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1. Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: A prospective analysis

Author

Laura Sánchez-Cirera, Saima Bashir, Adina Ciscar, Carla Marco, Verónica Cruz, Mikel Terceño, Yolanda Silva, Joaquín Serena, Institut Català de la Salut, [Sánchez-Cirera L] Fellow of Neurology, Stroke Unit, Departament de Neurologia, Hospital Universitari de Girona Dr. Josep Trueta, Institut Català de la Salut (ICS), Girona, Spain. [Bashir S, Marco C, Terceño M, Silva Y] Neurologist, Stroke Unit, Departament de Neurologia, Hospital Universitari de Girona Dr. Josep Trueta, Institut Català de la Salut (ICS), Girona, Spain. Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain. [Ciscar A] Student of Medicine, Medicine Faculty, University of Girona, Girona, Spain. [Cruz V] Nurse of Neurology, Stroke Unit, Departament de Neurologia, Hospital Universitari de Girona Dr. Josep Trueta, Institut Català de la Salut (ICS), Girona, Spain. [Serena J] Departament de Neurologia, Hospital Universitari de Girona Doctor Josep Trueta, Institut Català de la Salut (ICS), Girona, Spain. Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Girona, Spain, and Departament de Salut

Subjects
Male, Endocrine Disorders, Cerebrovascular Diseases, Science, Cardiology, enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular [ENFERMEDADES], Cardiovascular Medicine, Vascular Medicine, Orelles - Malalties - Patogènesi, órganos de los sentidos::oído::oído externo::pabellón auricular [ANATOMÍA], Medical Conditions, Signs and Symptoms, Endocrinology, Medicine and Health Sciences, Diabetes Mellitus, Humans, Coronary Heart Disease, Ear, External, Aged, Ischemic Stroke, Aged, 80 and over, Stenosis, Multidisciplinary, Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders [DISEASES], Biology and Life Sciences, Arteries, Middle Aged, Atherosclerosis, Sense Organs::Ear::Ear, External::Ear Auricle [ANATOMY], Stroke, Hemorrhagic Stroke, Other subheadings::Other subheadings::/pathology [Other subheadings], Cross-Sectional Studies, Carotid Arteries, Neurology, Cardiovascular Diseases, Metabolic Disorders, Cardiovascular Anatomy, Blood Vessels, Medicine, Female, Clinical Medicine, Anatomy, Otros calificadores::Otros calificadores::/patología [Otros calificadores], Malalties cerebrovasculars, Research Article
Abstract

Enfermedades cerebrovasculares; Pabellón auricular Cerebrovascular disorders; Ear auricle Malalties cerebrovasculars; Pavelló auricular Background and purpose: The Frank's sign is a diagonal earlobe crease running from the tragus to the edge of the auricle at an angle of 45°. Many studies have associated this sign with coronary artery disease and some with cerebrovascular disease. The objective of this study was to analyse the prevalence of the Frank's sign in patients suffering from acute stroke with a particular focus on its prevalence in each of the five aetiopathogenic stroke subtypes. Special interest is given to embolic stroke of undetermined source (ESUS), correlating the sign with clinical and radiological markers that support an underlying causal profile in this subgroup. Methods: Cross-sectional descriptive study including 124 patients admitted consecutively to a stroke unit after suffering an acute stroke. The Frank's sign was evaluated by the same blinded member of the research team from photographs taken of the patients. The stroke subtype was classified following SSS-TOAST criteria and the aetiological study was performed following the ESO guidelines. Results: The Frank's sign was present in 75 patients and was more prevalent in patients with an ischaemic stroke in comparison with haemorrhagic stroke (63.9 vs. 37.5, p

Published
2021
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2. Trends in socioeconomic inequalities in mortality in small areas of 33 Spanish cities

