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  • 1. Accordini, Simone
    et al.
    Calciano, Lucia
    Johannessen, Ane
    Portas, Laura
    Benediktsdóttir, Bryndis
    Bertelsen, Randi Jacobsen
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Carsin, Anne-Elie
    Dharmage, Shyamali C.
    Dratva, Julia
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gomez Real, Francisco
    Heinrich, Joachim
    Holloway, John W.
    Holm, Mathias
    Janson, Christer
    Jögi, Rain
    Leynaert, Bénédicte
    Malinovschi, Andrei
    Marcon, Alessandro
    Martínez-Moratalla Rovira, Jesús
    Raherison, Chantal
    Sánchez-Ramos, José Luis
    Schlünssen, Vivi
    Bono, Roberto
    Corsico, Angelo G.
    Demoly, Pascal
    Dorado Arenas, Sandra
    Nowak, Dennis
    Pin, Isabelle
    Weyler, Joost
    Jarvis, Deborah
    Svanes, Cecilie
    A three-generation study on the association of tobacco smoking with asthma2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 4, p. 1106-1117Article in journal (Refereed)
    Abstract [en]

    Background: Mothers' smoking during pregnancy increases asthma risk in their offspring. There is some evidence that grandmothers' smoking may have a similar effect, and biological plausibility that fathers' smoking during adolescence may influence offspring's health through transmittable epigenetic changes in sperm precursor cells. We evaluated the three-generation associations of tobacco smoking with asthma.

    Methods: Between 2010 and 2013, at the European Community Respiratory Health Survey III clinical interview, 2233 mothers and 1964 fathers from 26 centres reported whether their offspring (aged ≤51 years) had ever had asthma and whether it had coexisted with nasal allergies or not. Mothers and fathers also provided information on their parents' (grandparents) and their own asthma, education and smoking history. Multilevel mediation models within a multicentre three-generation framework were fitted separately within the maternal (4666 offspring) and paternal (4192 offspring) lines.

    Results: Fathers' smoking before they were 15 [relative risk ratio (RRR) = 1.43, 95% confidence interval (CI): 1.01-2.01] and mothers' smoking during pregnancy (RRR = 1.27, 95% CI: 1.01-1.59) were associated with asthma without nasal allergies in their offspring. Grandmothers' smoking during pregnancy was associated with asthma in their daughters [odds ratio (OR) = 1.55, 95% CI: 1.17-2.06] and with asthma with nasal allergies in their grandchildren within the maternal line (RRR = 1.25, 95% CI: 1.02-1.55).

    Conclusions: Fathers' smoking during early adolescence and grandmothers' and mothers' smoking during pregnancy may independently increase asthma risk in offspring. Thus, risk factors for asthma should be sought in both parents and before conception.

  • 2. Alberts, Marianne
    et al.
    Dikotope, Sekgothe A
    Choma, Solomon R
    Masemola, Matshane L
    Modjadji, Sewela EP
    Mashinya, Felistas
    Burger, Sandra
    Cook, Ian
    Brits, Sanette J
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesberg, South Africa.
    Health & Demographic Surveillance System Profile: The Dikgale Health and Demographic Surveillance System.2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 5, p. 1565-1571Article in journal (Refereed)
  • 3. Aleksandrova, Krasimira
    et al.
    Jenab, Mazda
    Leitzmann, Michael
    Bueno-de-Mesquita, Bas
    Kaaks, Rudolf
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Rinaldi, Sabina
    Freisling, Heinz
    Carayol, Marion
    Pischon, Tobias
    Drogan, Dagmar
    Weiderpass, Elisabete
    Jakszyn, Paula
    Overvad, Kim
    Dahm, Christina C.
    Tjonneland, Anne
    Bouton-Ruault, Marie-Christine
    Kuehn, Tilman
    Peppa, Eleni
    Valanou, Elissavet
    La Vecchia, Carlo
    Palli, Domenico
    Panico, Salvatore
    Sacerdote, Carlotta
    Agnoli, Claudia
    Tumino, Rosario
    May, Anne
    van Vulpen, Jonna
    Borch, Kristin Benjaminsen
    Oyeyemi, Sunday Oluwafemi
    Ramon Quiros, J.
    Bonet, Catalina
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Navarro, Carmen
    Barricarte, Aurelio
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Key, Timothy J.
    Khaw, Kay-Tee
    Wareham, Nicholas
    Assi, Nada
    Ward, Heather A.
    Aune, Dagfinn
    Riboli, Elio
    Boeing, Heiner
    Physical activity, mediating factors and risk of colon cancer: insights into adiposity and circulating biomarkers from the EPIC cohort2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 6, p. 1823-1835Article in journal (Refereed)
    Abstract [en]

    There is convincing evidence that high physical activity lowers the risk of colon cancer; however, the underlying biological mechanisms remain largely unknown. We aimed to determine the extent to which body fatness and biomarkers of various biologically plausible pathways account for the association between physical activity and colon cancer. We conducted a nested case-control study in a cohort of 519 978 men and women aged 25 to 70 years followed from 1992 to 2003. A total of 713 incident colon cancer cases were matched, using risk-set sampling, to 713 controls on age, sex, study centre, fasting status and hormonal therapy use. The amount of total physical activity during the past year was expressed in metabolic equivalent of task [MET]-h/week. Anthropometric measurements and blood samples were collected at study baseline. High physical activity was associated with a lower risk of colon cancer: relative risk a parts per thousand<yen>91 MET-h/week vs < 91 MET-h/week = 0.75 [95% confidence interval (CI): 0.57 to 0.96]. In mediation analyses, this association was accounted for by waist circumference: proportion explained effect (PEE) = 17%; CI: 4% to 52%; and the biomarkers soluble leptin receptor (sOB-R): PEE = 15%; 95% CI: 1% to 50% and 5-hydroxyvitamin D (25[OH]D): PEE = 30%; 95% CI: 12% to 88%. In combination, these factors explained 45% (95% CI: 20% to 125%) of the association. Beyond waist circumference, sOB-R and 25[OH]D additionally explained 10% (95% CI: 1%; 56%) and 23% (95% CI: 6%; 111%) of the association, respectively. Promoting physical activity, particularly outdoors, and maintaining metabolic health and adequate vitamin D levels could represent a promising strategy for colon cancer prevention.

  • 4. Anantharaman, Devasena
    et al.
    Muller, David C
    Lagiou, Pagona
    Ahrens, Wolfgang
    Holcátová, Ivana
    Merletti, Franco
    Kjærheim, Kristina
    Polesel, Jerry
    Simonato, Lorenzo
    Canova, Cristina
    Castellsague, Xavier
    Macfarlane, Tatiana V
    Znaor, Ariana
    Thomson, Peter
    Robinson, Max
    Conway, David I
    Healy, Claire M
    Tjønneland, Anne
    Westin, Ulla
    Ekström, Johanna
    Chang-Claude, Jenny
    Kaaks, Rudolf
    Overvad, Kim
    Drogan, Dagmar
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Biobank Research.
    Laurell, Göran
    Bueno-de-Mesquita, H B
    Peeters, Petra H
    Agudo, Antonio
    Larrañaga, Nerea
    Travis, Ruth C
    Palli, Domenico
    Barricarte, Aurelio
    Trichopoulou, Antonia
    George, Saitakis
    Trichopoulos, Dimitrios
    Quirós, J Ramón
    Grioni, Sara
    Sacerdote, Carlotta
    Navarro, Carmen
    Sánchez, María-José
    Tumino, Rosario
    Severi, Gianluca
    Boutron-Ruault, Marie-Christine
    Clavel-Chapelon, Francoise
    Panico, Salvatore
    Weiderpass, Elisabete
    Lund, Eiliv
    Gram, Inger T
    Riboli, Elio
    Pawlita, Michael
    Waterboer, Tim
    Kreimer, Aimée R
    Johansson, Mattias
    Umeå University, Faculty of Medicine, Department of Biobank Research.
    Brennan, Paul
    Combined effects of smoking and HPV16 in oropharyngeal cancer2016In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 3, p. 752-761Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although smoking and HPV infection are recognized as important risk factors for oropharyngeal cancer, how their joint exposure impacts on oropharyngeal cancer risk is unclear. Specifically, whether smoking confers any additional risk to HPV-positive oropharyngeal cancer is not understood.

    METHODS: Using HPV serology as a marker of HPV-related cancer, we examined the interaction between smoking and HPV16 in 459 oropharyngeal (and 1445 oral cavity and laryngeal) cancer patients and 3024 control participants from two large European multi-centre studies. Odds ratios and credible intervals [CrI], adjusted for potential confounders, were estimated using Bayesian logistic regression.

