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Testing Differential Associations Between Smoking and Chronic Disease Across Socioeconomic Groups: Pooled Data From 15 Prospective Studies.

ABSTRACT: BACKGROUND:For the same quantity of cigarettes smoked, relative to more affluent people, socioeconomically disadvantaged people have higher levels of smoking biomarkers. This may be ascribed to inhaling cigarette smoke more deeply and more frequently and/or choosing higher tar-containing brands. We investigated whether this increased tobacco load, as captured using cotinine measurements, is associated with a greater risk of mortality in lower social groups. METHODS:We used Cox proportional hazards models stratified by socioeconomic position to calculate hazard ratios in a pooled sample of 15 English and Scottish prospective cohort studies (N = 81,476). RESULTS:During a mean (SD) follow-up of 10.3 (4.4) years, 8234 deaths occurred. Risk of total mortality (hazard ratio; 95% confidence interval) for smokers relative to never-smokers in the high (2.5; 2.1, 3.1), intermediate (2.1; 1.8, 2.4), and low (2.0; 1.9, 2.2) educational groups did not differ markedly (P for interaction=0.61). Similar findings emerged when using cause-specific outcomes and occupational social class and housing tenure as socioeconomic indices. CONCLUSION:Contrary to our hypothesis, we found no indication that chronic disease mortality associated with smoking was higher in disadvantaged people.

SUBMITTER: de Mestral C

PROVIDER: S-EPMC6278911 | biostudies-other | 2019 Jan

REPOSITORIES: biostudies-other

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Testing Differential Associations Between Smoking and Chronic Disease Across Socioeconomic Groups: Pooled Data From 15 Prospective Studies.

de Mestral Carlos C Bell Steven S Stamatakis Emmanuel E Batty G David GD

Epidemiology (Cambridge, Mass.) 20190101 1

<h4>Background</h4>For the same quantity of cigarettes smoked, relative to more affluent people, socioeconomically disadvantaged people have higher levels of smoking biomarkers. This may be ascribed to inhaling cigarette smoke more deeply and more frequently and/or choosing higher tar-containing brands. We investigated whether this increased tobacco load, as captured using cotinine measurements, is associated with a greater risk of mortality in lower social groups.<h4>Methods</h4>We used Cox pro ...[more]

PMID: 30247206

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Project description:Background:Parity is widely recognized as protective for breast cancer, but breast cancer risk may be increased shortly after childbirth. Whether this risk varies with breastfeeding, family history of breast cancer, or specific tumor subtype has rarely been evaluated. Objective:To characterize breast cancer risk in relation to recent childbirth. Design:Pooled analysis of individual-level data from 15 prospective cohort studies. Setting:The international Premenopausal Breast Cancer Collaborative Group. Participants:Women younger than 55 years. Measurements:During 9.6 million person-years of follow-up, 18 826 incident cases of breast cancer were diagnosed. Hazard ratios (HRs) and 95% CIs for breast cancer were calculated using Cox proportional hazards regression. Results:Compared with nulliparous women, parous women had an HR for breast cancer that peaked about 5 years after birth (HR, 1.80 [95% CI, 1.63 to 1.99]) before decreasing to 0.77 (CI, 0.67 to 0.88) after 34 years. The association crossed over from positive to negative about 24 years after birth. The overall pattern was driven by estrogen receptor (ER)-positive breast cancer; no crossover was seen for ER-negative cancer. Increases in breast cancer risk after childbirth were pronounced when combined with a family history of breast cancer and were greater for women who were older at first birth or who had more births. Breastfeeding did not modify overall risk patterns. Limitations:Breast cancer diagnoses during pregnancy were not uniformly distinguishable from early postpartum diagnoses. Data on human epidermal growth factor receptor 2 (HER2) oncogene overexpression were limited. Conclusion:Compared with nulliparous women, parous women have an increased risk for breast cancer for more than 20 years after childbirth. Health care providers should consider recent childbirth a risk factor for breast cancer in young women. Primary Funding Source:The Avon Foundation, the National Institute of Environmental Health Sciences, Breast Cancer Now and the UK National Health Service, and the Institute of Cancer Research.

Project description:BACKGROUND:Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking. OBJECTIVE:To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days. METHODS:In total, 1220 women and men, 18-75?years, from the population-based Sweden Attitude Behaviour and Change study 2000-2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay. RESULTS:Over a follow-up of 14.4?years (SD?=?1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48-0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33-0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR?=?0.56, 95% CI: 0.37-0.85). Higher sedentary time increased the risk of in-hospital days. (IRR?=?2.38, 95% CI: 1.20-4.74). CONCLUSION:This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message "sit less and move more".

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Testing Differential Associations Between Smoking and Chronic Disease Across Socioeconomic Groups: Pooled Data From 15 Prospective Studies.

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Testing Differential Associations Between Smoking and Chronic Disease Across Socioeconomic Groups: Pooled Data From 15 Prospective Studies.

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