Author

Andreu Nolasco, Felicitas Domínguez-Berjón, Ana Gandarillas, Maica Rodríguez-Sanz, Montse Calvo, Mercè Gotsens, Mónica Ballesta, Lluís Cirera, Conchi Moreno-Iribas, Diego Salmerón, Carmen Martos, Antonio Daponte, Marc Marí-Dell’Olmo, Laia Palència, Natividad Izco Goñi, Margarita Taracido, Carme Borrell, Miguel A. Martinez-Beneito, [Marí-Dell’Olmo,M, Gotsens,M, Palència,L, Rodríguez-Sanz,M, Martinez-Beneito,MA, Ballesta,M, Cirera,L, Daponte,A, Salmerón,D, Taracido,M, Borrell,C] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. [Marí-Dell’Olmo,M, Borrell,C] Agència de Salut Pública de Barcelona, Barcelona, Spain. [Marí-Dell’Olmo,M, Borrell,C] Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain. [Marí-Dell’Olmo,M] Universitat Rovira i Virgili, Tarragona, Spain. [Martinez-Beneito,MA] Fundación para el fomento de la investigación sanitaria y biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain. [Ballesta,M, Salmerón,D] Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain. [Calvo,M] Estudios e investigación Sanitaria, Departamento de Sanidad y Consumo, Gobierno Vasco, Vitoria-Gasteiz, Spain. [Daponte,A] Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública (EASP), Granada, Spain. [Domínguez-Berjón,F, Gandarillas,A] Subdirección de Promoción de la Salud y Prevención, Consejería de Sanidad, Comunidad de Madrid, Spain. [Izco Goñi,N] Registro de Mortalidad, Consejería de Salud y Servicios Sociales, La Rioja, Spain. [Martos,C] Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. [Moreno-Iribas,C] Instituto de Salud Pública de Navarra, Departamento de Salud, Gobierno de Navarra, Pamplona, Navarra, Spain. [Nolasco,A] Unidad de Investigación en Análisis de la Mortalidad y Estadísticas Sanitarias, Universidad de Alicante, San Vicente del Raspeig, Spain. [Taracido,M] Departamento de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, Spain. [Borrell,C] Universitat Pompeu Fabra, Barcelona, Spain., This article was partially funded by Plan Nacional de I + D + I 2008–2011 and Instituto de Salud Carlos III (ISCIII) –Subdirección General de Evaluación y Fomento de la Investigación- (Award numbers: PI081488, PI081978, PI080367, PI08/1017, PI080330, P08/0142, PI081785, PI080662, PI081713, PI081058, PI081340, PI080803, PI126/08), Fundación Canaria de Investigación Sanitaria FUNCIS 84/07 and by CIBER Epidemiología y Salud Pública (CIBERESP)., Universidade de Santiago de Compostela. Departamento de Psiquiatría, Radioloxía, Saúde Pública, Enfermaría e Medicina, Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, and Grupo Balmis de Investigación en Salud Comunitaria e Historia de la Ciencia

Subjects
Male, España, Poison control, Inequalities in mortality, Ciudades, 0302 clinical medicine, Risk Factors, Medicine, Socioeconomic inequalities, 030212 general & internal medicine, Censos, Urban areas, Child, Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings], Aged, 80 and over, Geografía, lcsh:Public aspects of medicine, Mortality rate, Multilevel model, Factores socioeconómicos, Censuses, Middle Aged, Random effects model, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cross-Sectional Studies [Medical Subject Headings], Child, Preschool, Disease mapping, Enfermería, Disciplines and Occupations::Social Sciences::Sociology::Socioeconomic Factors [Medical Subject Headings], Female, 0305 other medical science, Research Article, Adult, Bayesian methods, Adolescent, Multilevel analysis, Disciplines and Occupations::Social Sciences::Demography::Censuses [Medical Subject Headings], Geographical inequalities, 03 medical and health sciences, Young Adult, Environmental health, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Bayes Theorem [Medical Subject Headings], Humans, Mortality, Cities, Phenomena and Processes::Biological Phenomena::Ecological and Environmental Phenomena::Environment::Cities [Medical Subject Headings], Socioeconomic status, Aged, Demography, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, Infant, Newborn, Urban Health, Ecological study, Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Probability::Risk [Medical Subject Headings], Infant, lcsh:RA1-1270, Bayes Theorem, Fixed effects model, Health Status Disparities, Small areas, Cross-Sectional Studies, Socioeconomic Factors, Disciplines and Occupations::Natural Science Disciplines::Earth Sciences::Geography [Medical Subject Headings], Spain, Biostatistics, Trends, business
Abstract

