C, Stein DJ, Steinbeis F, Steiner C, Steinmetz JD, Steiropoulos P, Stevanović A, Stockfelt L, Stokes MA, Stortecky S, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun HZ, Sun J, Sundström J, Sunkersing D, Sunnerhagen KS, Swain CK, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabish M, TADAKAMADLA JYOTHI, Tadakamadla SK, Taheri Abkenar Y, Taheri Soodejani M, Taiba J, Takahashi K, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tandukar S, Tang H, Tang HK, Tarigan IU, Tariku MK, Tariqujjaman M, Tarkang EE, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tefera YM, Temsah MH, Temsah RMH, Teramoto M, Tesler R, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Tharwat S, Thayakaran R, Thomas N, Thomas NK, Thomson AM, Thrift AG, Thum CCC, Thygesen LC, Tian J, Tichopad A, Ticoalu JHV, Tillawi T, Tiruye TY, Titova MV, Tonelli M, Topor-Madry R, Toriola AT, Torre AE, Touvier M, Tovani-Palone MR, Tran JT, Tran NM, Trico D, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Uddin SMN, Udoakang AJ, Udoh A, Ullah A, Ullah I, Ullah S, Ullah S, Umakanthan S, Umeokonkwo CD, Unim B, Unnikrishnan B, Unsworth CA, Upadhyay E, Urso D, Usman JS, Vahabi SM, Vaithinathan AG, Valizadeh R, Van de Velde SM, Van den Eynde J, Varga O, Vart P, Varthya SB, Vasankari TJ, Vasic M, Vaziri S, Vellingiri B, Venketasubramanian N, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Villanueva GI, Vinayak M, Violante FS, Viskadourou M, Vladimirov SK, Vlassov V, Vo B, Vollset SE, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang N, Wang S, Wang S, Wang Y, Wang YP, Waqas M, Ward P, Wassie EG, Watson S, Watson SLW, Weerakoon KG, Wei MY, Weintraub RG, Weiss DJ, Westerman R, Whisnant JL, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Wilandika A, Wilkerson C, Willeit P, Wilson S, Wojewodzic MW, Woldegebreal DH, Wolf AW, Wolfe CDA, Wondimagegene YA, Wong YJ, Wongsin U, Wu AM, Wu C, Wu F, Wu X, Wu Z, Xia J, Xiao H, Xie Y, Xu S, Xu WD, Xu X, Xu YY, Yadollahpour A, Yamagishi K, Yang D, Yang L, Yano Y, Yao Y, Yaribeygi H, Ye P, Yehualashet SS, Yesiltepe M, Yesuf SA, Yezli S, Yi S, Yigezu A, Yiğit A, Yiğit V, Yip P, Yismaw MB, Yismaw Y, Yon DK, Yonemoto N, Yoon SJ, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Yuh FH, Zadey S, Zadnik V, Zafari N, Zakham F, Zaki N, Zaman SB, Zamora N, Zand R, Zangiabadian M, Zar HJ, Zare I, Zarrintan A, Zeariya MGM, Zeinali Z, Zhang H, Zhang J, Zhang J, Zhang L, Zhang Y, Zhang ZJ, Zhao H, Zhong C, Zhou J, Zhu B, Zhu L, Ziafati M, Zielińska M, Zitoun OA, Zoladl M, Zou Z, Zuhlke LJ, Zumla A, Zweck E, Zyoud SH, Wool EE, Murray CJL. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
4
|
Brozek W, Clemens P, Ulmer H, Häring N, Concin H, Zitt E, Nagel G. Evaluation of a Population-Based Targeted Screening Approach for Skin Cancer with Long-Time Follow-Up in Austria including Potential Effects on Melanoma Mortality. Cancers (Basel) 2024; 16:1283. [PMID: 38610961 PMCID: PMC11011036 DOI: 10.3390/cancers16071283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND whether screening for skin cancer affects melanoma-specific mortality in a population-based setting remains unclear. METHODS in this population-based cohort study, we characterized and evaluated a skin cancer prevention program following a targeted screening approach conducted in 1989-1994 in the Austrian province Vorarlberg, with follow-up until 2019. The general population and attendees of a health examination program served for comparison. RESULTS in the screening program including full follow-up until 2019, 207 invasive and 187 in situ melanomas were identified in 8997 individuals. Incidences of invasive and in situ melanomas were elevated compared to the general population (IRR 2.92, 95%-CI 2.49-3.41, and IRR 4.13, 95%-CI 3.53-4.83, respectively) and the health examination program (HR 3.02, 95%-CI 2.59-3.52, and HR 3.90, 95%-CI 3.30-4.61, respectively). Breslow thickness and Clark's level at time of invasive diagnosis were significantly lower in 1989-2019, but the tumor characteristics of the melanomas diagnosed during 1989-1994 did not differ from the comparison groups. Moreover, melanoma mortality was significantly elevated in the screening program (IRR 1.66, 95%-CI 1.00-2.75 vs. the general population, HR 2.12, 95%-CI 1.25-3.61 vs. the health examination cohort). Melanoma mortality in Vorarlberg declined until 2004, though statistically non-significantly. CONCLUSIONS given the uncertain effectiveness and high public expenditures of population-wide mass screening programs, primary prevention and targeted risk-based skin cancer screening might be promising alternatives.
Collapse
Affiliation(s)
- Wolfgang Brozek
- Agency for Preventive and Social Medicine, 6900 Bregenz, Austria; (P.C.); (H.U.); (H.C.); (E.Z.); (G.N.)
| | - Patrick Clemens
- Agency for Preventive and Social Medicine, 6900 Bregenz, Austria; (P.C.); (H.U.); (H.C.); (E.Z.); (G.N.)
- Department of Radio-Oncology, Feldkirch Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, 6900 Bregenz, Austria; (P.C.); (H.U.); (H.C.); (E.Z.); (G.N.)
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Nina Häring
- Department of Dermatology and Venerology, Feldkirch Academic Teaching Hospital, 6800 Feldkirch, Austria;
| | - Hans Concin
- Agency for Preventive and Social Medicine, 6900 Bregenz, Austria; (P.C.); (H.U.); (H.C.); (E.Z.); (G.N.)
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, 6900 Bregenz, Austria; (P.C.); (H.U.); (H.C.); (E.Z.); (G.N.)
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), 6800 Feldkirch, Austria
- Department of Internal Medicine 3 (Nephrology, Dialysis and Hypertension), Feldkirch Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, 6900 Bregenz, Austria; (P.C.); (H.U.); (H.C.); (E.Z.); (G.N.)
- Institute of Epidemiology and Medical Biometry, Ulm University, 89081 Ulm, Germany
| |
Collapse
|
5
|
Phelps NH, Singleton RK, Zhou B, Heap RA, Mishra A, Bennett JE, Paciorek CJ, Lhoste VPF, Carrillo-Larco RM, Stevens GA, Rodriguez-Martinez A, Bixby H, Bentham J, Di Cesare M, Danaei G, Rayner AW, Barradas-Pires A, Cowan MJ, Savin S, Riley LM, Aguilar-Salinas CA, Baker JL, Barkat A, Bhutta ZA, Branca F, Caixeta RB, Cuschieri S, Farzadfar F, Ganapathy S, Ikeda N, Iotova V, Kengne AP, Khang YH, Laxmaiah A, Lin HH, Ma J, Mbanya JCN, Miranda JJ, Pradeepa R, Rodríguez-Artalejo F, Sorić M, Turley M, Wang L, Webster-Kerr K, Aarestrup J, Abarca-Gómez L, Abbasi-Kangevari M, Abdeen ZA, Abdrakhmanova S, Abdul Ghaffar S, Abdul Rahim HF, Abdurrahmonova Z, Abu-Rmeileh NM, Abubakar Garba J, Acosta-Cazares B, Adam I, Adamczyk M, Adams RJ, Adu-Afarwuah S, Aekplakorn W, Afsana K, Afzal S, Agbor VN, Agdeppa IA, Aghazadeh-Attari J, Ågren Å, Aguenaou H, Agyemang C, Ahmad MH, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed I, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Al-Raddadi R, Al Asfoor D, Al Hourani HM, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Alexius S, Ali MM, Alieva AV, Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alomary SA, Alomirah HF, Alshangiti AM, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Amiano Etxezarreta P, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Assefa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Aurélio de Valois CJM, Auvinen J, Avdičová M, Avi S, Azad K, Azevedo A, Azimi-Nezhad M, Azizi F, Babu BV, Bacopoulou F, Bæksgaard Jørgensen M, Baharudin A, Bahijri S, Bajramovic I, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Barbosa Filho V, Barceló A, Baretić M, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JL, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedek T, Benedics J, Benet M, Benitez Rolandi GE, Benzeval M, Bere E, Berger N, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Berrios Carrasola X, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Blychfeld Magnazu M, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Botomba S, Bourne RRA, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Braithwaite T, Brajkovich I, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Bringolf-Isler B, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buoncristiano M, Burazeri G, Burns C, Cabrera de León A, Cacciottolo J, Cai H, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes-Loaiza M, Cesar JA, Chamnan P, Chamukuttan S, Chan A, Chan Q, Charchar FJ, Charles MA, Chaturvedi HK, Chaturvedi N, Che Abdul Rahim N, Chee ML, Chen CJ, Chen F, Chen H, Chen LS, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clare P, Clarke J, Clays E, Cohen E, Cojocaru CR, Colorado-Yohar S, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Czenczek-Lewandowska E, D'Arrigo G, d'Orsi E, da Silva AG, Dacica L, Dahm CC, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis Guedes de Vasconcelos F, de Assis MAA, De Backer G, De Bacquer D, De Bacquer J, de Bont J, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, De Neve JW, Duarte de Oliveira P, De Ridder D, De Ridder K, de Rooij SR, de Sá ACMGN, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Devrishov RD, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Díaz Fernández P, Díez Ripollés MP, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Dörr M, Doua K, Dragano N, Drygas W, Du S, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dwyer T, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Ebrahimi N, Echeverría G, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Elliott P, Enang O, Endevelt R, Engle-Stone R, Erasmus RT, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Evans RG, Faeh D, Fagherazzi G, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Farrugia Sant'Angelo V, Farzi Y, Fattahi MR, Fawwad A, Fawzi WW, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fink G, Fisberg M, Fischer K, Foo LH, Forsner M, Fottrell EF, Fouad HM, Francis DK, Franco MDC, Fras Z, Fraser B, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gabriela SA, Gaciong Z, Gafencu M, Galán Cuesta M, Galbarczyk A, Galcheva SV, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, García Mérida MJ, García Solano M, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Gerdts E, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez Gómez JH, Gomez LF, Gómez SF, Gomula A, Gonçalves Cordeiro da Silva B, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregg EW, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerchet M, Guerrero R, Guessous I, Guimaraes AL, Gujral UP, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, Gurinović MA, Gutiérrez González E, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hardy L, Hari Kumar R, Harmer Lassen T, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Heinen M, Hejgaard T, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Heude B, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hoogendijk E, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huidumac Petrescu C, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea J, Ibrahim MM, Ibrahim Wong N, Igland J, Ijoma C, Ikram MA, Iñiguez C, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ittermann T, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jan N, Jansson A, Janszky I, Janus E, Jarani J, Jarnig G, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jøran Kjerpeseth L, Jørgensen T, Joshi P, Joshi R, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Jurca Simina I, Juresa V, Kaaks R, Kaducu FO, Kadvan AL, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kanala KR, Kannan S, Kapantais E, Karaglani E, Karakosta A, Kårhus LL, Karki KB, Karlsson O, Kassi Anicet A, Katchunga PB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Kaze FF, Kazembe BM, Ke C, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Killewo J, Kim HC, Kim J, Kindblom JM, Kingston A, Klakk H, Klanarong S, Klanova J, Klimek M, Klimont J, Klumbiene J, Knoflach M, Kobel S, Koirala B, Kolle E, Kolo SM, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Kos J, Koskinen S, Kouda K, Koussoh Simone M, Kovács É, Kovacs VA, Kovalskys I, Kowlessur S, Koziel S, Kratenova J, Kratzer W, Kriaucioniene V, Kriemler S, Kristensen PL, Krizan H, Kroker-Lobos MF, Krokstad S, Kromhout D, Kruger HS, Kruger R, Kryst Ł, Kubinova R, Kuciene R, Kujala UM, Kujundzic E, Kulaga Z, Kulimbet M, Kulothungan V, Kumar RK, Kumari M, Kunešová M, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, La QN, Laamiri FZ, Laatikainen T, Labadarios D, Lachat C, Lackner KJ, Lai D, Laid Y, Lall L, Lam TH, Landaeta Jimenez M, Landais E, Lankila T, Lanska V, Lappas G, Larijani B, Larissa SP, Lateva MP, Latt TS, Laurenzi M, Lauria L, Lazo-Porras M, Le Coroller G, Le Nguyen Bao K, Le Port A, Le TD, Lee J, Lee J, Lee PH, Lehtimäki T, Lemogoum D, Leong E, Leskošek B, Leszczak J, Leth-Møller KB, Leung GM, Levitt NS, Li Y, Liivak M, Lilly CL, Lim C, Lim WY, Lima-Costa MF, Lin X, Lind L, Lingam V, Linkohr B, Linneberg A, Lissner L, Litwin M, Liu J, Liu L, Liu L, Liu X, Lo WC, Loit HM, Long KQ, Longo Abril G, Lopes L, Lopes MSS, Lopes O, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukrafka JL, Luksiene D, Lundqvist A, Lunet N, Lunogelo C, Lustigová M, Łuszczki E, M'Buyamba-Kabangu JR, Ma G, Ma X, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Madraisau S, Madsen AL, Maestre GE, Maggi S, Magliano DJ, Magnacca S, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Mäki P, Malekpour MR, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malta DC, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mannix MI, Mansour-Ghanaei F, Manyanga T, Manzato E, Mapatano MA, Marcil A, Margozzini P, Maria-Magdalena R, Mariño J, Markaki A, Markey O, Markidou Ioannidou E, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Maruf FA, Maruszczak K, Marventano S, Masala G, Mascarenhas LP, Masinaei M, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matłosz P, Matsha TE, Matsudo V, Matteo G, Maulik PK, Mavrogianni C, Mazur A, McFarlane SR, McGarvey ST, McKee M, McLean RM, McLean SB, McNairy ML, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Melgarejo JD, Melkumova M, Mello J, Méndez F, Mendivil CO, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Meshram II, Meto DT, Meyer HE, Mi J, Michaelsen KF, Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monroy-Valle M, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Mridha MK, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Musić Milanović S, Musil V, Musinguzi G, Muyer MT, Nabipour I, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Narayan KMV, Nardone P, Naseri T, Nathalie M, Neal WA, Neelapaichit N, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Norton KI, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O'Neill TW, O'Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Oldenburg B, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Onodugo O, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Ottendahl CB, Otu A, Overvad K, Owusu-Dabo E, Oyeyemi AY, Oyeyemi AL, Paccaud FM, Padez CP, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Pajula N, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Pang Z, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Perez-Londoño A, Pérez CM, Peterkova V, Peters A, Petkeviciene J, Petrauskiene A, Petrovna Kovtun O, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Phiri FP, Pichardo RN, Pierannunzio D, Pierre-Marie P, Pigeot I, Pikhart H, Pilav A, Piler P, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popkin BM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puhakka S, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qiao Q, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Quoc Bao T, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Ramachandra Rao S, Ramachandran A, Ramadan OPC, Ramires VV, Ramirez-Zea M, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Ramsay SE, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rashidi MM, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Reynolds A, Rezaei N, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Risérus U, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Roccaldo R, Rodrigues D, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Ruiz Moreno E, Rusakova IA, Rusek W, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Saamel M, Saar CG, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saieva C, Sakata S, Saki N, Šalaj S, Salanave B, Salazar Martinez E, Salhanova A, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Sánchez Rodríguez I, Sandjaja, Sans S, Santa-Marina L, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schaffrath Rosario A, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt B, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schultz G, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Sewpaul R, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suarez-Ortegón MF, Suebsamran P, Sugiyama M, Suka M, Sulo G, Sun CA, Sun L, Sund M, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szponar L, Tabone L, Tai ES, Takuro F, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Taxová Braunerová R, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tessema M, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thrift AG, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Topór-Mądry R, Torheim LE, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Udoji N, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vatasescu R, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Viriyautsahakul N, Virtanen JK, Visser M, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Vourli G, Voutilainen A, Vrijheid M, Vrijkotte TGM, Vuletić S, Wade AN, Waldhör T, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang C, Wang H, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wartha O, Weber A, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
Collapse
|
6
|
Leiherer A, Brozek W, Muendlein A, Ulmer H, Saely CH, Fraunberger P, Nagel G, Zitt E, Drexel H, Concin H. The value of earlier-in-life systolic and diastolic blood pressure for cardiovascular risk prediction. iScience 2024; 27:109097. [PMID: 38384855 PMCID: PMC10879708 DOI: 10.1016/j.isci.2024.109097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/20/2023] [Accepted: 01/30/2024] [Indexed: 02/23/2024] Open
Abstract
Blood pressure (BP) varies over a lifetime. This cardiovascular observation study (OS) compared the predictive value of earlier- and later-in-life blood pressure (BP) in 1,497 cardiovascular disease patients utilizing readings taken during a health survey (HS) and 15 years later from the same subjects at the baseline of this OS. Prediction of the cardiovascular risk during the OS follow-up (21 years) was significantly more effective if the earlier BP readings at HS were used instead of recent OS readings (NRI = 0.30, p < 0.001). For HS readings, each 10 mm Hg increase of systolic and diastolic BP was associated with a 17% and 20% higher risk, respectively. At OS, systolic BP lost significance and diastolic BP reversed its association. Noteworthy, different BP categorizations (European vs. US guidelines) yielded similar results. This study highlights the poor predictive power of BP readings in elderly cardiovascular disease patients but emphasizes the significant prognostic value of earlier-in-life BP.
Collapse
Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | | | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Peter Fraunberger
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| |
Collapse
|
7
|
Weinmayr G, Chen J, Jaensch A, Skodda L, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Pershagen G, Rizzuto D, Samoli E, Severi G, Stafoggia M, Tjønneland A, Vermeulen R, Wolf K, Zitt E, Brunekreef B, Thurston G, Hoek G, Raaschou-Nielsen O, Nagel G. Long-term exposure to several constituents and sources of PM 2.5 is associated with incidence of upper aerodigestive tract cancers but not gastric cancer: Results from the large pooled European cohort of the ELAPSE project. Sci Total Environ 2024; 912:168789. [PMID: 37996018 DOI: 10.1016/j.scitotenv.2023.168789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
It is unclear whether cancers of the upper aerodigestive tract (UADT) and gastric cancer are related to air pollution, due to few studies with inconsistent results. The effects of particulate matter (PM) may vary across locations due to different source contributions and related PM compositions, and it is not clear which PM constituents/sources are most relevant from a consideration of overall mass concentration alone. We therefore investigated the association of UADT and gastric cancers with PM2.5 elemental constituents and sources components indicative of different sources within a large multicentre population based epidemiological study. Cohorts with at least 10 cases per cohort led to ten and eight cohorts from five countries contributing to UADT- and gastric cancer analysis, respectively. Outcome ascertainment was based on cancer registry data or data of comparable quality. We assigned home address exposure to eight elemental constituents (Cu, Fe, K, Ni, S, Si, V and Zn) estimated from Europe-wide exposure models, and five source components identified by absolute principal component analysis (APCA). Cox regression models were run with age as time scale, stratified for sex and cohort and adjusted for relevant individual and neighbourhood level confounders. We observed 1139 UADT and 872 gastric cancer cases during a mean follow-up of 18.3 and 18.5 years, respectively. UADT cancer incidence was associated with all constituents except K in single element analyses. After adjustment for NO2, only Ni and V remained associated with UADT. Residual oil combustion and traffic source components were associated with UADT cancer persisting in the multiple source model. No associations were found for any of the elements or source components and gastric cancer incidence. Our results indicate an association of several PM constituents indicative of different sources with UADT but not gastric cancer incidence with the most robust evidence for traffic and residual oil combustion.
Collapse
Affiliation(s)
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lea Skodda
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805, Villejuif, France
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; The Danish Cancer Institute, Copenhagen, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - George Thurston
- Division of Environmental Medicine, Depts of Medicine and Population Health, New York University Grossman School of Medicine, New York, USA
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; The Danish Cancer Institute, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| |
Collapse
|
8
|
Taj T, Chen J, Rodopoulou S, Strak M, de Hoogh K, Poulsen AH, Andersen ZJ, Bellander T, Brandt J, Zitt E, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Jørgensen JT, Katsouyanni K, Ketzel M, Lager A, Leander K, Liu S, Ljungman P, Severi G, Besson C, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, Samoli E, Sørensen M, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long-term exposure to ambient air pollution and risk of leukemia and lymphoma in a pooled European cohort. Environ Pollut 2024; 343:123097. [PMID: 38065336 DOI: 10.1016/j.envpol.2023.123097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
Leukemia and lymphoma are the two most common forms of hematologic malignancy, and their etiology is largely unknown. Pathophysiological mechanisms suggest a possible association with air pollution, but little empirical evidence is available. We aimed to investigate the association between long-term residential exposure to outdoor air pollution and risk of leukemia and lymphoma. We pooled data from four cohorts from three European countries as part of the "Effects of Low-level Air Pollution: a Study in Europe" (ELAPSE) collaboration. We used Europe-wide land use regression models to assess annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) at residences. We also estimated concentrations of PM2.5 elemental components: copper (Cu), iron (Fe), zinc (Zn); sulfur (S); nickel (Ni), vanadium (V), silicon (Si) and potassium (K). We applied Cox proportional hazards models to investigate the associations. Among the study population of 247,436 individuals, 760 leukemia and 1122 lymphoma cases were diagnosed during 4,656,140 person-years of follow-up. The results showed a leukemia hazard ratio (HR) of 1.13 (95% confidence intervals [CI]: 1.01-1.26) per 10 μg/m3 NO2, which was robust in two-pollutant models and consistent across the four cohorts and according to smoking status. Sex-specific analyses suggested that this association was confined to the male population. Further, the results showed increased lymphoma HRs for PM2.5 (HR = 1.16; 95% CI: 1.02-1.34) and potassium content of PM2.5, which were consistent in two-pollutant models and according to sex. Our results suggest that air pollution at the residence may be associated with adult leukemia and lymphoma.
Collapse
Affiliation(s)
- Tahir Taj
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| | | | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom.
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
| | | | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shuo Liu
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805, Villejuif, France; Department of Statistics, Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy.
| | - Caroline Besson
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805, Villejuif, France.
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany.
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Mette Sørensen
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy.
| | - Anne Tjønneland
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Ole Raaschou-Nielsen
- Danish Cancer Institute, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| |
Collapse
|
9
|
Fritz J, Jochems SHJ, Bjørge T, Wood AM, Häggström C, Ulmer H, Nagel G, Zitt E, Engeland A, Harlid S, Drake I, Stattin P, Stocks T. Body mass index, triglyceride-glucose index, and prostate cancer death: a mediation analysis in eight European cohorts. Br J Cancer 2024; 130:308-316. [PMID: 38087039 PMCID: PMC10803806 DOI: 10.1038/s41416-023-02526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Insulin resistance is a hypothesised biological mechanism linking obesity with prostate cancer (PCa) death. Data in support of this hypothesis is limited. METHODS We included 259,884 men from eight European cohorts, with 11,760 incident PCa's and 1784 PCa deaths during follow-up. We used the triglyceride-glucose (TyG) index as indicator of insulin resistance. We analysed PCa cases with follow-up from PCa diagnosis, and the full cohort with follow-up from the baseline cancer-free state, thus incorporating both PCa incidence and death. We calculated hazard ratios (HR) and the proportion of the total effect of body mass index (BMI) on PCa death mediated through TyG index. RESULTS In the PCa-case-only analysis, baseline TyG index was positively associated with PCa death (HR per 1-standard deviation: 1.11, 95% confidence interval (CI); 1.01-1.22), and mediated a substantial proportion of the baseline BMI effect on PCa death (HRtotal effect per 5-kg/m2 BMI: 1.24; 1.14-1.35, of which 28%; 4%-52%, mediated). In contrast, in the full cohort, the TyG index was not associated with PCa death (HR: 1.03; 0.94-1.13), hence did not substantially mediate the effect of BMI on PCa death. CONCLUSIONS Insulin resistance could be an important pathway through which obesity accelerates PCa progression to death.