    RESULTS: Both smoking [odds ratio (OR [CrI]: 6.82 [4.52, 10.29]) and HPV seropositivity (OR [CrI]: 235.69 [99.95, 555.74]) were independently associated with oropharyngeal cancer. The joint association of smoking and HPV seropositivity was consistent with that expected on the additive scale (synergy index [CrI]: 1.32 [0.51, 3.45]), suggesting they act as independent risk factors for oropharyngeal cancer.

    CONCLUSIONS: Smoking was consistently associated with increase in oropharyngeal cancer risk in models stratified by HPV16 seropositivity. In addition, we report that the prevalence of oropharyngeal cancer increases with smoking for both HPV16-positive and HPV16-negative persons. The impact of smoking on HPV16-positive oropharyngeal cancer highlights the continued need for smoking cessation programmes for primary prevention of head and neck cancer.

  • 5. Andersson, T
    et al.
    Högberg, U
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bergström, S
    Community-based prevention of perinatal deaths: lessons from nineteenth-century Sweden.2000In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 29, no 3, p. 542-8Article in journal (Refereed)
    Abstract [en]

    Poor reproductive history, particularly previously high perinatal mortality, is associated with high perinatal mortality. Midwifery-assisted at home deliveries successfully reduced perinatal mortality.

  • 6. Bjørge, Tone
    et al.
    Lukanova, Annekatrin
    Tretli, Steinar
    Manjer, Jonas
    Ulmer, Hanno
    Stocks, Tanja
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Selmer, Randi
    Nagel, Gabriele
    Almquist, Martin
    Concin, Hans
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. null.
    Jonsson, Håkan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. null.
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. null.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. null.
    Engeland, Anders
    null.
    Metabolic risk factors and ovarian cancer in the metabolic syndrome and cancer project2011In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 40, no 6, p. 1667-1677Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: No studies have so far evaluated the impact of the metabolic syndrome (MetS) as an entity on ovarian cancer risk. The authors aimed to examine the association between factors in the MetS, individually and combined, and risk of ovarian cancer incidence and mortality. METHODS: Altogether, 290 000 women from Austria, Norway and Sweden were enrolled during 1974-2005, with measurements taken of height, weight, blood pressure and levels of glucose, cholesterol and triglycerides. Relative risks (RRs) of ovarian cancer were estimated using Cox regression for each MetS factor in quintiles and for standardized levels (z-scores), and for a composite z-score for the MetS. RRs were corrected for random error in measurements. RESULTS: During follow-up, 644 epithelial ovarian cancers and 388 deaths from ovarian cancer were identified. There was no overall association between MetS and ovarian cancer risk. Increasing levels of cholesterol [RR 1.52, 95% confidence interval (95% CI) 1.01-2.29, per 1-U increment of z-score] and blood pressure (RR 1.79, 95% CI 1.12-2.86) conferred, however, increased risks of mucinous and endometrioid tumours, respectively. In women below the age of 50 years, there was increased risk of ovarian cancer mortality for MetS (RR 1.52, 95% CI 1.00-2.30). Increasing levels of BMI (RR 1.17, 95% CI 1.01-1.37) conferred increased risk of ovarian cancer mortality in women above the age of 50 years. CONCLUSION: There was no overall association between MetS and ovarian cancer risk. However, increasing levels of cholesterol and blood pressure increased the risks of mucinous and endometrioid tumours, respectively. Increasing levels of BMI conferred an increased risk of ovarian cancer mortality in women above the age of 50 years.

  • 7. Bonn, S. E.
    et al.
    Wiklund, F.
    Sjölander, A.
    Szulkin, R.
    Stattin, Pär
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Holmberg, E.
    Grönberg, H.
    Bälter, K.
    Body Mass Index and Weight Change in Men with Prostate Cancer: Progression and Mortality2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, p. 141-142Article in journal (Other academic)
  • 8.
    Brännström, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Persson, Lars Åke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Wester, P O
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme1993In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 22, no 6, p. 1026-1037Article in journal (Refereed)
    Abstract [en]

    Since 1985 a small-scale community-based cardiovascular disease (CVD) preventive programme has been in operation in an inland municipality, Norsjö, in Northern Sweden. The aim of this study was to assess the development of the relationship between social position and CVD risk factors in repeated cross-sectional surveys (1985-1990) among all men and women aged 30, 40, 50 and 60 years in the study area, using an age-stratified random sample from the Northern Sweden MONICA Study of 1986 and 1990 as reference population. These multiple cross-sectional surveys comprised a self-administered questionnaire and a health examination. Of the study population 95% (n = 1499) and 80% of those in the reference area (n = 3208) participated. Subjects were classified with regard to demographic, structural and social characteristics in relation to CVD risk factors and self-reported health status. Time trends in classical risk factor occurrence were assessed in terms of age- and sex- adjusted odds ratios using Mantel-Haenszel procedures. When simultaneously adjusting for several potential confounders we used a logistic regression analysis. Initially, more than half of the study population, both males and females, had and elevated (> or = 6.5 mmol/l) serum cholesterol level. After adjustments had been made for age and social factors it was found that the relative risk of hypercholesterolaemia dropped substantially and significantly among both sexes during the 6 years of CVD intervention in the study area. However, the probability of being a smoker was significantly reduced only in highly educated groups. Among other risk factors no single statistically significant change over time could be found. In the reference area there were no changes over time for the selected CVD risk factors. People in the study area had a less favourable perception of their health than those in the reference area. Social differences were found when perceived good health was measured, especially in variables indicating emotional and social support. When sex, age and social factors had been accounted for there was not clear change over the years in perceived good health.

  • 9. Cameron, Adrian J.
    et al.
    Magliano, Dianna J.
    Shaw, Jonathan E.
    Zimmet, Paul Z.
    Carstensen, Bendix
    Alberti, K. George M. M.
    Tuomilehto, Jaakko
    Barr, Elizabeth L. M.
    Pauvaday, Vassen K.
    Kowlessur, Sudhirsen
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    The influence of hip circumference on the relationship between abdominal obesity and mortality2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 2, p. 484-494Article in journal (Refereed)
    Abstract [en]

    Background Higher waist circumference and lower hip circumference are both associated with increased cardiovascular disease (CVD) risk, despite being directly correlated. The real effects of visceral obesity may therefore be underestimated when hip circumference is not fully taken into account. We hypothesized that adding waist and hip circumference to traditional risk factors would significantly improve CVD risk prediction. Methods In a population-based survey among South Asian and African Mauritians (n = 7978), 1241 deaths occurred during 15 years of follow-up. In a model that included variables used in previous CVD risk calculations (a Framingham-type model), the association between waist circumference and mortality was examined before and after adjustment for hip circumference. The percentage with an increase in estimated 10-year cumulative mortality of > 25% and a decrease of > 20% after waist and hip circumference were added to the model was calculated. Results Waist circumference was strongly related to mortality only after adjustment for hip circumference and vice versa. Adding waist and hip circumference to a Framingham-type model increased estimated 10-year cumulative CVD mortality by > 25% for 23.7% of those who died and 15.7% of those censored. Cumulative mortality decreased by > 20% for 4.5% of those who died and 14.8% of those censored. Conclusions The effect of central obesity on mortality risk is seriously underestimated without adjustment for hip circumference. Adding waist and hip circumference to a Framingham-type model for CVD mortality substantially increased predictive power. Both may be important inclusions in CVD risk prediction models.

  • 10.
    Desvars, Amélie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Furberg, Maria
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hjertqvist, Marika
    Vidman, Linda
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Sjöstedt, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Rydén, Patrik
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Epidemiology and Ecology of Tularemia in Sweden2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, p. 58-58Article in journal (Other academic)
  • 11.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia.
    Axmon, Anna
    Powell, Rhonda
    Davey, Mary-Ann
    Male-biased sex ratios in Australian migrant populations: a population-based study of 1 191 250 births 1999-20152018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 6, p. 2025-2037Article in journal (Refereed)
    Abstract [en]

    Background: The naturally occurring male-to-female (M/F) ratio at birth is 1.05. Higher ratios found primarily in countries across Asia have been attributed to prenatal sex selection due to son preference. There is growing evidence that sex-selective practices continue following migration; however, little is known about these practices following migration to Australia.

    Methods: In this population-based study we assessed M/F ratios at birth per mother’s country of birth for all registered births 1999–2015 in Victoria, Australia (n = 1 191 250). We also compared the M/F ratio among births to mothers born elsewhere to that of mothers born in Australia, stratified by time period and parity.

    Results: Compared with the naturally occurring M/F ratio as well as to the M/F ratio among births to mothers born in Australia, there was an increased ratio of male births to mothers born in India, China and South-East Asia, particularly at higher parities and in more recent time periods (elevated M/F ratios ranged from 1·079 to 1·248, relative risks of male birth ranged from 1·012 to 1·084 with confidence intervals between 1·001 and 1·160 and P-values between 0·005 and 0·039). The most male-biased sex ratios were found among multiple births to Indian-born mothers, and parity of two or more births to Indian and Chinese-born mothers in 2011–15.