Background: In Spain, several ecological studies have analyzed trends in socioeconomic inequalities in mortality from all causes in urban areas over time. However, the results of these studies are quite heterogeneous finding, in general, that inequalities decreased, or remained stable. Therefore, the objectives of this study are: (1) to identify trends in geographical inequalities in all-cause mortality in the census tracts of 33 Spanish cities between the two periods 1996–1998 and 2005–2007; (2) to analyse trends in the relationship between these geographical inequalities and socioeconomic deprivation; and (3) to obtain an overall measure which summarises the relationship found in each one of the cities and to analyse its variation over time. Methods: Ecological study of trends with 2 cross-sectional cuts, corresponding to two periods of analysis: 1996– 1998 and 2005–2007. Units of analysis were census tracts of the 33 Spanish cities. A deprivation index calculated for each census tracts in all cities was included as a covariate. A Bayesian hierarchical model was used to estimate smoothed Standardized Mortality Ratios (sSMR) by each census tract and period. The geographical distribution of these sSMR was represented using maps of septiles. In addition, two different Bayesian hierarchical models were used to measure the association between all-cause mortality and the deprivation index in each city and period, and by sex: (1) including the association as a fixed effect for each city; (2) including the association as random effects. In both models the data spatial structure can be controlled within each city. The association in each city was measured using relative risks (RR) and their 95 % credible intervals (95 % CI). Results: For most cities and in both sexes, mortality rates decline over time. For women, the mortality and deprivation patterns are similar in the first period, while in the second they are different for most cities. For men, RRs remain stable over time in 29 cities, in 3 diminish and in 1 increase. For women, in 30 cities, a non-significant change over time in RR is observed. However, in 4 cities RR diminishes. In overall terms, inequalities decrease (with a probability of 0.9) in both men (RR = 1.13, 95 % CI = 1.12–1.15 in the 1st period; RR = 1.11, 95 % CI = 1.09–1.13 in the 2nd period) and women (RR = 1.07, 95 % CI = 1.05–1.08 in the 1st period; RR = 1.04, 95 % CI = 1.02–1.06 in the 2nd period). Conclusions: In the future, it is important to conduct further trend studies, allowing to monitoring trends in socioeconomic inequalities in mortality and to identify (among other things) temporal factors that may influence these inequalities This article was partially funded by Plan Nacional de I + D + I 2008–2011 and Instituto de Salud Carlos III (ISCIII) –Subdirección General de Evaluación y Fomento de la Investigación- (Award numbers: PI081488, PI081978, PI080367, PI08/1017, PI080330, P08/0142, PI081785, PI080662, PI081713, PI081058, PI081340, PI080803, PI126/08), Fundación Canaria de Investigación Sanitaria FUNCIS 84/07 and by CIBER Epidemiología y Salud Pública (CIBERESP) SI

