J Yarnell, S Yu, E McCrum, D Arveiler, B Hass, J Dallongeville, M Montaye, P Amouyel, J Ferrières, J-B Ruidavets, A Evans, A Bingham, and P Ducimetière for the PRIME study group.  Education, socioeconomic and lifestyle factors, and risk of coronary heart disease: The PRIME Study.  International Journal of Epidemiology 34(2):268-275, April 2005.

Summary: The contribution of socioeconomic factors to risk of coronary heart disease (CHD) was examined in a large cohort study in France and Northern Ireland. The subjects, 10,593 men aged 50–59 years, were examined between 1991 and 1994 in centers in Northern Ireland, Lille, Strasbourg, and Toulouse. Details on a number of socioeconomic indicators were obtained from the participants at the baseline examination. The men were also screened for evidence of CHD and followed annually by questionnaire for incident cases of CHD. Coronary events (coronary deaths, myocardial infarction, and angina) were documented by clinical records. Some evidence of CHD was seen in 842 men (8%) at screening. These men were more likely to be poorer, to be unemployed, or to have had less full-time education than men without CHD at screening in both countries. These relationships persisted after adjustment for all known risk factors for CHD. Among men who were initially free of CHD there were clear socioeconomic differentials (years of full-time education, unemployment, and educational level) in the distribution of several risk factors for CHD, notably smoking (which differs in France and Northern Ireland), systolic blood pressure, body mass index, and fibrinogen. No socioeconomic differences in total cholesterol were observed. Men with a shorter period of full-time education and men who were unemployed tended to be high consumers of alcohol. In this cohort of men free of CHD at baseline few socioeconomic indicators showed relationships with risk of CHD by 5 years of follow-up. Only years in full education, educational level achieved, and unemployment status when adjusted only for age and country showed significant relationships with CHD risk, but these became non-significant after adjustment for major CHD risk factors. In conclusion, socioeconomic differentials in long-term risk of CHD are apparent, particularly in men with evidence of CHD at baseline. Among men free of CHD at baseline there is strong evidence of socioeconomic differentials in cardiovascular risk factors, but these do not contribute independently to risk of CHD at 5 years of follow-up in this cohort of men from France and Northern Ireland. NIAAA Glossary Terms:  coronary artery disorder, risk analysis, risk factors, socioeconomic status, AOD consumption, heavy AOD use, educational level achieved, unemployment, smoking, blood pressure, body mass index, fibrinogen, cholesterol, incidence, mortality, myocardial infarction, angina pectoris, cohort study, follow-up study, longitudinal study, male, middle-aged adult, France, Northern Ireland, human study

Charlotte Lewden, Dominique Salmon, Philippe Morlat, Sibylle Bévilacqua, Eric Jougla, Fabrice Bonnet, Laurence Héripret, Dominique Costagliola, Thierry May, Geneviève Chêne, and the Mortality 2000 study group.  Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: Emerging role of hepatitis and cancers, persistent role of AIDS.  International Journal of Epidemiology 34(1):121-130, February 2005.

Summary: Mortality among persons infected with human immunodeficiency virus has decreased substantially among those with access to highly active antiretroviral therapy (HAART), but there are concerns about comorbidities and adverse effects of HAART, which may impair prognosis. The Mortality 2000 study examined the causes of death in HIV-infected adults in France. All French hospital wards known to be involved in the management of HIV infection were asked to report deaths as they occurred in 2000 among HIV-infected adults, using a standardized questionnaire to document the causes of death. The 185 participating wards reported 964 deaths, the main underlying causes of which were AIDS-related (non-Hodgkin's lymphoma, 23%; viral hepatitis, 11%; hepatitis C, 9%; hepatitis B, 2%); cancer not related to AIDS or hepatitis (11%); cardiovascular disease (7%); bacterial infections (6%); suicide (4%); and adverse effect of antiretroviral treatments (1%). Among AIDS-related deaths, HIV infection had been diagnosed recently in 20%. Smoking was recorded in 72% of cancer-related deaths and alcohol consumption in 54% of hepatitis-related deaths. Among non-HIV related deaths of those aged 25 to 64 years, the proportion of infectious diseases (including hepatitis C virus- and hepatitis B virus-related deaths) was higher in HIV-infected adults than in the general population. Improved strategies for detecting HIV infection before AIDS-defining complications occur are needed in the era of HAART. The prevention of non-AIDS related cancers, especially lung cancer, and the management of non-Hodgkin's lymphoma and viral hepatitis are also important priorities. NIAAA Glossary Terms:  human immunodeficiency virus, acquired immunodeficiency syndrome, retroviral disease, drug therapy, death, mortality, comorbidity, liver disorder, viral disease, hepatitis, hepatitis C virus, hepatitis B virus, HIV infection, lymph node, cancer, lung disorder, suicide, alcoholic beverage, AOD consumption, infection, smoking, prevention, patient care management, human study