    Conclusions: The male-biased sex ratios observed in this study indicate that prenatal sex selection may be continuing following migration to Australia from countries where these practices have been documented. The excess of males among multiple births raises the question as to what role assisted reproduction plays. Findings also suggest that systematic discrimination against females starts in the womb.

  • 12.
    Forsberg, Bertil
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Environmental Medicine.
    Pekkanen, J
    Clench-Aas, J
    Mårtensson, MB
    Stjernberg, Nils
    Bartonova, A
    Timonen, KL
    Skerfving, S
    Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects1997In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 26, no 3, p. 610-619Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs.

    METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited.

    RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one.

    CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.

  • 13.
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Skane Univ Hosp, Dept Clin Sci, Malmo, Sweden ; Harvard TH Chan Sch Publ Hlth, Dept Nutr, Boston, MA USA.
    Commentary: mining gene-lifestyle interactions in UK Biobank: all that glitters isn't gold2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 2, p. 576-577Article in journal (Refereed)
  • 14. Fritz, Josef
    et al.
    Bjørge, Tone
    Nagel, Gabriele
    Manjer, Jonas
    Engeland, Anders
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Concin, Hans
    Teleka, Stanley
    Tretli, Steinar
    Gylling, Björn
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Lang, Alois
    Stattin, Pär
    Stocks, Tanja
    Ulmer, Hanno
    The triglyceride-glucose index as a measure of insulin resistance and risk of obesity-related cancers2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, p. 1-12, article id dyz053Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The role of insulin resistance as a mediator in the association of body mass index (BMI) with site-specific cancer risk has, to our knowledge, never been systematically quantified.

    METHODS: Altogether 510 471 individuals from six European cohorts, with a mean age of 43.1 years, were included. We used the triglyceride glucose product (TyG index) as a surrogate measure for insulin resistance. We fitted Cox models, adjusted for relevant confounders, to investigate associations of TyG index with 10 common obesity-related cancers, and quantified the proportion of the effect of BMI mediated through TyG index on the log-transformed hazard ratio (HR) scale.

    RESULTS: During a median follow-up of 17.2 years, 16 052 individuals developed obesity-related cancers. TyG index was associated with the risk of cancers of the kidney HR per one standard deviation increase 1.13, 95% confidence interval: 1.07 to 1.20], liver (1.13, 1.04 to 1.23), pancreas (1.12, 1.06 to 1.19), colon (1.07, 1.03 to 1.10) and rectum (1.09, 1.04 to 1.14). Substantial proportions of the effect of BMI were mediated by TyG index for cancers of the pancreas (42%), rectum (34%) and colon (20%); smaller proportions for kidney (15%) and liver (11%). Little or no mediation was observed for breast (postmenopausal), endometrial and ovarian cancer. Results were similar for males and females, except for pancreatic cancer where the proportions mediated were 20% and 91%, respectively.

    CONCLUSIONS: The TyG index was associated with increased risk of cancers of the digestive system and substantially mediated the effect of BMI, suggesting that insulin resistance plays a promoting role in the pathogenesis of gastrointestinal cancers.

  • 15. Gallo, Valentina
    et al.
    Vineis, Paolo
    Cancellieri, Mariagrazia
    Chiodini, Paolo
    Barker, Roger A.
    Brayne, Carol
    Pearce, Neil
    Vermeulen, Roel
    Panico, Salvatore
    Bueno-de-Mesquita, Bas
    Vanacore, Nicola
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Ramat, Silvia
    Ardanaz, Eva
    Arriola, Larraitz
    Peterson, Jesper
    Hansson, Oskar
    Gavrila, Diana
    Sacerdote, Carlotta
    Sieri, Sabina
    Kühn, Tilman
    Katzke, Verena A.
    van der Schouw, Yvonne T.
    Kyrozis, Andreas
    Masala, Giovanna
    Mattiello, Amalia
    Perneczky, Robert
    Middleton, Lefkos
    Saracci, Rodolfo
    Riboli, Elio
    Exploring causality of the association between smoking and Parkinson's disease2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this paper is to investigate the causality of the inverse association between cigarette smoking and Parkinson's disease (PD). The main suggested alternatives include a delaying effect of smoking, reverse causality or an unmeasured confounding related to a low-risk-taking personality trait.

    Methods: A total of 715 incident PD cases were ascertained in a cohort of 220 494 individuals from NeuroEPIC4PD, a prospective European population-based cohort study including 13 centres in eight countries. Smoking habits were recorded at recruitment. We analysed smoking status, duration, and intensity and exposure to passive smoking in relation to PD onset.

    Results: Former smokers had a 20% decreased risk and current smokers a halved risk of developing PD compared with never smokers. Strong dose-response relationships with smoking intensity and duration were found. Hazard ratios (HRs) for smoking <20 years were 0.84 [95% confidence interval (CI) 0.67-1.07], 20-29 years 0.73 (95% CI 0.56-0.96) and >30 years 0.54 (95% CI 0.43-0.36) compared with never smokers. The proportional hazard assumption was verified, showing no change of risk over time, arguing against a delaying effect. Reverse causality was disproved by the consistency of dose-response relationships among former and current smokers. The inverse association between passive smoking and PD, HR 0.70 (95% CI 0.49-0.99) ruled out the effect of unmeasured confounding.

    Conclusions: These results are highly suggestive of a true causal link between smoking and PD, although it is not clear which is the chemical compound in cigarette smoking responsible for the biological effect.

  • 16.
    Gomez-Olive, F. Xavier
    et al.
    School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Thorogood, Margaret
    School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Bocquier, Philippe
    School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Mee, Paul
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, and INDEPTH Network .
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, and INDEPTH Network .
    Berkman, Lisa
    Harvard Centre for Population and Development Studies.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, and INDEPTH Network.
    Social conditions and disability related to the mortality of older people in rural South Africa2014In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, no 5, p. 1531-1541Article in journal (Refereed)
    Abstract [en]

    Background: South Africa is experiencing a health and social transition including an ageing population and an HIV epidemic. We report mortality experience of an older rural South African population.

    Methods: Individual survey data and longer-term demographic data were used to describe factors associated with mortality. Individuals aged 50 years and over (n = 4085) answered a health and quality of life questionnaire in 2006 and were followed for 3 years thereafter. Additional vital events and socio-demographic data were extracted from the Agincourt Health and Demographic Surveillance System from 1993 to 2010, to provide longer-term trends in mortality. Cox regression analysis was used to determine factors related to survival.

    Results: In 10 967 person-years of follow-up between August 2006 and August 2009, 377 deaths occurred. Women had lower mortality {hazard ratio [HR] 0.35 [95% confidence interval (CI) 0.28-0.45]}. Higher mortality was associated with being single [HR 1.48 (95% CI 1.16-1.88)], having lower household assets score [HR 1.79 (95% CI 1.28-2.51)], reporting greater disability [HR 2.40 (95% CI 1.68-3.42)] and poorer quality of life [HR 1.59 (95% CI 1.09-2.31)]. There was higher mortality in those aged under 69 as compared with those 70 to 79 years old. Census data and cause specific regression models confirmed that this was due to deaths from HIV/TB in the younger age group.

    Conclusions: Mortality due to HIV/TB is increasing in men, and to some extent women, aged over 50. Policy makers and practitioners should consider the needs of this growing and often overlooked group.

  • 17. Gustafson, Per
    et al.
    Gomes, Victor F
    Vieira, Cesaltina S
    Rabna, Paulo
    Seng, Rémonie
    Johansson, Peter
    Sandström, Anita
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Projecto de Saúde de Bandim, Danish Epidemiology Science Centre, Bissau, Guinea-Bissau .
    Norberg, Renée
    Lisse, Ida
    Samb, Badara
    Aaby, Peter
    Nauclér, Anders
    Tuberculosis in Bissau: incidence and risk factors in an urban community in sub-Saharan Africa2004In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 33, no 1, p. 163-172Article in journal (Refereed)
    Abstract [en]

    Background Despite the long history of tuberculosis (TB) research, population-based studies from developing countries are rare.

    Methods In a prospective community study in Bissau, the capital of Guinea-Bissau, we assessed the impact of demographic, socioeconomic and cultural risk factors on active TB. A surveillance system in four districts of the capital identified 247 adult (greater than or equal to15 years) cases of intrathoracic TB between May 1996 and June 1998. Risk factors were evaluated comparing cases with the 25 189 adults living in the area in May 1997.

