Annals of Epidemiology - Articles in Press

Gender Differences in Widowhood Effects Among Community-Dwelling Elders by Causes of Death in Taiwan - Corrected Proof

2012-05-14

Purpose: We sought to determine whether widowhood-associated excess mortality differs by gender in terms of causes of death.Methods: Data were collected from a five-wave interview of approximately 2500 community-dwelling elders in the Survey of Health and Living Status of the Nearly Elderly and Elderly. Baseline characteristics were used to derive the risk score (RS) to reflect individual’s baseline pre-widowhood vulnerability. Time-dependent Cox regression analyses were used to estimate spousal loss-related mortality by causes.Results: For males, the adjusted hazard ratios (aHRs) of widowhood for all-cause and some major causes of death (e.g., neoplasm) increased inversely with RS: the aHRs for all-cause death were 4.81 and 1.76 in the lowest and highest RS groups, respectively. In contrast, the corresponding aHRs were relatively homogeneous for women (1.52 and 1.70).Conclusions: Identifying gender heterogeneity in widowhood effects can guide further efforts to devise gender-tailored programs to enhance healthy aging.

Lean Tissue Mass Wasting Is Associated With Increased Risk of Mortality Among Women With Pulmonary Tuberculosis in Urban Uganda - Corrected Proof

2012-05-11

Objectives: We assessed the impact of wasting on survival in patients with tuberculosis by using a precise height-normalized lean tissue mass index (LMI) estimated by bioelectrical impedance analysis and body mass index (BMI).Methods: In a retrospective cohort study, 747 adult pulmonary patients with tuberculosis who were screened for HIV and nutritional status were followed for survival.Results: Of 747 patients, 310 had baseline wasting by BMI (kg/m2) and 103 by LMI (kg/m2). Total deaths were 105. Among men with reduced BMI, risk of death was 70% greater (hazard ratio [HR] 1.7, 95% confidence interval [95% CI] 1.03–2.81) than in men with normal BMI. Survival did not differ by LMI among men (HR 1.1; 95% CI 0.5–2.9). In women, both the BMI and LMI were associated with survival. Among women with reduced BMI, risk of death was 80% greater (HR 1.8; 95% CI 0.9–3.5) than in women with normal BMI; risk of death was 5-fold greater (HR 5.0; 95% CI 1.6–15.9) for women with low LMI compared with women with normal LMI.Conclusions: Wasting assessed by reduced BMI is associated with an increased risk for death among both men and women whereas reduced LMI is among women with tuberculosis.

Relationships Among Alcohol Consumption, Facial Flushing Response, and Metabolic Syndrome in Healthy Men - Corrected Proof

Jin-Gyu Jung, Jong-Sung Kim, Seok-Joon Yoon, Mi-Kyeong Oh — 2012-05-11

Purpose: It is believed that alcohol has an intimate connection with metabolic syndrome (MS). However, the role of facial flushing after alcohol consumption in this relationship has not yet been well known. We explored the relationship between weekly alcohol consumption, risk of MS, and the flushing response.Methods: The subjects were 1823 Korean adult males (305 nondrinkers, 540 flushers, 978 nonflushers) who had undergone a comprehensive medical check-up at Chungnam National University Hospital. We excluded the cases with the history of hypertension, diabetes, dyslipidemia, or who had taken medication in the previous month. After controlling for age, body mass index, exercise status, and smoking history, we used a logistic regression analysis to calculate the risk of MS with drinks per week in flushers and nonflushers as compared with nondrinkers.Results: The risk of MS in flushers was significantly increased with alcohol consumption >4 drinks (4–16 drinks: odds ratio [OR] 1.93; >16 drinks: OR 2.20). However, in nonflushers, the risk of MS was increased in those consuming >16 drinks (OR 2.02).Conclusions: Our results suggest that the threshold for MS from alcohol consumption is lower in flushers than in nonflushers.