Richard Doll, Richard Peto, Jillian Boreham, and Isabelle Sutherland.  Mortality in relation to alcohol consumption: A prospective study among male British doctors.  International Journal of Epidemiology 34(1):199-204, February 2005.

Summary: Data from a 23-year prospective study of 12,000 male British doctors aged 48–78 years in 1978, involving 7,000 deaths, were analyzed to study the relationship between alcohol consumption patterns and mortality. Questionnaires about drinking and smoking were completed in 1978 and again in 1989–91. Mortality analyses were standardized for age, follow-up duration, and smoking. During the last decade of the study (1991–2001) non-drinkers were subdivided into never-drinkers and ex-drinkers. In this elderly population, with mean alcohol consumption per drinker of 2 to 3 units a day, the causes of death that are already known to be augmentable by alcohol accounted for only 5% of the deaths (1% liver disease; 2% cancer of the mouth, pharynx, larynx, or esophagus; and 2% external causes of death) and were significantly elevated only among men consuming >2 units a day. Vascular disease and respiratory disease accounted for over half of all the deaths and both were significantly less common among current than among non-drinkers; hence, overall mortality was also significantly lower (relative risk [RR] = 0.81; confidence interval [CI], 0.76–0.87; p = 0.001). The non-drinkers, however, include the ex-drinkers, some of whom may have stopped recently because of illness, and during the last decade of the study (1991–2001) overall mortality was significantly higher in the few ex-drinkers who had been current drinkers in 1978 than in the never-drinkers or current drinkers. To avoid bias, these 239 ex-drinkers were considered together with the 6,271 current drinkers and compared with the 750 men who had been non-drinkers in both questionnaires. Even so, ischemic heart disease (RR = 0.72; CI, 0.58–0.88, p = 0.002), respiratory disease (RR = 0.69; CI, 0.52–0.92; p = 0.01), and all-cause (RR = 0.88;, CI, 0.79–0.98; p = 0.02) mortality were significantly lower than in the non-drinkers. The authors conclude that although some of the apparently protective effect of alcohol against disease is real, some of it is artefactual. NIAAA Glossary Terms:  AOD use pattern, AOD intake per occasion, AOD nonuse, AOD abstinence, mortality, prospective study, longitudinal study, questionnaire, alcoholic liver disorder, cancer, mouth, oral disorder, pharynx, larynx, esophageal disorder, myocardial ischemia, respiratory disorder, risk analysis, risk factors, relative risk, protective factors, protective drug effect, epidemiology, statistical estimation, human study

Masuma Khatun, Christina Ahlgren, and Anne Hammarström.  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 study.   International Journal of Epidemiology 33(6): 1353-1360, December 2004.