    Results The incidence of intrathoracic TB in the adult population was 471 per 100 000 person-years. Significant risk factors in a multivariate analysis were increasing age (P < 0.0001), male sex (odds ratio [OR] = 2.58, 95% CI: 1.85, 3.60), ethnic group other than the largest group (Pepel) (OR = 1.64, 95% CI: 1.20, 2.22), adult crowding (OR = 1.68, 95% CI: 1.18, 2.39 for >2 adults in household), and poor quality of housing (OR = 1.66, 95% CI: 1.24, 2.22). Household type was important; adults living alone or with adults of their own sex only, had a higher risk of developing TB than households with husband and wife present, the adjusted OR being 1.76 (95% CI: 1.11, 2.78) for male households and 3.80 (95% CI: 1.69, 8.56) for female households. In a multivariate analysis excluding household type, child crowding was a protective factor, the OR being 0.68 (95% CI: 0.51, 0.90) for households with >2 children per household.

    Conclusions Bissau has a very high incidence of intrathoracic TB. Human immunodeficiency virus (HIV), increasing age, male sex, ethnicity, adult crowding, family structure, and poor housing conditions were independent risk factors for TB. Apart from HIV prevention, TB control programmes need to emphasize risk factors such as socioeconomic inequality, ethnic differences, crowding, and gender.

  • 18. Gómez-Olivé, F. Xavier
    et al.
    Montana, Livia
    Wagner, Ryan G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; INDEPTH Network, East Legon, Accra, Ghana.
    Kabudula, Chodziwadziwa W.
    Rohr, Julia K.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; INDEPTH Network, East Legon, Accra, Ghana.
    Bärnighausen, Till
    Collinson, Mark A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; INDEPTH Network, East Legon, Accra, Ghana.
    Canning, David
    Gaziano, Thomas
    Salomon, Joshua A.
    Payne, Collin F.
    Wade, Alisha
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa; INDEPTH Network, East Legon, Accra, Ghana.
    Berkman, Lisa
    Cohort Profile: Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 3, p. 689-690jArticle in journal (Refereed)
  • 19.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Cohort Profile: The Northern Swedish Cohort2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 6, p. 1545-1552Article in journal (Refereed)
  • 20. Hardell, Lennart
    et al.
    Carlberg, Michael
    Hansson Mild, Kjell
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Re-analysis of risk for glioma in relation to mobile telephone use: comparison with the results of the Interphone international case-control study2011In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 40, no 4, p. 1126-1128Article in journal (Refereed)
  • 21.
    Hassler, Sven
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Johansson, Robert
    Umeå University, Faculty of Medicine, Radiation Sciences, Oncology.
    Sjölander, Per
    Grönberg, Henrik
    Umeå University, Faculty of Medicine, Radiation Sciences, Oncology.
    Damber, Lena
    Umeå University, Faculty of Medicine, Radiation Sciences, Oncology.
    Causes of death in the Sami population of Sweden, 1961-20002005In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 34, no 3, p. 623-629Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Indigenous people often have a pattern of mortality that is disadvantageous in comparison with the general population. The knowledge on causes of death among the Sami, the natives of northern Scandinavia, is limited. The aim of the present study was to compare gender and cause specific mortality patterns for reindeer herding Sami, non-herding Sami, and non-Sami between 1961 and 2000. METHODS: A Sami cohort was constructed departing from a group of index-Sami identified as either reindeer herding Sami or Sami eligible to vote for the Sami parliament. Relatives of index-Sami were identified in the National Kinship Register and added to the cohort. The cohort contained a total of 41 721 people (7482 reindeer herding Sami and 34 239 non-herding Sami). A demographically matched non-Sami reference population four times as large, was compiled in the same way. Relative mortality risks were analysed by calculating standardized mortality ratios (SMRs). RESULTS: The differences in overall mortality and life expectancy of the Sami, both reindeer herding and non-herding, compared with the reference population were relatively small. However, Sami men showed significantly lower SMR for cancers but higher for external causes of injury. For Sami women, significantly higher SMR was found for diseases of the circulatory system and diseases of the respiratory system. An increased risk of dying from subarachnoid haemorrhage was observed among both Sami men and women. CONCLUSIONS: The similarities in mortality patterns are probably a result of centuries of close interaction between the Sami and the non-Sami, while the observed differences might be due to lifestyle, psychosocial and/or genetic factors.

  • 22.
    Hirve, Siddhivinayak
    et al.
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Juvekar, Sanjay
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Sambhudas, Somnath
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Lele, Pallavi
    Vadu Rural Health Program, KEM Hospital Research Centre, Pune, Maharashtra, India.
    Blomstedt, Yulia
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Berkman, Lisa
    3 Harvard Center for Population and Development Studies, Harvard University, Boston, MA, USA.
    Tollman, Steve
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance.2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 6, p. 1719-1727Article in journal (Refereed)
    Abstract [en]

    Background The Study on Global Ageing and Adult Health (SAGE) aims to improve empirical understanding of health and well-being of adults in developing countries. We examine the role of self-rated health (SRH) in predicting mortality and assess how socio-demographic and other disability measures influence this association.

    Methods In 2007, a shortened SAGE questionnaire was administered to 5087 adults aged >= 50 years under the Health Demographic Surveillance System in rural Pune district, India. Respondents rated their own health with a single global question on SRH. Disability and well-being were assessed using the WHO Disability Assessment Schedule Index, Health State Score and quality-of-life score. Respondents were followed up every 6 months till June 2011. Any change in spousal support, migration or death during follow-up was updated in the SAGE dataset.

    Results In all, 410 respondents (8%) died in the 3-year follow-up period. Mortality risk was higher with bad/very bad SRH [hazard ratio (HR) in men: 3.06, 95% confidence interval (CI): 1.93-4.87; HR in women: 1.64, 95% CI: 0.94-2.86], independent of age, disability and other covariates. Disability measure (WHO Disability Assessment Schedule Index) and absence of spousal support were also associated with increased mortality risk.

    Conclusion Our findings confirm an association between bad/very bad SRH and mortality for men, independent of age, socio-demographic factors and other disability measures, in a rural Indian population. This association loses significance in women when adjusted for disability. Our study highlights the strength of nesting cross-sectional surveys within the context of the Health Demographic Surveillance System in studying the role of SRH and mortality.

  • 23. Houle, Brian
    et al.
    Stein, Alan
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Madhavan, Sangeetha
    Collinson, Mark
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Clark, Samuel J.
    Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status2013In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 42, no 5, p. 1444-1454Article in journal (Refereed)
    Abstract [en]

    Background Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children's risk of dying in rural South Africa.

    Methods We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994-2008. Using discrete time event history analysis we estimate children's probability of dying by child characteristics and household composition (other children and adults other than parents) (N = 924 818 child-months), and household socio-economic status (N = 501 732 child-months).

    Results Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1-5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2-3.6), 3-5 months (OR 3.0; 95% CI 1.5-5.9), and 2 months (OR 11.8; 95% CI 7.6-18.3) before another household child dies. The odds of dying remain high at the time of another child's death (OR 11.7; 95% CI 6.3-21.7) and for the 2 months following (OR 4.0; 95% CI 1.9-8.6). Having a related but non-parent adult aged 20-59 years in the household reduces the odds (OR 0.6; 95% CI 0.5-0.8). There is an inverse relationship between a child's odds of dying and household socio-economic status.

    Conclusions This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas.

  • 24.
    Hurtig, Anna-Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Epidemiology on the side of the angels...Or the people?2003In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 32, no 4, p. 658-9; author reply 659Article in journal (Refereed)
  • 25.
    Hurtig, Anna-Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    San Sebastián, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Geographical differences in cancer incidence in the Amazon basin of Ecuador in relation to residence near oil fields.2002In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 31, no 5, p. 1021-7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Since 1972, oil companies have extracted more than 2 billion barrels of crude oil from the Ecuadorian Amazon, releasing billions of gallons of untreated wastes and oil directly into the environment. This study aimed to determine if there was any difference in overall and specific cancer incidence rates between populations living in proximity to oil fields and those who live in areas free from oil exploitation.

    METHODS: Cancer cases from the provinces of Sucumbios, Orellana, Napo and Pastaza during the period 1985-1998 were included in the study. The exposed population was defined as those living in a county (n = 4) where oil exploitation had been ongoing for a minimum of 20 years up to the date of the study. Non-exposed counties were identified as those (n = 11) without oil development activities. Relative risks (RR) along with 95% CI were calculated for men and women as ratios of the age-adjusted incidence rates in the exposed versus non-exposed group.

    RESULTS: The RR of all cancer sites combined was significantly elevated in both men and women in exposed counties. Significantly elevated RR were observed for cancers of the stomach, rectum, skin melanoma, soft tissue and kidney in men and for cancers of the cervix and lymph nodes in women. An increase in haematopoietic cancers was also observed in the population under 10 years in the exposed counties in both males and females.