Published
2016

3. Modifiable causes of premature death in middle-age in Western Europe : Results from the EPIC cohort study

Author

Marc J. Gunter, Ellen A. Struijk, Paul Brennan, Paolo Vineis, Christina Bamia, Guri Skeie, David C. Muller, M. Luisa Redondo, Cornelia Weikert, Salvatore Panico, Elena Molina-Portillo, Antonio Agudo, Rosario Tumino, Françoise Clavel, W M Monique Verschuren, Petra H.M. Peeters, Olle Melander, Jone M. Altzibar, Heiner Boeing, H. Bas Bueno-de-Mesquita, Ruth C. Travis, Elisabete Weiderpass, Gunnar Engström, Malin Sund, Teresa Norat, Anne Tjønneland, Manuela M. Bergmann, Philippos Orfanos, Laureen Dartois, Nicholas J. Wareham, Mattias Johansson, Elio Riboli, Kuanrong Li, Kay-Tee Khaw, Neil Murphy, Eiliv Lund, Antonia Trichopoulou, Marie-Christine Boutron-Ruault, Domenico Palli, Rudolf Kaaks, Konstantinos K. Tsilidis, Lluís Cirera, Pietro Ferrari, Valeria Pala, Timothy J. Key, Kim Overvad, Eva Ardanaz, Muller, David C, Murphy, Neil, Johansson, Mattia, Ferrari, Pietro, Tsilidis, Konstantinos K, Boutron Ruault, Marie Christine, Clavel, Francoise, Dartois, Laureen, Li, Kuanrong, Kaaks, Rudolf, Weikert, Cornelia, Bergmann, Manuela, Boeing, Heiner, Tjønneland, Anne, Overvad, Kim, Redondo, M. Luisa, Agudo, Antonio, Molina Portillo, Elena, Altzibar, Jone M, Cirera, Lluí, Ardanaz, Eva, Khaw, Kay Tee, Wareham, Nicholas J, Key, Timothy J, Travis, Ruth C, Bamia, Christina, Orfanos, Philippo, Trichopoulou, Antonia, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Vineis, Paolo, Panico, Salvatore, Bueno de Mesquita, H. Ba, Verschuren, W. M. Monique, Struijk, Ellen A, Peeters, Petra H, Engström, Gunnar, Melander, Olle, Sund, Malin, Weiderpass, Elisabete, Skeie, Guri, Lund, Eiliv, Norat, Teresa, Gunter, Marc, Riboli, Elio, Brennan, Paul, [Muller,DC, Johansson,M, Ferrari,P, Brennan,P] International Agency for Research on Cancer, Lyon, France. [Murphy,N, Vineis,P, Bueno-de-Mesquita,HB, Peeters,PH, Norat,T, Gunter,M, Riboli,E] School of Public Health, Imperial College London, London, UK] [Tsilidis,KK] Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. [Boutron-Ruault,M] Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France. [Boutron-Ruault,M, Clavel,F, Dartois,L] Université Paris Sud, Villejuif, France. [Boutron-Ruault,M, Dartois,L, Dartois,L] Inserm, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France. [Li,K, Kaaks,R] Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. [Weikert,C, Bergmann,M, Boeing,H] German Institute of Human Nutrition Potsdam-Rehbrücke (DifE), Nuthetal, Germany. [Tjønneland,A] Danish Cancer Society Research Center, Copenhagen, Denmark. [Overvad,K] Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark. [Redondo,ML] Public Health Directorate, Asturias, Spain. [Agudo,A] Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain. [Molina-Portillo,E] Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain. [Molina-Portillo,E, Altzibar,JM, Cirera,M, Ardanaz,E] Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Madrid, Spain. [Altzibar,JM] Public Health Division of Gipuzkoa-BIODONOSTIA, Basque Regional Health Department, Donostia - San Sebastián, Spain. [Cirera, L] Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain. Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain. Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain. [Ardanaz,E] Navarra Public Health Institute, Pamplona, Spain. Navarra Institute for Health Research (IdiSNA) Pamplona, Pamplona, Spain. [Khaw,K] School of Clinical Medicine, University of Cambridge, Cambridge, UK. [Wareham,NJ] MRC Epidemiology Unit, University of Cambridge, Cambridge, UK. [Key,TJ, Travis,RC] Cancer Epidemiology Unit, University of Oxford, Oxford, UK. [Bamia,C, Orfanos,P, Trichopoulou,A] Hellenic Health Foundation, Athens, Greece. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece. [Palli,D] Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy. [Pala,V] Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. [Tumino,R] Cancer Registry and Histopathology Unit, 'Civic - M. P. Arezzo' Hospital, ASP Ragusa, Ragusa, Italy. [Vineis,P] Human Genetics Foundation (HuGeF), Torino, Italy. [Panico,S] Dipartimento di Medicina Clinica e Sperimentale, Federico II University, Naples, Italy. [Bueno-de-Mesquita,HB, Verschuren,WMM] Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. [Bueno-de-Mesquita,HB] Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. [Verschuren,WMM, Struijk,EA, Peeters,PH] Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. [Engström,G] Department of Clinical Science, Malmö Lund University, Lund, Sweden. [Melander,O] Department of Clinical Sciences, Hypertension & Cardiovascular Disease, Clinical Research Centre, Malmö University Hospital, Malmö, Sweden. [Sund,M] Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden. [Weiderpass,E, Skeie,G, Lund,E] Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. [Weiderpass,E] Department of Research, Cancer Registry of Norway, Oslo, Norway. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Samfundet Folkhälsan, Helsinki, Finland. [Skeie,G, Lund,E] The Arctic University of Norway, Tromsø, Norway., This work was supported by the French Social Affairs & Health Ministry, Department of Health (Direction Générale de la Santé). The work undertaken by David C Muller for this project was performed during the tenure of an IARC-Australia fellowship supported by Cancer Council Australia. Elio Riboli was supported by the Imperial College Biomedical Research Centre funded by the National Institute of Health Research of UK. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark), Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France), Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany), the Hellenic Health Foundation (Greece), Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy), Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands), Nordic Centre of xcellence programme on Food, Nutrition and Health. (Norway), Health Research Fund (FIS), PI13/00061 to Granada, Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020) (Spain), Swedish Cancer Society, Swedish Scientific Council and County Councils of Skåne and Västerbotten (Sweden), Cancer Research UK (14136 to EPIC-Norfolk, C570/A16491 to EPIC-Oxford),Medical Research Council (1000143 to EPIC-Norfolk) (United Kingdom). The sponsors did not have any input into study design, study conduct, data collection, analysis, or interpretation nor did they influence the preparation, review, or approval of the manuscript., Khaw, Kay-Tee [0000-0002-8802-2903], Wareham, Nicholas [0000-0003-1422-2993], and Apollo - University of Cambridge Repository

Subjects
Gerontology, Male, 030204 cardiovascular system & hematology, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors [Medical Subject Headings], Cohort Studies, Institut Gustave Roussy, 0302 clinical medicine, Risk Factors, Medicine, 030212 general & internal medicine, Prospective Studies, Diseases::Pathological Conditions, Signs and Symptoms::Signs and Symptoms::Body Weight::Overweight [Medical Subject Headings], Non-U.S. Gov't, media_common, Medicine(all), VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality::Mortality, Premature [Medical Subject Headings], Research Support, Non-U.S. Gov't, Smoking, Public Health, Global Health, Social Medicine and Epidemiology, 11 Medical And Health Sciences, General Medicine, Middle Aged, Europe, Hypertension, Absolute risk, Modifiable risk factors, Mortality, Premature death, Attributable fraction, language, Female, Cohort study, Research Article, Adult, medicine.medical_specialty, Alcohol Drinking, media_common.quotation_subject, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Habits::Smoking [Medical Subject Headings], Library science, Motor Activity, Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Diet [Medical Subject Headings], Research Support, Danish, 03 medical and health sciences, Diseases::Cardiovascular Diseases::Vascular Diseases::Hypertension [Medical Subject Headings], Life Expectancy, Excellence, General & Internal Medicine, Journal Article, Humans, Obesity, Aged, business.industry, Mortality, Premature, Public health, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Life Expectancy [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Body Constitution::Body Weights and Measures::Waist-Hip Ratio [Medical Subject Headings], language.human_language, Cancer registry, Diseases::Nutritional and Metabolic Diseases::Nutrition Disorders::Overnutrition::Obesity [Medical Subject Headings], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Mortalidad, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Drinking Behavior::Alcohol Drinking [Medical Subject Headings], Life expectancy, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, Welfare, Modifiable risk factor, Mortalidad prematura
Abstract