Summary: The contributions to social class inequities in musculoskeletal disorders (MSD) were assessed in a population-based prospective study using data from a cohort of 547 men and 497 women from a town in north Sweden. The participants were given a baseline examination at age 16 and followed to age 30. Logistic regression models were used to estimate the unadjusted odds ratios (ORs) for MSD for blue-collar versus white-collar workers in men and women separately. Significant class differences were found at age 30 with higher MSD among blue-collar workers (OR = 2.03 in men; 95% confidence interval [CI], 1.42-2.90 and OR = 1.98 in women; 95% CI, 1.29-3.02). Class differences decreased after adjustment for explanatory factors and were no longer significant (OR = 1.20 in men; 95% CI, 0.76-1.95 and OR = 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. In conclusion, the accumulation of adverse behavioral and social circumstances from adolescence to early adulthood may explain class differences in MSD at age 30. Implications for intervention are discussed. NIAAA Glossary Terms:  social class, musculoskeletal system, musculoskeletal and connective tissue disorder, sense of pain, neck, back (body region), risk factors, risk analysis, relative risk, age of AODU onset, alcoholic beverage, smoking, physical activity, income effect, academic performance, marital status, adolescence, adulthood, occupational status by degree of skill, gender differences, health related behavior, longitudinal study, prospective study, cohort study, human study

David Kriebel, Ariana Zeka, Ellen A Eisen, and David H Wegman.  Quantitative evaluation of the effects of uncontrolled confounding by alcohol and tobacco in occupational cancer studies.  International Journal of Epidemiology 33(5):1040-1045, October 2004.

Summary: The inferential power of occupational cohort studies can be limited by uncontrolled confounding by personal exposures such as smoking. The authors of this study demonstrate their refinement of an existing type of sensitivity analysis, indirect adjustment, for evaluating the potential magnitude of confounding by alcohol and tobacco. To illustrate the methods, they use results of a large retrospective cohort study of laryngeal cancer and exposure to metalworking fluids (MWF). Data on smoking and drinking habits representative of the study cohort were obtained from a sample of U.S. manufacturing workers from the 1977 National Health Interview Survey (NHIS). Socially determined differences and chance differences were assumed to affect the distribution of confounding factors between MWF exposure groups. Chance variation was investigated with Monte Carlo sampling from the NHIS survey distribution of smoking and drinking. An upper bound on systematic differences in smoking and drinking was set by assuming that differences between exposure groups within the same unionized blue collar workforce were highly unlikely to be larger than differences between blue and white collar manufacturing workers in the NHIS data. Under plausibly large differences in smoking and drinking habits among MWF exposure groups occurring by either mechanism, the exposure–risk association was unlikely to have been over- or under-estimated by as much as 20%. In conclusion, when comparing exposure groups within the same working population, it is unlikely that either systematic or chance differences in smoking and drinking habits will cause as much as a 20% change in the relative risk in large studies. While this study focused on an occupational exposure and laryngeal cancer, there are many situations in which epidemiologists are concerned that unmeasured ‘lifestyle factors’ may differ among exposure groups; it appears that the likely confounding effect of such differences will often be modest. NIAAA Glossary Terms:  AOD consumption, AOD use pattern, smoking, alcoholic beverage, tobacco in any form, confounding variable, occupational health and safety, toxic substances, carcinogens, blue collar worker, white collar worker, statistical estimation, interview, survey, retrospective study, cohort study, risk analysis, lifestyle, cancer, larynx, human study, epidemiology

Gerdur Run Gudlaugsdottir, Runar Vilhjalmsson, Gudrun Kristjansdottir, Rune Jacobsen, and Dan Meyrowitsch.  Violent behaviour among adolescents in Iceland: A national survey.  International Journal of Epidemiology 33(5):1046-1051, October 2004.

Summary: The prevalence of violent behavior and its correlates were assessed among 15–16 year old Icelandic schoolchildren, based on a  cross-sectional survey in 1997 among a random half of all Icelandic schoolchildren in that age group. The overall response rate was 91% (N = 3,872). In the present study, sociodemographic background, social support, negative life events, psychological distress, and substance use were considered in relation to violent behavior using logistic regression. The majority of the respondents reported having committed violence within the last year. Boys were more likely to use violence than girls (odds ratio [OR] = 5.6; 95% CI, 4.7-6.6). Respondents who had experienced 4 or more negative life events in the past year were more likely to use violence than respondents with no negative life events (OR = 3.0; 95% CI, 2.2-4.2). Smokers were more likely than non-smokers to use violence (OR = 1.7; 95% CI, 1.2-2.2), and adolescents who had used alcohol more than 20 times in their lifetime were more than twice as likely to commit violence compared with those who had never used alcohol (OR = 2.5; 95% CI, 1.8-3.4). It was concluded that rates of violent behavior among Icelandic schoolchildren were high. Gender, parental support, life stress, anger/aggression, and substance use were all significantly related to the perpetration of violent acts. NIAAA Glossary Terms:  adolescent, Iceland, violence, AOD use behavior, AODR violence, behavioral problem, risk factors, relative risk, underage drinking, smoking, prevalence, gender differences, parent-child relations, stress, anger, aggressive behavior, regression analysis, survey, demographic characteristics, social support, psychological stress, life circumstances, life events, cross-sectional study, human study, epidemiology