    CONCLUSION: Study results are compatible with a relationship between cancer incidence and living in proximity to oil fields. An environmental monitoring and cancer surveillance system in the area is recommended.

  • 26.
    Högström, Gabriel
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Aerobic fitness in late adolescence and the risk of early death: a prospective cohort study of 1.3 million Swedish men2016In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 4, p. 1159-1168Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fitness level and obesity have been associated with death in older populations. We investigated the relationship between aerobic fitness in late adolescence and early death, and whether a high fitness level can compensate the risk of being obese.

    METHODS: The cohort comprised 1 317 713 Swedish men (mean age, 18 years) that conscripted between 1969 and 1996. Aerobic fitness was assessed by an electrically braked cycle test. All-cause and specific causes of death were tracked using national registers. Multivariable adjusted associations were tested using Cox regression models.

    RESULTS: During a mean follow-up period of 29 years, 44 301 subjects died. Individuals in the highest fifth of aerobic fitness were at lower risk of death from any cause [hazard ratio (HR), 0.49; 95% confidence interval (CI), 0.47-0.51] in comparison with individuals in the lowest fifth, with the strongest association seen for death related to alcohol and narcotics abuse (HR, 0.20; 95% CI, 0.15-0.26). Similar risks were found for weight-adjusted aerobic fitness. Aerobic fitness was associated with a reduced risk of death from any cause in normal-weight and overweight individuals, whereas the benefits were reduced in obese individuals (P < 0.001 for interaction). Furthermore, unfit normal-weight individuals had 30% lower risk of death from any cause (HR, 0.70; 95% CI, 0.53-0.92) than did fit obese individuals.

    CONCLUSIONS: Low aerobic fitness in late adolescence is associated with an increased risk of early death. Furthermore, the risk of early death was higher in fit obese individuals than in unfit normal-weight individuals.

  • 27. Jacquemin, Bénédicte
    et al.
    Sunyer, Jordi
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Occupational and Enviromental Medicine.
    Götschi, Thomas
    Bayer-Oglesby, Lucy
    Ackermann-Liebrich, Ursula
    de Marco, Roberto
    Heinrich, Joachim
    Jarvis, Deborah
    Torén, Kjell
    Künzli, Nino
    Annoyance due to air pollution in Europe.2007In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 36, no 4, p. 809-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Annoyance due to air pollution is a subjective score of air quality, which has been incorporated into the National Environmental monitoring of some countries. The objectives of this study are to describe the variations in annoyance due to air pollution in Europe and its individual and environmental determinants. METHODS: This study took place in the context of the European Community Respiratory Health Survey II (ECRHS II) that was conducted during 1999-2001. It included 25 centres in 12 countries and 7867 randomly selected adults from the general population. Annoyance due to air pollution was self-reported on an 11-point scale. Annual mean mass concentration of fine particles (PM(2.5)) and its sulphur (S) content were measured in 21 centres as a surrogate of urban air pollution. RESULTS: Forty-three per cent of participants reported moderate annoyance (1-5 on the scale) and 14% high annoyance (> or =6) with large differences across centres (2-40% of high annoyance). Participants in the Northern European countries reported less annoyance. Female gender, nocturnal dyspnoea, phlegm and rhinitis, self-reported car and heavy vehicle traffic in front of the home, high education, non-smoking and exposure to environmental tobacco smoke were associated with higher annoyance levels. At the centre level, adjusted means of annoyance scores were moderately associated with sulphur urban levels (slope 1.43 microg m(-3), standard error 0.40, r = 0.61). CONCLUSIONS: Annoyance due to air pollution is frequent in Europe. Individuals' annoyance may be a useful measure of perceived ambient quality and could be considered a complementary tool for health surveillance.

  • 28. Joubert, Jané
    et al.
    Bradshaw, Debbie
    Kabudula, Chodziwadziwa
    Rao, Chalapati
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Mee, Paul
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Lopez, Alan D.
    Vos, Theo
    Record-linkage comparison of verbal autopsy and routine civil registration death certification in rural north-east South Africa: 2006-092014In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, no 6, p. 1945-1958Article in journal (Refereed)
    Abstract [en]

    Background: South African civil registration (CR) provides a key data source for local health decision making, and informs the levels and causes of mortality in data-lacking sub-Saharan African countries. We linked mortality data from CR and the Agincourt Health and Socio-demographic Surveillance System (Agincourt HDSS) to examine the quality of rural CR data. Methods: Deterministic and probabilistic techniques were used to link death data from 2006 to 2009. Causes of death were aggregated into the WHO Mortality Tabulation List 1 and a locally relevant short list of 15 causes. The matching rate was compared with informant-reported death registration. Using the VA diagnoses as reference, misclassification patterns, sensitivity, positive predictive values and cause-specific mortality fractions (CSMFs) were calculated for the short list. Results: A matching rate of 61% [95% confidence interval (CI): 59.2 to 62.3] was attained, lower than the informant-reported registration rate of 85% (CI: 83.4 to 85.8). For the 2264 matched cases, cause agreement was 15% (kappa 0.1083, CI: 0.0995 to 0.1171) for the WHO list, and 23% (kappa 0.1631, CI: 0.1511 to 0.1751) for the short list. CSMFs were significantly different for all but four (tuberculosis, cerebrovascular disease, other heart disease, and ill-defined natural) of the 15 causes evaluated. Conclusion: Despite data limitations, it is feasible to link official CR and HDSS verbal autopsy data. Data linkage proved a promising method to provide empirical evidence about the quality and utility of rural CR mortality data. Agreement of individual causes of death was low but, at the population level, careful interpretation of the CR data can assist health prioritization and planning.

  • 29.
    Kahn, Kathleen
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Collinson, Mark A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Gomez-Olive, F. Xavier
    Mokoena, Obed
    Twine, Rhian
    Mee, Paul
    Afolabi, Sulaimon A.
    Clark, Benjamin D.
    Kabudula, Chodziwadziwa W.
    Khosa, Audrey
    Khoza, Simon
    Shabangu, Mildred G.
    Silaule, Bernard
    Tibane, Jeffrey B.
    Wagner, Ryan G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Garenne, Michel L.
    Clark, Samuel J.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Profile: Agincourt Health and Socio-demographic Surveillance System2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 4, p. 988-1001Article in journal (Refereed)
    Abstract [en]

    The Agincourt health and socio-demographic surveillance system (HDSS), located in rural northeast South Africa close to the Mozambique border, was established in 1992 to support district health systems development led by the post-apartheid ministry of health. The HDSS (90 000 people), based on an annual update of resident status and vital events, now supports multiple investigations into the causes and consequences of complex health, population and social transitions. Observational work includes cohorts focusing on different stages along the life course, evaluation of national policy at population, household and individual levels and examination of household responses to shocks and stresses and the resulting pathways influencing health and well-being. Trials target children and adolescents, including promoting psycho-social well-being, preventing HIV transmission and reducing metabolic disease risk. Efforts to enhance the research platform include using automated measurement techniques to estimate cause of death by verbal autopsy, full 'reconciliation' of in- and out-migrations, follow-up of migrants departing the study area, recording of extra-household social connections and linkage of individual HDSS records with those from sub-district clinics. Fostering effective collaborations (including INDEPTH multi-centre work in adult health and ageing and migration and urbanization), ensuring cross-site compatibility of common variables and optimizing public access to HDSS data are priorities.

  • 30.
    Karlsson, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Commentary: Metabolic syndrome as a result of shift work exposure?2009In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 38, no 3, p. 854-855Article in journal (Refereed)
  • 31.
    Khatun, Masuma
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    An epidemiological study of the influence of adolescence and early adulthood factors upon the social class inequity of musculuskeletal pain in young adults.2004In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 33, p. 1-8Article in journal (Refereed)
  • 32.
    Khatun, Masuma
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    The influence of factors identified in adolescence and early adulthood on social class inequities of musculoskeletal disorders at age 30: A prospective population-based cohort study2004In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 33, no 6, p. 1353-1360Article in journal (Refereed)
    Abstract [en]

    Background Social class inequities have been observed for most measures of health. A greater understanding of the relative importance of different explanations is required. In this prospective population-based cohort study we explored the contribution of factors, ascertained at different stages between adolescence and early adulthood, to social class inequities in musculoskeletal disorders (MSD) at age 30.

    Methods We used data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 and followed up to age 30. Using logistic regression models, we estimated the unadjusted odds ratios (OR) for MSD for blue-collar versus white-collar workers in men and women separately. We assessed the contribution of different factors identified between adolescence and early adulthood by comparing the unadjusted OR for social class differences with OR adjusted for these explanatory factors.