Background: Life expectancy is increasing in Europe, yet a substantial proportion of adults still die prematurely before the age of 70 years. We sought to estimate the joint and relative contributions of tobacco smoking, hypertension, obesity, physical inactivity, alcohol and poor diet towards risk of premature death. Methods: We analysed data from 264,906 European adults from the EPIC prospective cohort study, aged between 40 and 70 years at the time of recruitment. Flexible parametric survival models were used to model risk of death conditional on risk factors, and survival functions and attributable fractions (AF) for deaths prior to age 70 years were calculated based on the fitted models. Results: We identified 11,930 deaths which occurred before the age of 70. The AF for premature mortality for smoking was 31 % (95 % confidence interval (CI), 31–32 %) and 14 % (95 % CI, 12–16 %) for poor diet. Important contributions were also observed for overweight and obesity measured by waist-hip ratio (10 %; 95 % CI, 8–12 %) and high blood pressure (9 %; 95 % CI, 7–11 %). AFs for physical inactivity and excessive alcohol intake were 7 % and 4 %, respectively. Collectively, the AF for all six risk factors was 57 % (95 % CI, 55–59 %), being 35 % (95 % CI, 32–37 %) among never smokers and 74 % (95 % CI, 73–75 %) among current smokers. Conclusions: While smoking remains the predominant risk factor for premature death in Europe, poor diet, overweight and obesity, hypertension, physical inactivity, and excessive alcohol consumption also contribute substantially. Any attempt to minimise premature deaths will ultimately require all six factors to be addressed., This work was supported by the French Social Affairs & Health Ministry, Department of Health (Direction Générale de la Santé). The work undertaken by David C Muller for this project was performed during the tenure of an IARC-Australia fellowship supported by Cancer Council Australia. Elio Riboli was supported by the Imperial College Biomedical Research Centre funded by the National Institute of Health Research of UK. The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Nordic Centre of Excellence programme on Food, Nutrition and Health. (Norway); Health Research Fund (FIS), PI13/00061 to Granada, Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk) (United Kingdom). The sponsors did not have any input into study design, study conduct, data collection, analysis, or interpretation nor did they influence the preparation, review, or approval of the manuscript.

Published
2016
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4. Occupational exposures contribute to educational inequalities in lung cancer incidence among men: evidence from the EPIC prospective cohort study

Author

Menvielle, Gwenn, Boshuizen, Hendriek, Kunst, Anton E., Vineis, Paolo, Dalton, Susanne O., Bergmann, Manuela M., Hermann, Silke, Veglia, Fabrizio, Ferrari, Pietro, Overvad, Kim, Raaschou-Nielsen, Ole, Tjønneland, Anne, Kaaks, Rudolf, Linseisen, Jakob, Palli, Domenico, Krogh, Vittorio, Tumino, Rosario, Rodriguez, Laudina, Agudo, Antonio, Sánchez, Maria-José, Arozena, Jone Miren Altzibar, Cirera, Lluis, Ardanaz, Eva, Bingham, Sheila, Khaw, Kay-Tee, Boffetta, Paolo, Duell, Eric, Slimani, Nadia, Gallo, Valentina, Riboli, Elio, Bueno-de-Mesquita, H. Bas, Menvielle, G., Boshuizen, H., Kunst, A.E., Vineis, P., Dalton, S.O., Bergmann, M.M., Hermann, S., Veglia, F., Ferrari, P., Overvad, K., Raaschou-Nielsen, O., Tjønneland, A., Kaaks, R., Linseisen, J., Palli, D., Krogh, V., Tumino, R., Rodriguez, L., Agudo, A., Sánchez, M.-J., Arozena, J.M.A., Cirera, L., Ardanaz, E., Bingham, S., Khaw, K.-T., Boffetta, P., Duell, E., Slimani, N., Gallo, V., Riboli, E., Bas Bueno-de-Mesquita, H., Public Health, Amsterdam Public Health, and Public and occupational health

Subjects
Male, prospective cohort study, Lung Neoplasms, Incidence, men, educational, Article, Occupational, Cohort Studies, lung cancer, SDG 3 - Good Health and Well-being, Socioeconomic Factors, exposure, inequalitie, Occupational Exposure, incidence, Educational Status, Humans, Prospective Studies, ddc:610, EPIC, Proportional Hazards Models
Abstract

The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude. Some authors are partners of Environmental Cancer Risk, Nutrition and Individual Susceptibility, a network of excellence of the European Commission (6FP contract 513943). Antonio Agudo and Paolo Vineis were supported by ECNIS.