Collapse
Affiliation(s)
- Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden.
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
| | | | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christel Häggström
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Isabel Drake
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
10
|
Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Forastiere F, Brynedal B, Hertel O, Hoffmann B, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Multiple myeloma risk in relation to long-term air pollution exposure - A pooled analysis of four European cohorts. Environ Res 2023; 239:117230. [PMID: 37806476 DOI: 10.1016/j.envres.2023.117230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Air pollution is a growing concern worldwide, with significant impacts on human health. Multiple myeloma is a type of blood cancer with increasing incidence. Studies have linked air pollution exposure to various types of cancer, including leukemia and lymphoma, however, the relationship with multiple myeloma incidence has not been extensively investigated. METHODS We pooled four European cohorts (N = 234,803) and assessed the association between residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), and ozone (O3) and multiple myeloma. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 4,415,817 person-years of follow-up (average 18.8 years), we observed 404 cases of multiple myeloma. The results of the fully adjusted linear analyses showed hazard ratios (95% confidence interval) of 0.99 (0.84, 1.16) per 10 μg/m³ NO2, 1.04 (0.82, 1.33) per 5 μg/m³ PM2.5, 0.99 (0.84, 1.18) per 0.5 10-5 m-1 BCE, and 1.11 (0.87, 1.41) per 10 μg/m³ O3. CONCLUSIONS We did not observe an association between long-term ambient air pollution exposure and incidence of multiple myeloma.
Collapse
Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, GU2 7XH, United Kingdom
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, And Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- The Danish Cancer Institute, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| |
Collapse
|
11
|
Vahl JM, Nagel G, Abou Kors T, Brand M, von Witzleben A, Sonntag M, Grages A, Theodoraki MN, Greve J, Denkinger M, Dallmeier D, Idel C, Stilgenbauer S, Hoffmann TK, Laban S. Regional outcome disparities in German head and neck cancer patients: Shorter survival in Eastern Germany. Cancer Med 2023; 12:21426-21435. [PMID: 38037808 PMCID: PMC10726835 DOI: 10.1002/cam4.6690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Demographics are important prognostic factors in malignant diseases. A nationwide analysis concerning the prognostic impact of demographics in head and neck cancer (HNC) patients (HNCP) has not been performed previously. METHODS A retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) and the Federal Statistical Office (Destatis) between 2002 and 2017 was performed. A total of 212'920 HNCP were included. Incidence, tumor stage, age development, sex distribution, age-, residence-, and diagnosis-time-specific survival were examined. RESULTS Mean age of HNCP increased more rapidly than in the general population (slope coefficient: 0.29 vs. 0.20; p < 0.0001). Higher age and male sex were associated with a worse prognosis. Whereas overall survival (OS) increased from the early to the later observation period for HNCP <70 years, no OS improvement for HNCP >70 years was found. Furthermore, an OS disadvantage was observed for East Germany compared to West Germany (median 47 vs. 60 months; p < 0.0001). This disparity was associated with a disproportionately high ratio of men in East Germany (men/women: 4.4 vs. 3.1; p < 0.0001) and a lower mean age (61 vs. 63 years; p < 0.0001). In addition to stage, age and sex, residence in East Germany were confirmed as an independent factor for OS in a multivariate analysis. CONCLUSION Finally, three decades after the German reunion, a survival disadvantage for patients in East Germany still exists. This discrepancy may be a result of socioeconomic disparities.
Collapse
Affiliation(s)
- Julius M. Vahl
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Gabriele Nagel
- Department of Epidemiology and Medical BiometryUniversity Medical Center UlmUlmGermany
| | - Tsima Abou Kors
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Matthias Brand
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Adrian von Witzleben
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Michael Sonntag
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Ayla Grages
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Marie N. Theodoraki
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Jens Greve
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Michael Denkinger
- Agaplesion Bethesda UlmInstitute of Geriatric Research at Ulm University Medical Center and Geriatric CenterUlmGermany
| | - Dhayana Dallmeier
- Agaplesion Bethesda UlmInstitute of Geriatric Research at Ulm University Medical Center and Geriatric CenterUlmGermany
| | - Christian Idel
- Department of OtorhinolaryngologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | | | - Thomas K. Hoffmann
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Simon Laban
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| |
Collapse
|
12
|
Nagel G, Kurz D, Peter RS, Rosenbohm A, Koenig W, Dupuis L, Bäzner H, Börtlein A, Dempewolf S, Schabet M, Hecht M, Kohler A, Opherk C, Naegele A, Sommer N, Lindner A, Tumani H, Ludolph AC, Rothenbacher D. Cystatin C based estimation of chronic kidney disease and amyotrophic lateral sclerosis in the ALS registry Swabia: associated risk and prognostic value. Sci Rep 2023; 13:19594. [PMID: 37949878 PMCID: PMC10638424 DOI: 10.1038/s41598-023-46179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
Kidney function as part of metabolic changes could be associated with amyotrophic lateral-sclerosis (ALS). We investigated the associations between estimated chronic kidney disease (CKD), based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) cystatin C equation, and the risk at onset and prognostic value of CKD for ALS. Between October 2010 and June 2014, 362 ALS cases (59.4% men, mean age 65.7 years) and 681 controls (59.5% men, means age 66.3 years) were included in a population-based case-control study based on the ALS registry Swabia in Southern Germany. All ALS cases were followed-up (median 89.7 months), 317 died. Serum samples were measured for cystatin C to estimate the glomerular filtration rate (eGFR) according to the CKD-EPI equation. Information on covariates were assessed by an interview-based standardized questionnaire. Conditional logistic regression models were applied to calculate odds ratios (OR) for risk of ALS associated with eGFR/CKD stages. Time-to-death associated with renal parameters at baseline was assessed in ALS cases only. ALS cases were characterized by lower body mass index, slightly lower smoking prevalence, more intense occupational work and lower education than controls. Median serum cystatin-C based eGFR concentrations were lower in ALS cases than in controls (54.0 vs. 59.5 mL/min pro 1.73 m2). The prevalence of CKD stage ≥ 3 was slightly higher in ALS cases than in controls (14.1 vs. 11.0%). In the adjusted models, CKD stage 2 (OR 1.82, 95% CI 1.32, 2.52) and stage 3 (OR 2.34, 95% CI 1.38, 3.96) were associated with increased ALS risk. In this cohort of ALS cases, eGFR and CKD stage ≥ 3 (HR 0.94; 95% CI 0.64, 1.38) were not associated with prognosis. In this case-control study, higher CKD stages were associated with increased ALS risk, while in the prospective cohort of ALS cases, no indication of an association of CysC-based CKD on mortality was seen. In addition, our work strengthens the importance to evaluate renal function using a marker independent of muscle mass in ALS patients.
Collapse
Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - Deborah Kurz
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | | | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Luc Dupuis
- Université de Strasbourg, Inserm, UMR-S1118, Centre de Recherches en Biomédecine de Strasbourg, Strasbourg, France
| | - Hansjörg Bäzner
- Department of Neurology, Klinikum Stuttgart, Stuttgart, Germany
| | - Axel Börtlein
- Department of Neurology, Klinikum Stuttgart, Stuttgart, Germany
| | - Silke Dempewolf
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Schabet
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Hecht
- Department of Neurology, Klinikum Kaufbeuren, Kliniken Ostallgäu Kaufbeuren, Kaufbeuren, Germany
| | - Andreas Kohler
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Christian Opherk
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Andrea Naegele
- Department of Neurology, Christophsbad Goeppingen, Goeppingen, Germany
| | - Norbert Sommer
- Department of Neurology, Christophsbad Goeppingen, Goeppingen, Germany
| | - Alfred Lindner
- Department of Neurology, Marienhospital Stuttgart, Stuttgart, Germany
| | | | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE), Ulm, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| |
Collapse
|
13
|
Zhou B, Sheffer KE, Bennett JE, Gregg EW, Danaei G, Singleton RK, Shaw JE, Mishra A, Lhoste VPF, Carrillo-Larco RM, Kengne AP, Phelps NH, Heap RA, Rayner AW, Stevens GA, Paciorek CJ, Riley LM, Cowan MJ, Savin S, Vander Hoorn S, Lu Y, Pavkov ME, Imperatore G, Aguilar-Salinas CA, Ahmad NA, Anjana RM, Davletov K, Farzadfar F, González-Villalpando C, Khang YH, Kim HC, Laatikainen T, Laxmaiah A, Mbanya JCN, Narayan KMV, Ramachandran A, Wade AN, Zdrojewski T, Abbasi-Kangevari M, Rahim HFA, Abu-Rmeileh NM, Adambekov S, Adams RJ, Aekplakorn W, Agdeppa IA, Aghazadeh-Attari J, Agyemang C, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed SH, Ajlouni K, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Asfoor DA, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Ali MM, Alinezhad F, Alkandari A, Alomirah HF, Aly E, Amarapurkar DN, Andersen LB, Anderssen SA, Andrade DS, Ansari-Moghaddam A, Aounallah-Skhiri H, Aris T, Arlappa N, Aryal KK, Assah FK, Assembekov B, Auvinen J, Avdičová M, Azad K, Azimi-Nezhad M, Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dastgiri S, De Curtis A, de Gaetano G, De Henauw S, Deepa M, DeGennaro V, Demarest S, Dennison E, Deschamps V, Dhimal M, Dika Z, Djalalinia S, Donfrancesco C, Dong G, Dorobantu M, Dörr M, Dragano N, Drygas W, Du Y, Duante CA, Duboz P, Dushpanova A, Dziankowska-Zaborszczyk E, Ebrahimi N, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eghtesad S, El-Khateeb M, El Ati J, Eldemire-Shearer D, Elosua R, Enang O, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Esmaeili A, Evans RG, Fakhradiyev I, Fall CH, Faramarzi E, Farjam M, Farzi Y, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrari M, Ferreccio C, Ferreira HS, Ferrer E, Feskens EJM, Flood D, Forsner M, Fosse S, Fottrell EF, Fouad HM, Francis DK, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gasull M, Gazzinelli A, Gehring U, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gianfagna F, Gill TK, Gironella G, Giwercman A, Goltzman D, Gomula A, Gonçalves H, Gonçalves M, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando ME, Gonzalez AR, Gottrand F, Grafnetter D, Grodzicki T, Grøntved A, Guerrero R, Gujral UP, Gupta R, Gutierrez L, Gwee X, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hantunen S, Hao J, Hari Kumar R, Harooni J, Hashemi-Shahri SM, Hata J, Heidemann C, Henrique RDS, Herrala S, Herzig KH, Heshmat R, Ho SY, Holdsworth M, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga C, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Husseini A, Huybrechts I, Iacoviello L, Iakupova EM, Iannone AG, Ibrahim Wong N, Ijoma C, Irazola VE, Ishida T, Isiguzo GC, Islam SMS, Islek D, Ittermann T, Iwasaki M, Jääskeläinen T, Jacobs JM, Jaddou HY, Jadoul M, Jallow B, James K, Jamil KM, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jimenez RO, Jöckel KH, Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekpour MR, Malekzadeh F, Malekzadeh R, Mallikharjuna Rao K, Malyutina S, Maniego LV, Manios Y, Mannix MI, Mansour-Ghanaei F, Manzato E, Margozzini P, Mariño J, Marques LP, Martorell R, Mascarenhas LP, Masinaei M, Mathiesen EB, Matsha TE, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, Mediene Benchekor S, Mehlig K, Mehrparvar AH, Melgarejo JD, Méndez F, Menezes AMB, Mereke A, Meshram II, Meto DT, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Modesti PA, Moghaddam SS, Mohamed MK, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohd Yusoff MF, Mohebbi I, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Moosazadeh M, Moradpour F, Morejon A, Moreno LA, Morgan K, Morin SN, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Mursu J, Musa KI, Mustafa N, Muyer MTMC, Nabipour I, Nagel G, Naidu BM, Najafi F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
Collapse
|
14
|
Tailor V, Brady LM, Miller J, Bays L, Zane J, Nagel G, Baker H, Crosby-Nwaobi R, Dahlmann-Noor A. 18 Engaging with young people to improve research, services and workforce development: eye-YPAG and 'visually' workshops. BMJ Open Ophthalmol 2023; 8:A6-A7. [PMID: 37797991 DOI: 10.1136/bmjophth-2023-biposa.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Involving children and young people (CYP) in service and research design improves quality and accessibility. Running events in schools to invite CYP to volunteer and explore careers in the NHS may contribute to uptake of training posts and developing the NHS workforce.Here we evaluate two activities with CYP, our Young Person's Advisory Group for research (eye-YPAG) and our workshop for secondary schools, 'visually'.We evaluated eye-YPAG in focus groups and online surveys with group members, parents/carers, researchers, facilitators and funders. We conducted thematic analysis and descriptive statistics. To evaluate 'visually', we monitored the numbers of workshops and young people applying for volunteering roles. We asked those who started working with us about their experience.eye-YPAG members valued social and creative aspects as well as learning about research and developing skills and confidence. Researchers reported that CYP gave novel suggestions, modifying research plans, and that their different perspective was helpful in making research more relevant for children and families.Over 6 months, we held 15 'visually' workshops in secondary schools. Ninety students applied for volunteering roles, and 20 have completed the Human Resources onboarding process. Young volunteers report that this work has increased their confidence and that they have gained insights into how a hospital works. One is considering training to become an orthoptist.Both eye-YPAG and 'visually' are available to all eye researchers and units in the UK and can facilitate outreach activities.
Collapse
Affiliation(s)
- V Tailor
- Moorfields Eye Hospital NHS foundation Trust, London, UK
| | - L M Brady
- Moorfields Eye Hospital NHS foundation Trust, London, UK
| | - J Miller
- Moorfields Eye Hospital NHS foundation Trust, London, UK
| | - L Bays
- Moorfields Eye Hospital NHS foundation Trust, London, UK
| | - J Zane
- Moorfields Eye Hospital NHS foundation Trust, London, UK
| | - G Nagel
- Moorfields Eye Hospital NHS foundation Trust, London, UK
| | - H Baker
- Moorfields Eye Hospital NHS foundation Trust, London, UK
| | | | | |
Collapse
|
15
|
Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Katsouyanni K, Ketzel M, Leander K, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long-term air pollution exposure and malignant intracranial tumours of the central nervous system: a pooled analysis of six European cohorts. Br J Cancer 2023; 129:656-664. [PMID: 37420001 PMCID: PMC10421949 DOI: 10.1038/s41416-023-02348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/06/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Risk factors for malignant tumours of the central nervous system (CNS) are largely unknown. METHODS We pooled six European cohorts (N = 302,493) and assessed the association between residential exposure to nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), ozone (O3) and eight elemental components of PM2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) and malignant intracranial CNS tumours defined according to the International Classification of Diseases ICD-9/ICD-10 codes 192.1/C70.0, 191.0-191.9/C71.0-C71.9, 192.0/C72.2-C72.5. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 5,497,514 person-years of follow-up (average 18.2 years), we observed 623 malignant CNS tumours. The results of the fully adjusted linear analyses showed a hazard ratio (95% confidence interval) of 1.07 (0.95, 1.21) per 10 μg/m³ NO2, 1.17 (0.96, 1.41) per 5 μg/m³ PM2.5, 1.10 (0.97, 1.25) per 0.5 10-5m-1 BC, and 0.99 (0.84, 1.17) per 10 μg/m³ O3. CONCLUSIONS We observed indications of an association between exposure to NO2, PM2.5, and BC and tumours of the CNS. The PM elements were not consistently associated with CNS tumour incidence.
Collapse
Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate-interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, GU2 7XH, UK
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| |
Collapse
|
16
|
Vahl JM, Nagel G, Grages A, Brand M, von Witzleben A, Sonntag M, Theodoraki M, Greve J, Aboukors T, Denkinger M, Dallmeier D, Idel C, Hoffmann TK, Laban S. Demographics and access to head and neck cancer care in rural areas compared to urban areas in Germany. Cancer Med 2023; 12:18826-18836. [PMID: 37706654 PMCID: PMC10557897 DOI: 10.1002/cam4.6505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Demographic development in rural and urban areas differs substantially. Demographics and access to specialized head and neck cancer centers may affect head and neck cancer patients' (HNCP) outcomes. Here, we compare epidemiological indicators and outcomes of HNCP in rural and urban Germany. PATIENTS AND METHODS In a retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) between 2002 and 2017, 212,920 HNCP were included. Incidence, demographics, travel distance to specialized centers, and ground values were compared between rural and urban areas with a focus on their association with patient outcomes. RESULTS The mean age of HNCP was significantly higher in urban areas (mean difference = 1.4 years; p < 0.0001), but increased at a comparable rate (p = 0.26) in rural and urban areas during the observation period. Gender imbalance was higher in rural areas (mean ratio of men/women: 4.1 vs. 3.1; p < 0.0001), but showed a comparable trend toward equilibration in both, rural and urban districts (p = 0.46). The portion of HNCP of the entire HNCP population living in urban areas increased from 55.9% in the year 2002 to 76.4% in the year 2017. There was no significant difference or change in the ratio of advanced to low UICC stage during the observation period (p = 0.26). However, travel distances to medical centers were higher in rural areas, especially (p < 0.0001) in East Germany. Median survival of HNCP in rural areas was significantly lower than in urban areas (42 months [SEM = 0.7; CI: 40.5-43.5] vs. 54 months [SEM = 1.2; CI: 51.7-56.3]; p < 0.0001) in East Germany, whereas in West Germany no significant difference was observed (59 months [SEM = 0.8; CI: 57.4-60.6] vs. 60 months [SEM = 0.5; CI: 59.0-61.0]; p = 0.15). CONCLUSIONS Place of residence contributes to survival outcome of HNCP. Access to specialized care and socioeconomic factors could be improved in East Germany.
Collapse
Affiliation(s)
- Julius M. Vahl
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Gabriele Nagel
- Department of Epidemiology and Medical BiometryUniversity Medical Center UlmUlmGermany
| | - Ayla Grages
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Matthias Brand
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Adrian von Witzleben
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Michael Sonntag
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Marie‐Nicole Theodoraki
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Jens Greve
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Tsima Aboukors
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Michael Denkinger
- Agaplesion Bethesda Ulm, Geriatric Research Ulm University and Geriatric CenterUlmGermany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Ulm, Geriatric Research Ulm University and Geriatric CenterUlmGermany
| | - Christian Idel
- Department of OtorhinolaryngologyUniversity Hospital Schleswig‐HolsteinLübeckGermany
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| | - Simon Laban
- Department of Otorhinolaryngology and Head & Neck Surgery, Head and Neck Cancer Center of the Comprehensive Cancer Center UlmUniversity Medical Center UlmUlmGermany
| |
Collapse
|
17
|
Wirsching J, Nagel G, Tsai MY, de Hoogh K, Jaensch A, Anwander B, Sokhi RS, Ulmer H, Zitt E, Concin H, Brunekreef B, Hoek G, Weinmayr G. Corrigendum to 'Exposure to ambient air pollution and elevated blood levels of gammaglutamyl transferase in a large Austrian cohort' [Sci. Total Environ.883 (2023) 163658]. Sci Total Environ 2023; 886:164016. [PMID: 37172554 DOI: 10.1016/j.scitotenv.2023.164016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Jan Wirsching
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Ming-Yi Tsai
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Bernhard Anwander
- Institut für Umwelt und Lebensmittelsicherheit des Landes Vorarlberg, Bregenz, Austria
| | - Ranjeet S Sokhi
- Centre for Climate Change Research (C3R), School of Physics, Engineering and Computer Science, University of Hertfordshire, UK
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands Affiliations of authors
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| |
Collapse
|
18
|
Wirsching J, Nagel G, Tsai MY, de Hoogh K, Jaensch A, Anwander B, Sokhi RS, Ulmer H, Zitt E, Concin H, Brunekreef B, Hoek G, Weinmayr G. Exposure to ambient air pollution and elevated blood levels of gamma-glutamyl transferase in a large Austrian cohort. Sci Total Environ 2023; 883:163658. [PMID: 37100134 DOI: 10.1016/j.scitotenv.2023.163658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/05/2023] [Accepted: 04/18/2023] [Indexed: 05/07/2023]
Abstract
Gamma glutamyl transferase (GGT) is related to oxidative stress and an indicator for liver damage. We investigated the association between air pollution and GGT in a large Austrian cohort (N = 116,109) to better understand how air pollution affects human health. Data come from voluntary prevention visits that were routinely collected within the Vorarlberg Health Monitoring and Prevention Program (VHM&PP). Recruitment was ongoing from 1985 to 2005. Blood was drawn and GGT measured centralized in two laboratories. Land use regression models were applied to estimate individuals' exposure at their home address for particulate matter (PM) with a diameter of <2.5 μm (PM2.5), <10 μm (PM10), fraction between 10 μm and 2.5 μm (PMcoarse), as well as PM2.5 absorbance (PM2.5abs), NO2, NOx and eight components of PM. Linear regression models, adjusting for relevant individual and community-level confounders were calculated. The study population was 56 % female with a mean age of 42 years and mean GGT was 19.0 units. Individual PM2.5 and NO2 exposures were essentially below European limit values of 25 and 40 μg/m3, respectively, with means of 13.58 μg/m3 for PM2.5 and 19.93 μg/m3 for NO2. Positive associations were observed for PM2.5, PM10, PM2.5abs, NO2, NOx, and Cu, K, S in PM2.5 and PM10 fractions and Zn mainly in PM2.5 fraction. The strongest association per interquartile range observed was an increase of serum GGT concentration by 1.40 % (95 %-CI: 0.85 %; 1.95 %) per 45.7 ng/m3 S in PM2.5. Associations were robust to adjustments for other biomarkers, in two-pollutant models and the subset with a stable residential history. We found that long-term exposure to air pollution (PM2.5, PM10, PM2.5abs, NO2, NOx) as well as certain elements, were positively associated with baseline GGT levels. The elements associated suggest a role of traffic emissions, long range transport and wood burning.