    Results We found significant class differences at age 30 with higher MSD among blue-collar workers (OR = 2.03 in men [95% CI: 1.42, 2.90] and 1.98 in women [95% CI: 1.29, 3.02]). After adjustment for explanatory factors, class differences decreased and were no longer significant, with OR of 1.20 in men (95% CI: 0.76, 1.95) and 1.18 in women (95% CI: 0.69, 2.03). School grades at age 16; being single and alcohol consumption at age 21; having children, restricted financial resources, physical activity, alcohol consumption, smoking, and working conditions at age 30 were important for men; parents' social class, school grade, smoking and physical activity at age 16; being single at age 21; and working conditions at age 30 were important for women.

    Conclusion The accumulation of adverse behavioural and social circumstances from adolescence to early adulthood may be an explanation for the class differences in MSD at age 30. Interventions aimed at reducing health inequities need to consider exploratory factors identified at early and later stages in life, also including structural determinants of health.

  • 33. Kitahara, Cari M
    et al.
    Wang, Sophia S
    Melin, Beatrice S
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wang, Zhaoming
    Braganza, Melissa
    Inskip, Peter D
    Albanes, Demetrius
    Andersson, Ulrika
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Beane Freeman, Laura E
    Buring, Julie E
    Carreón, Tania
    Feychting, Maria
    Gapstur, Susan M
    Gaziano, J Michael
    Giles, Graham G
    Hallmans, Goran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Hankinson, Susan E
    Henriksson, Roger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Hsing, Ann W
    Johansen, Christoffer
    Linet, Martha S
    McKean-Cowdin, Roberta
    Michaud, Dominique S
    Peters, Ulrike
    Purdue, Mark P
    Rothman, Nathaniel
    Ruder, Avima M
    Sesso, Howard D
    Severi, Gianluca
    Shu, Xiao-Ou
    Stevens, Victoria L
    Visvanathan, Kala
    Waters, Martha A
    White, Emily
    Wolk, Alicja
    Zeleniuch-Jacquotte, Anne
    Zheng, Wei
    Hoover, Robert
    Fraumeni, Joseph F
    Chatterjee, Nilanjan
    Yeager, Meredith
    Chanock, Stephen J
    Hartge, Patricia
    Rajaraman, Preetha
    Association between adult height, genetic susceptibility and risk of glioma.2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 4, p. 1075-1085Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Some, but not all, observational studies have suggested that taller stature is associated with a significant increased risk of glioma. In a pooled analysis of observational studies, we investigated the strength and consistency of this association, overall and for major sub-types, and investigated effect modification by genetic susceptibility to the disease. METHODS: We standardized and combined individual-level data on 1354 cases and 4734 control subjects from 13 prospective and 2 case-control studies. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for glioma and glioma sub-types were estimated using logistic regression models stratified by sex and adjusted for birth cohort and study. Pooled ORs were additionally estimated after stratifying the models according to seven recently identified glioma-related genetic variants. RESULTS: Among men, we found a positive association between height and glioma risk (≥190 vs 170-174 cm, pooled OR = 1.70, 95% CI: 1.11-2.61; P-trend = 0.01), which was slightly stronger after restricting to cases with glioblastoma (pooled OR = 1.99, 95% CI: 1.17-3.38; P-trend = 0.02). Among women, these associations were less clear (≥175 vs 160-164 cm, pooled OR for glioma = 1.06, 95% CI: 0.70-1.62; P-trend = 0.22; pooled OR for glioblastoma = 1.36, 95% CI: 0.77-2.39; P-trend = 0.04). In general, we did not observe evidence of effect modification by glioma-related genotypes on the association between height and glioma risk. CONCLUSION: An association of taller adult stature with glioma, particularly for men and stronger for glioblastoma, should be investigated further to clarify the role of environmental and genetic determinants of height in the etiology of this disease.

  • 34. Kowal, Paul
    et al.
    Chatterji, Somnath
    Naidoo, Nirmala
    Biritwum, Richard
    Fan, Wu
    Lopez Ridaura, Ruy
    Maximova, Tamara
    Arokiasamy, Perianayagam
    Phaswana-Mafuya, Nancy
    Williams, Sharon
    Snodgrass, J Josh
    Minicuci, Nadia
    D'Este, Catherine
    Peltzer, Karl
    Boerma, J Ties
    Yawson, A
    Mensah, G
    Yong, J
    Guo, Y
    Zheng, Y
    Parasuraman, P
    Lhungdim, H
    Sekher, TV
    Rosa, R
    Belov, VB
    Lushkina, NP
    Peltzer, K
    Makiwane, M
    Zuma, K
    Ramlagan, S
    Davids, A
    Mbelle, N
    Matseke, G
    Schneider, M
    Tabane, C
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kahn, Kathy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Juvekar, S
    Sankoh, O
    Debpuur, CY
    Nguyen, TK Chuc
    Gomez-Olive, FX
    Hakimi, M
    Hirve, Siddhivinayak
    Abdullah, S
    Hodgson, A
    Kyobutungi, C
    Egondi, T
    Mayombana, C
    Minh, HV
    Mwanyangala, MA
    Razzaque, A
    Wilopo, S
    Streatfield, PK
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Scholten, F
    Mugisha, J
    Seeley, J
    Kinyanda, E
    Nyirenda, M
    Mutevedzi, P
    Newell, M-L
    Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE)2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 6, p. 1639-1649Article in journal (Refereed)
    Abstract [en]

    Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organization's Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHO's SAGE website (www.who.int/healthinfo/systems/sage) and WHO's archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata).

  • 35. Larose, Tricia L.
    et al.
    Guida, Florence
    Fanidi, Anouar
    Langhammer, Arnulf
    Kveem, Kristian
    Stevens, Victoria L.
    Jacobs, Eric J.
    Smith-Warner, Stephanie A.
    Giovannucci, Edward
    Albanes, Demetrius
    Weinstein, Stephanie J.
    Freedman, Neal D.
    Prentice, Ross
    Pettinger, Mary
    Thomson, Cynthia A.
    Cai, Qiuyin
    Wu, Jie
    Blot, William J.
    Arslan, Alan A.
    Zeleniuch-Jacquotte, Anne
    Le Marchand, Loic
    Wilkens, Lynne R.
    Haiman, Christopher A.
    Zhang, Xuehong
    Stampfer, Meir J.
    Hodge, Allison M.
    Giles, Graham G.
    Severi, Gianluca
    Johansson, Mikael
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Wang, Renwei
    Yuan, Jian-Min
    Gao, Yu-Tang
    Koh, Woon-Puay
    Shu, Xiao-Ou
    Zheng, Wei
    Xiang, Yong-Bing
    Li, Honglan
    Lan, Qing
    Visvanathan, Kala
    Bolton, Judith Hoffman
    Ueland, Per Magne
    Midttun, Oivind
    Caporaso, Neil
    Purdue, Mark
    Sesso, Howard D.
    Buring, Julie E.
    Lee, I-Min
    Gaziano, J. Michael
    Manjer, Jonas
    Brunnstrom, Hans
    Brennan, Paul
    Johansson, Mattias
    Circulating cotinine concentrations and lung cancer risk in the Lung Cancer Cohort Consortium (LC3)2018In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 6, p. 1760-1771Article in journal (Refereed)
    Abstract [en]

    Background: Self-reported smoking is the principal measure used to assess lung cancer risk in epidemiological studies. We evaluated if circulating cotinine—a nicotine metabolite and biomarker of recent tobacco exposure—provides additional information on lung cancer risk.

    Methods: The study was conducted in the Lung Cancer Cohort Consortium (LC3) involving 20 prospective cohort studies. Pre-diagnostic serum cotinine concentrations were measured in one laboratory on 5364 lung cancer cases and 5364 individually matched controls. We used conditional logistic regression to evaluate the association between circulating cotinine and lung cancer, and assessed if cotinine provided additional risk-discriminative information compared with self-reported smoking (smoking status, smoking intensity, smoking duration), using receiver-operating characteristic (ROC) curve analysis.

    Results: We observed a strong positive association between cotinine and lung cancer risk for current smokers [odds ratio (OR ) per 500 nmol/L increase in cotinine (OR500): 1.39, 95% confidence interval (CI): 1.32–1.47]. Cotinine concentrations consistent with active smoking (≥115 nmol/L) were common in former smokers (cases: 14.6%; controls: 9.2%) and rare in never smokers (cases: 2.7%; controls: 0.8%). Former and never smokers with cotinine concentrations indicative of active smoking (≥115 nmol/L) also showed increased lung cancer risk. For current smokers, the risk-discriminative performance of cotinine combined with self-reported smoking (AUCintegrated: 0.69, 95% CI: 0.68–0.71) yielded a small improvement over self-reported smoking alone (AUCsmoke: 0.66, 95% CI: 0.64–0.68) (P = 1.5x10–9).