Influence of Family History of Colorectal Cancer on Health Behavior and Performance of Early Detection Procedures: The SUN Project - Corrected Proof

2012-05-10

Purpose: The aim of this study is to explore the relationship between family history of colorectal cancer and both health behavior and screening procedures in a population cohort.Methods: This study is a cross-sectional analysis of 15,169 participants belonging to a prospective cohort study (the SUN Project) based on two self-reported questionnaires: one of them related to lifestyle and the other a semiquantitative food frequency questionnaire. We explored the influence of family history of colorectal cancer in lifestyles (consumption of alcohol, weight, and diet) and medical management behaviors (screening of chronic diseases).Results: People with family history of colorectal cancer increased their number of colorectal cancer screening tests (adjusted odds ratio for fecal occult blood test: 1.98, 95% confidence interval: 1.48–2.65; and adjusted odds ratio for colonoscopy/sigmoidoscopy: 3.42, 2.69–4.36); nevertheless, health behavior changes in diet of relatives of colorectal cancer patients were undetectable.Conclusions: We show that individuals with a family history of colorectal cancer increase their compliance with screening tests, although they exhibit no better health-related behaviors than people without family history of colorectal cancer. Further prospective studies are required to confirm these results and to identify tools to empower the subjects to change their risk profile.

Identification of Dietary Patterns Using Two Statistical Approaches and Their Association With Breast Cancer Risk: A Case-Control Study in Southern France - Corrected Proof

Faïza Bessaoud, Brigitte Tretarre, Jean-Pierre Daurès, Mariette Gerber — 2012-05-10

Purpose: The aim of this case–control study was to compare two different statistical methods in the identification of dietary patterns by use of principal component analysis (PCA) and variable clustering (VC) and to examine their association with the risk of breast cancer (BC).Methods: A dose–response association was then performed by the use of an adaptation of free knot spline function in logistic models.Results: A “Western” pattern was revealed by PCA and VC and was then shown to be associated with a nonsignificant increase of BC risk. Only PCA identified a “meat/alcohol” pattern. Above the spline threshold, BC risk increased significantly (OR ≥ s vs. < s = 2.56, 95% CI 1.54–4.27). When we used PCA, a “Mediterranean” pattern was identified, but no association between BC risk and this pattern was shown. VC split the “Mediterranean” dietary pattern in two: “raw vegetables and olive oil” and “fish.” Above the spline threshold, the “fish” pattern tended to protect against BC risk (OR ≥ s vs. < s = 0.77, 95% CI 0.58–1.01), whereas an excess of raw vegetables and olive oil increased BC risk (OR 1 se = 1.22, 95% CI = 1.06–1.32).Conclusions: Some results from the PCA and the VC methods were similar, whereas others were different but gave complementary results.

Mortality From Tuberculosis in Spain, 1971 to 2007: Slow Decrease in Female and in Elderly Patients - Corrected Proof

Javier Llorca, Trinidad Dierssen-Sotos, Beatriz Arbaizar, Inés Gómez-Acebo — 2012-05-10

Purpose: Mortality by tuberculosis in Spain remains greater than in other highly developed countries. The aim of this study is to identify the temporal trends in tuberculosis mortality in Spain from 1971 to 2007.Methods: Data were obtained from the Spanish National Institute for Statistics. Age- and sex-specific mortality rates and age-adjusted mortality rates were estimated (direct method). Joinpoint regression was used to identify the years when there were changes in mortality trend and the annual percentage change in mortality rates.Results: In men, age-adjusted mortality decreased by 10.3% each year until 1984 and by 7.3% from then on; in women, mortality decreased by 10.4% each year until 1987 but only by 5.1% each year from 1987 on. An age-specific analysis revealed that mortality rates decreased by 10% each year in people younger than 65; from 65 years and older, the greater the age, the slower the annual average decrease (approximately, every additional 5 years is associated with a 1% slower annual percentage change).Conclusions: Tuberculosis mortality in Spain decreases faster in men than in women, and in young adults than in the elderly. Greater efforts should be made to identify the causes of these different trends.

Timing of Procedure and Compliance With Outpatient Endoscopy among an Underserved Population in an Inner-City Tertiary Institution - Corrected Proof

2012-05-10

Purpose: Anecdotal evidence suggests that patient compliance with colonoscopy is poorer with Monday procedures and better during the winter months because “there is not much else to do.” We examined patients' compliance with scheduled outpatient endoscopy by time of the day, days of the week, and seasons of the year.Methods: We included 2873 patients who were scheduled for endoscopy from September 2009 to August 2010. Compliant patients were those who showed up for their procedures whereas noncompliant patients were those who did not show up without canceling or rescheduling their procedures up to 24 hours before their scheduled procedures. We used logistic regression models to evaluate the association between the timing of the scheduled procedure and compliance.Results: A total of 574 (20%) patients did not show up. There was no difference in compliance by time of day of the procedures. However, when compared with patients scheduled for procedures on Monday, there was a trend towards improved compliance as the week progressed, becoming significant on Friday (odds ratio 1.46; 95% confidence interval 1.06–2.00). There was also better compliance in the warmer months.Conclusions: Noncompliance with outpatient endoscopy is substantial among underserved populations with limited predictive pattern of compliance by the timing of the procedures.