Philippe Lunetta, Gordon S Smith, Antti Penttilä, and Antti Sajantila.  Unintentional drowning in Finland 1970–2000: a population-based study.  International Journal of Epidemiology 33(5):1053-1063, October 2004.

Summary: This study assessed the true burden of drowning in Finland and factors related to the country's high rates. A descriptive, retrospective, population-based analysis of all deaths by drowning during 1970-2000 was carried out  among residents of all ages. Mortality and population data from Statistics Finland (SF) were used to determine age- and sex-specific drowning mortality rates using both nature- and cause-of-injury codes. Individual-level data from the death certificates were analyzed and cross-linked to a nationwide postmortem toxicology database. There were 9,279 unintentional drownings from 1970 to 2000 (mean: 299.3/year, SD 84.3, rate 6.1/100 000/year; male:female ratio = 8.6:1), accounting for 11.7% of all unintentional injury deaths. Drowning rates overall have decreased from 9.9/100,000/year in 1970–1972, to 4.5 in 1998–2000 (–2.7%/year; 95% CL: –3.0; –2.5). The most frequent activities related to drowning included boating (29.8%), falling (26.1%), swimming (25.0%), and activities on ice (12.4%). In non-boating-related drownings, 74.5% of males and 67.4% of females tested had a blood alcohol concentration (BAC) ≥50 mg/dl, while in boating-related drownings, the respective values were 78.1% and 71.4%. It was concluded that WHO statistics underestimate the true burden of drowning in Finland by up to 40-50%. Drowning rates and alcohol involvement in drowning are much higher than in other comparable developed countries. The authors recommend broad-based countermeasures to reduce alcohol use in water activities as part of any strategy to reduce drowning rates. NIAAA Glossary Terms:  drowning, Finland, mortality, risk factors, AODR accident mortality, boating, sailing, aquatic accident, accidental fall, BAC level, gender differences, trend, statistical data, retrospective study, database, autopsy, postmortem study, human study, epidemiology

Enrique Regidor, José R Banegas, Juan L Gutiérrez-Fisac, Vicente Domínguez, and Fernando Rodríguez-Artalejo.  Socioeconomic position in childhood and cardiovascular risk factors in older Spanish people.  International Journal of Epidemiology 33(4):723-730, August 2004.

Summary: The association between childhood social class and the prevalence of cardiovascular risk factors in old age was investigated in a cross-sectional study of 4,009 subjects representative of the Spanish non-institutionalized population aged 60 years or older, for whom information was available on father's occupation. The prevalences of hypertension, obesity, diabetes mellitus, physical inactivity, smoking, and alcohol intake were estimated. Belonging to a working social class in childhood was associated with increased hypertension, having ever smoked, and heavy drinking, independent of adult social class in men. No association was found between social class in childhood and the other cardiovascular risk factors in men. Belonging to a working social class in childhood was associated with increased general obesity, abdominal obesity, diabetes mellitus, and physical inactivity in women, but after adjustment for social class the size of the association for abdominal obesity and diabetes mellitus decreased and the statistical significance disappeared. The highest smoking prevalence was observed in women who were in social class I in childhood and the lowest in women who were in social class IV. In conclusion, the results show increased prevalence of some cardiovascular risk factors in men who belonged to a working social class in childhood, but they do not support the existing evidence about an association between adverse social circumstances in childhood and increased prevalence of cardiovascular risk factors in later life in women. NIAAA Glossary Terms:  risk factors, cardiovascular disorder, heavy AOD use, alcoholic beverage, smoking, prevalence, social class, socioeconomic status, childhood, elderly, Spain, blue collar worker, white collar worker, occupational status by degree of skill, hypertensive disorder, obesity, diabetes, physical activity, gender differences, human study, epidemiology