    Conclusions: Circulating cotinine concentrations are consistently associated with lung cancer risk for current smokers and provide additional risk-discriminative information compared with self-report smoking alone.

  • 36.
    Lindgren, Urban
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    de Luna, Xavier
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Data Resource Profile: Swedish Microdata Research from Childhood into Lifelong Health and Welfare (Umeå SIMSAM Lab)2016In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 4, p. 1075-1075gArticle in journal (Refereed)
  • 37. Martin-Ruiz, Carmen M
    et al.
    Baird, Duncan
    Roger, Laureline
    Boukamp, Petra
    Krunic, Damir
    Cawthon, Richard
    Dokter, Martin M
    Van Der Harst, Pim
    Bekaert, Sofie
    De Meyer, Tim
    Roos, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Svenson, Ulrika
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Codd, Veryan
    Samani, Nilesh J
    Mcglynn, Liane
    Shiels, Paul G
    Pooley, Karen A
    Dunning, Alison M
    Cooper, Rachel
    Wong, Andrew
    Kingston, Andrew
    Von Zglinicki, Thomas
    Is Southern blotting necessary to measure telomere length reproducibly?: Authors' Response to: Commentary: The reliability of telomere length measurements2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 5, p. 1686-1687Article in journal (Other academic)
  • 38. Martin-Ruiz, Carmen M
    et al.
    Baird, Duncan
    Roger, Laureline
    Boukamp, Petra
    Krunic, Damir
    Cawthon, Richard
    Dokter, Martin M
    van der Harst, Pim
    Bekaert, Sofie
    de Meyer, Tim
    Roos, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Svenson, Ulrika
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Codd, Veryan
    Samani, Nilesh J
    McGlynn, Liane
    Shiels, Paul G
    Pooley, Karen A
    Dunning, Alison M
    Cooper, Rachel
    Wong, Andrew
    Kingston, Andrew
    von Zglinicki, Thomas
    Reproducibility of telomere length assessment: an international collaborative study2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 5, p. 1673-1683Article in journal (Refereed)
    Abstract [en]

    Background: Telomere length is a putative biomarker of ageing, morbidity and mortality. Its application is hampered by lack of widely applicable reference ranges and uncertainty regarding the present limits of measurement reproducibility within and between laboratories. Methods: We instigated an international collaborative study of telomere length assessment: 10 different laboratories, employing 3 different techniques [Southern blotting, single telomere length analysis (STELA) and real-time quantitative PCR (qPCR)] performed two rounds of fully blinded measurements on 10 human DNA samples per round to enable unbiased assessment of intra- and inter-batch variation between laboratories and techniques. Results: Absolute results from different laboratories differed widely and could thus not be compared directly, but rankings of relative telomere lengths were highly correlated (correlation coefficients of 0.63-0.99). Intra-technique correlations were similar for Southern blotting and qPCR and were stronger than inter-technique ones. However, inter-laboratory coefficients of variation (CVs) averaged about 10% for Southern blotting and STELA and more than 20% for qPCR. This difference was compensated for by a higher dynamic range for the qPCR method as shown by equal variance after z-scoring. Technical variation per laboratory, measured as median of intra- and inter-batch CVs, ranged from 1.4% to 9.5%, with differences between laboratories only marginally significant (P = 0.06). Gel-based and PCR-based techniques were not different in accuracy. Conclusions: Intra- and inter-laboratory technical variation severely limits the usefulness of data pooling and excludes sharing of reference ranges between laboratories. We propose to establish a common set of physical telomere length standards to improve comparability of telomere length estimates between laboratories.

  • 39. Martin-Ruiz, Carmen M
    et al.
    Baird, Duncan
    Roger, Laureline
    Boukamp, Petra
    Krunic, Damir
    Cawthon, Richard
    Dokter, Martin M
    Van der Harst, Pim
    Bekaert, Sofie
    De Meyer, Tim
    Roos, Göran
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Svenson, Ulrika
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Codd, Veryan
    Samani, Nilesh J
    Mcglynn, Liane
    Shiels, Paul G
    Pooley, Karen A
    Dunning, Alison M
    Cooper, Rachel
    Wong, Andrew
    Kingston, Andrew
    Von Zglinicki, Thomas
    Reproducibility of telomere length assessment: Authors' Response to Damjan Krstajic and Ljubomir Buturovic2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 5, p. 1739-1741Article in journal (Refereed)
  • 40.
    Mogren, I
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Högberg, U
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Stegmayr, B
    Lindahl, B
    Stenlund, H
    Fetal exposure, heredity and risk indicators for cardiovascular disease in a Swedish welfare cohort.2001In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 30, no 4, p. 853-62Article in journal (Refereed)
    Abstract [en]

    Our interpretation is that the 'fetal origins' hypothesis' is valid for middle-age subjects who grow up in a welfare society. The population attributable proportions that result from different exposures to LBW were relatively small overall; from a public health perspective, heredity was more important than LBW for elevated SBP.

  • 41.
    Mogren, I
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Stenlund, H
    Högberg, U
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Recurrence of prolonged pregnancy.1999In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 28, no 2, p. 253-7Article in journal (Refereed)
    Abstract [en]

    Although moderate, prolonged pregnancy in mother may be a risk factor for prolonged pregnancy in daughter. A previous prolonged pregnancy increases the risk of prolonged pregnancy in a subsequent birth. However, the familial factor of prolonged pregnancy explains just a minor part of its occurrence in the population (due to small population attributable proportions).

  • 42.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    How is Health Affected by Unemployment?: A Review of Methodological Shortcomings2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, p. 278-278Article in journal (Other academic)
  • 43.
    Norström, Fredrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nordyke, Katrina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Carlsson, A.
    Hammarroth, S.
    Högberg, L.
    Stenhammar, L.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The Cost-Effectiveness of a Screening for Celiac Disease2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, p. 250-250Article in journal (Other academic)
  • 44. Reniers, Georges
    et al.
    Wamukoya, Marylene
    Urassa, Mark
    Nyaguara, Amek
    Nakiyingi-Miiro, Jessica
    Lutalo, Tom
    Hosegood, Vicky
    Gregson, Simon
    Gomez-Olive, Xavier
    Geubbels, Eveline
    Crampin, Amelia C.
    Wringe, Alison
    Waswa, Laban
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Todd, Jim
    Slaymaker, Emma
    Serwadda, David
    Price, Alison
    Oti, Samuel
    Nyirenda, Moffat J.
    Nabukalu, Dorean
    Nyamukapa, Constance
    Nalugoda, Fred
    Mugurungi, Owen
    Mtenga, Baltazar
    Mills, Lisa
    Michael, Denna
    McLean, Estelle
    McGrath, Nuala
    Martin, Emmanuel
    Marston, Milly
    Maquins, Sewe
    Levira, Francis
    Kyobutungi, Catherine
    Kwaro, Daniel
    Kasamba, Ivan
    Kanjala, Chifundo
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kabudula, Chodziwadziwa
    Herbst, Kobus
    Gareta, Dickman
    Eaton, Jeffrey W.
    Clark, Samuel J.
    Church, Kathryn
    Chihana, Menard
    Calvert, Clara
    Beguy, Donatien
    Asiki, Gershim
    Amri, Shamte
    Abdul, Ramadhani
    Zaba, Basia
    Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network)2016In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 45, no 1, p. 83-93Article in journal (Refereed)
  • 45. Rosenberg, Molly
    et al.
    Pettifor, Audrey
    Miller, William C.
    Thirumurthy, Harsha
    Emch, Michael
    Afolabi, Sulaimon A.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Collinson, Mark
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Tollman, Stephen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. University of the Witwatersrand, Johannesburg, South Africa ; INDEPTH Network, Accra, Ghana.
    Relationship between school dropout and teen pregnancy among rural South African young women2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 3, p. 928-936Article in journal (Refereed)
    Abstract [en]

    Background: Sexual activity may be less likely to occur during periods of school enrolment because of the structured and supervised environment provided, the education obtained and the safer peer networks encountered while enrolled. We examined whether school enrolment was associated with teen pregnancy in South Africa. Methods: Using longitudinal demographic surveillance data from the rural Agincourt sub-district, we reconstructed the school enrolment status from 2000 through 2011 for 15 457 young women aged 12-18 years and linked them to the estimated conception date for each pregnancy during this time. We examined the effect of time-varying school enrolment on teen pregnancy using a Cox proportional hazard model, adjusting for: age; calendar year; household socioeconomic status; household size; and gender, educational attainment and employment of household head. A secondary analysis compared the incidence of pregnancy among school enrolees by calendar time: school term vs school holiday. Results: School enrolment was associated with lower teen pregnancy rates [adjusted hazard ratio (95% confidence interval): 0.57 (0.50, 0.65)]. This association was robust to potential misclassification of school enrolment. For those enrolled in school, pregnancy occurred less commonly during school term than during school holidays [incidence rate ratio (95% confidence interval): 0.90 (0.78, 1.04)]. Conclusions: Young women who drop out of school may be at higher risk for teen pregnancy and could likely benefit from receipt of accessible and high quality sexual health services. Preventive interventions designed to keep young women in school or addressing the underlying causes of dropout may also help reduce the incidence of teen pregnancy.