Collapse
Affiliation(s)
- Jan Wirsching
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Ming-Yi Tsai
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Bernhard Anwander
- Institut für Umwelt und Lebensmittelsicherheit des Landes Vorarlberg, Bregenz, Austria
| | - Ranjeet S Sokhi
- Centre for Atmospheric and Climate Physics Research (CACP), School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| |
Collapse
|
19
|
Cole-Hunter T, Zhang J, Lim YH, Samoli E, Chen J, Strak M, Wolf K, Weinmayr G, Zitt E, Hoffmann B, Jöckel KH, Mortensen LH, Ketzel M, Méndez DY, Ljungman P, Nagel G, Pershagen G, Rizzuto D, Schramm S, Brunekreef B, Hoek G, Andersen ZJ. Reply to Rumrich and colleagues (What does "Parkinson's disease mortality" mean?). Environ Int 2023; 173:107853. [PMID: 36931779 DOI: 10.1016/j.envint.2023.107853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | | | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
20
|
Mishra A, Zhou B, Rodriguez-Martinez A, Bixby H, Singleton RK, Carrillo-Larco RM, Sheffer KE, Paciorek CJ, Bennett JE, Lhoste V, Iurilli MLC, Di Cesare M, Bentham J, Phelps NH, Sophiea MK, Stevens GA, Danaei G, Cowan MJ, Savin S, Riley LM, Gregg EW, Aekplakorn W, Ahmad NA, Baker JL, Chirita-Emandi A, Farzadfar F, Fink G, Heinen M, Ikeda N, Kengne AP, Khang YH, Laatikainen T, Laxmaiah A, Ma J, Monroy-Valle M, Mridha MK, Padez CP, Reynolds A, Sorić M, Starc G, Wirth JP, Abarca-Gómez L, Abdeen ZA, Abdrakhmanova S, Ghaffar SA, Abdul Rahim HF, Abdurrahmonova Z, Abu-Rmeileh NM, Garba JA, Acosta-Cazares B, Adam I, Adamczyk M, Adams RJ, Adu-Afarwuah S, Afsana K, Afzal S, Agbor VN, Agdeppa IA, Aghazadeh-Attari J, Aguenaou H, Aguilar-Salinas CA, Agyemang C, Ahmad MH, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed I, Ahmed SH, Ahrens W, Aitmurzaeva G, Ajlouni K, Al-Hazzaa HM, Al-Lahou B, Al-Raddadi R, Al Hourani HM, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Alexius S, Ali MM, Alkandari A, Alkerwi A, Alkhatib BM, Allin K, Alvarez-Pedrerol M, Aly E, Amarapurkar DN, Etxezarreta PA, Amoah J, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Androutsos O, Ängquist L, Anjana RM, Ansari-Moghaddam A, Anufrieva E, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aseffa N, Aspelund T, Assah FK, Assembekov B, Assunção MCF, Aung MS, Auvinen J, Avdičová M, Avi S, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Jørgensen MB, Baharudin A, Bahijri S, Bakacs M, Balakrishna N, Balanova Y, Bamoshmoosh M, Banach M, Banegas JR, Baran J, Baran R, Barbagallo CM, Filho VB, Barceló A, Baretić M, Barkat A, Barnoya J, Barrera L, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batista AP, Batista RL, Battakova Z, Baur LA, Bayauli PM, Beaglehole R, Bel-Serrat S, Belavendra A, Ben Romdhane H, Benedics J, Benet M, Rolandi GEB, Bere E, Bergh IH, Berhane Y, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Carrasola XB, Bettiol H, Beutel ME, Beybey AF, Bezerra J, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bi H, Bi Y, Bia D, Biasch K, Lele ECB, Bikbov MM, Bista B, Bjelica DJ, Bjerregaard AA, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Magnazu MB, Bo S, Bobak M, Boddy LM, Boehm BO, Boer JMA, Boggia JG, Bogova E, Boissonnet CP, Bojesen SE, Bonaccio M, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boymatova K, Braeckevelt L, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Breda J, Brenner H, Brewster LM, Brian GR, Briceño Y, Brinduse L, Brito M, Brophy S, Brug J, Bruno G, Bugge A, Buntinx F, Buoncristiano M, Burazeri G, Burns C, de León AC, Cacciottolo J, Cai H, Caixeta RB, Cama T, Cameron C, Camolas J, Can G, Cândido APC, Cañete F, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardol M, Cardoso VC, Carlsson AC, Carmuega E, Carvalho J, Casajús JA, Casanueva FF, Casas M, Celikcan E, Censi L, Cervantes‐Loaiza M, Cesar JA, Chamukuttan S, Chan A, Chan Q, Chaturvedi HK, Chaturvedi N, Rahim NCA, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheng YJ, Cheraghian B, Chetrit A, Chikova-Iscener E, Chinapaw MJM, Chinnock A, Chiolero A, Chiou ST, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cifkova R, Cilia M, Cinteza E, Cirillo M, Claessens F, Clarke J, Clays E, Cohen E, Compañ-Gabucio LM, Concin H, Confortin SC, Cooper C, Coppinger TC, Corpeleijn E, Cortés LY, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Cross AJ, Crujeiras AB, Cruz JJ, Csányi T, Csilla S, Cucu AM, Cui L, Cureau FV, Cuschieri S, Czenczek-Lewandowska E, D’Arrigo G, d’Orsi E, Dacica L, Dallongeville J, Damasceno A, Damsgaard CT, Dankner R, Dantoft TM, Dasgupta P, Dastgiri S, Dauchet L, Davletov K, de Assis MAA, De Backer G, De Bacquer D, De Curtis A, de Fragas Hinnig P, de Gaetano G, De Henauw S, De Miguel-Etayo P, de Oliveira PD, De Ridder D, De Ridder K, de Rooij SR, De Smedt D, Deepa M, Deev AD, DeGennaro V, Delisle H, Delpeuch F, Demarest S, Dennison E, Dereń K, Deschamps V, Dhimal M, Di Castelnuovo A, Dias-da-Costa JS, Díaz-Sánchez ME, Diaz A, Fernández PD, Ripollés MPD, Dika Z, Djalalinia S, Djordjic V, Do HTP, Dobson AJ, Dominguez L, Donati MB, Donfrancesco C, Dong G, Dong Y, Donoso SP, Döring A, Dorobantu M, Dorosty AR, Doua K, Dragano N, Drygas W, Duan JL, Duante CA, Duboz P, Duleva VL, Dulskiene V, Dumith SC, Dushpanova A, Dyussupova A, Dzerve V, Dziankowska-Zaborszczyk E, Echeverría G, Eddie R, Eftekhar E, Egbagbe EE, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ammari L, El Ati J, Eldemire-Shearer D, Eliasen M, Elliott P, Endevelt R, Engle-Stone R, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhradiyev I, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Sant’Angelo VF, Fattahi MR, Fawwad A, Fawzi WW, Feigl E, Felix-Redondo FJ, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari G, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fijalkowska A, Fisberg M, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, do Carmo Franco M, Fras Z, Frontera G, Fuchs FD, Fuchs SC, Fujiati II, Fujita Y, Fumihiko M, Furdela V, Furusawa T, Gaciong Z, Gafencu M, Cuesta MG, Galbarczyk A, Galenkamp H, Galeone D, Galfo M, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Mérida MJG, Solano MG, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gaya ACA, Gaya AR, Gazzinelli A, Gehring U, Geiger H, Geleijnse JM, George R, Ghaderi E, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Gialluisi A, Giampaoli S, Gianfagna F, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Glushkova N, Gluškova N, Godara R, Godos J, Gogen S, Goldberg M, Goltzman D, Gómez G, Gómez JHG, Gomez LF, Gómez SF, Gomula A, da Silva BGC, Gonçalves H, Gonçalves M, González-Alvarez AD, Gonzalez-Chica DA, González-Gil EM, Gonzalez-Gross M, González-Leon M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gottrand F, Graça AP, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Gregório MJ, Grøholt EK, Grøntved A, Grosso G, Gruden G, Gu D, Guajardo V, Gualdi-Russo E, Guallar-Castillón P, Gualtieri A, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Guo XH, Guo Y, Gupta PC, Gupta R, Gureje O, González EG, Gutierrez L, Gutzwiller F, Gwee X, Ha S, Hadaegh F, Hadjigeorgiou CA, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Kumar RH, Lassen TH, Harooni J, Hashemi-Shahri SM, Hassapidou M, Hata J, Haugsgjerd T, Hayes AJ, He J, He Y, He Y, Heidinger-Felső R, Heier M, Hejgaard T, Hendriks ME, dos Santos Henrique R, Henriques A, Cadena LH, Herrala S, Herrera-Cuenca M, Herrera VM, Herter-Aeberli I, Herzig KH, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Höfelmann DA, Holdsworth M, Homayounfar R, Homs C, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Petrescu CH, Huisman M, Husseini A, Huu CN, Huybrechts I, Hwalla N, Hyska J, Iacoviello L, Iakupova EM, Ibarluzea JM, Ibrahim MM, Wong NI, Ikram MA, Iñiguez C, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Islek D, Ivanova-Pandourska IY, Iwasaki M, Jääskeläinen T, Jackson RT, Jacobs JM, Jadoul M, Jafar T, Jallow B, James K, Jamil KM, Jamrozik K, Jansson A, Janszky I, Janus E, Jarani J, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Jokelainen JJ, Jonas JB, Jonnagaddala J, Jørgensen T, Joshi P, Josipović J, Joukar F, Jóźwiak JJ, Judge DS, Juolevi A, Jurak G, Simina IJ, Juresa V, Kaaks R, Kaducu FO, Kafatos A, Kaj M, Kajantie EO, Kakutia N, Kállayová D, Kalmatayeva Z, Kalter-Leibovici O, Kameli Y, Kampmann FB, Kanala KR, Kannan S, Kapantais E, Karaglani E, Karakosta A, Kårhus LL, Karki KB, Katchunga PB, Katibeh M, Katz J, Katzmarzyk PT, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Kaze FF, Ke C, Keil U, Boker LK, Keinänen-Kiukaanniemi S, Kelishadi R, Kelleher C, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khaledifar A, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Khouw IMSL, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Killewo J, Kim HC, Kim J, Kindblom JM, Kingston A, Klakk H, Klimek M, Klimont J, Klumbiene J, Knoflach M, Koirala B, Kolle E, Kolsteren P, König J, Korpelainen R, Korrovits P, Korzycka M, Kos J, Koskinen S, Kouda K, Kovács É, Kovacs VA, Kovalskys I, Kowlessur S, Koziel S, Kratenova J, Kratzer W, Kriaucioniene V, Kriemler S, Kristensen PL, Krizan H, Kroker-Lobos MF, Krokstad S, Kromhout D, Kruger HS, Kruger R, Kryst Ł, Kubinova R, Kuciene R, Kujala UM, Kujundzic E, Kulaga Z, Kulimbet M, Kumar RK, Kunešová M, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, La QN, Laamiri FZ, Lachat C, Lackner KJ, Laid Y, Lall L, Lam TH, Jimenez ML, Landais E, Lanska V, Lappas G, Larijani B, Larissa SP, Latt TS, Laurenzi M, Lauria L, Lazo-Porras M, Le Coroller G, Le Nguyen Bao K, Le Port A, Le TD, Lee J, Lee J, Lee PH, Lehmann N, Lehtimäki T, Lemogoum D, Leskošek B, Leszczak J, Leth-Møller KB, Leung GM, Levitt NS, Li Y, Liivak M, Lilly CL, Lim C, Lim WY, Lima-Costa MF, Lin HH, Lin X, Lin YT, Lind L, Lingam V, Linkohr B, Linneberg A, Lissner L, Litwin M, Liu J, Liu L, Lo WC, Loit HM, Long KQ, Abril GL, Lopes L, Lopes MVV, Lopes O, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukrafka JL, Luksiene D, Lundqvist A, Lunet N, Lunogelo C, Lustigová M, Łuszczki E, M’Buyamba-Kabangu JR, Ma G, Ma X, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Madsen AL, Maestre GE, Maggi S, Magliano DJ, Magnacca S, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Mäki P, Malekzadeh F, Malekzadeh R, Malhotra R, Rao KM, Malyutina SK, Maniego LV, Manios Y, Manix MI, Mann JI, Mansour-Ghanaei F, Manyanga T, Manzato E, Marcil A, Margozzini P, Mariño J, Markaki A, Markey O, Ioannidou EM, Marques-Vidal P, Marques LP, Marrugat J, Martin-Prevel Y, Martin R, Martorell R, Martos E, Maruszczak K, Marventano S, Masala G, Mascarenhas LP, Masoodi SR, Mathiesen EB, Mathur P, Matijasevich A, Matłosz P, Matsha TE, Matsudo V, Mavrogianni C, Mazur A, Mbanya JCN, McFarlane SR, McGarvey ST, McKee M, McLachlan S, McLean RM, McLean SB, McNairy ML, McNulty BA, Benchekor SM, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisfjord J, Meisinger C, Melgarejo JD, Melkumova M, Mello J, Méndez F, Mendivil CO, Menezes AMB, Menon GR, Mensink GBM, Menzano MT, Meshram II, Meto DT, Mi J, Michaelsen KF, Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Yusoff MFM, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Milanović SM, Musil V, Musinguzi G, Muyer MTMC, Nabipour I, Naderimagham S, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Nardone P, Naseri T, Nauck M, Neal WA, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O’Neill TW, O’Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Pérez CM, Peterkova V, Peters A, Petersmann A, Petkeviciene J, Petrauskiene A, Kovtun OP, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Pichardo RN, Pierannunzio D, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Bao TQ, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Rao SR, Ramachandran A, Ramadan OPC, Ramires VV, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Richter A, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Robitaille C, Roccaldo R, Rodrigues D, Rodríguez-Artalejo F, del Cristo Rodriguez-Perez M, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Moreno ER, Rusakova IA, Jonsson KR, Russo P, Rust P, Rutkowski M, Saamel M, Sabanayagam C, Sabbaghi H, Sacchini E, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Martinez ES, Saleva C, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Samoutian M, Sánchez-Abanto J, Rodríguez IS, Sandjaja, Sans S, Marina LS, Santacruz E, Santos DA, Santos IS, Santos LC, Santos MP, Santos O, Santos R, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Savy M, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Rosario AS, Schargrodsky H, Schienkiewitz A, Schindler K, Schipf S, Schmidt CO, Schmidt IM, Schneider A, Schnohr P, Schöttker B, Schramm S, Schramm S, Schröder H, Schultsz C, Schulze MB, Schutte AE, Sebert S, Sedaghattalab M, Selamat R, Sember V, Sen A, Senbanjo IO, Sepanlou SG, Sequera G, Serra-Majem L, Servais J, Ševčíková Ľ, Shalnova S, Shamah-Levy T, Shamshirgaran SM, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, de Moura Silva CR, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina NA, Skodje G, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Jérome CS, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, Suka M, Sun CA, Sun L, Sundström J, Sung YT, Sunyer J, Suriyawongpaisal P, Sweis NWG, Swinburn BA, Sy RG, Sylva RC, Szklo M, Szponar L, Tabone L, Tai ES, Tambalis KD, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanrygulyyeva M, Tanser F, Tao Y, Tarawneh MR, Tarp J, Tarqui-Mamani CB, Braunerová RT, Taylor A, Taylor J, Tchibindat F, Te Velde S, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thorand B, Thuesen BH, Tichá Ľ, Timmermans EJ, Tjandrarini DH, Tjonneland A, Tolonen HK, Tolstrup JS, Topbas M, Topór-Mądry R, Torheim LE, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Toselli S, Touloumi G, Traissac P, Tran TTH, Tremblay MS, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tsao YH, Tshepo L, Tsigga M, Tsintavis P, Tsugane S, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzala E, Tzotzas T, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Unal B, Usupova Z, Uusitalo HMT, Uysal N, Vaitkeviciute J, Valdivia G, Vale S, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Lippevelde W, Van Minh H, Van Schoor NM, van Valkengoed IGM, Vanderschueren D, Vanuzzo D, Varbo A, Varela-Moreiras G, Vargas LN, Varona-Pérez P, Vasan SK, Vasques DG, Vega T, Veidebaum T, Velasquez-Melendez G, Velika B, Verloigne M, Veronesi G, Verschuren WMM, Victora CG, Viegi G, Viet L, Vik FN, Vilar M, Villalpando S, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vladulescu M, Vlasoff T, Vocanec D, Vollenweider P, Völzke H, Voutilainen A, Vrijheid M, Vrijkotte TGM, Wade AN, Waldhör T, Walton J, Wambiya EOA, Bebakar WMW, Mohamud WNW, de Souza Wanderley Júnior R, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Weber A, Webster-Kerr K, Wedderkopp N, Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wojciech R, Wojtyniak B, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, García MY, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Vrkic TZ, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Cisneros JZ, Zuziak M, Bhutta ZA, Black RE, Ezzati M. Diminishing benefits of urban living for children and adolescents' growth and development. Nature 2023; 615:874-883. [PMID: 36991188 PMCID: PMC10060164 DOI: 10.1038/s41586-023-05772-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Abstract
Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.
Collapse
|
21
|
Sun M, Fritz J, Häggström C, Bjørge T, Nagel G, Manjer J, Engeland A, Zitt E, van Guelpen B, Stattin P, Ulmer H, Stocks T. Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study. J Natl Cancer Inst 2023; 115:456-467. [PMID: 36647199 PMCID: PMC10086630 DOI: 10.1093/jnci/djad008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Studies of obesity with or without metabolic aberrations, commonly termed metabolically unhealthy or healthy obesity, in relation to cancer risk are scarce. METHODS We investigated body mass index (BMI, normal weight/overweight/obesity) jointly and in interaction with metabolic health status in relation to obesity-related cancer risk (n = 23,630) among 797,193 European individuals. A metabolic score comprising mid-blood pressure, plasma glucose and triglycerides was used to define metabolically healthy and unhealthy status. Hazard ratios (HRs) and multiplicative interactions were assessed using Cox regression, and additive interactions were assessed using the relative excess risk for interaction. All statistical tests were two-sided. RESULTS Metabolically unhealthy obesity, with a baseline prevalence of 7%, was, compared to metabolically healthy normal weight, associated with an increased relative risk of any obesity-related cancer and of colon, rectal, pancreas, endometrial, liver, gallbladder, and renal cell cancer (p < 0.05), with the highest risk estimates for endometrial, liver, and renal cell cancer (HRs, 2.55 to 3.00). Metabolically healthy obesity showed a higher relative risk for any obesity-related cancer and colon (in men), endometrial, renal cell, liver, and gallbladder cancer, though the risk relationships were weaker. There were no multiplicative interactions, but there were additive, positive interactions between BMI and metabolic health status on obesity-related and rectal cancer among men, and on endometrial cancer (p < 0.05). CONCLUSIONS This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk. In general, metabolic aberrations further increased the obesity-induced cancer risk, suggesting that both obesity and metabolic aberrations are useful targets for prevention.
Collapse
Affiliation(s)
- Ming Sun
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Chronic Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria.,Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
22
|
Hvidtfeldt UA, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann BH, Katsouyanni K, Ketzel M, Brynedal B, Leander K, Ljungman PLS, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Boutron-Ruault MC, Samoli E, So R, Stafoggia M, Tjønneland A, Vermeulen R, Verschuren WMM, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Breast Cancer Incidence in Relation to Long-Term Low-Level Exposure to Air Pollution in the ELAPSE Pooled Cohort. Cancer Epidemiol Biomarkers Prev 2023; 32:105-113. [PMID: 36215200 DOI: 10.1158/1055-9965.epi-22-0720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Established risk factors for breast cancer include genetic disposition, reproductive factors, hormone therapy, and lifestyle-related factors such as alcohol consumption, physical inactivity, smoking, and obesity. More recently a role of environmental exposures, including air pollution, has also been suggested. The aim of this study, was to investigate the relationship between long-term air pollution exposure and breast cancer incidence. METHODS We conducted a pooled analysis among six European cohorts (n = 199,719) on the association between long-term residential levels of ambient nitrogen dioxide (NO2), fine particles (PM2.5), black carbon (BC), and ozone in the warm season (O3) and breast cancer incidence in women. The selected cohorts represented the lower range of air pollutant concentrations in Europe. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS During 3,592,885 person-years of follow-up, we observed a total of 9,659 incident breast cancer cases. The results of the fully adjusted linear analyses showed a HR (95% confidence interval) of 1.03 (1.00-1.06) per 10 μg/m³ NO2, 1.06 (1.01-1.11) per 5 μg/m³ PM2.5, 1.03 (0.99-1.06) per 0.5 10-5 m-1 BC, and 0.98 (0.94-1.01) per 10 μg/m³ O3. The effect estimates were most pronounced in the group of middle-aged women (50-54 years) and among never smokers. CONCLUSIONS The results were in support of an association between especially PM2.5 and breast cancer. IMPACT The findings of this study suggest a role of exposure to NO2, PM2.5, and BC in development of breast cancer.
Collapse
Affiliation(s)
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.,National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy.,Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara H Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | | | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Roel Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria.,Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
| |
Collapse
|
23
|
Cole-Hunter T, Zhang J, So R, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Jöckel KH, Mortensen LH, Ketzel M, Yacamán Méndez D, Leander K, Ljungman P, Faure E, Lee PC, Elbaz A, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, Vermeulen RCH, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH, Andersen ZJ. Long-term air pollution exposure and Parkinson's disease mortality in a large pooled European cohort: An ELAPSE study. Environ Int 2023; 171:107667. [PMID: 36516478 DOI: 10.1016/j.envint.2022.107667] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The link between exposure to ambient air pollution and mortality from cardiorespiratory diseases is well established, while evidence on neurodegenerative disorders including Parkinson's Disease (PD) remains limited. OBJECTIVE We examined the association between long-term exposure to ambient air pollution and PD mortality in seven European cohorts. METHODS Within the project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven cohorts among six European countries. Annual mean residential concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (O3), as well as 8 PM2.5 components (copper, iron, potassium, nickel, sulphur, silicon, vanadium, zinc), for 2010 were estimated using Europe-wide hybrid land use regression models. PD mortality was defined as underlying cause of death being either PD, secondary Parkinsonism, or dementia in PD. We applied Cox proportional hazard models to investigate the associations between air pollution and PD mortality, adjusting for potential confounders. RESULTS Of 271,720 cohort participants, 381 died from PD during 19.7 years of follow-up. In single-pollutant analyses, we observed positive associations between PD mortality and PM2.5 (hazard ratio per 5 µg/m3: 1.25; 95% confidence interval: 1.01-1.55), NO2 (1.13; 0.95-1.34 per 10 µg/m3), and BC (1.12; 0.94-1.34 per 0.5 × 10-5m-1), and a negative association with O3 (0.74; 0.58-0.94 per 10 µg/m3). Associations of PM2.5, NO2, and BC with PD mortality were linear without apparent lower thresholds. In two-pollutant models, associations with PM2.5 remained robust when adjusted for NO2 (1.24; 0.95-1.62) or BC (1.28; 0.96-1.71), whereas associations with NO2 or BC attenuated to null. O3 associations remained negative, but no longer statistically significant in models with PM2.5. We detected suggestive positive associations with the potassium component of PM2.5. CONCLUSION Long-term exposure to PM2.5, at levels well below current EU air pollution limit values, may contribute to PD mortality.
Collapse
Affiliation(s)
- Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Diego Yacamán Méndez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Pei-Chen Lee
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Alexis Elbaz
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
24
|
Hvidtfeldt UA, Taj T, Chen J, Rodopoulou S, Strak M, de Hoogh K, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Jørgensen JT, Katsouyanni K, Ketzel M, Lager A, Leander K, Ljungman P, Magnusson PKE, Nagel G, Pershagen G, Rizzuto D, Samoli E, So R, Stafoggia M, Tjønneland A, Vermeulen R, Weinmayr G, Wolf K, Zhang J, Zitt E, Brunekreef B, Hoek G, Raaschou-Nielsen O. Long term exposure to air pollution and kidney parenchyma cancer - Effects of low-level air pollution: a Study in Europe (ELAPSE). Environ Res 2022; 215:114385. [PMID: 36154858 DOI: 10.1016/j.envres.2022.114385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/05/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Particulate matter (PM) is classified as a group 1 human carcinogen. Previous experimental studies suggest that particles in diesel exhaust induce oxidative stress, inflammation and DNA damage in kidney cells, but the evidence from population studies linking air pollution to kidney cancer is limited. METHODS We pooled six European cohorts (N = 302,493) to assess the association of residential exposure to fine particles (PM2.5), nitrogen dioxide (NO2), black carbon (BC), warm season ozone (O3) and eight elemental components of PM2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) with cancer of the kidney parenchyma. The main exposure model was developed for year 2010. We defined kidney parenchyma cancer according to the International Classification of Diseases 9th and 10th Revision codes 189.0 and C64. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level. RESULTS The participants were followed from baseline (1985-2005) to 2011-2015. A total of 847 cases occurred during 5,497,514 person-years of follow-up (average 18.2 years). Median (5-95%) exposure levels of NO2, PM2.5, BC and O3 were 24.1 μg/m3 (12.8-39.2), 15.3 μg/m3 (8.6-19.2), 1.6 10-5 m-1 (0.7-2.1), and 87.0 μg/m3 (70.3-97.4), respectively. The results of the fully adjusted linear analyses showed a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 0.92, 1.15) per 10 μg/m³ NO2, 1.04 (95% CI: 0.88, 1.21) per 5 μg/m³ PM2.5, 0.99 (95% CI: 0.89, 1.11) per 0.5 10-5 m-1 BCE, and 0.88 (95% CI: 0.76, 1.02) per 10 μg/m³ O3. We did not find associations between any of the elemental components of PM2.5 and cancer of the kidney parenchyma. CONCLUSION We did not observe an association between long-term ambient air pollution exposure and incidence of kidney parenchyma cancer.
Collapse
Affiliation(s)
| | - Tahir Taj
- Danish Cancer Society Research Center, Copenhagen, Denmark; Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Climate - Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Environmental Research Group, School of Public Health, Faculty of Medicine, Imperial College, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Departments of Ecoscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rina So
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | | | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jiawei Zhang
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| |
Collapse
|
25
|
Andersen ZJ, Zhang J, Jørgensen JT, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Monique Verschuren WM, Jöckel KH, So R, Cole-Hunter T, Mehta AJ, Mortensen LH, Ketzel M, Lager A, Leander K, Ljungman P, Severi G, Boutron-Ruault MC, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, van der Schouw YT, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH. Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study. Environ Int 2022; 170:107581. [PMID: 36244228 DOI: 10.1016/j.envint.2022.107581] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Ambient air pollution is an established risk factor for premature mortality from chronic cardiovascular, respiratory and metabolic diseases, while evidence on neurodegenerative diseases and psychiatric disorders remains limited. We examined the association between long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in seven European cohorts. Within the multicenter project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven European cohorts from six countries. Based on the residential addresses, annual mean levels of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), ozone (O3), and 8 PM2.5 components were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and mortality from dementia, psychiatric disorders, and suicide. Of 271,720 participants, 900 died from dementia, 241 from psychiatric disorders, and 164 from suicide, during a mean follow-up of 19.7 years. In fully adjusted models, we observed positive associations of NO2 (hazard ratio [HR] = 1.38; 95 % confidence interval [CI]: 1.13, 1.70 per 10 µg/m3), PM2.5 (HR = 1.29; 95 % CI: 0.98, 1.71 per 5 µg/m3), and BC (HR = 1.37; 95 % CI: 1.11, 1.69 per 0.5 × 10-5/m) with psychiatric disorders mortality, as well as with suicide (NO2: HR = 1.13 [95 % CI: 0.92, 1.38]; PM2.5: HR = 1.19 [95 % CI: 0.76, 1.87]; BC: HR = 1.08 [95 % CI: 0.87, 1.35]), and no association with dementia mortality. We did not detect any positive associations of O3 and 8 PM2.5 components with any of the three mortality outcomes. Long-term exposure to NO2, PM2.5, and BC may lead to premature mortality from psychiatric disorders and suicide.