Gwenn Menvielle, Danièle Luce, Paquerette Goldberg, and Annette Leclerc.  Smoking, alcohol drinking, occupational exposures and social inequalities in hypopharyngeal and laryngeal cancer.  International Journal of Epidemiology 33(4):799-806, August 2004.

Summary: A hospital-based case-control study was carried out to determine the extent to which smoking, alcohol drinking, and occupational explosure, explain social inequalities in the risk of hypopharyngeal and laryngeal cancers. The study participants included 504 male cancer patients (105 with glottic, 80 with supraglottic, 97 with epilaryngeal, and 201 with hypopharyngeal cancers) and 242 male controls with non-respiratory cancers. Information about sociodemographic characteristics, detailed alcohol and tobacco consumption, educational level, and occupational history were collected. Odds ratios (OR) and their 95% confidence intervals (CI) were computed using logistic regressions. With control for age only, laryngeal and hypopharyngeal cancers were strongly associated with educational level (OR for low versus high level = 3.22, 95% CI, 2.01-5.18) and with all indicators based on occupation (OR for ever versus never manual worker = 2.54, 95% CI, 1.78-3.62). When adjusted for alcohol and tobacco consumption, the OR decreased, but remained significant for occupation (OR for ever manual worker = 1.91, 95% CI, 1.23-2.95). After further adjustment for occupational exposures, there were no longer any significant associations. Associations differed between subsites. It was concluded that social inequalities observed for these cancers are not totally explained by alcohol and tobacco consumption and that a a substantial proportion could be attributable to occupational exposures. NIAAA Glossary Terms:  cancer, pharynx, larynx, AOD consumption, alcoholic beverage, tobacco in any form, smoking, occupational status by degree of skill, socioeconomic differences, educational level achieved, risk factors, risk analysis, relative risk, odds ratio, case-control study, regression analysis, human study, epidemiology

Hye Soon Park, Sang Woo Oh, Sung-Il Cho, Woong Hwan Choi, and Young Soel Kim.  The metabolic syndrome and associated lifestyle factors among South Korean adults.  International Journal of Epidemiology 33(2):328-336, April 2004.

Summary: The prevalence of metabolic syndrome and its associated risk factors among South Koreans was estimated using data obtained from 20–79-year-old participants in the 1998 Korean National Health and Nutrition Examination Survey, a cross-sectional health survey of a nationally representative sample of non-institutionalized civilian South Koreans. The prevalence of metabolic syndrome, as defined by the Third Report of the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III), was determined, and lifestyle factors associated with predisposition to the metabolic syndrome were analyzed. The age-adjusted prevalence of metabolic syndrome among South Korean adults was 14.2% for men and 17.7% for women, whereas the age-adjusted prevalence of obesity (body mass index (BMI) >=30 kg/m2) was 1.7% for men and 3.0% for women. Age, unemployment, higher BMI, and current smoking were associated factors for metabolic syndrome regardless of gender. Odds of developing metabolic syndrome were decreased by moderate exercise (2–3 sessions/week) in men and light alcohol drinking (<15 g/day) in women. In conclusion, metabolic syndrome is present in more than 15% of South Koreans despite a low prevalence of obesity. Higher BMI and current smoking were identified as independent modifiable risk factors of the metabolic syndrome. Weight control and smoking cessation may therefore decrease the prevalence of metabolic syndrome in South Korean adults. NIAAA Glossary Terms:  metabolic syndrome, metabolic disorder, obesity, body mass index, nutrition, prevalence, South Korea, risk analysis, risk factors, alcoholic beverage, light AOD use, AOD abstinence, smoking, physical exercise, gender differences, cross-sectional study, survey, human study, epidemiology