  • 46. Sacerdote, Carlotta
    et al.
    Ricceri, Fulvio
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Baldi, Ileana
    Chirlaque, Maria-Dolores
    Feskens, Edith
    Bendinelli, Benedetta
    Ardanaz, Eva
    Arriola, Larraitz
    Balkau, Beverley
    Bergmann, Manuela
    Beulens, Joline W. J.
    Boeing, Heiner
    Clavel-Chapelon, Francoise
    Crowe, Francesca
    de Lauzon-Guillain, Blandine
    Forouhi, Nita
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gallo, Valentina
    Gonzalez, Carlos
    Halkjaer, Jytte
    Illner, Anne-Kathrin
    Kaaks, Rudolf
    Key, Timothy
    Khaw, Kay-Tee
    Navarro, Carmen
    Nilsson, Peter M.
    Dalton, Susanne Oksbjerg
    Overvad, Kim
    Pala, Valeria
    Palli, Domenico
    Panico, Salvatore
    Polidoro, Silvia
    Ramon Quiros, J.
    Romieu, Isabelle
    Sanchez, Maria-Jose
    Slimani, Nadia
    Sluijs, Ivonne
    Spijkerman, Annemieke
    Teucher, Birgit
    Tjonneland, Anne
    Tumino, Rosario
    van der A, Daphne
    Vergnaud, Anne-Claire
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sharp, Stephen
    Langenberg, Claudia
    Riboli, Elio
    Vineis, Paolo
    Wareham, Nicholas
    Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 4, p. 1162-1173Article in journal (Refereed)
    Abstract [en]

    Background Type 2 diabetes mellitus ( T2DM) is one of the most common chronic diseases worldwide. In high- income countries, low socioeconomic status seems to be related to a high incidence of T2DM, but very little is known about the intermediate factors of this relationship.

    Method We performed a case-cohort study in eight Western European countries nested in the EPIC study (n = 340 234, 3.99 million person-years of follow-up). A random sub-cohort of 16 835 individuals and a total of 12 403 incident cases of T2DM were identified. Crude and multivariate-adjusted hazard ratios (HR) were estimated for each country and pooled across countries using meta-analytical methods. Age-, gender- and country-specific relative indices of inequality (RII) were used as the measure of educational level and RII tertiles were analysed.

    Results Compared with participants with a high educational level (RII tertile 1), participants with a low educational level (RII tertile 3) had a higher risk of T2DM [HR: 1.77, 95% confidence interval (CI): 1.69-1.85; P-trend < 0.01]. The HRs adjusted for physical activity, smoking status and propensity score according to macronutrient intake were very similar to the crude HR (adjusted HR: 1.67, 95% CI: 1.52-1.83 in men; HR: 1.88, 95% CI: 1.73-2.05 in women). The HRs were attenuated only when they were further adjusted for BMI (BMI-adjusted HR: 1.36, 95% CI: 1.23-1.51 in men; HR: 1.32, 95% CI: 1.20-1.45 in women).

    Conclusion This study demonstrates the inequalities in the risk of T2DM in Western European countries, with an inverse relationship between educational level and risk of T2DM that is only partially explained by variations in BMI.

  • 47. Sankoh, Osman
    Why population-based data are crucial to achieving the Sustainable Development Goals.2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 1, p. 4-7Article in journal (Refereed)
  • 48. Sankoh, Osman
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The INDEPTH Network: filling vital gaps in global epidemiology2012In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, no 3, p. 579-588Article in journal (Other academic)
  • 49. Sera, Francesco
    et al.
    Armstrong, Ben
    Tobias, Aurelio
    Vicedo-Cabrera, Ana Maria
    Åström, Christofer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Bell, Michelle L
    Chen, Bing-Yu
    de Sousa Zanotti Stagliorio Coelho, Micheline
    Matus Correa, Patricia
    Cruz, Julio Cesar
    Dang, Tran Ngoc
    Hurtado-Diaz, Magali
    Do Van, Dung
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Guo, Yue Leon
    Guo, Yuming
    Hashizume, Masahiro
    Honda, Yasushi
    Iñiguez, Carmen
    Jaakkola, Jouni J K
    Kan, Haidong
    Kim, Ho
    Lavigne, Eric
    Michelozzi, Paola
    Ortega, Nicolas Valdes
    Osorio, Samuel
    Pascal, Mathilde
    Ragettli, Martina S
    Ryti, Niilo R I
    Saldiva, Paulo Hilario Nascimento
    Schwartz, Joel
    Scortichini, Matteo
    Seposo, Xerxes
    Tong, Shilu
    Zanobetti, Antonella
    Gasparrini, Antonio
    How urban characteristics affect vulnerability to heat and cold: a multi-country analysis2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 4, p. 1101-1112Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators.

    METHODS: We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities.

    RESULTS: Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat.

    CONCLUSIONS: This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.

  • 50.
    Shungin, Dmitry
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Skåne University Hospital, Lund University.
    Cornelis, Marilyn C.
    Divaris, Kimon
    Holtfreter, Birte
    Shaffer, John R.
    Yu, Yau-Hua
    Barros, Silvana P.
    Beck, James D.
    Biffar, Reiner
    Boerwinkle, Eric A.
    Crout, Richard J.
    Ganna, Andrea
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Biobank Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Hindy, George
    Hu, Frank B.
    Kraft, Peter
    McNeil, Daniel W.
    Melander, Olle
    Moss, Kevin L.
    North, Kari E.
    Orho-Melander, Marju
    Pedersen, Nancy L.
    Ridker, Paul M.
    Rimm, Eric B.
    Rose, Lynda M.
    Rukh, Gull
    Teumer, Alexander
    Weyant, Robert J.
    Chasman, Daniel I.
    Joshipura, Kaumudi
    Kocher, Thomas
    Magnusson, Patrik K. E.
    Marazita, Mary L.
    Nilsson, Peter
    Offenbacher, Steve
    Smith, George Davey
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Palmer, Tom M.
    Timpson, Nicholas J.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Skåne University Hospital, Lund University; Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
    Using genetics to test the causal relationship of total adiposity and periodontitis: Mendelian randomization analyses in the Gene-Lifestyle Interactions and Dental Endpoints (GLIDE) Consortium2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, no 2, p. 638-650Article in journal (Refereed)
    Abstract [en]

    Background: The observational relationship between obesity and periodontitis is widely known, yet causal evidence is lacking. Our objective was to investigate causal associations between periodontitis and body mass index (BMI). Methods: We performed Mendelian randomization analyses with BMI-associated loci combined in a genetic risk score (GRS) as the instrument for BMI. All analyses were conducted within the Gene-Lifestyle Interactions and Dental Endpoints (GLIDE) Consortium in 13 studies from Europe and the USA, including 49 066 participants with clinically assessed (seven studies, 42.1% of participants) and self-reported (six studies, 57.9% of participants) periodontitis and genotype data (17 672/31 394 with/without periodontitis); 68 761 participants with BMI and genotype data; and 57 871 participants (18 881/38 990 with/without periodontitis) with data on BMI and periodontitis. Results: In the observational meta-analysis of all participants, the pooled crude observational odds ratio (OR) for periodontitis was 1.13 [95% confidence interval (CI): 1.03, 1.24] per standard deviation increase of BMI. Controlling for potential confounders attenuated this estimate (OR = 1.08; 95% CI: 1.03, 1.12). For clinically assessed periodontitis, corresponding ORs were 1.25 (95% CI: 1.10, 1.42) and 1.13 (95% CI: 1.10, 1.17), respectively. In the genetic association meta-analysis, the OR for periodontitis was 1.01 (95% CI: 0.99, 1.03) per GRS unit (per one effect allele) in all participants and 1.00 (95% CI: 0.97, 1.03) in participants with clinically assessed periodontitis. The instrumental variable meta-analysis of all participants yielded an OR of 1.05 (95% CI: 0.80, 1.38) per BMI standard deviation, and 0.90 (95% CI: 0.56, 1.46) in participants with clinical data. Conclusions: Our study does not support total adiposity as a causal risk factor for periodontitis, as the point estimate is very close to the null in the causal inference analysis, with wide confidence intervals.

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