Collapse
Affiliation(s)
- Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy
| | - Marie-Christine Boutron-Ruault
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
26
|
Leiherer A, Ulmer H, Muendlein A, Saely CH, Fraunberger P, Mader A, Sprenger L, Maechler M, Vonbank A, Larcher B, Brozek W, Nagel G, Zitt E, Concin H, Drexel H. Value of blood pressure measurement earlier versus later in life to predict cardiovascular mortality. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Hypertension is a potent risk factor for cardiovascular morbidity and mortality. High blood pressure (BP) correlates closely with all-cause and cardiovascular mortality.
The purpose of this study was to compare the value of systolic blood pressure earlier versus later in life to predict cardiovascular mortality.
In a cardiovascular observation study (OS) we prospectively recorded fatal cardiovascular events over up to 19 years in 1282 patients of whom 570 had the Metabolic Syndrome (MetS) at baseline. These patients had participated in a health survey (HS) 15 years prior to the OS baseline. BP was measured both at the HS and at the baseline of the OS.
We found that the increase in cardiovascular mortality matched the increase of BP in the HS in a linear way but this is not the case for BP assessed at the OS (figure). A cox regression analysis revealed that each millimeter of mercury (mm Hg) increased the risk for cardiovascular death by 2% (HR = 1.02 [1.01–1.03], p<0.001). Applying a stratification for the presence of MetS, we found that in both groups BP was a significant predictor of cardiovascular mortality (HRMetS = 1.02 [1.01–1.02], p<0.001 and HRnoMetS = 1.02 [1.01–1.03], p<0.001). In contrast, BP as measured at the baseline of the OS was not significantly associated with cardiovascular death during follow-up neither in the total population nor in any subgroup (HR = 1.00 [0.99–1.01], p=0.652; HRMetS = 1.00 [0.99–1.01], p=0.468 and HRnoMetS = 1.00 [0.99–1.01], p=4.66).
We thus conclude that BP assessed earlier in life is a better predictor of cardiovascular mortality than BP assessed later in life.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Leiherer
- Vorarlberg Institute for Vascular Investigation & Treatment , Feldkirch , Austria
| | - H Ulmer
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - A Muendlein
- Vorarlberg Institute for Vascular Investigation & Treatment , Feldkirch , Austria
| | - C H Saely
- Private University of the Principality of Liechtenstein , Triesen , Liechtenstein
| | | | - A Mader
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - L Sprenger
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - M Maechler
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - A Vonbank
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - B Larcher
- Academic Teaching Hospital Feldkirch , Feldkirch , Austria
| | - W Brozek
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - G Nagel
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - E Zitt
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - H Concin
- Agency of Preventive and Social Medicine , Bregenz , Austria
| | - H Drexel
- County Hospital Bregenz , Bregenz , Austria
| |
Collapse
|
27
|
Tran KB, Lang JJ, Compton K, Xu R, Acheson AR, Henrikson HJ, Kocarnik JM, Penberthy L, Aali A, Abbas Q, Abbasi B, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abbastabar H, Abdelmasseh M, Abd-Elsalam S, Abdelwahab AA, Abdoli G, Abdulkadir HA, Abedi A, Abegaz KH, Abidi H, Aboagye RG, Abolhassani H, Absalan A, Abtew YD, Abubaker Ali H, Abu-Gharbieh E, Achappa B, Acuna JM, Addison D, Addo IY, Adegboye OA, Adesina MA, Adnan M, Adnani QES, Advani SM, Afrin S, Afzal MS, Aggarwal M, Ahinkorah BO, Ahmad AR, Ahmad R, Ahmad S, Ahmad S, Ahmadi S, Ahmed H, Ahmed LA, Ahmed MB, Ahmed Rashid T, Aiman W, Ajami M, Akalu GT, Akbarzadeh-Khiavi M, Aklilu A, Akonde M, Akunna CJ, Al Hamad H, Alahdab F, Alanezi FM, Alanzi TM, Alessy SA, Algammal AM, Al-Hanawi MK, Alhassan RK, Ali BA, Ali L, Ali SS, Alimohamadi Y, Alipour V, Aljunid SM, Alkhayyat M, Al-Maweri SAA, Almustanyir S, Alonso N, Alqalyoobi S, Al-Raddadi RM, Al-Rifai RHH, Al-Sabah SK, Al-Tammemi AB, Altawalah H, Alvis-Guzman N, Amare F, Ameyaw EK, Aminian Dehkordi JJ, Amirzade-Iranaq MH, Amu H, Amusa GA, Ancuceanu R, Anderson JA, Animut YA, Anoushiravani A, Anoushirvani AA, Ansari-Moghaddam A, Ansha MG, Antony B, Antwi MH, Anwar SL, Anwer R, Anyasodor AE, Arabloo J, Arab-Zozani M, Aremu O, Argaw AM, Ariffin H, Aripov T, Arshad M, Artaman A, Arulappan J, Aruleba RT, Aryannejad A, Asaad M, Asemahagn MA, Asemi Z, Asghari-Jafarabadi M, Ashraf T, Assadi R, Athar M, Athari SS, Atout MMW, Attia S, Aujayeb A, Ausloos M, Avila-Burgos L, Awedew AF, Awoke MA, Awoke T, Ayala Quintanilla BP, Ayana TM, Ayen SS, Azadi D, Azadnajafabad S, Azami-Aghdash S, Azanaw MM, Azangou-Khyavy M, Azari Jafari A, Azizi H, Azzam AYY, Babajani A, Badar M, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bahadory S, Baig AA, Baker JL, Bakhtiari A, Bakshi RK, Banach M, Banerjee I, Bardhan M, Barone-Adesi F, Barra F, Barrow A, Bashir NZ, Bashiri A, Basu S, Batiha AMM, Begum A, Bekele AB, Belay AS, Belete MA, Belgaumi UI, Bell AW, Belo L, Benzian H, Berhie AY, Bermudez ANC, Bernabe E, Bhagavathula AS, Bhala N, Bhandari BB, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhojaraja VS, Bhuyan SS, Bibi S, Bilchut AH, Bintoro BS, Biondi A, Birega MGB, Birhan HE, Bjørge T, Blyuss O, Bodicha BBA, Bolla SR, Boloor A, Bosetti C, Braithwaite D, Brauer M, Brenner H, Briko AN, Briko NI, Buchanan CM, Bulamu NB, Bustamante-Teixeira MT, Butt MH, Butt NS, Butt ZA, Caetano dos Santos FL, Cámera LA, Cao C, Cao Y, Carreras G, Carvalho M, Cembranel F, Cerin E, Chakraborty PA, Charalampous P, Chattu VK, Chimed-Ochir O, Chirinos-Caceres JL, Cho DY, Cho WCS, Christopher DJ, Chu DT, Chukwu IS, Cohen AJ, Conde J, Cortés S, Costa VM, Cruz-Martins N, Culbreth GT, Dadras O, Dagnaw FT, Dahlawi SMA, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Danielewicz A, Dao ATM, Darvishi Cheshmeh Soltani R, Darwesh AM, Das S, Davitoiu DV, Davtalab Esmaeili E, De la Hoz FP, Debela SA, Dehghan A, Demisse B, Demisse FW, Denova-Gutiérrez E, Derakhshani A, Derbew Molla M, Dereje D, Deribe KS, Desai R, Desalegn MD, Dessalegn FN, Dessalegni SAA, Dessie G, Desta AA, Dewan SMR, Dharmaratne SD, Dhimal M, Dianatinasab M, Diao N, Diaz D, Digesa LE, Dixit SG, Doaei S, Doan LP, Doku PN, Dongarwar D, dos Santos WM, Driscoll TR, Dsouza HL, Durojaiye OC, Edalati S, Eghbalian F, Ehsani-Chimeh E, Eini E, Ekholuenetale M, Ekundayo TC, Ekwueme DU, El Tantawi M, Elbahnasawy MA, Elbarazi I, Elghazaly H, Elhadi M, El-Huneidi W, Emamian MH, Engelbert Bain L, Enyew DB, Erkhembayar R, Eshetu T, Eshrati B, Eskandarieh S, Espinosa-Montero J, Etaee F, Etemadimanesh A, Eyayu T, Ezeonwumelu IJ, Ezzikouri S, Fagbamigbe AF, Fahimi S, Fakhradiyev IR, Faraon EJA, Fares J, Farmany A, Farooque U, Farrokhpour H, Fasanmi AO, Fatehizadeh A, Fatima W, Fattahi H, Fekadu G, Feleke BE, Ferrari AA, Ferrero S, Ferro Desideri L, Filip I, Fischer F, Foroumadi R, Foroutan M, Fukumoto T, Gaal PA, Gad MM, Gadanya MA, Gaipov A, Galehdar N, Gallus S, Garg T, Gaspar Fonseca M, Gebremariam YH, Gebremeskel TG, Gebremichael MA, Geda YF, Gela YY, Gemeda BNB, Getachew M, Getachew ME, Ghaffari K, Ghafourifard M, Ghamari SH, Ghasemi Nour M, Ghassemi F, Ghimire A, Ghith N, Gholamalizadeh M, Gholizadeh Navashenaq J, Ghozy S, Gilani SA, Gill PS, Ginindza TG, Gizaw ATT, Glasbey JC, Godos J, Goel A, Golechha M, Goleij P, Golinelli D, Golitaleb M, Gorini G, Goulart BNG, Grosso G, Guadie HA, Gubari MIM, Gudayu TW, Guerra MR, Gunawardane DA, Gupta B, Gupta S, Gupta VB, Gupta VK, Gurara MK, Guta A, Habibzadeh P, Haddadi Avval A, Hafezi-Nejad N, Hajj Ali A, Haj-Mirzaian A, Halboub ES, Halimi A, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hanif A, Hariri S, Harlianto NI, Haro JM, Hartono RK, Hasaballah AI, Hasan SMM, Hasani H, Hashemi SM, Hassan AM, Hassanipour S, Hayat K, Heidari G, Heidari M, Heidarymeybodi Z, Herrera-Serna BY, Herteliu C, Hezam K, Hiraike Y, Hlongwa MM, Holla R, Holm M, Horita N, Hoseini M, Hossain MM, Hossain MBH, Hosseini MS, Hosseinzadeh A, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Huang J, Hugo FN, Humayun A, Hussain S, Hussein NR, Hwang BF, Ibitoye SE, Iftikhar PM, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Innos K, Iranpour P, Irham LM, Islam MS, Islam RM, Islami F, Ismail NE, Isola G, Iwagami M, J LM, Jaiswal A, Jakovljevic M, Jalili M, Jalilian S, Jamshidi E, Jang SI, Jani CT, Javaheri T, Jayarajah UU, Jayaram S, Jazayeri SB, Jebai R, Jemal B, Jeong W, Jha RP, Jindal HA, John-Akinola YO, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kacimi SEO, Kadashetti V, Kahe F, Kakodkar PV, Kalankesh LR, Kalankesh LR, Kalhor R, Kamal VK, Kamangar F, Kamath A, Kanchan T, Kandaswamy E, Kandel H, Kang H, Kanno GG, Kapoor N, Kar SS, Karanth SD, Karaye IM, Karch A, Karimi A, Kassa BG, Katoto PDMC, Kauppila JH, Kaur H, Kebede AG, Keikavoosi-Arani L, Kejela GG, Kemp Bohan PM, Keramati M, Keykhaei M, Khajuria H, Khan A, Khan AAK, Khan EA, Khan G, Khan MN, Khan MAB, Khanali J, Khatab K, Khatatbeh MM, Khatib MN, Khayamzadeh M, Khayat Kashani HR, Khazeei Tabari MA, Khezeli M, Khodadost M, Kim MS, Kim YJ, Kisa A, Kisa S, Klugar M, Klugarová J, Kolahi AA, Kolkhir P, Kompani F, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy Y, Kucuk Bicer B, Kugbey N, Kulimbet M, Kumar A, Kumar GA, Kumar N, Kurmi OP, Kuttikkattu A, La Vecchia C, Lahiri A, Lal DK, Lám J, Lan Q, Landires I, Larijani B, Lasrado S, Lau J, Lauriola P, Ledda C, Lee SW, Lee SWH, Lee WC, Lee YY, Lee YH, Legesse SM, Leigh J, Leong E, Li MC, Lim SS, Liu G, Liu J, Lo CH, Lohiya A, Lopukhov PD, Lorenzovici L, Lotfi M, Loureiro JA, Lunevicius R, Madadizadeh F, Mafi AR, Magdeldin S, Mahjoub S, Mahmoodpoor A, Mahmoudi M, Mahmoudimanesh M, Mahumud RA, Majeed A, Majidpoor J, Makki A, Makris KC, Malakan Rad E, Malekpour MR, Malekzadeh R, Malik AA, Mallhi TH, Mallya SD, Mamun MA, Manda AL, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Mantovani LG, Martini S, Martorell M, Masoudi S, Masoumi SZ, Matei CN, Mathews E, Mathur MR, Mathur V, McKee M, Meena JK, Mehmood K, Mehrabi Nasab E, Mehrotra R, Melese A, Mendoza W, Menezes RG, Mengesha SID, Mensah LG, Mentis AFA, Mera-Mamián AYM, Meretoja TJ, Merid MW, Mersha AG, Meselu BT, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Mijena GFW, Miller TR, Mir SA, Mirinezhad SK, Mirmoeeni S, Mirza-Aghazadeh-Attari M, Mirzaei H, Mirzaei HR, Misganaw AS, Misra S, Mohammad KA, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed A, Mohammed S, Mohan S, Mohseni M, Moka N, Mokdad AH, Molassiotis A, Molokhia M, Momenzadeh K, Momtazmanesh S, Monasta L, Mons U, Montasir AA, Montazeri F, Montero A, Moosavi MA, Moradi A, Moradi Y, Moradi Sarabi M, Moraga P, Morawska L, Morrison SD, Morze J, Mosapour A, Mostafavi E, Mousavi SM, Mousavi Isfahani H, Mousavi Khaneghah A, Mpundu-Kaambwa C, Mubarik S, Mulita F, Munblit D, Munro SB, Murillo-Zamora E, Musa J, Nabhan AF, Nagarajan AJ, Nagaraju SP, Nagel G, Naghipour M, Naimzada MD, Nair TS, Naqvi AA, Narasimha Swamy S, Narayana AI, Nassereldine H, Natto ZS, Nayak BP, Ndejjo R, Nduaguba SO, Negash WW, Nejadghaderi SA, Nejati K, Neupane Kandel S, Nguyen HVN, Niazi RK, Noor NM, Noori M, Noroozi N, Nouraei H, Nowroozi A, Nuñez-Samudio V, Nzoputam CI, Nzoputam OJ, Oancea B, Odukoya OO, Oghenetega OB, Ogunsakin RE, Oguntade AS, Oh IH, Okati-Aliabad H, Okekunle AP, Olagunju AT, Olagunju TO, Olakunde BO, Olufadewa II, Omer E, Omonisi AEE, Ong S, Onwujekwe OE, Orru H, Otstavnov SS, Oulhaj A, Oumer B, Owopetu OF, Oyinloye BE, P A M, Padron-Monedero A, Padubidri JR, Pakbin B, Pakshir K, Pakzad R, Palicz T, Pana A, Pandey A, Pandey A, Pant S, Pardhan S, Park EC, Park EK, Park S, Patel J, Pati S, Paudel R, Paudel U, Paun M, Pazoki Toroudi H, Peng M, Pereira J, Pereira RB, Perna S, Perumalsamy N, Pestell RG, Pezzani R, Piccinelli C, Pillay JD, Piracha ZZ, Pischon T, Postma MJ, Pourabhari Langroudi A, Pourshams A, Pourtaheri N, Prashant A, Qadir MMF, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi M, Rafiee A, Rafiei A, Raheem N, Rahim F, Rahman MO, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmanian V, Rajai N, Rajesh A, Ram P, Ramezanzadeh K, Rana J, Ranabhat K, Ranasinghe P, Rao CR, Rao SJ, Rashedi S, Rashidi A, Rashidi M, Rashidi MM, Ratan ZA, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Razeghinia MS, Rehman AU, Rehman IU, Reitsma MB, Renzaho AMN, Rezaei M, Rezaei N, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Rezapour A, Riad A, Rikhtegar R, Rios-Blancas M, Roberts TJ, Rohloff P, Romero-Rodríguez E, Roshandel G, Rwegerera GM, S M, Saber-Ayad MM, Saberzadeh-Ardestani B, Sabour S, Saddik B, Sadeghi E, Saeb MR, Saeed U, Safaei M, Safary A, Sahebazzamani M, Sahebkar A, Sahoo H, Sajid MR, Salari H, Salehi S, Salem MR, Salimzadeh H, Samodra YL, Samy AM, Sanabria J, Sankararaman S, Sanmarchi F, Santric-Milicevic MM, Saqib MAN, Sarveazad A, Sarvi F, Sathian B, Satpathy M, Sayegh N, Schneider IJC, Schwarzinger M, Šekerija M, Senthilkumaran S, Sepanlou SG, Seylani A, Seyoum K, Sha F, Shafaat O, Shah PA, Shahabi S, Shahid I, Shahrbaf MA, Shahsavari HR, Shaikh MA, Shaka MF, Shaker E, Shannawaz M, Sharew MMS, Sharifi A, Sharifi-Rad J, Sharma P, Shashamo BB, Sheikh A, Sheikh M, Sheikhbahaei S, Sheikhi RA, Sheikhy A, Shepherd PR, Shetty A, Shetty JK, Shetty RS, Shibuya K, Shirkoohi R, Shirzad-Aski H, Shivakumar KM, Shivalli S, Shivarov V, Shobeiri P, Shokri Varniab Z, Shorofi SA, Shrestha S, Sibhat MM, Siddappa Malleshappa SK, Sidemo NB, Silva DAS, Silva LMLR, Silva Julian G, Silvestris N, Simegn W, Singh AD, Singh A, Singh G, Singh H, Singh JA, Singh JK, Singh P, Singh S, Sinha DN, Sinke AH, Siraj MS, Sitas F, Siwal SS, Skryabin VY, Skryabina AA, Socea B, Soeberg MJ, Sofi-Mahmudi A, Solomon Y, Soltani-Zangbar MS, Song S, Song Y, Sorensen RJD, Soshnikov S, Sotoudeh H, Sowe A, Sufiyan MB, Suk R, Suleman M, Suliankatchi Abdulkader R, Sultana S, Sur D, Szócska M, Tabaeian SP, Tabarés-Seisdedos R, Tabatabaei SM, Tabuchi T, Tadbiri H, Taheri E, Taheri M, Taheri Soodejani M, Takahashi K, Talaat IM, Tampa M, Tan KK, Tat NY, Tat VY, Tavakoli A, Tavakoli A, Tehrani-Banihashemi A, Tekalegn Y, Tesfay FH, Thapar R, Thavamani A, Thoguluva Chandrasekar V, Thomas N, Thomas NK, Ticoalu JHV, Tiyuri A, Tollosa DN, Topor-Madry R, Touvier M, Tovani-Palone MR, Traini E, Tran MTN, Tripathy JP, Ukke GG, Ullah I, Ullah S, Ullah S, Unnikrishnan B, Vacante M, Vaezi M, Valadan Tahbaz S, Valdez PR, Vardavas C, Varthya SB, Vaziri S, Velazquez DZ, Veroux M, Villeneuve PJ, Violante FS, Vladimirov SK, Vlassov V, Vo B, Vu LG, Wadood AW, Waheed Y, Walde MT, Wamai RG, Wang C, Wang F, Wang N, Wang Y, Ward P, Waris A, Westerman R, Wickramasinghe ND, Woldemariam M, Woldu B, Xiao H, Xu S, Xu X, Yadav L, Yahyazadeh Jabbari SH, Yang L, Yazdanpanah F, Yeshaw Y, Yismaw Y, Yonemoto N, Younis MZ, Yousefi Z, Yousefian F, Yu C, Yu Y, Yunusa I, Zahir M, Zaki N, Zaman BA, Zangiabadian M, Zare F, Zare I, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zeineddine MA, Zhang D, Zhang J, Zhang Y, Zhang ZJ, Zhou L, Zodpey S, Zoladl M, Vos T, Hay SI, Force LM, Murray CJL. The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400:563-591. [PMID: 35988567 PMCID: PMC9395583 DOI: 10.1016/s0140-6736(22)01438-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/13/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). INTERPRETATION The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
28
|
Bereziartua A, Chen J, de Hoogh K, Rodopoulou S, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Arthur Hvidtfeldt U, Verschuren WMM, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Hjertager Krog N, Brynedal B, Leander K, Liu S, Ljungman P, Faure E, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rizzuto D, Samoli E, van der Schouw YT, Schramm S, Severi G, Stafoggia M, Strak M, Sørensen M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Hoek G. Exposure to surrounding greenness and natural-cause and cause-specific mortality in the ELAPSE pooled cohort. Environ Int 2022; 166:107341. [PMID: 35717714 DOI: 10.1016/j.envint.2022.107341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/28/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The majority of studies have shown higher greenness exposure associated with reduced mortality risks, but few controlled for spatially correlated air pollution and traffic noise exposures. We aim to address this research gap in the ELAPSE pooled cohort. METHODS Mean Normalized Difference Vegetation Index (NDVI) in a 300-m grid cell and 1-km radius were assigned to participants' baseline home addresses as a measure of surrounding greenness exposure. We used Cox proportional hazards models to estimate the association of NDVI exposure with natural-cause and cause-specific mortality, adjusting for a number of potential confounders including socioeconomic status and lifestyle factors at individual and area-levels. We further assessed the associations between greenness exposure and mortality after adjusting for fine particulate matter (PM2.5), nitrogen dioxide (NO2) and road traffic noise. RESULTS The pooled study population comprised 327,388 individuals who experienced 47,179 natural-cause deaths during 6,374,370 person-years of follow-up. The mean NDVI in the pooled cohort was 0.33 (SD 0.1) and 0.34 (SD 0.1) in the 300-m grid and 1-km buffer. In the main fully adjusted model, 0.1 unit increment of NDVI inside 300-m grid was associated with 5% lower risk of natural-cause mortality (Hazard Ratio (HR) 0.95 (95% CI: 0.94, 0.96)). The associations attenuated after adjustment for air pollution [HR (95% CI): 0.97 (0.96, 0.98) adjusted for PM2.5; 0.98 (0.96, 0.99) adjusted for NO2]. Additional adjustment for traffic noise hardly affected the associations. Consistent results were observed for NDVI within 1-km buffer. After adjustment for air pollution, NDVI was inversely associated with diabetes, respiratory and lung cancer mortality, yet with wider 95% confidence intervals. No association with cardiovascular mortality was found. CONCLUSIONS We found a significant inverse association between surrounding greenness and natural-cause mortality, which remained after adjusting for spatially correlated air pollution and traffic noise.
Collapse
Affiliation(s)
- Ainhoa Bereziartua
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Zorana J Andersen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Center for Climate Change, Aarhus University, Denmark.
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK.
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
| | - Jeanette T Jørgensen
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK.
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom.
| | - Norun Hjertager Krog
- Section of Air Pollution and Noise, Norwegian Institute of Public Health, Norway.
| | - Boel Brynedal
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Shuo Liu
- Section of Environment and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France.
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden.
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Chair of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany.
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany.
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy.
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy.
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark.
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Diet, Genes and Environment (DGE), Denmark.
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria.