Is Intergenerational Social Mobility Related to the Type and Amount of Physical Activity in Mid-Adulthood? Results from the 1946 British Birth Cohort Study - Corrected Proof

Richard J. Silverwood, Mary Pierce, Dorothea Nitsch, Gita D. Mishra, Diana Kuh — 2012-04-26

Purpose: Greater levels of leisure-time or moderate-vigorous physical activity have consistently been found in those with greater socioeconomic position (SEP). Less is known about the effects of intergenerational social mobility.Methods: We examined the influence of SEP and social mobility on mid-adulthood physical activity in the Medical Research Council National Survey of Health and Development. Two sub-domains of SEP were used: occupational class and educational attainment. Latent classes for walking, cycling, and leisure-time physical activity (LTPA) were used, plus sedentary behavior at age 36. Associations between types of physical activity and SEP were examined with the use of logistic or multinomial logistic regression.Results: Being a manual worker oneself or having a father who was a manual worker was, relative to nonmanual work, associated with lower levels of sedentary behavior and greater walking activity, but also with lower LTPA. Compared with those who remained in a manual occupational class, upward occupational mobility was associated with more sedentary behavior, less walking, and increased LTPA. Associations with downward mobility were in the opposite directions. Similar results were obtained for educational attainment.Conclusions: This study found clear evidence of social differences in physical activity. Persistently high SEP and upward social mobility were associated with greater levels of LTPA but also increased sedentary behavior and less walking.

Commentary on Harper S, Strumpf EC, Kaufman JS. Do Medical Marijuana Laws Increase Marijuana Use? Replication study and extension - Corrected Proof

2012-04-26

Replicability is a crucial element of good science, particularly so when the subject matter is sensitive and political. Therefore, we welcome close scrutiny of our brief report in the Annals of Epidemiology in 2011, “Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear.” We were glad to see that Harper et al. were able to replicate our results showing that states with medical marijuana laws (MML) showed greater rates of marijuana use among their residents during 2002 to 2008 and that states that passed MML after 2002 already had greater use among their residents before they passed the law. However, we have several concerns with the additional analyses run by Harper et al. and further concerns with the way their results were presented. We summarize our concerns in this commentary.

Can Tissue-Based Immune Markers be Used for Studying the Natural History of Cancer? - Corrected Proof

Jill Koshiol, Shih-Wen Lin — 2012-04-06

Increasing evidence suggests that altered immunity and chronic inflammation play a key role in the etiology of many malignancies, but the underlying biological mechanisms involved remain unclear. Systemic markers of immunity may not represent the clinically relevant, site-specific immune response, whereas tissue-based markers may more accurately reflect the local immunologic mechanisms by which precursor lesions develop into cancer. Tissues are often only available in individuals with disease. Previous studies have measured tumor-infiltrating lymphocytes to predict prognosis and survival, but it can be challenging to use tissue-based markers to study the natural history of cancer owing to limitations with regard to temporality, the availability of appropriate comparison groups, and other epidemiologic issues. In this commentary, we discuss several epidemiologic study design and study population considerations to address these issues, including the strengths and limitations of using tissue-based markers to study immune response and cancer development. We also discuss how the use of tissue-based immune markers fits into the greater context of molecular epidemiology, which encompasses multiple technologies and techniques, and how implementation of tissue-based immune markers will provide an increased understanding of site-specific biological mechanisms involved in carcinogenesis.

The Use and Misuse of Psychiatric Drugs: An Evidence-Based Critique by Joel Paris - Corrected Proof

C. Ineke Neutel — 2012-03-16

Joel Paris wrote this book for the benefit of “health professionals, service planners, and drug companies.” A long-time psychiatrist, professor, and author of several other books on mental health topics, he is well qualified to write this book. Two main concerns in writing this book were that practitioners need to be aware not only of the benefits but also the limitations of these medications, and that academic psychiatry is greatly influenced by the pharmaceutical industry (p. xii). The objective of this review is to determine whether this book could be useful to epidemiologists as background reading.