Published
2009
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5. Lung cancers attributable to environmental tobacco smoke and air pollution in non-smokers in different European countries : a prospective study

Author

Eiliv Lund E, Françoise Clavel-Chapelon, Kim Overvad, Petra H.M. Peeters, Miren Dorronsoro, Elio Riboli, H. Bas Bueno-de-Mesquita, Aurelio Barricarte, Lluís Cirera, Carmen Martinez, Ole Raaschou-Nielsen, Domenico Palli, Vittorio Krogh, Fabrizio Veglia, Jonas Manjer, Göran Berglund, Salvatore Panico, J. Linseisen, Rudolf Kaaks, Antonio Agudo, J. Ramón Quirós, Nicholas E. Day, Rodolfo Saracci, Bertil Forsberg, Gerard Hoek, Timothy J. Key, Luisa Airoldi, Heiner Boeing, Paolo Vineis, Federica Vigna-Taglianti, Michal Krzyzanowski, Rosario Tumino, Antonia Trichopoulou, Vineis, P, Hoek, G, Krzyzanowski, M, VIGNA TAGLIANTI, F, Veglia, F, Airoldi, L, Overvad, K, RAASCHOU NIELSEN, O, CLAVEL CHAPELON, F, Linseisen, J, Boeing, H, Trichopoulou, A, Palli, D, Krogh, V, Tumino, R, Panico, Salvatore, BUENO DE MESQUITA, Hb, Peeters, Ph, Lund, E. E., Agudo, A, Martinez, C, Dorronsoro, M, Barricarte, A, Cirera, L, Quiros, Jr, Berglund, G, Manjer, J, Forsberg, B, Day, Ne, Key, Tj, Kaaks, R, Saracci, R, Riboli, E., and Apollo - University of Cambridge Repository

Subjects
Lung Neoplasms, Health, Toxicology and Mutagenesis, Air pollution, medicine.disease_cause, Tobacco smoke, Cohort Studies, 0302 clinical medicine, Cost of Illness, Odds Ratio, Prevalence, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Public, Environmental & Occupational Health, Air Pollutants, Inhalation Exposure, education.field_of_study, lcsh:Public aspects of medicine, Epedimologic evidence, European Prospective Investigation into Cancer and Nutrition, Causality, Europe, 030220 oncology & carcinogenesis, lcsh:Industrial medicine. Industrial hygiene, Lung cancer, Risk assessment, Life Sciences & Biomedicine, Cohort study, Population, Environmental Sciences & Ecology, Risk Assessment, lcsh:RC963-969, 03 medical and health sciences, Air Pollution, Environmental health, medicine, Humans, ddc:610, education, Science & Technology, business.industry, Research, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, medicine.disease, 13. Climate action, Case-Control Studies, Tobacco Smoke Pollution, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business, Environmental Sciences
Abstract

BACKGROUND: Several countries are discussing new legislation on the ban of smoking in public places, and on the acceptable levels of traffic-related air pollutants. It is therefore useful to estimate the burden of disease associated with indoor and outdoor air pollution. METHODS: We have estimated exposure to Environmental Tobacco Smoke (ETS) and to air pollution in never smokers and ex-smokers in a large prospective study in 10 European countries (European Prospective Investigation into Cancer and Nutrition)(N = 520,000). We report estimates of the proportion of lung cancers attributable to ETS and air pollution in this population. RESULTS: The proportion of lung cancers in never- and ex-smokers attributable to ETS was estimated as between 16 and 24%, mainly due to the contribution of work-related exposure. We have also estimated that 5-7% of lung cancers in European never smokers and ex-smokers are attributable to high levels of air pollution, as expressed by NO2 or proximity to heavy traffic roads. NO2 is the expression of a mixture of combustion (traffic-related) particles and gases, and is also related to power plants and waste incinerator emissions. DISCUSSION: We have estimated risks of lung cancer attributable to ETS and traffic-related air pollution in a large prospective study in Europe. Information bias can be ruled out due to the prospective design, and we have thoroughly controlled for potential confounders, including restriction to never smokers and long-term ex-smokers. Concerning traffic-related air pollution, the thresholds for indicators of exposure we have used are rather strict, i.e. they correspond to the high levels of exposure that characterize mainly Southern European countries (levels of NO2 in Denmark and Sweden are closer to 10-20 ug/m3, whereas levels in Italy are around 30 or 40, or higher).Therefore, further reduction in exposure levels below 30 ug/m3 would correspond to additional lung cancer cases prevented, and our estimate of 5-7% is likely to be an underestimate. Overall, our prospective study draws attention to the need for strict legislation concerning the quality of air in Europe. This paper was made possible by a grant of the European Community (5th Framework Programme) to PV (grant QLK4CT199900927), a grant from the European Union for the project ECNIS (WP4 and 8) to PV, and a grant of the Compagnia di San Paolo to the ISI Foundation. All authors are independent from funders. Mortality data for the Netherlands were obtained from "Statistics Netherlands".