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
29
|
Brozek W, Ulmer H, Pompella A, Nagel G, Leiherer A, Preyer O, Concin H, Zitt E. Response to comments on "Gamma-glutamyl-transferase is associated with incident hip fractures in women and men ≥ 50 years: a large population-based cohort study". Osteoporos Int 2022; 33:1827-1829. [PMID: 35763075 DOI: 10.1007/s00198-022-06442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Wolfgang Brozek
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria.
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Alfonso Pompella
- Department of Translational Research and New Technologies in Medicine and Surgery, Università di Pisa, Pisa, Italy
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - Oliver Preyer
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
| | - Hans Concin
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900, Bregenz, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| |
Collapse
|
30
|
Chen J, Hoek G, de Hoogh K, Rodopoulou S, Andersen ZJ, Bellander T, Brandt J, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Verschuren WMM, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Méndez DY, Leander K, Liu S, Ljungman P, Faure E, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Rizzuto D, Samoli E, van der Schouw YT, Schramm S, Severi G, Stafoggia M, Strak M, Sørensen M, Tjønneland A, Weinmayr G, Wolf K, Zitt E, Brunekreef B, Thurston GD. Long-Term Exposure to Source-Specific Fine Particles and Mortality─A Pooled Analysis of 14 European Cohorts within the ELAPSE Project. Environ Sci Technol 2022; 56:9277-9290. [PMID: 35737879 PMCID: PMC9261290 DOI: 10.1021/acs.est.2c01912] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
We assessed mortality risks associated with source-specific fine particles (PM2.5) in a pooled European cohort of 323,782 participants. Cox proportional hazard models were applied to estimate mortality hazard ratios (HRs) for source-specific PM2.5 identified through a source apportionment analysis. Exposure to 2010 annual average concentrations of source-specific PM2.5 components was assessed at baseline residential addresses. The source apportionment resulted in the identification of five sources: traffic, residual oil combustion, soil, biomass and agriculture, and industry. In single-source analysis, all identified sources were significantly positively associated with increased natural mortality risks. In multisource analysis, associations with all sources attenuated but remained statistically significant with traffic, oil, and biomass and agriculture. The highest association per interquartile increase was observed for the traffic component (HR: 1.06; 95% CI: 1.04 and 1.08 per 2.86 μg/m3 increase) across five identified sources. On a 1 μg/m3 basis, the residual oil-related PM2.5 had the strongest association (HR: 1.13; 95% CI: 1.05 and 1.22), which was substantially higher than that for generic PM2.5 mass, suggesting that past estimates using the generic PM2.5 exposure response function have underestimated the potential clean air health benefits of reducing fossil-fuel combustion. Source-specific associations with cause-specific mortality were in general consistent with findings of natural mortality.
Collapse
Affiliation(s)
- Jie Chen
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
| | - Gerard Hoek
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
| | - Kees de Hoogh
- Swiss
Tropical and Public Health Institute, 4051 Basel, Switzerland
- University
of Basel, 4001 Basel, Switzerland
| | - Sophia Rodopoulou
- Department
of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Zorana J. Andersen
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Tom Bellander
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Centre
for Occupational and Environmental Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Jørgen Brandt
- Department
of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
- iClimate—Interdisciplinary
Center for Climate Change, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
| | - Daniela Fecht
- MRC
Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2
1PG London, U.K.
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region
Health Service, ASL Roma
1, 00147 Rome, Italy
- Environmental Research Group, School of
Public Health, Imperial College London, W2 1PG London, U.K.
| | - John Gulliver
- MRC
Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, W2
1PG London, U.K.
- Centre for Environmental Health and Sustainability
& School of
Geography, Geology and the Environment, University of Leicester, LE1 7RH Leicester, U.K.
| | - Ole Hertel
- Department of Ecoscience, Aarhus
University, 4000 Roskilde, Denmark
| | - Barbara Hoffmann
- Institute
for Occupational, Social and Environmental Medicine, Centre
for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, 40001 Düsseldorf, Germany
| | | | - W. M. Monique Verschuren
- National Institute for Public Health and
the Environment, 3720 BA Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, the Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical
Informatics, Biometry and Epidemiology, Medical
Faculty, University of Duisburg-Essen, 45259 Essen, Germany
| | - Jeanette T. Jørgensen
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Klea Katsouyanni
- Department
of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Environmental Research Group, School of
Public Health, Imperial College London, W2 1PG London, U.K.
| | - Matthias Ketzel
- Department
of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, GU2
7XH Guildford, United Kingdom
| | - Diego Yacamán Méndez
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Karin Leander
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Shuo Liu
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Petter Ljungman
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Cardiology, Danderyd
University
Hospital, 182 88 Stockholm, Sweden
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy,
“Exposome and Heredity” Team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K. E. Magnusson
- Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gabriele Nagel
- Institute
of Epidemiology and Medical Biometry, Ulm
University, Helmholtzstrasse 22, 89081 Ulm, Germany
| | - Göran Pershagen
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Centre
for Occupational and Environmental Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Annette Peters
- Institute
of Epidemiology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Chair of Epidemiology, Ludwig
Maximilians Universität München, 81377 Munich, Germany
| | - Ole Raaschou-Nielsen
- Department
of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
- Danish
Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences,
and Society, Karolinska Institutet and Stockholm
University, 171 77 Stockholm, Sweden
| | - Evangelia Samoli
- Department
of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical
Informatics, Biometry and Epidemiology, Medical
Faculty, University of Duisburg-Essen, 45259 Essen, Germany
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy,
“Exposome and Heredity” Team, CESP UMR1018, 94805 Villejuif, France
- Department of Statistics, Computer Science and Applications
“G. Parenti” (DISIA), University
of Florence, 50121 Firenze FI, Italy
| | - Massimo Stafoggia
- Institute
of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Epidemiology, Lazio Region
Health Service, ASL Roma
1, 00147 Rome, Italy
| | - Maciej Strak
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
- National Institute for Public Health and
the Environment, 3720 BA Bilthoven, The Netherlands
| | - Mette Sørensen
- Danish
Cancer Society Research Center, 2100 Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, 4000 Roskilde, Denmark
| | - Anne Tjønneland
- Section
of Environment and Health, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
- Danish
Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - Gudrun Weinmayr
- Institute
of Epidemiology and Medical Biometry, Ulm
University, Helmholtzstrasse 22, 89081 Ulm, Germany
| | - Kathrin Wolf
- Institute
of Epidemiology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), 6900 Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, 6800 Feldkirch, Austria
| | - Bert Brunekreef
- Institute
for Risk Assessment Sciences (IRAS), Utrecht
University, 3584 CM Utrecht, The Netherlands
| | - George D. Thurston
- Departments of Environmental Medicine and
Population
Health, New York University Grossman School
of Medicine, New York, 10010-2598 New York, United States
| |
Collapse
|
31
|
Liu S, Lim YH, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Verschuren WMM, Jöckel KH, Jørgensen JT, So R, Amini H, Cole-Hunter T, Mehta AJ, Mortensen LH, Ketzel M, Lager A, Leander K, Ljungman P, Severi G, Boutron-Ruault MC, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Rizzuto D, van der Schouw YT, Schramm S, Sørensen M, Stafoggia M, Tjønneland A, Katsouyanni K, Huang W, Samoli E, Brunekreef B, Hoek G, Andersen ZJ. Long-term Air Pollution Exposure and Pneumonia-related Mortality in a Large Pooled European Cohort. Am J Respir Crit Care Med 2022; 205:1429-1439. [PMID: 35258439 DOI: 10.1164/rccm.202106-1484oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Ambient air pollution exposure has been linked to mortality from chronic cardiorespiratory diseases, while evidence on respiratory infections remains more limited. Objectives: We examined the association between long-term exposure to air pollution and pneumonia-related mortality in adults in a pool of eight European cohorts. Methods: Within the multicenter project ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO2), black carbon (BC), and ozone were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and pneumonia, influenza, and acute lower respiratory infections (ALRI) mortality. Measurements and Main Results: Of 325,367 participants, 712 died from pneumonia and influenza combined, 682 from pneumonia, and 695 from ALRI during a mean follow-up of 19.5 years. NO2 and BC were associated with 10-12% increases in pneumonia and influenza combined mortality, but 95% confidence intervals included unity (hazard ratios, 1.12 [0.99-1.26] per 10 μg/m3 for NO2; 1.10 [0.97-1.24] per 0.5 10-5m-1 for BC). Associations with pneumonia and ALRI mortality were almost identical. We detected effect modification suggesting stronger associations with NO2 or BC in overweight, employed, or currently smoking participants compared with normal weight, unemployed, or nonsmoking participants. Conclusions: Long-term exposure to combustion-related air pollutants NO2 and BC may be associated with mortality from lower respiratory infections, but larger studies are needed to estimate these associations more precisely.
Collapse
Affiliation(s)
| | | | - Jie Chen
- Institute for Risk Assessment Sciences and
| | - Maciek Strak
- Institute for Risk Assessment Sciences and.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science.,iClimate, Interdisciplinary Centre for Climate Change, and
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria.,Department of Internal Medicine 3, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- Medical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/Azienda Sanitaria Locale Roma 1, Rome, Italy.,Science Policy & Epidemiology Environmental Research Group King's College London, London, United Kingdom
| | - John Gulliver
- Medical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | | | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | | | - Rina So
- Section of Environmental Health
| | | | | | - Amar J Mehta
- Section of Epidemiology, and.,Statistics Denmark, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, and.,Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | | | | | - Petter Ljungman
- Institute of Environmental Medicine.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gianluca Severi
- University Paris-Saclay, University of Versailles Saint-Quentin, Inserm, Gustave Roussy, "Exposome and Heredity" team, The Centre de Recherche en Epidémiologie et Santé des Populations UMR1018, Villejuif, France.,Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Marie-Christine Boutron-Ruault
- University Paris-Saclay, University of Versailles Saint-Quentin, Inserm, Gustave Roussy, "Exposome and Heredity" team, The Centre de Recherche en Epidémiologie et Santé des Populations UMR1018, Villejuif, France
| | | | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.,Chair of Epidemiology, Ludwig Maximilians Universität München, Germany
| | - Ole Raaschou-Nielsen
- Department of Environmental Science.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine.,Department of Epidemiology, Lazio Region Health Service/Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Diet, Genes and Environment (DGE), Copenhagen, Denmark; and
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Science Policy & Epidemiology Environmental Research Group King's College London, London, United Kingdom
| | - Wei Huang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
32
|
Brozek W, Ulmer H, Pompella A, Nagel G, Leiherer A, Preyer O, Concin H, Zitt E. Gamma-glutamyl-transferase is associated with incident hip fractures in women and men ≥ 50 years: a large population-based cohort study. Osteoporos Int 2022; 33:1295-1307. [PMID: 35059776 DOI: 10.1007/s00198-022-06307-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/08/2022] [Indexed: 12/30/2022]
Abstract
UNLABELLED The association of serum gamma-glutamyl-transferase (GGT) with hip fracture risk has not been examined in women and men ≥ 50 years. We show that elevated GGT was associated with increased hip fracture risk, particularly in men. GGT could be a candidate serum marker of long-term hip fracture risk in the elderly. INTRODUCTION We herein examined a possible relation between serum levels of GGT and hip fracture risk in women and men aged ≥ 50 years, which has not been investigated before. METHODS In this population-based prospective cohort study, approximately 41,000 women and nearly 33,000 men ≥ 50 years participating in a medical prevention program 1985-2005 in western Austria were followed up for the occurrence of osteoporotic hip fractures during 2003-2013. ICD-10 based discharge diagnoses for hip fracture included S72.0, S72.1, and S72.2 available from all regional hospitals. GGT-related hip fracture risk was ascertained at each participant´s first and last examination during the prevention program. In a subset of 5445 participants, alcohol consumption could be included as a covariate. RESULTS In men, hip fracture risk rose significantly by 75% and 86% for every tenfold increase of GGT measured at the first and last examination, respectively, and in women, hip fracture risk rose by 22% from the last examination. Elevated GGT (≥ 36 U/l in women, ≥ 56 U/l in men) at the first examination was associated with increased hip fracture risk only in men (HR 1.51, 95% CI 1.25-1.82), and at the last examination in both women (HR 1.14, 95% CI 1.02-1.28) and men (HR 1.61, 95% CI 1.33-1.95). Alcohol consumption had no significant influence on GGT-mediated hip fracture risk in women and men. CONCLUSIONS Our findings identified an association of elevated GGT and hip fracture in women and men ≥ 50 years and suggest GGT as a candidate serum marker of long-term hip fracture risk in an elderly population.
Collapse
Affiliation(s)
- W Brozek
- Agency for Preventive and Social Medicine, Bregenz, Austria.
| | - H Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - A Pompella
- Department of Translational Research and New Technologies in Medicine and Surgery, Università Di Pisa, Pisa, Italy
| | - G Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - A Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Medical Central Laboratories, Feldkirch, Austria
| | - O Preyer
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - H Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - E Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Department of Internal Medicine 3 (Nephrology and Dialysis), Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| |
Collapse
|
33
|
Fritz J, Brozek W, Concin H, Nagel G, Kerschbaum J, Lhotta K, Ulmer H, Zitt E. The Association of Excess Body Weight with Risk of ESKD Is Mediated Through Insulin Resistance, Hypertension, and Hyperuricemia. J Am Soc Nephrol 2022; 33:1377-1389. [PMID: 35500938 PMCID: PMC9257805 DOI: 10.1681/asn.2021091263] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/24/2022] [Indexed: 01/02/2023] Open
Abstract
BackgroundInsulin resistance, hypertension, hyperuricemia, and hypercholesterolemia are hypothesized to be important intermediates in the relationship between excess body weight and CKD risk. However, the magnitude of the total effect of excess body weight on ESKD mediated through these four pathways remains to be quantified.MethodsWe applied a model for analysis of correlated mediators to population-based data from 100,269 Austrian individuals (mean age 46.4 years). Association of body mass index (BMI) was coalesced with ESKD risk into direct association. Indirect associations were mediated through the triglyceride-glucose (TyG) index (as an indicator of insulin resistance), mean arterial pressure (MAP), uric acid (UA), and total cholesterol (TC).ResultsMean follow-up was 23.1 years with 463 (0.5%) incident ESKD cases. An unhealthy metabolic profile (prevalence 32.4%) was associated with a markedly increased ESKD risk (multivariably adjusted hazard ratio (aHR), 3.57; 95% CI, 2.89 to 4.40), independent of BMI. A 5-kg/m2 higher BMI was associated with a 57% increased ESKD risk (aHRtotal association, 1.57; 1.38 to 1.77). Of this association, 99% (76% to 140%) arose from all mediators jointly; 33% (22% to 49%) through TyG index; 34% (24% to 50%) through MAP; 30% (21% to 45%) through UA; and 2% (−1% to 4%) through TC. The remaining direct association was nonsignificant (aHRdirect association, 1.01; 0.88 to 1.14).ConclusionsTyG index, MAP, and UA, but not TC, mediate the association of BMI with ESKD in middle-aged adults. Our findings highlight that in addition to weight reduction, the control of metabolic risk factors might be essential in mitigating the adverse effects of BMI on kidney function.
Collapse
Affiliation(s)
- Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Julia Kerschbaum
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
- Austrian Dialysis and Transplant Registry (OEDTR), Medical University of Innsbruck, Innsbruck, Austria
| | - Karl Lhotta
- Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
- Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| |
Collapse
|
34
|
Kandler K, Witzel S, Eder K, Rothenbacher D, Nagel G, Peter RS, Schuster J, Dorst J, Rosenbohm A, Ludolph AC. Phenotyping of the thoracic-onset variant of amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:563-565. [PMID: 34667101 DOI: 10.1136/jnnp-2021-326712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Affiliation(s)
| | - Simon Witzel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - Johannes Dorst
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | | |
Collapse
|
35
|
Castelpietra G, Knudsen AKS, Agardh EE, Armocida B, Beghi M, Iburg KM, Logroscino G, Ma R, Starace F, Steel N, Addolorato G, Andrei CL, Andrei T, Ayuso-Mateos JL, Banach M, Bärnighausen TW, Barone-Adesi F, Bhagavathula AS, Carvalho F, Carvalho M, Chandan JS, Chattu VK, Couto RA, Cruz-Martins N, Dargan PI, Deuba K, da Silva DD, Fagbamigbe AF, Fernandes E, Ferrara P, Fischer F, Gaal PA, Gialluisi A, Haagsma JA, Haro JM, Hasan MT, Hasan SS, Hostiuc S, Iacoviello L, Iavicoli I, Jamshidi E, Jonas JB, Joo T, Jozwiak JJ, Katikireddi SV, Kauppila JH, Khan MA, Kisa A, Kisa S, Kivimäki M, Koly KN, Koyanagi A, Kumar M, Lallukka T, Langguth B, Ledda C, Lee PH, Lega I, Linehan C, Loureiro JA, Madureira-Carvalho ÁM, Martinez-Raga J, Mathur MR, McGrath JJ, Mechili EA, Mentis AFA, Mestrovic T, Miazgowski B, Mirica A, Mirijello A, Moazen B, Mohammed S, Mulita F, Nagel G, Negoi I, Negoi RI, Nwatah VE, Padron-Monedero A, Panda-Jonas S, Pardhan S, Pasovic M, Patel J, Petcu IR, Pinheiro M, Pollok RCG, Postma MJ, Rawaf DL, Rawaf S, Romero-Rodríguez E, Ronfani L, Sagoe D, Sanmarchi F, Schaub MP, Sharew NT, Shiri R, Shokraneh F, Sigfusdottir ID, Silva JP, Silva R, Socea B, Szócska M, Tabarés-Seisdedos R, Torrado M, Tovani-Palone MR, Vasankari TJ, Veroux M, Viner RM, Werdecker A, Winkler AS, Hay SI, Ferrari AJ, Naghavi M, Allebeck P, Monasta L. The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990-2019: Findings from the Global Burden of Disease Study 2019. Lancet Reg Health Eur 2022; 16:100341. [PMID: 35392452 PMCID: PMC8980870 DOI: 10.1016/j.lanepe.2022.100341] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 - 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432-912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9-412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (-29·1%;23·8-38·5). YLLs decreased in self-harm (-27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding The Bill and Melinda Gates Foundation.
Collapse
Affiliation(s)
- Giulio Castelpietra
- Outpatient and Inpatient Care Service, Central Health Directorate, Region Friuli Venezia Giulia, Italy
| | | | - Emilie E. Agardh
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Benedetta Armocida
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
| | | | | | - Giancarlo Logroscino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Department of Clinical Research in Neurology, Fondazione Cardinale Giovanni Panico Hospital, Tricase, Italy
| | - Rui Ma
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Fabrizio Starace
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - Nicholas Steel
- Department of Primary Care and Public Health, University of East Anglia, Norwich, UK
- Public Health England, London, UK
| | | | | | - Tudorel Andrei
- Department of Statistics and Econometrics Bucharest Carol Davila University of Economic Studies, Bucharest, Romania
| | - Jose L Ayuso-Mateos
- CIBERSAM, Institute of Health Carlos III, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid (Autonomous University of Madrid), Madrid, Spain
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akshaya Srikanth Bhagavathula
- Department of Social and Clinical Pharmacy, Charles University, Hradec Kralova, Czech Republic
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Felix Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Márcia Carvalho
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vijay Kumar Chattu
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
- Independent Consultant, Athens, Greece
| | - Rosa A.S. Couto
- Department of Chemical Sciences, University of Porto, Porto, Portugal
| | - Natália Cruz-Martins
- Department of Medicine (Prof N Cruz-Martins PhD), University of Porto, Porto, Portugal
- Department of Health Sciences Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Famalicão, Portugal
| | - Paul I. Dargan
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Keshab Deuba
- National Centre for AIDS and STD Control, Save the Children, Kathmandu, Nepal
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Adeniyi Francis Fagbamigbe
- Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Population and Behavioural Sciences, University of St Andrews, St Andrews, UK
| | - Eduarda Fernandes
- Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
| | - Pietro Ferrara
- Research Center on Public Health, University of Milan Bicocca, Monza, Italy
| | - Florian Fischer
- Institute of Public Health, Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany
| | - Peter Andras Gaal
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
- Department of Applied Social Sciences, Sapientia Hungarian University of Transylvania, Târgu-Mureş, Romania
| | | | - Juanita A. Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Josep Maria Haro
- Research Unit, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center for Mental Health Network (CiberSAM), Barcelona, Spain
| | - M. Tasdik Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, UK
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Syed Shahzad Hasan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | - Ivo Iavicoli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elham Jamshidi
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehram, Iran
- Division of Pulmonary Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jost B. Jonas
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
| | - Tamas Joo
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Jacek Jerzy Jozwiak
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | | | - Joonas H. Kauppila
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Surgery Research Unit, University of Oulu, Oulu, Finland
| | - Moien A.B. Khan
- Family Medicine Department, United Arab Emirates University, Al Ain, United Arab Emirates
- Primary Care Department, NHS North West London, London, UK
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Mika Kivimäki
- Department of Epidemiology and Public Health University College London, London, UK
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kamrun Nahar Koly
- Health System and Population Studies Divisions, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Center for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ai Koyanagi
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Manasi Kumar
- Division of Psychology and Language Sciences, University College London, London, UK
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Caterina Ledda
- Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Paul H. Lee
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Ilaria Lega
- National Center for Disease Prevention and Health Promotion, Istituto Superiore di Sanità - Italian National Insitute of Health, Rome, Italy
| | - Christine Linehan
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Joana A. Loureiro
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE) University of Porto, Porto, Portugal
- School of Health, Polytechnic Institute of Porto, Portugal
| | - Áurea M Madureira-Carvalho
- Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
- Institute for Research and Advanced Training in Health Sciences and Technologies, Instituto Universitário de Ciências da Saúde (University Institute of Health Sciences), Gandra, Portugal
| | - Jose Martinez-Raga
- Psychiatry Department, Hospital Universitario Doctor Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Manu Raj Mathur
- Health Policy Research Public Health Foundation of India, Gurugram, India
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - John J. McGrath
- Queensland Brain Institute, School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Enkeleint A. Mechili
- Department of Healthcare, University of Vlora, Vlora city, Albania
- Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
| | | | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
| | - Andreea Mirica
- Department of Statistics and Econometrics Bucharest University of Economic Studies, Bucharest, Romania
| | - Antonio Mirijello
- Department of Medical Sciences IRCCS Casa Sollievo della Sofferenza General Hospital, San Giovanni Rotondo, Italy
| | - Babak Moazen
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Shafiu Mohammed
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
- Medical School, University of Thessaly, Larissa, Greece
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry Ulm University, Ulm, Germany
| | - Ionut Negoi
- Department of General Surgery Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Department of Anatomy and Embryology Romania, Bucharest, Romania
- Cardio-Aid, Bucharest, Romania
| | - Vincent Ebuka Nwatah
- Department of Pediatrics, National Hospital, Abuja, Nigeria
- Department of International Public Health, University of Liverpool, Liverpool, UK
| | | | | | - Shahina Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - Maja Pasovic
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jay Patel
- Global Health Governance Programme, University of Edinburgh, Edinburgh, UK
- School of Dentistry, University of Leeds, Leeds, UK
| | - Ionela-Roxana Petcu
- Department of Statistics and Econometrics Bucharest University of Economic Studies, Bucharest, Romania
| | - Marina Pinheiro
- Department of Chemistry, University of Porto, Porto, Portugal
| | | | - Maarten J. Postma
- University Medical Center Groningen, School of Economics and Business University of Groningen, Groningen, Netherlands
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training Imperial College London, London, UK
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, UK
- University College London Hospitals, London, UK
- Academic Public Health England, London, UK
| | - Esperanza Romero-Rodríguez
- Clinical and Epidemiological Research in Primary Care (GICEAP), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Dominic Sagoe
- Department of Psychosocial Science University of Bergen, Bergen, Norway
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction University of Zürich, Zurich, Switzerland
| | - Nigussie Tadesse Sharew
- Interdisciplinary Centre Psychopathology and Emotion regulation (ICPE) University of Groningen, Groningen, Netherlands
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Farhad Shokraneh
- London Institute for Healthcare Engineering, King's College London, London, UK
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
- Department of Health and Behavior Studies, Columbia University, New York, NY, USA
| | - João Pedro Silva
- Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
| | - Renata Silva
- Department of Biological Sciences, University of Porto, Porto, Portugal
| | - Bogdan Socea
- Surgery, "Sf. Pantelimon" Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - Miklós Szócska
- Faculty of Health and Public Administration, Semmelweis University, Budapest, Hungary
| | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia, Valencia, Spain
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
| | - Marco Torrado
- Psychiatry and Medical Psychology Department, University of Lisbon, Lisbon, Portugal
- Child and Adolescent Mental Health Services (CAMHS), Hospital Garcia de Orta, Almada, Portugal
| | - Marcos Roberto Tovani-Palone
- Department of Pathology and Legal Medicine, University of São Paulo, Ribeirão Preto, Brazil
- Modestum LTD, London, UK
| | - Tommi Juhani Vasankari
- UKK Institute, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Russell M. Viner
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrea Werdecker
- Demographic Change and Aging Research Area, Federal Institute for Population Research, Wiesbaden, Germany
| | - Andrea Sylvia Winkler
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alize J. Ferrari
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- School of Public Health (A J Ferrari PhD), The University of Queensland, Brisbane, QLD, Australia
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Peter Allebeck
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| |
Collapse
|
36
|
Coburger J, Onken J, Rueckriegel S, von der Brelie C, Nadji-Ohl M, Forster MT, Gerlach R, Unteroberdörster M, Roder C, Kniese K, Schommer S, Rothenbacher D, Nagel G, Wirtz CR, Ernestus RI, Nabavi A, Tatagiba M, Czabanka M, Ganslandt O, Rohde V, Löhr M, Vajkoczy P, Pala A. Eloquent Lower Grade Gliomas, a Highly Vulnerable Cohort: Assessment of Patients' Functional Outcome After Surgery Based on the LoG-Glio Registry. Front Oncol 2022; 12:845992. [PMID: 35311092 PMCID: PMC8927728 DOI: 10.3389/fonc.2022.845992] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 11/28/2022] Open
Abstract
Majority of lower grade glioma (LGG) are located eloquently rendering surgical resection challenging. Aim of our study was to assess rate of permanent deficits and its predisposing risk factors. We retrieved 83 patients harboring an eloquently located LGGs from the prospective LoG-Glio Database. Patients without surgery or incomplete postoperative data were excluded. Sign rank test, explorative correlations by Spearman ρ and multivariable regression for new postoperative deficits were calculated. Eloquent region involved predominantly motor (45%) and language (40%). At first follow up after 3 months permanent neuro-logical deficits (NDs) were noted in 39%. Mild deficits remained in 29% and severe deficits in 10%. Complete tumor removal (CTR) was successfully in 62% of intended cases. Postoperative and 3-month follow up National Institute of Health Stroke Score (NIHSS) showed significantly lower values than preoperatively (p<0.001). 38% cases showed a decreased NIHSS at 3-month, while occurrence was only 14% at 9-12-month follow up. 6/7 patients with mild aphasia recovered after 9-12 months, while motor deficits present at 3-month follow up were persistent in majority of patients. Eastern oncology group functional status (ECOG) significantly decreased by surgery (p < 0.001) in 31% of cases. Between 3-month and 9-12-months follow up no significant improvement was seen. In the multivariable model CTR (p=0.019, OR 31.9), and ECOG>0 (p=0.021, OR 8.5) were independent predictors for permanent postoperative deficit according to NIHSS at 3-month according to multivariable regression model. Patients harboring eloquently located LGG are highly vulnerable for permanent deficits. Almost one third of patients have a permanent reduction of their functional status based on ECOG. Risk of an extended resection has to be balanced with the respective oncological benefit. Especially, patients with impaired pre-operative status are at risk for new permanent deficits. There is a relevant improvement of neurological symptoms in the first year after surgery, especially for patients with slight aphasia.