Published
2007

6. Air pollution and risk of lung cancer in a prospective study in Europe

Author

Rudolf Kaaks, H. Bas Bueno-de-Mesquita, Domenico Palli, Kim Overvad, Giuseppe Matullo, J. Linseisen, Antonia Trichopoulou, Seymour Garte, Pierre Hainaut, Eiliv Lund, Petra H.M. Peeters, Rodolfo Saracci, Aurelio Barricarte, J. Ramón Quirós, Lluís Cirera, Carmen Martinez, Heiner Boeing, Elio Riboli, Federica Vigna-Taglianti, Michal Krzyzanowski, Françoise Clavel-Chapelon, Göran Berglund, Ole Raaschou-Nielsen, Timothy J. Key, Luisa Airoldi, Salvatore Panico, Miren Dorronsoro, Christian Malaveille, Nicholas E. Day, Bertil Forsberg, Gerard Hoek, Fabrizio Veglia, Carlos A. González, Vittorio Krogh, Herman Autrup, Paolo Vineis, Marco Peluso, Alison M. Dunning, Rosario Tumino, Vineis, P, Hoek, G, Krzyzanowski, M, VIGNA TAGLIANTI, F, Veglia, F, Airoldi, L, Autrup, H, Dunning, A, Garte, S, Hainaut, P, Malaveille, C, Matullo, G, Overvad, K, RAASCHOU NIELSEN, O, CLAVEL CHAPELON, F, Linseisen, J, Boeing, H, Trichopoulou, A, Palli, D, Peluso, M, Krogh, V, Tumino, R, Panico, Salvatore, BUENO DE MESQUITA, Hb, Peeters, Ph, Lund, Ee, Gonzalez, Ca, Martinez, C, Dorronsoro, M, Barricarte, A, Cirera, L, Quiros, Jr, Berglund, G, Forsberg, B, Day, Ne, Key, Tj, Saracci, R, Kaaks, R, and Riboli, E.

Subjects
Adult, Male, Cancer Research, medicine.medical_specialty, Lung Neoplasms, non-smokers, Risk Assessment, chemistry.chemical_compound, Residence Characteristics, Risk Factors, Environmental health, Air Pollution, medicine, Odds Ratio, Humans, ddc:610, Prospective Studies, Risk factor, Lung cancer, Prospective cohort study, Aged, business.industry, Incidence, Case-control study, Odds ratio, Environmental exposure, Environmental Exposure, Middle Aged, medicine.disease, Confidence interval, Surgery, air pollution, lung cancer, prospective study, Europe, Logistic Models, Oncology, chemistry, Case-Control Studies, Female, business, Cotinine
Abstract

To estimate the relationship between air pollution and lung cancer, a nested case-control study was set up within EPIC (European Prospective Investigation on Cancer and Nutrition). Cases had newly diagnosed lung cancer, accrued after a median follow-up of 7 years among the EPIC exsmokers (since at least 10 years) and never smokers. Three controls per case were matched. Matching criteria were gender, age (±5 years), smoking status, country of recruitment and time elapsed between recruitment and diagnosis. We studied residence in proximity of heavy traffic roads as an indicator of exposure to air pollution. In addition, exposure to air pollutants (NO2, PM10, SO2) was assessed using concentration data from monitoring stations in routine air quality monitoring networks. Cotinine was measured in plasma. We found a nonsignificant association between lung cancer and residence nearby heavy traffic roads (odds ratio = 1.46, 95% confidence interval, CI, 0.89-2.40). Exposure data for single pollutants were available for 197 cases and 556 matched controls. For NO2 we found an odds ratio of 1.14 (95% CI, 0.78-1.67) for each increment of 10 μg/m3, and an odds ratio of 1.30 (1.02-1.66) for concentrations greater than 30 μg/m3. The association with NO2 did not change after adjustment by cotinine and additional potential confounders, including occupational exposures. No clear association was found with other pollutants. © 2006 Wiley-Liss, Inc.

Published
2006

7. A combined analysis of the short-term effects of photochemical air pollutants on mortality within the EMECAM project

Author

Federico Arribas, Nuria Aragonés, Aurelio Tobias, Álvaro Cañada, Juan Bellido, Lluís Cirera, Maria Antònia Barceló, Ferran Ballester, Marc Saez, José María Tenías, Ricardo Ocaña, Santiago Pérez-Hoyos, Adolfo Figueiras, The EMECAM group, [Saez,M, Barceló,A] Research Group on Statistics, Applied Economics and Health, GRECS, Department of Economics, University of Girona, Spain. [Ballester,F, Pérez-Hoyos,S, and Tenías,JM] Epidemiology and Statistics Unit, Valencian School for Health Studies (EVES), Spain. [Bellido,J] Epidemiological Service, Regional Health Authority, Castelló, Spain. [Ocaña,R] Andalusian School of Public Health, Granada, Spain. [Figueiras,A] Preventive Medicine, University of Santiago de Compostela, Spain. [Arribas,F] Health, Welfare and Labour Department, Zaragoza, Spain. [Aragonés,N] Public Health Authority, Madrid, Spain. [Tobías,A] Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. [Cirera,L] Epidemiology Department, Regional Health Council, Murcia, Spain. [Cañada,Á] Public Health Regional Authority, Social Services Council, Oviedo, Spain.