Collapse
Affiliation(s)
- Jan Coburger
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité - University of Berlin, Berlin, Germany
| | | | | | - Minou Nadji-Ohl
- Department of Neurosurgery, Katharinenhospital Stuttgart, Stuttgart, Germany
| | | | - Rüdiger Gerlach
- Department of Neurosurgery, Helios Hospital Erfurt, Erfurt, Germany
| | | | - Constantin Roder
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Katja Kniese
- Department of Neurosurgery, KRH Klinikum Region Hannover, Hannover, Germany
| | - Stefan Schommer
- Department of Neurosurgery, Katharinenhospital Stuttgart, Stuttgart, Germany
| | | | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | | | - Arya Nabavi
- Department of Neurosurgery, KRH Klinikum Region Hannover, Hannover, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, University of Frankfurt, Frankfurt am Main, Germany
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Veit Rohde
- Department of Neurosurgery, University of Göttingen, Göttingen, Germany
| | - Mario Löhr
- Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - University of Berlin, Berlin, Germany
| | - Andrej Pala
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| |
Collapse
|
37
|
Cousin E, Duncan BB, Stein C, Ong KL, Vos T, Abbafati C, Abbasi-Kangevari M, Abdelmasseh M, Abdoli A, Abd-Rabu R, Abolhassani H, Abu-Gharbieh E, Accrombessi MMK, Adnani QES, Afzal MS, Agarwal G, Agrawaal KK, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi K, Ahmadi S, Ahmadi A, Ahmed A, Ahmed Salih Y, Akande-Sholabi W, Akram T, Al Hamad H, Al-Aly Z, Alcalde-Rabanal JE, Alipour V, Aljunid SM, Al-Raddadi RM, Alvis-Guzman N, Amini S, Ancuceanu R, Andrei T, Andrei CL, Anjana RM, Ansar A, Antonazzo IC, Antony B, Anyasodor AE, Arabloo J, Arizmendi D, Armocida B, Artamonov AA, Arulappan J, Aryan Z, Asgari S, Ashraf T, Astell-Burt T, Atorkey P, Atout MMW, Ayanore MA, Badiye AD, Baig AA, Bairwa M, Baker JL, Baltatu OC, Banik PC, Barnett A, Barone MTU, Barone-Adesi F, Barrow A, Bedi N, Belete R, Belgaumi UI, Bell AW, Bennett DA, Bensenor IM, Beran D, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bijani A, Bikbov B, Birara S, Bodolica V, Bonny A, Brenner H, Briko NI, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Cao Y, Cao C, Cerin E, Chakraborty PA, Chandan JS, Chattu VK, Chen S, Choi JYJ, Choudhari SG, Chowdhury EK, Chu DT, Corso B, Dadras O, Dai X, Damasceno AAM, Dandona L, Dandona R, Dávila-Cervantes CA, De Neve JW, Denova-Gutiérrez E, Dhamnetiya D, Diaz D, Ebtehaj S, Edinur HA, Eftekharzadeh S, El Sayed I, Elgendy IY, Elhadi M, Elmonem MA, Faisaluddin M, Farooque U, Feng X, Fernandes E, Fischer F, Flood D, Freitas M, Gaal PA, Gad MM, Gaewkhiew P, Getacher L, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Gill PS, Ginawi IA, Glushkova EV, Golechha M, Gopalani SV, Guimarães RA, Gupta RD, Gupta R, Gupta VK, Gupta VB, Gupta S, Habtewold TD, Hafezi-Nejad N, Halwani R, Hanif A, Hankey GJ, Haque S, Hasaballah AI, Hasan SS, Hashi A, Hassanipour S, Hay SI, Hayat K, Heidari M, Hossain MBH, Hossain S, Hosseini M, Hoveidamanesh S, Huang J, Humayun A, Hussain R, Hwang BF, Ibitoye SE, Ikuta KS, Inbaraj LR, Iqbal U, Islam MS, Islam SMS, Islam RM, Ismail NE, Isola G, Itumalla R, Iwagami M, Iyamu IO, Jahani MA, Jakovljevic M, Jayawardena R, Jha RP, John O, Jonas JB, Joo T, Kabir A, Kalhor R, Kamath A, Kanchan T, Kandel H, Kapoor N, Kayode GA, Kebede SA, Keshavarz P, Keykhaei M, Khader YS, Khajuria H, Khan MAB, Khan MN, Khan M, Khater AM, Khoja TAM, Khubchandani J, Kim MS, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kivimäki M, Korshunov VA, Korzh O, Koyanagi A, Krishan K, Kuate Defo B, Kumar GA, Kumar N, Kusuma D, La Vecchia C, Lacey B, Larsson AO, Lasrado S, Lee WC, Lee CB, Lee PH, Lee SWH, Li MC, Lim SS, Lim LL, Lucchetti G, Majeed A, Malik AA, Mansouri B, Mantovani LG, Martini S, Mathur P, McAlinden C, Mehedi N, Mekonnen T, Menezes RG, Mersha AG, Miao Jonasson J, Miazgowski T, Michalek IM, Mirica A, Mirrakhimov EM, Mirza AZ, Mithra P, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed A, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moradpour F, Moradzadeh R, Mostafavi E, Mueller UO, Murray CJL, Mustafa A, Nagel G, Nangia V, Naqvi AA, Nayak BP, Nazari J, Ndejjo R, Negoi RI, Neupane Kandel S, Nguyen CT, Nguyen HLT, Noubiap JJ, Nowak C, Oancea B, Odukoya OO, Oguntade AS, Ojo TT, Olagunju AT, Onwujekwe OE, Ortiz A, Owolabi MO, Palladino R, Panda-Jonas S, Pandi-Perumal SR, Pardhan S, Parekh T, Parvizi M, Pepito VCF, Perianayagam A, Petcu IR, Pilania M, Podder V, Polibin RV, Postma MJ, Prashant A, Rabiee N, Rabiee M, Rahimi-Movaghar V, Rahman MA, Rahman MM, Rahman M, Rahmawaty S, Rajai N, Ram P, Rana J, Ranabhat K, Ranasinghe P, Rao CR, Rao S, Rawaf S, Rawaf DL, Rawal L, Renzaho AMN, Rezaei N, Rezapour A, Riahi SM, Ribeiro D, Rodriguez JAB, Roever L, Rohloff P, Rwegerera GM, Ryan PM, Saber-Ayad MM, Sabour S, Saddik B, Saeedi Moghaddam S, Sahebkar A, Sahoo H, Saif-Ur-Rahman KM, Salimzadeh H, Samaei M, Sanabria J, Santric-Milicevic MM, Sathian B, Sathish T, Schlaich MP, Seidu AA, Šekerija M, Senthil Kumar N, Seylani A, Shaikh MA, Shamshad H, Shawon MSR, Sheikhbahaei S, Shetty JK, Shiri R, Shivakumar KM, Shuval K, Singh JA, Singh A, Skryabin VY, Skryabina AA, Sofi-Mahmudi A, Soheili A, Sun J, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Tadbiri H, Tadesse EG, Tariqujjaman M, Thankappan KR, Thapar R, Thomas N, Timalsina B, Tobe-Gai R, Tonelli M, Tovani-Palone MR, Tran BX, Tripathy JP, Tudor Car L, Tusa BS, Uddin R, Upadhyay E, Valadan Tahbaz S, Valdez PR, Vasankari TJ, Verma M, Villalobos-Daniel VE, Vladimirov SK, Vo B, Vu GT, Vukovic R, Waheed Y, Wamai RG, Werdecker A, Wickramasinghe ND, Winkler AS, Wubishet BL, Xu X, Xu S, Yahyazadeh Jabbari SH, Yatsuya H, Yaya S, Yazie TSY, Yi S, Yonemoto N, Yunusa I, Zadey S, Zaman SB, Zamanian M, Zamora N, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zhong C, Zmaili M, Zumla A, Naghavi M, Schmidt MI. Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019. Lancet Diabetes Endocrinol 2022; 10:177-192. [PMID: 35143780 PMCID: PMC8860753 DOI: 10.1016/s2213-8587(21)00349-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/27/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990-2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. FINDINGS In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (-28·4 to -2·9) for all diabetes, and by 21·0% (-33·0 to -5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (-13·6% [-28·4 to 3·4]) and for type 1 diabetes (-13·6% [-29·3 to 8·9]). INTERPRETATION Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
38
|
Klimek M, Peter RS, Denkinger M, Dallmeier D, Rapp K, Rothenbacher D, Klenk J, Böhm B, Geiger H, Lukas A, Stingl J, Riepe M, Rapp K, Scharffetter-Kochanek K, Koenig W, Steinacker JM, Ludolph A, Nagel G, Peter R. The relationship of weather with daily physical activity and the time spent out of home in older adults from Germany – the ActiFE study. Eur Rev Aging Phys Act 2022; 19:6. [PMID: 35151273 PMCID: PMC8903592 DOI: 10.1186/s11556-022-00286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is a need for a comprehensive evaluation of the associations between varieties of weather conditions on the time spent out-of-home (TOH) and on walking duration (WD) among older adults. We aim to investigate the extent to which various weather parameters (temperature, solar radiation, sunshine duration, humidity, windspeed, and rain) determine daily WD the TOH in older adults. Methods The ActiFE (Activity and Function in Older People in Ulm) study is a prospective study of participants aged 65 years or older who wore an accelerometer and kept a movement diary in up to three temporally separated waves from 2009 to 2018 for a duration up to seven days per wave (up to three weeks in summary). We used weather data from a weather station near the participants‘ homes. Age-adjusted and gender-stratified generalized mixed models were used to predict WD and TOH (with 95% confidence interval (CI)) within and between weather categories. Generalized additive models were computed for the single predictions at the weather quartile boundaries. Cubic splines (with 95% pointwise confidence bands (CB)) visualized the continuous course of the weather values. Results Higher temperatures, solar radiation and more hours of sunshine, led to an increase in WD and TOH, while higher precipitation, humidities and windspeeds led to a decrease. Women had in general higher WD and TOH times than men. Conclusions Our data suggest that weather parameters have a considerable influence on PA and TOH. Future analyses and interpretation of PA data should therefore account for weather parameters. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-022-00286-0.
Collapse
|
39
|
Nichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, Abdoli A, Abualhasan A, Abu-Gharbieh E, Akram TT, Al Hamad H, Alahdab F, Alanezi FM, Alipour V, Almustanyir S, Amu H, Ansari I, Arabloo J, Ashraf T, Astell-Burt T, Ayano G, Ayuso-Mateos JL, Baig AA, Barnett A, Barrow A, Baune BT, Béjot Y, Bezabhe WMM, Bezabih YM, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bijani A, Biswas A, Bolla SR, Boloor A, Brayne C, Brenner H, Burkart K, Burns RA, Cámera LA, Cao C, Carvalho F, Castro-de-Araujo LFS, Catalá-López F, Cerin E, Chavan PP, Cherbuin N, Chu DT, Costa VM, Couto RAS, Dadras O, Dai X, Dandona L, Dandona R, De la Cruz-Góngora V, Dhamnetiya D, Dias da Silva D, Diaz D, Douiri A, Edvardsson D, Ekholuenetale M, El Sayed I, El-Jaafary SI, Eskandari K, Eskandarieh S, Esmaeilnejad S, Fares J, Faro A, Farooque U, Feigin VL, Feng X, Fereshtehnejad SM, Fernandes E, Ferrara P, Filip I, Fillit H, Fischer F, Gaidhane S, Galluzzo L, Ghashghaee A, Ghith N, Gialluisi A, Gilani SA, Glavan IR, Gnedovskaya EV, Golechha M, Gupta R, Gupta VB, Gupta VK, Haider MR, Hall BJ, Hamidi S, Hanif A, Hankey GJ, Haque S, Hartono RK, Hasaballah AI, Hasan MT, Hassan A, Hay SI, Hayat K, Hegazy MI, Heidari G, Heidari-Soureshjani R, Herteliu C, Househ M, Hussain R, Hwang BF, Iacoviello L, Iavicoli I, Ilesanmi OS, Ilic IM, Ilic MD, Irvani SSN, Iso H, Iwagami M, Jabbarinejad R, Jacob L, Jain V, Jayapal SK, Jayawardena R, Jha RP, Jonas JB, Joseph N, Kalani R, Kandel A, Kandel H, Karch A, Kasa AS, Kassie GM, Keshavarz P, Khan MAB, Khatib MN, Khoja TAM, Khubchandani J, Kim MS, Kim YJ, Kisa A, Kisa S, Kivimäki M, Koroshetz WJ, Koyanagi A, Kumar GA, Kumar M, Lak HM, Leonardi M, Li B, Lim SS, Liu X, Liu Y, Logroscino G, Lorkowski S, Lucchetti G, Lutzky Saute R, Magnani FG, Malik AA, Massano J, Mehndiratta MM, Menezes RG, Meretoja A, Mohajer B, Mohamed Ibrahim N, Mohammad Y, Mohammed A, Mokdad AH, Mondello S, Moni MAA, Moniruzzaman M, Mossie TB, Nagel G, Naveed M, Nayak VC, Neupane Kandel S, Nguyen TH, Oancea B, Otstavnov N, Otstavnov SS, Owolabi MO, Panda-Jonas S, Pashazadeh Kan F, Pasovic M, Patel UK, Pathak M, Peres MFP, Perianayagam A, Peterson CB, Phillips MR, Pinheiro M, Piradov MA, Pond CD, Potashman MH, Pottoo FH, Prada SI, Radfar A, Raggi A, Rahim F, Rahman M, Ram P, Ranasinghe P, Rawaf DL, Rawaf S, Rezaei N, Rezapour A, Robinson SR, Romoli M, Roshandel G, Sahathevan R, Sahebkar A, Sahraian MA, Sathian B, Sattin D, Sawhney M, Saylan M, Schiavolin S, Seylani A, Sha F, Shaikh MA, Shaji KS, Shannawaz M, Shetty JK, Shigematsu M, Shin JI, Shiri R, Silva DAS, Silva JP, Silva R, Singh JA, Skryabin VY, Skryabina AA, Smith AE, Soshnikov S, Spurlock EE, Stein DJ, Sun J, Tabarés-Seisdedos R, Thakur B, Timalsina B, Tovani-Palone MR, Tran BX, Tsegaye GW, Valadan Tahbaz S, Valdez PR, Venketasubramanian N, Vlassov V, Vu GT, Vu LG, Wang YP, Wimo A, Winkler AS, Yadav L, Yahyazadeh Jabbari SH, Yamagishi K, Yang L, Yano Y, Yonemoto N, Yu C, Yunusa I, Zadey S, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Murray CJL, Vos T. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health 2022; 7:e105-e125. [PMID: 34998485 PMCID: PMC8810394 DOI: 10.1016/s2468-2667(21)00249-8] [Citation(s) in RCA: 963] [Impact Index Per Article: 481.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors. METHODS We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis. FINDINGS We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4-65·1) million cases globally in 2019 to 152·8 (130·8-175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [-7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64-1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52-1·85]). There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41-67]) and western Europe (74% [58-90]), and the largest in north Africa and the Middle East (367% [329-403]) and eastern sub-Saharan Africa (357% [323-395]). Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia. INTERPRETATION Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia. FUNDING Bill & Melinda Gates Foundation and Gates Ventures.
Collapse
|
40
|
Stafoggia M, Oftedal B, Chen J, Rodopoulou S, Renzi M, Atkinson RW, Bauwelinck M, Klompmaker JO, Mehta A, Vienneau D, Andersen ZJ, Bellander T, Brandt J, Cesaroni G, de Hoogh K, Fecht D, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Jöckel KH, Jørgensen JT, Katsouyanni K, Ketzel M, Kristoffersen DT, Lager A, Leander K, Liu S, Ljungman PLS, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Rizzuto D, Schramm S, Schwarze PE, Severi G, Sigsgaard T, Strak M, van der Schouw YT, Verschuren M, Weinmayr G, Wolf K, Zitt E, Samoli E, Forastiere F, Brunekreef B, Hoek G, Janssen NAH. Long-term exposure to low ambient air pollution concentrations and mortality among 28 million people: results from seven large European cohorts within the ELAPSE project. Lancet Planet Health 2022; 6:e9-e18. [PMID: 34998464 DOI: 10.1016/s2542-5196(21)00277-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Long-term exposure to ambient air pollution has been associated with premature mortality, but associations at concentrations lower than current annual limit values are uncertain. We analysed associations between low-level air pollution and mortality within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE). METHODS In this multicentre longitudinal study, we analysed seven population-based cohorts of adults (age ≥30 years) within ELAPSE, from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland (enrolled in 2000-11; follow-up until 2011-17). Mortality registries were used to extract the underlying cause of death for deceased individuals. Annual average concentrations of fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and tropospheric warm-season ozone (O3) from Europe-wide land use regression models at 100 m spatial resolution were assigned to baseline residential addresses. We applied cohort-specific Cox proportional hazard models with adjustment for area-level and individual-level covariates to evaluate associations with non-accidental mortality, as the main outcome, and with cardiovascular, non-malignant respiratory, and lung cancer mortality. Subset analyses of participants living at low pollutant concentrations (as per predefined values) and natural splines were used to investigate the concentration-response function. Cohort-specific effect estimates were pooled in a random-effects meta-analysis. FINDINGS We analysed 28 153 138 participants contributing 257 859 621 person-years of observation, during which 3 593 741 deaths from non-accidental causes occurred. We found significant positive associations between non-accidental mortality and PM2·5, NO2, and black carbon, with a hazard ratio (HR) of 1·053 (95% CI 1·021-1·085) per 5 μg/m3 increment in PM2·5, 1·044 (1·019-1·069) per 10 μg/m3 NO2, and 1·039 (1·018-1·059) per 0·5 × 10-5/m black carbon. Associations with PM2·5, NO2, and black carbon were slightly weaker for cardiovascular mortality, similar for non-malignant respiratory mortality, and stronger for lung cancer mortality. Warm-season O3 was negatively associated with both non-accidental and cause-specific mortality. Associations were stronger at low concentrations: HRs for non-accidental mortality at concentrations lower than the WHO 2005 air quality guideline values for PM2·5 (10 μg/m3) and NO2 (40 μg/m3) were 1·078 (1·046-1·111) per 5 μg/m3 PM2·5 and 1·049 (1·024-1·075) per 10 μg/m3 NO2. Similarly, the association between black carbon and non-accidental mortality was highest at low concentrations, with a HR of 1·061 (1·032-1·092) for exposure lower than 1·5× 10-5/m, and 1·081 (0·966-1·210) for exposure lower than 1·0× 10-5/m. INTERPRETATION Long-term exposure to concentrations of PM2·5 and NO2 lower than current annual limit values was associated with non-accidental, cardiovascular, non-malignant respiratory, and lung cancer mortality in seven large European cohorts. Continuing research on the effects of low concentrations of air pollutants is expected to further inform the process of setting air quality standards in Europe and other global regions. FUNDING Health Effects Institute.
Collapse
Affiliation(s)
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography-Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Amar Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate Aarhus University Interdisciplinary Centre for Climate Change, Aarhus, Denmark
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Fecht
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - John Gulliver
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK; Centre for Environmental Health and Sustainability and School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research, University of Surrey, Guildford, UK
| | | | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, Munich, Germany
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Germany
| | - Per E Schwarze
- Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gianluca Severi
- Exposome and Heredity Team, University Paris-Saclay, UVSQ, INSERM, Gustave Roussy, Villejuif, France; Department of Statistics, Computer Science and Applications "G Parenti", University of Florence, Italy
| | - Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service, ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| |
Collapse
|
41
|
Peter RS, Föger B, Concin H, Nagel G. Effect of Secular Trend, Age, and Length of Follow-up on Optimum Body Mass Index From 1985 Through 2015 in a Large Austrian Cohort. J Epidemiol 2021; 31:601-607. [PMID: 33012774 PMCID: PMC8593575 DOI: 10.2188/jea.je20200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Obesity and its health consequences will dominate health care systems in many countries during the next decades. However, the body mass index (BMI) optimum in relation to all-cause mortality is still a matter of debate. Material and Methods Data of the Vorarlberg Health Monitoring & Prevention Program (VHM&PP, 1985–2005) and data provided by the Main Association of Austrian Social Security Institutions (MAASSI, 2005–2015) were analyzed. Information was available on age, sex, smoking status, measured height and weight, and mortality. Generalized additive models were used to model mortality as a function of BMI, calendar time, age, and follow-up. Results In MAASSI (N = 282,216, 46.0% men), men and women were on average 2.7 years older than in VHM&PP (N = 185,361, 46.1% men). Average BMI was slightly higher in men (26.1 vs 25.7 kg/m2) but not in women (24.6 vs 24.7 kg/m2). We found an interactive effect of age and follow-up on the BMI optimum. Over age 35 years in men and 55 years in women, the BMI optimum decreased with length of follow-up. While keeping covariates fixed, BMI optimum increased slightly between 1985 and 2015 in men and women, 24.9 (95% CI, 23.9–25.9) to 26.4 (95% CI, 25.3–27.3), and 22.4 (95% CI, 21.7–23.1) to 23.3 (95% CI, 22.6–24.5) kg/m2, respectively. Conclusion Age and length of follow-up have a pronounced effect on the BMI associated with the lowest all-cause mortality. After controlling for age and length of follow-up, the BMI optimum increased slightly over 30 years in this large study sample.
Collapse
Affiliation(s)
| | | | - Hans Concin
- Agency for Preventive and Social Medicine (aks)
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University.,Agency for Preventive and Social Medicine (aks)
| |
Collapse
|
42
|
Rosenbohm A, Peter R, Dorst J, Kassubek J, Rothenbacher D, Nagel G, Ludolph AC. Life Course of Physical Activity and Risk and Prognosis of Amyotrophic Lateral Sclerosis in a German ALS Registry. Neurology 2021; 97:e1955-e1963. [PMID: 34670816 DOI: 10.1212/wnl.0000000000012829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Whether physical activity (PA) is a risk factor for amyotrophic lateral sclerosis (ALS) is controversial because data on lifelong PA are rare. The main objective of this study is to provide insight into PA as a potential risk factor for ALS, reporting data on cumulative PA, leisure-time PA, and occupational PA. This study also aims to gather evidence on the role of PA as a prognostic factor in disease course. METHODS Lifetime PA values collected by questionnaires addressing work and leisure time were quantified into metabolic equivalents (METs). A population-based case-control study embedded in the ALS Registry Swabia served to calculate the odds ratio (OR) of ALS by PA in different time intervals and prognosis. RESULTS In ALS cases (393 cases, 791 age- and sex-matched controls), we observed reduced total PA at interview and up to 5 years before interview compared to controls. Total PA was not associated with ALS risk 5 to 55 years before interview. Heavy occupational work intensity was associated with increased ALS risk (OR 1.97, 95% confidence interval 1.34, 2.89). Total PA levels were associated with survival in a nonlinear manner: inactive patients and highest activity levels (25 MET-h/wk) revealed the worst survival time of 15.4 and 19.3 months, respectively. Best median survival with 29.8 months was seen at 10.5 MET-h/wk after adjustment for other prognostic factors. DISCUSSION Lifetime combined PA decreased sharply several years before disease onset compared to controls. The risk of developing ALS was not associated with former total PA levels 5 to 55 years before interview in contrast to occupational PA, probably reflecting work-associated exposures. We found a strong nonlinear association of current and prediagnostic PA level and survival in ALS cases with the best survival with moderate PA. PA intensity may be a disease-modifying factor with an unfavorable outcome in sedentary and hyperactive behavior. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that PA was not associated with the development of ALS.
Collapse
Affiliation(s)
- Angela Rosenbohm
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany.
| | - Raphael Peter
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Johannes Dorst
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Jan Kassubek
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Dietrich Rothenbacher
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Gabriele Nagel
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | - Albert C Ludolph
- From the Department of Neurology (A.R., J.D., J.K., A.C.L.) and Institute of Epidemiology and Medical Biometry (R.P., D.R., G.N.), Ulm University; and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) (J.D., J.K., A.C.L.), Ulm Site, Germany
| | | |
Collapse
|
43
|
Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, Gregg EW, Bennett JE, Solomon B, Singleton RK, Sophiea MK, Iurilli MLC, Lhoste VPF, Cowan MJ, Savin S, Woodward M, Balanova Y, Cifkova R, Damasceno A, Elliott P, Farzadfar F, He J, Ikeda N, Kengne AP, Khang YH, Kim HC, Laxmaiah A, Lin HH, Margozzini Maira P, Miranda JJ, Neuhauser H, Sundström J, Varghese C, Widyahening IS, Zdrojewski T, Abarca-Gómez L, Abdeen ZA, Abdul Rahim HF, Abu-Rmeileh NM, Acosta-Cazares B, Adams RJ, Aekplakorn W, Afsana K, Afzal S, Agdeppa IA, Aghazadeh-Attari J, Aguilar-Salinas CA, Agyemang C, Ahmad NA, Ahmadi A, Ahmadi N, Ahmadi N, Ahmadizar F, Ahmed SH, Ahrens W, Ajlouni K, Al-Raddadi R, Alarouj M, AlBuhairan F, AlDhukair S, Ali MM, Alkandari A, Alkerwi A, Allin K, Aly E, Amarapurkar DN, Amougou N, Amouyel P, Andersen LB, Anderssen SA, Anjana RM, Ansari-Moghaddam A, Ansong D, Aounallah-Skhiri H, Araújo J, Ariansen I, Aris T, Arku RE, Arlappa N, Aryal KK, Aspelund T, Assah FK, Assunção MCF, Auvinen J, Avdićová M, Azevedo A, Azimi-Nezhad M, Azizi F, Azmin M, Babu BV, Bahijri S, Balakrishna N, Bamoshmoosh M, Banach M, Banadinović M, Bandosz P, Banegas JR, Baran J, Barbagallo CM, Barceló A, Barkat A, Barreto M, Barros AJD, Barros MVG, Bartosiewicz A, Basit A, Bastos JLD, Bata I, Batieha AM, Batyrbek A, Baur LA, Beaglehole R, Belavendra A, Ben Romdhane H, Benet M, Benson LS, Berkinbayev S, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bezerra J, Bhagyalaxmi A, Bhargava SK, Bia D, Biasch K, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boeing H, Boggia JG, Boissonnet CP, Bojesen SE, Bongard V, Bonilla-Vargas A, Bopp M, Borghs H, Bovet P, Boyer CB, Braeckman L, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Briceño Y, Brito M, Bruno G, Bueno-de-Mesquita HB, Bueno G, Bugge A, Burns C, Bursztyn M, Cabrera de León A, Cacciottolo J, Cameron C, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano V, Cardoso VC, Carlsson AC, Carvalho J, Casanueva FF, Censi L, Cervantes-Loaiza M, Chadjigeorgiou CA, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chee ML, Chen CJ, Chen F, Chen H, Chen S, Chen Z, Cheng CY, Cheraghian B, Cherkaoui Dekkaki I, Chetrit A, Chien KL, Chiolero A, Chiou ST, Chirita-Emandi A, Chirlaque MD, Cho B, Christensen K, Christofaro DG, Chudek J, Cinteza E, Claessens F, Clarke J, Clays E, Cohen E, Concin H, Cooper C, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crampin AC, Crujeiras AB, Cruz JJ, Csilla S, Cui L, Cureau FV, Cuschieri S, D'Arrigo G, d'Orsi E, Dallongeville J, Dankner R, Dantoft TM, Dauchet L, Davletov K, De Backer G, De Bacquer D, De Curtis A, de Gaetano G, De Henauw S, de Oliveira PD, De Ridder D, De Smedt D, Deepa M, Deev AD, DeGennaro VJ, Delisle H, Demarest S, Dennison E, Deschamps V, Dhimal M, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Dickerson TT, Dika Z, Djalalinia S, Do HTP, Dobson AJ, Donfrancesco C, Donoso SP, Döring A, Dorobantu M, Dörr M, Doua K, Dragano N, Drygas W, Duante CA, Duboz P, Duda RB, Dulskiene V, Dushpanova A, Džakula A, Dzerve V, Dziankowska-Zaborszczyk E, Eddie R, Eftekhar E, Eggertsen R, Eghtesad S, Eiben G, Ekelund U, El-Khateeb M, El Ati J, Eldemire-Shearer D, Eliasen M, Elosua R, Erasmus RT, Erbel R, Erem C, Eriksen L, Eriksson JG, Escobedo-de la Peña J, Eslami S, Esmaeili A, Evans A, Faeh D, Fakhretdinova AA, Fall CH, Faramarzi E, Farjam M, Fattahi MR, Fawwad A, Felix-Redondo FJ, Felix SB, Ferguson TS, Fernandes RA, Fernández-Bergés D, Ferrante D, Ferrao T, Ferrari M, Ferrario MM, Ferreccio C, Ferreira HS, Ferrer E, Ferrieres J, Figueiró TH, Fink G, Fischer K, Foo LH, Forsner M, Fouad HM, Francis DK, Franco MDC, Frikke-Schmidt R, Frontera G, Fuchs FD, Fuchs SC, Fujita Y, Fumihiko M, Furdela V, Furer A, Furusawa T, Gaciong Z, Galbarczyk A, Galenkamp H, Galvano F, Gao J, Gao P, Garcia-de-la-Hera M, Garcia P, Gareta D, Garnett SP, Gaspoz JM, Gasull M, Gazzinelli A, Gehring U, Geleijnse JM, George R, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gieger C, Gill TK, Giovannelli J, Gironella G, Giwercman A, Gkiouras K, Goldberg M, Goldsmith RA, Gomez LF, Gomula A, Gonçalves H, Gonçalves M, Gonçalves Cordeiro da Silva B, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando C, González-Villalpando ME, Gonzalez AR, Gorbea MB, Gottrand F, Graff-Iversen S, Grafnetter D, Grajda A, Grammatikopoulou MG, Gregor RD, Grodzicki T, Grosso G, Gruden G, Gu D, Guan OP, Gudmundsson EF, Gudnason V, Guerrero R, Guessous I, Guimaraes AL, Gulliford MC, Gunnlaugsdottir J, Gunter MJ, Gupta PC, Gupta R, Gureje O, Gurzkowska B, Gutierrez L, Gutzwiller F, Ha S, Hadaegh F, Haghshenas R, Hakimi H, Halkjær J, Hambleton IR, Hamzeh B, Hange D, Hanif AAM, Hantunen S, Hao J, Hardman CM, Hari Kumar R, Hashemi-Shahri SM, Hata J, Haugsgjerd T, Hayes AJ, He Y, Heier M, Hendriks ME, Henrique RDS, Henriques A, Hernandez Cadena L, Herqutanto, Herrala S, Heshmat R, Hill AG, Ho SY, Ho SC, Hobbs M, Holdsworth M, Homayounfar R, Horasan Dinc G, Horimoto ARVR, Hormiga CM, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Hu Y, Huerta JM, Huhtaniemi IT, Huiart L, Huisman M, Husseini AS, Huybrechts I, Hwalla N, Iacoviello L, Iannone AG, Ibrahim MM, Ibrahim Wong N, Ikram MA, Iotova V, Irazola VE, Ishida T, Isiguzo GC, Islam M, Islam SMS, Iwasaki M, Jackson RT, Jacobs JM, Jaddou HY, Jafar T, James K, Jamrozik K, Janszky I, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jiang CQ, Jimenez RO, Jöckel KH, Joffres M, Johansson M, Jokelainen JJ, Jonas JB, Jørgensen T, Joshi P, Joukar F, Jóżwiak J, Juolevi A, Jurak G, Jureša V, Kaaks R, Kafatos A, Kajantie EO, Kalmatayeva Z, Kalpourtzi N, Kalter-Leibovici O, Kampmann FB, Kannan S, Karaglani E, Kårhus LL, Karki KB, Katibeh M, Katz J, Kauhanen J, Kaur P, Kavousi M, Kazakbaeva GM, Keil U, Keinan Boker L, Keinänen-Kiukaanniemi S, Kelishadi R, Kemper HCG, Keramati M, Kerimkulova A, Kersting M, Key T, Khader YS, Khalili D, Khaw KT, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl S, Killewo J, Kim DW, Kim J, Klakk H, Klimek M, Klumbiene J, Knoflach M, Kolle E, Kolsteren P, Kontto JP, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kouda K, Kowlessur S, Koziel S, Kratenova J, Kriaucioniene V, Kristensen PL, Krokstad S, Kromhout D, Kruger HS, Kubinova R, Kuciene R, Kujala UM, Kulaga Z, Kumar RK, Kurjata P, Kusuma YS, Kutsenko V, Kuulasmaa K, Kyobutungi C, Laatikainen T, Lachat C, Laid Y, Lam TH, Landrove O, Lanska V, Lappas G, Larijani B, Latt TS, Le Coroller G, Le Nguyen Bao K, Le TD, Lee J, Lee J, Lehmann N, Lehtimäki T, Lemogoum D, Levitt NS, Li Y, Lilly CL, Lim WY, Lima-Costa MF, Lin X, Lin YT, Lind L, Lingam V, Linneberg A, Lissner L, Litwin M, Lo WC, Loit HM, Lopez-Garcia E, Lopez T, Lotufo PA, Lozano JE, Lukačević Lovrenčić I, Lukrafka JL, Luksiene D, Lundqvist A, Lundqvist R, Lunet N, Lustigová M, Luszczki E, Ma G, Ma J, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Majer M, Makdisse M, Malekzadeh F, Malekzadeh R, Malhotra R, Mallikharjuna Rao K, Malyutina SK, Maniego LV, Manios Y, Mann JI, Mansour-Ghanaei F, Manzato E, Marcil A, Mårild SB, Marinović Glavić M, Marques-Vidal P, Marques LP, Marrugat J, Martorell R, Mascarenhas LP, Matasin M, Mathiesen EB, Mathur P, Matijasevich A, Matlosz P, Matsha TE, Mavrogianni C, Mbanya JCN, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, McLachlan S, McLean RM, McLean SB, McNulty BA, Mediene Benchekor S, Medzioniene J, Mehdipour P, Mehlig K, Mehrparvar AH, Meirhaeghe A, Meisinger C, Mendoza Montano C, Menezes AMB, Menon GR, Mereke A, Meshram II, Metspalu A, Meyer HE, Mi J, Michels N, Mikkel K, Milkowska K, Miller JC, Minderico CS, Mini GK, Mirjalili MR, Mirrakhimov E, Mišigoj-Duraković M, Modesti PA, Moghaddam SS, Mohajer B, Mohamed MK, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Mohebi F, Moitry M, Møllehave LT, Molnár D, Momenan A, Mondo CK, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Moreira LB, Morejon A, Moreno LA, Morgan K, Moschonis G, Mossakowska M, Mostafa A, Mostafavi SA, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Mridha MK, Msyamboza KP, Mu TT, Muhihi AJ, Muiesan ML, Müller-Nurasyid M, Murphy N, Mursu J, Musa KI, Musić Milanović S, Musil V, Mustafa N, Nabipour I, Naderimagham S, Nagel G, Naidu BM, Najafi F, Nakamura H, Námešná J, Nang EEK, Nangia VB, Narake S, Ndiaye NC, Neal WA, Nejatizadeh A, Nenko I, Neovius M, Nguyen CT, Nguyen ND, Nguyen QV, Nguyen QN, Nieto-Martínez RE, Niiranen TJ, Nikitin YP, Ninomiya T, Nishtar S, Njelekela MA, Noale M, Noboa OA, Noorbala AA, Norat T, Nordendahl M, Nordestgaard BG, Noto D, Nowak-Szczepanska N, Nsour MA, Nunes B, O'Neill TW, O'Reilly D, Ochimana C, Oda E, Odili AN, Oh K, Ohara K, Ohtsuka R, Olié V, Olinto MTA, Oliveira IO, Omar MA, Onat A, Ong SK, Ono LM, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostojic SM, Ostovar A, Otero JA, Overvad K, Owusu-Dabo E, Paccaud FM, Padez C, Pahomova E, Paiva KMD, Pająk A, Palli D, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Papandreou D, Park SW, Park S, Parnell WR, Parsaeian M, Pasquet P, Patel ND, Pavlyshyn H, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres KGDA, Peres MA, Peters A, Petkeviciene J, Peykari N, Pham ST, Pichardo RN, Pigeot I, Pikhart H, Pilav A, Pilotto L, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Polašek O, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Price AJ, Price JF, Providencia R, Puhakka SE, Puiu M, Punab M, Qasrawi RF, Qorbani M, Queiroz D, Quoc Bao T, Radić I, Radisauskas R, Rahimikazerooni S, Rahman M, Raitakari O, Raj M, Rakhimova EM, Ramachandra Rao S, Ramachandran A, Ramos E, Rampal L, Rampal S, Rangel Reina DA, Rarra V, Rech CR, Redon J, Reganit PFM, Regecová V, Revilla L, Rezaianzadeh A, Ribeiro R, Riboli E, Richter A, Rigo F, Rinke de Wit TF, Ritti-Dias RM, Robitaille C, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Roggenbuck U, Rojas-Martinez R, Romaguera D, Romeo EL, Rosengren A, Roy JGR, Rubinstein A, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Rusakova IA, Russo P, Rutkowski M, Sabanayagam C, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saidi O, Sakarya S, Saki N, Salanave B, Salazar Martinez E, Salmerón D, Salomaa V, Salonen JT, Salvetti M, Sánchez-Abanto J, Sans S, Santos DA, Santos IS, Santos LC, Santos MP, Santos R, Saramies JL, Sardinha LB, Sarganas G, Sarrafzadegan N, Sathish T, Saum KU, Savva S, Sawada N, Sbaraini M, Scazufca M, Schaan BD, Schargrodsky H, Schipf S, Schmidt CO, Schnohr P, Schöttker B, Schramm S, Schultsz C, Schutte AE, Sebert S, Sein AA, Sen A, Senbanjo IO, Sepanlou SG, Servais J, Shalnova SA, Shamah-Levy T, Shamshirgaran M, Shanthirani CS, Sharafkhah M, Sharma SK, Shaw JE, Shayanrad A, Shayesteh AA, Shi Z, Shibuya K, Shimizu-Furusawa H, Shin DW, Shirani M, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Silva CRDM, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Sonestedt E, Song Y, Sørensen TIA, Sørgjerd EP, Sorić M, Sossa Jérome C, Soumaré A, Sparboe-Nilsen B, Sparrenberger K, Staessen JA, Starc G, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stergiou GS, Stessman J, Stieber J, Stöckl D, Stocks T, Stokwiszewski J, Stronks K, Strufaldi MW, Suka M, Sun CA, Sung YT, Suriyawongpaisal P, Sy RG, Syddall HE, Sylva RC, Szklo M, Tai ES, Tammesoo ML, Tamosiunas A, Tan EJ, Tang X, Tanser F, Tao Y, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tebar WR, Tell GS, Tello T, Tham YC, Thankappan KR, Theobald H, Theodoridis X, Thijs L, Thinggaard M, Thomas N, Thorand B, Thuesen BH, Timmermans EJ, Tjandrarini DH, Tjonneland A, Toft U, Tolonen HK, Tolstrup JS, Topbas M, Topór-Madry R, Tormo MJ, Tornaritis MJ, Torrent M, Torres-Collado L, Touloumi G, Traissac P, Triantafyllou A, Trichopoulos D, Trichopoulou A, Trinh OTH, Trivedi A, Tshepo L, Tsugane S, Tuliakova AM, Tulloch-Reid MK, Tullu F, Tuomainen TP, Tuomilehto J, Turley ML, Twig G, Tynelius P, Tzourio C, Ueda P, Ugel E, Ulmer H, Uusitalo HMT, Valdivia G, Valvi D, van Dam RM, van den Born BJ, Van der Heyden J, van der Schouw YT, Van Herck K, Van Minh H, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Varbo A, Vasan SK, Vega T, Veidebaum T, Velasquez-Melendez G, Veronesi G, Verschuren WMM, Verstraeten R, Victora CG, Viet L, Villalpando S, Vineis P, Vioque J, Virtanen JK, Visvikis-Siest S, Viswanathan B, Vlasoff T, Vollenweider P, Voutilainen A, Wade AN, Walton J, Wambiya EOA, Wan Bebakar WM, Wan Mohamud WN, Wanderley Júnior RDS, Wang MD, Wang N, Wang Q, Wang X, Wang YX, Wang YW, Wannamethee SG, Wareham N, Wei W, Weres A, Werner B, Whincup PH, Widhalm K, Wiecek A, Wilks RJ, Willeit J, Willeit P, Williams EA, Wilsgaard T, Wojtyniak B, Wong-McClure RA, Wong A, Wong TY, Woo J, Wu FC, Wu S, Wyszynska J, Xu H, Xu L, Yaacob NA, Yan W, Yang L, Yang X, Yang Y, Yasuharu T, Ye X, Yiallouros PK, Yoosefi M, Yoshihara A, You SL, Younger-Coleman NO, Yusoff AF, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zapata ME, Zaw KK, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhen S, Zheng Y, Zholdin B, Zhu D, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 938] [Impact Index Per Article: 312.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
Collapse
|
44
|
Strak M, Weinmayr G, Rodopoulou S, Chen J, de Hoogh K, Andersen ZJ, Atkinson R, Bauwelinck M, Bekkevold T, Bellander T, Boutron-Ruault MC, Brandt J, Cesaroni G, Concin H, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Janssen NAH, Jöckel KH, Jørgensen JT, Ketzel M, Klompmaker JO, Lager A, Leander K, Liu S, Ljungman P, Magnusson PKE, Mehta AJ, Nagel G, Oftedal B, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rizzuto D, van der Schouw YT, Schramm S, Severi G, Sigsgaard T, Sørensen M, Stafoggia M, Tjønneland A, Verschuren WMM, Vienneau D, Wolf K, Katsouyanni K, Brunekreef B, Hoek G, Samoli E. Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis. BMJ 2021; 374:n1904. [PMID: 34470785 PMCID: PMC8409282 DOI: 10.1136/bmj.n1904] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. DESIGN Pooled analysis of eight cohorts. SETTING Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. PARTICIPANTS 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon. MAIN OUTCOME MEASURES Deaths due to natural causes and cause specific mortality. RESULTS Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. CONCLUSIONS Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.