Subjects
Male, Geographicals::Geographic Locations::Cities [Medical Subject Headings], Combinatorial analysis, Health, Toxicology and Mutagenesis, España, Air pollution, Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Photochemistry, medicine.disease_cause, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], chemistry.chemical_compound, Contaminants, Chemicals and Drugs::Chemical Actions and Uses::Toxic Actions::Environmental Pollutants::Air Pollutants [Medical Subject Headings], Child, Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings], Dióxido de Nitrógeno, Air Pollutants, Named Groups::Persons::Age Groups::Child::Child, Preschool [Medical Subject Headings], Aire -- Contaminació, Oxidantes Fotoquímicos, Environmental exposure, Middle Aged, Random effects model, Health Care::Environment and Public Health::Public Health::Environmental Pollution::Environmental Exposure [Medical Subject Headings], Chemicals and Drugs::Inorganic Chemicals::Gases::Oxygen::Ozone [Medical Subject Headings], Named Groups::Persons::Age Groups::Adolescent [Medical Subject Headings], Child, Preschool, Regression Analysis, Female, Named Groups::Persons::Age Groups::Infant [Medical Subject Headings], Chemicals and Drugs::Chemical Actions and Uses::Specialty Uses of Chemicals::Oxidants::Oxidants, Photochemical [Medical Subject Headings], Anàlisi combinatòria, Air -- Pollution, Research Article, Adult, Pollutants, Adolescent, Nitrogen Dioxide, Named Groups::Persons::Age Groups::Infant::Infant, Newborn [Medical Subject Headings], Chemicals and Drugs::Inorganic Chemicals::Gases::Nitrogen Oxides::Nitrogen Dioxide [Medical Subject Headings], Risk Assessment, Oxidants, Photochemical, Ozone, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], medicine, Mortalitat, Humans, Nitrogen dioxide, Named Groups::Persons::Age Groups::Adult::Aged [Medical Subject Headings], Cities, Mortality, Ozono, Named Groups::Persons::Age Groups::Child [Medical Subject Headings], Aged, Pollutant, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Regression Analysis [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Assessment [Medical Subject Headings], Public Health, Environmental and Occupational Health, Infant, Newborn, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Mortality [Medical Subject Headings], Infant, Fixed effects model, Environmental Exposure, Confidence interval, Epidemiologic Studies, Check Tags::Female [Medical Subject Headings], chemistry, Spain, Relative risk, Contaminantes del Aire, Environmental science, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies [Medical Subject Headings]
Abstract

Journal Article; Research Support, Non-U.S. Gov't; In recent years, some epidemiologic studies have attributed adverse effects of air pollutants on health not only to particles and sulfur dioxide but also to photochemical air pollutants (nitrogen dioxide and ozone). The effects are usually small, leading to some inconsistencies in the results of the studies. Furthermore, the different methodologic approaches of the studies used has made it difficult to derive generic conclusions. We provide here a quantitative summary of the short-term effects of photochemical air pollutants on mortality in seven Spanish cities involved in the EMECAM project, using generalized additive models from analyses of single and multiple pollutants. Nitrogen dioxide and ozone data were provided by seven EMECAM cities (Barcelona, Gijón, Huelva, Madrid, Oviedo, Seville, and Valencia). Mortality indicators included daily total mortality from all causes excluding external causes, daily cardiovascular mortality, and daily respiratory mortality. Individual estimates, obtained from city-specific generalized additive Poisson autoregressive models, were combined by means of fixed effects models and, if significant heterogeneity among local estimates was found, also by random effects models. Significant positive associations were found between daily mortality (all causes and cardiovascular) and NO(2), once the rest of air pollutants were taken into account. A 10 microg/m(3) increase in the 24-hr average 1-day NO(2)level was associated with an increase in the daily number of deaths of 0.43% [95% confidence interval (CI), -0.003-0.86%] for all causes excluding external. In the case of significant relationships, relative risks for cause-specific mortality were nearly twice as much as that for total mortality for all the photochemical pollutants. Ozone was independently related only to cardiovascular daily mortality. No independent statistically significant relationship between photochemical air pollutants and respiratory mortality was found. The results in this study suggest that, given the present levels of photochemical pollutants, people living in Spanish cities are exposed to health risks derived from air pollution. Yes

Published
2002

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