Collapse
Affiliation(s)
- Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Zorana J Andersen
- Department of Public Health, Section of Environment and Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Terese Bekkevold
- Department of Method Development and Analytics, Norwegian Institute of Public Health, Oslo, Norway
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | | | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Hans Concin
- Agency for Preventive and Social Medicine (AKS), Bregenz, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
- Science Policy and Epidemiology Environmental Research Group King's College London, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability and School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Jeanette T Jørgensen
- Department of Public Health, Section of Environment and Health, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shuo Liu
- Department of Public Health, Section of Environment and Health, University of Copenhagen, Copenhagen, Denmark
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amar J Mehta
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Ludwig Maximilians Universität München, Munich, Germany
| | | | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry, and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, Paris, France
- Department of Statistics, Computer Science and Applications "G Parenti" (DISIA), University of Florence, Italy
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Science Policy and Epidemiology Environmental Research Group King's College London, London, UK
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
45
|
Brunekreef B, Strak M, Chen J, Andersen ZJ, Atkinson R, Bauwelinck M, Bellander T, Boutron MC, Brandt J, Carey I, Cesaroni G, Forastiere F, Fecht D, Gulliver J, Hertel O, Hoffmann B, de Hoogh K, Houthuijs D, Hvidtfeldt U, Janssen N, Jorgensen J, Katsouyanni K, Ketzel M, Klompmaker J, Hjertager Krog N, Liu S, Ljungman P, Mehta A, Nagel G, Oftedal B, Pershagen G, Peters A, Raaschou-Nielsen O, Renzi M, Rodopoulou S, Samoli E, Schwarze P, Sigsgaard T, Stafoggia M, Vienneau D, Weinmayr G, Wolf K, Hoek G. Mortality and Morbidity Effects of Long-Term Exposure to Low-Level PM 2.5, BC, NO 2, and O 3: An Analysis of European Cohorts in the ELAPSE Project. Res Rep Health Eff Inst 2021; 2021:1-127. [PMID: 36106702 PMCID: PMC9476567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Epidemiological cohort studies have consistently found associations between long-term exposure to outdoor air pollution and a range of morbidity and mortality endpoints. Recent evaluations by the World Health Organization and the Global Burden of Disease study have suggested that these associations may be nonlinear and may persist at very low concentrations. Studies conducted in North America in particular have suggested that associations with mortality persisted at concentrations of particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5) well below current air quality standards and guidelines. The uncertainty about the shape of the concentration-response function at the low end of the concentration distribution, related to the scarcity of observations in the lowest range, was the basis of the current project. Previous studies have focused on PM2.5, but increasingly associations with nitrogen dioxide (NO2) are being reported, particularly in studies that accounted for the fine spatial scale variation of NO2. Very few studies have evaluated the effects of long-term exposure to low concentrations of ozone (O3). Health effects of black carbon (BC), representing primary combustion particles, have not been studied in most large cohort studies of PM2.5. Cohort studies assessing health effects of particle composition, including elements from nontailpipe traffic emissions (iron, copper, and zinc) and secondary aerosol (sulfur) have been few in number and reported inconsistent results. The overall objective of our study was to investigate the shape of the relationship between long-term exposure to four pollutants (PM2.5, NO2, BC, and O3) and four broad health effect categories using a number of different methods to characterize the concentration-response function (i.e., linear, nonlinear, or threshold). The four health effect categories were (1) natural- and cause-specific mortality including cardiovascular and nonmalignant as well as malignant respiratory and diabetes mortality; and morbidity measured as (2) coronary and cerebrovascular events; (3) lung cancer incidence; and (4) asthma and chronic obstructive pulmonary disease (COPD) incidence. We additionally assessed health effects of PM2.5 composition, specifically the copper, iron, zinc, and sulfur content of PM2,5. METHODS We focused on analyses of health effects of air pollutants at low concentrations, defined as less than current European Union (EU) Limit Values, U.S. Environmental Protection Agency (U.S. EPA), National Ambient Air Quality Standards (NAAQS), and/or World Health Organization (WHO) Air Quality Guideline values for PM2.5, NO2, and O3. We address the health effects at low air pollution levels by performing new analyses within selected cohorts of the ESCAPE study (European Study of Cohorts for Air Pollution Effects; Beelen et al. 2014a) and within seven very large European administrative cohorts. By combining well-characterized ESCAPE cohorts and large administrative cohorts in one study the strengths and weaknesses of each approach can be addressed. The large administrative cohorts are more representative of national or citywide populations, have higher statistical power, and can efficiently control for area-level confounders, but have fewer possibilities to control for individual-level confounders. The ESCAPE cohorts have detailed information on individual confounders, as well as country-specific information on area-level confounding. The data from the seven included ESCAPE cohorts and one additional non-ESCAPE cohort have been pooled and analyzed centrally. More than 300,000 adults were included in the pooled cohort from existing cohorts in Sweden, Denmark, Germany, the Netherlands, Austria, France, and Italy. Data from the administrative cohorts have been analyzed locally, without transfer to a central database. Privacy regulations prevented transfer of data from administrative cohorts to a central database. More than 28 million adults were included from national administrative cohorts in Belgium, Denmark, England, the Netherlands, Norway, and Switzerland as well as an administrative cohort in Rome, Italy. We developed central exposure assessment using Europewide hybrid land use regression (LUR) models, which incorporated European routine monitoring data for PM2.5, NO2, and O3, and ESCAPE monitoring data for BC and PM2.5 composition, land use, and traffic data supplemented with satellite observations and chemical transport model estimates. For all pollutants, we assessed exposure at a fine spatial scale, 100 × 100 m grids. These models have been applied to individual addresses of all cohorts including the administrative cohorts. In sensitivity analyses, we applied the PM2.5 models developed within the companion HEI-funded Canadian MAPLE study (Brauer et al. 2019) and O3 exposures on a larger spatial scale for comparison with previous studies. Identification of outcomes included linkage with mortality, cancer incidence, hospital discharge registries, and physician-based adjudication of cases. We analyzed natural-cause, cardiovascular, ischemic heart disease, stroke, diabetes, cardiometabolic, respiratory, and COPD mortality. We also analyzed lung cancer incidence, incidence of coronary and cerebrovascular events, and incidence of asthma and COPD (pooled cohort only). We applied the Cox proportional hazard model with increasing control for individual- and area-level covariates to analyze the associations between air pollution and mortality and/or morbidity for both the pooled cohort and the individual administrative cohorts. Age was used as the timescale because of evidence that this results in better adjustment for potential confounding by age. Censoring occurred at the time of the event of interest, death from other causes, emigration, loss to follow-up for other reasons, or at the end of follow-up, whichever came first. A priori we specified three confounder models, following the modeling methods of the ESCAPE study. Model 1 included only age (time axis), sex (as strata), and calendar year of enrollment. Model 2 added individual-level variables that were consistently available in the cohorts contributing to the pooled cohort or all variables available in the administrative cohorts, respectively. Model 3 further added area-level socioeconomic status (SES) variables. A priori model 3 was selected as the main model. All analyses in the pooled cohort were stratified by subcohort. All analyses in the administrative cohorts accounted for clustering of the data in neighborhoods by adjusting the variance of the effect estimates. The main exposure variable we analyzed was derived from the Europewide hybrid models based on 2010 monitoring data. Sensitivity analyses were conducted using earlier time periods, time-varying exposure analyses, local exposure models, and the PM2.5 models from the Canadian MAPLE project. We first specified linear single-pollutant models. Two-pollutant models were specified for all combinations of the four main pollutants. Two-pollutant models for particle composition were analyzed with PM2.5 and NO2 as the second pollutant. We then investigated the shape of the concentration-response function using natural splines with two, three, and four degrees of freedom; penalized splines with the degrees of freedom determined by the algorithm and shape-constrained health impact functions (SCHIF) using confounder model 3. Additionally, we specified linear models in subsets of the concentration range, defined by removing concentrations above a certain value from the analysis, such as for PM2.5 25 μg/m3 (EU limit value), 20, 15, 12 μg/m3 (U.S. EPA National Ambient Air Quality Standard), and 10 μg/m3 (WHO Air Quality Guideline value). Finally, threshold models were evaluated to investigate whether the associations persisted below specific concentration values. For PM2.5, we evaluated 10, 7.5, and 5 μg/m3 as potential thresholds. Performance of threshold models versus the corresponding no-threshold linear model were evaluated using the Akaike information criterion (AIC). RESULTS In the pooled cohort, virtually all subjects in 2010 had PM2.5 and NO2 annual average exposures below the EU limit values (25 μg/m3 and 40 μg/m3, respectively). More than 50,000 had a residential PM2.5 exposure below the U.S. EPA NAAQS (12 μg/m3). More than 25,000 subjects had a residential PM2.5 exposure below the WHO guideline (10 μg/m3). We found significant positive associations between PM2.5, NO2, and BC and natural-cause, respiratory, cardiovascular, and diabetes mortality. In our main model, the hazard ratios (HRs) (95% [confidence interval] CI) were 1.13 (CI = 1.11, 1.16) for an increase of 5 μg/m3 PM2.5, 1.09 (CI = 1.07, 1.10) for an increase of 10 μg/m3 NO2, and 1.08 (CI = 1.06, 1.10) for an increase of 0.5 × 10-5/m BC for natural-cause mortality. The highest HRs were found for diabetes mortality. Associations with O3 were negative, both in the fine spatial scale of the main ELAPSE model and in large spatial scale exposure models. For PM2.5, NO2, and BC, we generally observed a supralinear association with steeper slopes at low exposures and no evidence of a concentration below which no association was found. Subset analyses further confirmed that these associations remained at low levels: below 10 μg/m3 for PM2.5 and 20 μg/m3 for NO2. HRs were similar to the full cohort HRs for subjects with exposures below the EU limit values for PM2.5 and NO2, the U.S. NAAQS values for PM2.5, and the WHO guidelines for PM2.5 and NO2. The mortality associations were robust to alternative specifications of exposure, including different time periods, PM2.5 from the MAPLE project, and estimates from the local ESCAPE model. Time-varying exposure natural spline analyses confirmed associations at low pollution levels. HRs in two-pollutant models were attenuated but remained elevated and statistically significant for PM2.5 and NO2. In two-pollutant models of PM2.5 and NO2 HRs for natural-cause mortality were 1.08 (CI = 1.05, 1.11) for PM2.5 and 1.05 (CI = 1.03, 1.07) for NO2. Associations with O3 were attenuated but remained negative in two-pollutant models with NO2, BC, and PM2.5. We found significant positive associations between PM2.5, NO2, and BC and incidence of stroke and asthma and COPD hospital admissions. Furthermore, NO2 was significantly related to acute coronary heart disease and PM2.5 was significantly related to lung cancer incidence. We generally observed linear to supralinear associations with no evidence of a threshold, with the exception of the association between NO2 and acute coronary heart disease, which was sublinear. Subset analyses documented that associations remained even with PM2.5 below 20 μg/m3 and possibly 12 μg/m3. Associations remained even when NO2 was below 30 μg/m3 and in some cases 20 μg/m3. In two-pollutant models, NO2 was most consistently associated with acute coronary heart disease, stroke, asthma, and COPD hospital admissions. PM2.5 was not associated with these outcomes in two-pollutant models with NO2. PM2.5 was the only pollutant that was associated with lung cancer incidence in two-pollutant models. Associations with O3 were negative though generally not statistically significant. In the administrative cohorts, virtually all subjects in 2010 had PM2.5 and NO2 annual average exposures below the EU limit values. More than 3.9 million subjects had a residential PM2.5 exposure below the U.S. EPA NAAQS (12 μg/m3) and more than 1.9 million had residential PM2.5 exposures below the WHO guideline (10 μg/m3). We found significant positive associations between PM2.5, NO2, and BC and natural-cause, respiratory, cardiovascular, and lung cancer mortality, with moderate to high heterogeneity between cohorts. We found positive but statistically nonsignificant associations with diabetes mortality. In our main model meta-analysis, the HRs (95% CI) for natural-cause mortality were 1.05 (CI = 1.02, 1.09) for an increase of 5 μg/m3 PM2.5, 1.04 (CI = 1.02, 1.07) for an increase of 10 μg/m3 NO2, and 1.04 (CI = 1.02, 1.06) for an increase of 0.5 × 10-5/m BC, and 0.95 (CI = 0.93, 0.98) for an increase of 10 μg/m3 O3. The shape of the concentration-response functions differed between cohorts, though the associations were generally linear to supralinear, with no indication of a level below which no associations were found. Subset analyses documented that these associations remained at low levels: below 10 μg/m3 for PM2.5 and 20 μg/m3 for NO2. BC and NO2 remained significantly associated with mortality in two-pollutant models with PM2.5 and O3. The PM2.5 HR attenuated to unity in a two-pollutant model with NO2. The negative O3 association was attenuated to unity and became nonsignificant. The mortality associations were robust to alternative specifications of exposure, including time-varying exposure analyses. Time-varying exposure natural spline analyses confirmed associations at low pollution levels. Effect estimates in the youngest participants (<65 years at baseline) were much larger than in the elderly (>65 years at baseline). Effect estimates obtained with the ELAPSE PM2.5 model did not differ from the MAPLE PM2.5 model on average, but in individual cohorts, substantial differences were found. CONCLUSIONS Long-term exposure to PM2.5, NO2, and BC was positively associated with natural-cause and cause-specific mortality in the pooled cohort and the administrative cohorts. Associations were found well below current limit values and guidelines for PM2.5 and NO2. Associations tended to be supralinear, with steeper slopes at low exposures with no indication of a threshold. Two-pollutant models documented the importance of characterizing the ambient mixture with both NO2 and PM2.5. We mostly found negative associations with O3. In two-pollutant models with NO2, the negative associations with O3 were attenuated to essentially unity in the mortality analysis of the administrative cohorts and the incidence analyses in the pooled cohort. In the mortality analysis of the pooled cohort, significant negative associations with O3 remained in two-pollutant models. Long-term exposure to PM2.5, NO2, and BC was also positively associated with morbidity outcomes in the pooled cohort. For stroke, asthma, and COPD, positive associations were found for PM2.5, NO2, and BC. For acute coronary heart disease, an increased HR was observed for NO2. For lung cancer, an increased HR was found only for PM2.5. Associations mostly showed steeper slopes at low exposures with no indication of a threshold.
Collapse
Affiliation(s)
- Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard Atkinson
- Population Health Research, Institute St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography-Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, and Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | | | - Jorgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Iain Carey
- Population Health Research, Institute St George's, University of London, London, UK
| | - Giulia Cesaroni
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
- Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Danny Houthuijs
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Nicole Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Klea Katsouyanni
- Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jochem Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Norun Hjertager Krog
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Shuo Liu
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, and Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Amar Mehta
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Goran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, and Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Epidemiology, Ludwig Maximilians Universität München, Munich, Germany
| | | | - Matteo Renzi
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evi Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Per Schwarze
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Torben Sigsgaard
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Massimo Stafoggia
- Department of Epidemiology Lazio Regional Health Service, Rome, Italy
| | | | - Gudrun Weinmayr
- Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| |
Collapse
|
46
|
Wolf K, Hoffmann B, Andersen ZJ, Atkinson RW, Bauwelinck M, Bellander T, Brandt J, Brunekreef B, Cesaroni G, Chen J, de Faire U, de Hoogh K, Fecht D, Forastiere F, Gulliver J, Hertel O, Hvidtfeldt UA, Janssen NAH, Jørgensen JT, Katsouyanni K, Ketzel M, Klompmaker JO, Lager A, Liu S, MacDonald CJ, Magnusson PKE, Mehta AJ, Nagel G, Oftedal B, Pedersen NL, Pershagen G, Raaschou-Nielsen O, Renzi M, Rizzuto D, Rodopoulou S, Samoli E, van der Schouw YT, Schramm S, Schwarze P, Sigsgaard T, Sørensen M, Stafoggia M, Strak M, Tjønneland A, Verschuren WMM, Vienneau D, Weinmayr G, Hoek G, Peters A, Ljungman PLS. Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project. Lancet Planet Health 2021; 5:e620-e632. [PMID: 34508683 DOI: 10.1016/s2542-5196(21)00195-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 06/23/2021] [Accepted: 07/02/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease. METHODS We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values. FINDINGS From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8-19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01-1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04-1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02-1·10] per 0·5 10-5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01-1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2. INTERPRETATION Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. FUNDING Health Effects Institute.
Collapse
Affiliation(s)
- Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Interdisciplinary Centre for Climate Change, Aarhus University, Denmark
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Giulia Cesaroni
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Ulf de Faire
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Fecht
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Francesco Forastiere
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, Rome, Italy; School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - John Gulliver
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK; Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | | | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Klea Katsouyanni
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK; Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research, University of Surrey, Surrey, UK
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Conor J MacDonald
- INSERM U1018, CESP, Institut Gustave Roussy, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Ole Raaschou-Nielsen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Matteo Renzi
- Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Per Schwarze
- Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology-Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, Munich, Germany
| | - Petter L S Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
47
|
Brozek W, Preyer O, Concin H, Nagel G, Ulmer H, Zitt E. Response to comments on the paper "serum uric acid is associated with incident hip fractures in women and men". Maturitas 2021; 154:56-57. [PMID: 34344569 DOI: 10.1016/j.maturitas.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Wolfgang Brozek
- Agency for Preventive and Social Medicine, Bregenz, Austria.
| | - Oliver Preyer
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria; Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| |
Collapse
|
48
|
So R, Chen J, Mehta AJ, Liu S, Strak M, Wolf K, Hvidtfeldt UA, Rodopoulou S, Stafoggia M, Klompmaker JO, Samoli E, Raaschou-Nielsen O, Atkinson R, Bauwelinck M, Bellander T, Boutron-Ruault MC, Brandt J, Brunekreef B, Cesaroni G, Concin H, Forastiere F, van Gils CH, Gulliver J, Hertel O, Hoffmann B, de Hoogh K, Janssen N, Lim YH, Westendorp R, Jørgensen JT, Katsouyanni K, Ketzel M, Lager A, Lang A, Ljungman PL, Magnusson PKE, Nagel G, Simonsen MK, Pershagen G, Peter RS, Peters A, Renzi M, Rizzuto D, Sigsgaard T, Vienneau D, Weinmayr G, Severi G, Fecht D, Tjønneland A, Leander K, Hoek G, Andersen ZJ. Long-term exposure to air pollution and liver cancer incidence in six European cohorts. Int J Cancer 2021; 149:1887-1897. [PMID: 34278567 DOI: 10.1002/ijc.33743] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/25/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022]
Abstract
Particulate matter air pollution and diesel engine exhaust have been classified as carcinogenic for lung cancer, yet few studies have explored associations with liver cancer. We used six European adult cohorts which were recruited between 1985 and 2005, pooled within the "Effects of low-level air pollution: A study in Europe" (ELAPSE) project, and followed for the incidence of liver cancer until 2011 to 2015. The annual average exposure to nitrogen dioxide (NO2 ), particulate matter with diameter <2.5 μm (PM2.5 ), black carbon (BC), warm-season ozone (O3 ), and eight elemental components of PM2.5 (copper, iron, zinc, sulfur, nickel, vanadium, silicon, and potassium) were estimated by European-wide hybrid land-use regression models at participants' residential addresses. We analyzed the association between air pollution and liver cancer incidence by Cox proportional hazards models adjusting for potential confounders. Of 330 064 cancer-free adults at baseline, 512 developed liver cancer during a mean follow-up of 18.1 years. We observed positive linear associations between NO2 (hazard ratio, 95% confidence interval: 1.17, 1.02-1.35 per 10 μg/m3 ), PM2.5 (1.12, 0.92-1.36 per 5 μg/m3 ), and BC (1.15, 1.00-1.33 per 0.5 10-5 /m) and liver cancer incidence. Associations with NO2 and BC persisted in two-pollutant models with PM2.5 . Most components of PM2.5 were associated with the risk of liver cancer, with the strongest associations for sulfur and vanadium, which were robust to adjustment for PM2.5 or NO2 . Our study suggests that ambient air pollution may increase the risk of liver cancer, even at concentrations below current EU standards.
Collapse
Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Amar J Mehta
- Statistics Denmark, Copenhagen, Denmark.,Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | | | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Jochem O Klompmaker
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Centre, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Richard Atkinson
- Population Health Research Institute and MRC-PHE Centre for Environment and Health, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | | | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,iClimate, Aarhus University interdisciplinary Centre for Climate Change, Roskilde, Denmark
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Giulia Cesaroni
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Francesco Forastiere
- Environmental Research Group, School of Public Health, Imperial College, London, UK.,Institute for Biomedical Research and Innovation (IRIB), National Research Council, Palermo, Italy
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - John Gulliver
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nicole Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Anton Lager
- Department of Global Public Health, Karolinksa Institutet, Stockholm, Sweden
| | - Alois Lang
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Petter L Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Mette K Simonsen
- Department of Neurology and Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.,Ludwig-Maximilians University, Munich, Germany
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University and The Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gianluca Severi
- CESP, UMR 1018, Universit´e Paris-Saclay, Inserm, Gustave Roussy, Villejuif, France.,Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Anne Tjønneland
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
49
|
Wood AM, Jonsson H, Nagel G, Häggström C, Manjer J, Ulmer H, Engeland A, Zitt E, Jochems SHJ, Ghaderi S, Stattin P, Bjørge T, Stocks T. The Inverse Association of Body Mass Index with Lung Cancer: Exploring Residual Confounding, Metabolic Aberrations and Within-Person Variability in Smoking. Cancer Epidemiol Biomarkers Prev 2021; 30:1489-1497. [PMID: 34162656 DOI: 10.1158/1055-9965.epi-21-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The inverse observational association between body mass index (BMI) and lung cancer risk remains unclear. We assessed whether the association is explained by metabolic aberrations, residual confounding, and within-person variability in smoking, and compared against other smoking-related cancers. METHODS We investigated the association between BMI, and its combination with a metabolic score (MS) of mid-blood pressure, glucose, and triglycerides, with lung cancer and other smoking-related cancers in 778,828 individuals. We used Cox regression, adjusted and corrected for within-person variability in smoking (status/pack-years), calculated from 600,201 measurements in 221,958 participants. RESULTS Over a median follow-up of 20 years, 20,242 smoking-related cancers (6,735 lung cancers) were recorded. Despite adjustment and correction for substantial within-person variability in smoking, BMI remained inversely associated with lung cancer [HR per standard deviation increase, 0.87 (95% confidence interval 0.85-0.89)]. Individuals with BMI less than 25 kg/m2 and high MS had the highest risk [HR 1.52 (1.44-1.60) vs. BMI ≥25 with low MS]. These associations were weaker and nonsignificant among nonsmokers. Similar associations were observed for head and neck cancers and esophageal squamous cell carcinoma, whereas for other smoking-related cancers, we generally observed positive associations with BMI. CONCLUSIONS The increased lung cancer risk with low BMI and high MS is unlikely due to residual confounding and within-person variability in smoking. However, similar results for other cancers strongly related to smoking suggest a remaining, unknown, effect of smoking. IMPACT Extensive smoking-adjustments may not capture all the effects of smoking on the relationship between obesity-related factors and risk of smoking-related cancers.
Collapse
Affiliation(s)
- Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
| | - Håkan Jonsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Anders Engeland
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria.,Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - Sara Ghaderi
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| |
Collapse
|
50
|
Liu S, Jørgensen JT, Ljungman P, Pershagen G, Bellander T, Leander K, Magnusson PKE, Rizzuto D, Hvidtfeldt UA, Raaschou-Nielsen O, Wolf K, Hoffmann B, Brunekreef B, Strak M, Chen J, Mehta A, Atkinson RW, Bauwelinck M, Varraso R, Boutron-Ruault MC, Brandt J, Cesaroni G, Forastiere F, Fecht D, Gulliver J, Hertel O, de Hoogh K, Janssen NAH, Katsouyanni K, Ketzel M, Klompmaker JO, Nagel G, Oftedal B, Peters A, Tjønneland A, Rodopoulou SP, Samoli E, Kristoffersen DT, Sigsgaard T, Stafoggia M, Vienneau D, Weinmayr G, Hoek G, Andersen ZJ. Long-term exposure to low-level air pollution and incidence of asthma: the ELAPSE project. Eur Respir J 2021; 57:57/6/2003099. [PMID: 34088754 DOI: 10.1183/13993003.03099-2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/17/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Long-term exposure to ambient air pollution has been linked to childhood-onset asthma, although evidence is still insufficient. Within the multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we examined the associations of long-term exposures to particulate matter with a diameter <2.5 µm (PM2.5), nitrogen dioxide (NO2) and black carbon (BC) with asthma incidence in adults. METHODS We pooled data from three cohorts in Denmark and Sweden with information on asthma hospital diagnoses. The average concentrations of air pollutants in 2010 were modelled by hybrid land-use regression models at participants' baseline residential addresses. Associations of air pollution exposures with asthma incidence were explored with Cox proportional hazard models, adjusting for potential confounders. RESULTS Of 98 326 participants, 1965 developed asthma during a mean follow-up of 16.6 years. We observed associations in fully adjusted models with hazard ratios of 1.22 (95% CI 1.04-1.43) per 5 μg·m-3 for PM2.5, 1.17 (95% CI 1.10-1.25) per 10 µg·m-3 for NO2 and 1.15 (95% CI 1.08-1.23) per 0.5×10-5 m-1 for BC. Hazard ratios were larger in cohort subsets with exposure levels below the European Union and US limit values and possibly World Health Organization guidelines for PM2.5 and NO2. NO2 and BC estimates remained unchanged in two-pollutant models with PM2.5, whereas PM2.5 estimates were attenuated to unity. The concentration-response curves showed no evidence of a threshold. CONCLUSIONS Long-term exposure to air pollution, especially from fossil fuel combustion sources such as motorised traffic, was associated with adult-onset asthma, even at levels below the current limit values.
Collapse
Affiliation(s)
- Shuo Liu
- Dept of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Dept of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Patrik K E Magnusson
- Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Dept of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,The Stockholm Gerontology Research Center, Stockholm, Sweden
| | | | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Dept of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Barbara Hoffmann
- Institute of Occupational, Social and Environmental Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jie Chen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Amar Mehta
- Dept of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Mariska Bauwelinck
- Interface Demography, Dept of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Raphaëlle Varraso
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, Inserm UMR 1018, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- CESP, Faculté de Médecine, Université Paris-Saclay, UVSQ, Inserm UMR 1018, Villejuif, France.,Gustave Roussy, Villejuif, France
| | - Jørgen Brandt
- Dept of Environmental Science, Aarhus University, Roskilde, Denmark.,iClimate, Aarhus University Interdisciplinary Center for Climate Change, Roskilde, Denmark
| | - Giulia Cesaroni
- Dept of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | | | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- UK Small Area Health Statistics Unit, Dept of Epidemiology and Biostatistics, Imperial College London, London, UK.,Centre for Environmental Health and Sustainability and School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - Ole Hertel
- Dept of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Klea Katsouyanni
- Dept of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Matthias Ketzel
- Dept of Environmental Science, Aarhus University, Roskilde, Denmark.,Global Centre for Clean Air Research, University of Surrey, Guildford, UK
| | - Jochem O Klompmaker
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands.,National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Bente Oftedal
- Dept of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.,Epidemiology, Faculty of Medicine, Ludwig Maximilians Universität München, Munich, Germany
| | - Anne Tjønneland
- Dept of Public Health, University of Copenhagen, Copenhagen, Denmark.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Sophia P Rodopoulou
- Dept of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Dept of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Torben Sigsgaard
- Dept of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Dept of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | | | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Zorana Jovanovic Andersen
- Dept of Public Health, University of Copenhagen, Copenhagen, Denmark .,Center for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark
| |
Collapse
|