Eur J Epidemiol
· 2025 Aug · PMID 40397354
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There is an unsettled concern that treatment with aromatase inhibitors (AIT) may adversely affect lipid-levels. In light of the improved survival of women with breast cancer and increased risk of atherosclerotic cardiova...There is an unsettled concern that treatment with aromatase inhibitors (AIT) may adversely affect lipid-levels. In light of the improved survival of women with breast cancer and increased risk of atherosclerotic cardiovascular disease in older people, unfavorable effects on lipid-levels may represent a significant health concern for this group of patients. We used linked data from nationwide registries, including a clinical breast cancer database with information about allocated and dispensed AIT. Based on these, we investigated changes in plasma lipid-levels (primary outcome: low-density lipoprotein (LDL)-cholesterol, secondary outcomes: high-density lipoprotein (HDL)-cholesterol, total cholesterol, and triglycerides) following AIT in a nationwide cohort of postmenopausal women with early breast cancer, Denmark, 2009-2020. Included women had at least one LDL-cholesterol measurement before and after breast cancer diagnosis. Exposure was allocated and dispensed AIT as compared with not allocated to and no dispensed AIT. Outcome was the adjusted difference in lipid-level-change (from before to after breast cancer diagnosis) according to AIT. Among 10,461 women, there were 22,693 pre-breast cancer LDL-cholesterol measurements and 42,750 post-breast cancer LDL-cholesterol measurements. Overall, 7919 of the women were exposed to AIT and 2542 women were unexposed. For AIT exposed, the LDL-cholesterol-change was - 0.16 mmol/L (mM), and for unexposed, - 0.15 mM, respectively. The corresponding adjusted difference in LDL-cholesterol change for AIT exposed versus unexposed was - 0.03 mM (95% CI - 0.07 to 0.003). We found similar results in analysis of secondary outcomes. This study does not support the concern that AIT adversely affects lipid-levels.
Baumkötter R, Yilmaz S, Chalabi J
… +15 more, Ten Cate V, Mamoor Alam AS, Golriz Khatami S, Zahn D, Hettich-Damm N, Prochaska JH, Schmidtmann I, Lehnert K, Steinmetz A, Dörr M, Pfeiffer N, Münzel T, Lackner KJ, Beutel ME, Wild PS
Eur J Epidemiol
· 2025 Jul · PMID 40387979
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The aim was to determine the profile of long-term symptoms after known and undetected SARS-CoV-2 infections and to generate tools for risk and diagnostic assessment of Post-COVID syndrome (PCS). In the population-based G...The aim was to determine the profile of long-term symptoms after known and undetected SARS-CoV-2 infections and to generate tools for risk and diagnostic assessment of Post-COVID syndrome (PCS). In the population-based Gutenberg COVID-19 Study (N = 10,250), sequential, systematic screening for SARS-CoV-2 was performed in 2020/2021. Individuals received a standardized interview on newly occurred or worsened symptoms since the infection or the pandemic. Robust Poisson regression models were fit to compare the frequency of symptoms between groups. Two scores were developed using machine learning techniques and prospectively validated in an independent cohort. Among n = 942 individuals, prevalence of long-term symptoms was 36.4% among individuals with known SARS-CoV-2 infection, 25.0% in those unknowingly infected, and 28.1% among the controls. Individuals with known infection more often reported smell (Prevalence ratio [PR] = 13.66 [95% confidence interval 4.99;37.41]) and taste disturbances (PR = 5.57 [2.62;11.81]), forgetfulness (PR = 2.88 [1.55;5.35]), concentration difficulties (PR = 2.83 [1.55;5.16], trouble with balance (PR = 2.74 [1.18;6.35]), and dyspnea (PR = 2.22 [1.18;4.19]) than controls. The risk score for predicting long-term sequelae based on symptoms during the acute infection had a cross-validated AUC of 0.74 and 0.72 when applied in an independent cohort (N = 6,570). The diagnostic score providing a probability of the presence of PCS had a cross-validated AUC of 0.66 and of 0.64 in the validation cohort (N = 3,176). Individuals with and without SARS-COV-2 infection reported persistent symptoms, but symptoms attributable to PCS were identified. The data-driven scores may help guide further diagnostic decisions in the initial management of PCS.
Ludvigsson JF, Bergman D, Lundgren CI
… +7 more, Sundquist K, Geijerstam JA, Glenngård AH, Lindh M, Sundström J, Kaarme J, Yao J
Eur J Epidemiol
· 2025 May · PMID 40383868
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The Swedish population is characterized by high life expectancy and low avoidable mortality rates. This review outlines the Swedish healthcare system, which offers universal access to all residents and has a long traditi...The Swedish population is characterized by high life expectancy and low avoidable mortality rates. This review outlines the Swedish healthcare system, which offers universal access to all residents and has a long tradition of reforms for social equity. Responsibility for healthcare is shared between the state, the regions, and the municipalities. The Ministry of Health and Social Affairs provides the overall healthcare framework; additionally, several governmental agencies are directly involved in healthcare and public health initiatives. The 21 regions organize, finance, and provide most primary, secondary, and tertiary care, as well as health information channels. Resources for primary care are less plentiful than in many other countries. The 290 municipalities deliver care to elderly people and those with functional impairment. The Swedish healthcare system is primarily tax-funded, with 86% of total healthcare expenditures from public expenses and < 1% from voluntary health insurance. The gross domestic product (GDP) share of healthcare expenditures, 10.5% in 2022, is above the EU average. The level of unmet needs in the population is low, due to universal coverage and caps on user charges except for dental care. Sweden's healthcare system performs well on care quality and patient satisfaction, but suffers from workforce shortage and care fragmentation. Limitations in care coordination can be attributed to a siloed digital infrastructure and care governance, a low number of hospital beds per capita, and a compensation system that often does not incentivize coordination. Despite these challenges, life expectancy is high and avoidable mortality rates are low in Sweden.
Ahrenfeldt J, Jespersen J, Lyngstrand JE
… +5 more, Iisager L, Keller AK, Fristrup N, Laurberg T, Lyskjær I
Eur J Epidemiol
· 2025 May · PMID 40366611
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Renal cell carcinoma (RCC) management has advanced due to increased imaging-based diagnoses and improved therapies for metastatic disease. This nationwide registry-based cohort study examines changes in the number of pri...Renal cell carcinoma (RCC) management has advanced due to increased imaging-based diagnoses and improved therapies for metastatic disease. This nationwide registry-based cohort study examines changes in the number of primary RCC cases, stage at diagnosis, prognosis during the past 30 years in Denmark, and how these are associated with sex and age. All Danish patients aged 18 and older diagnosed with primary RCC from 1992 to 2021 with no prior cancer history (except non-melanoma skin cancer) were included and followed from diagnosis until death or end of follow-up (31-12-2023). Statistical analyses included Pearson's χ2, Cramer's V, Wilcoxon rank-sum test, Kruskal-Wallis, competing risk regression, Cox proportional hazard regression, and Kaplan-Meier. 17,423 RCC patients were identified. Primary RCC cases increased from 2,244 in 1992-1996 to 3,947 in 2017-2021. In this period, the proportion of male patients increased from 59 to 72% (P < 0.001). Male patients were younger at diagnosis than female patients (median age 65 vs. 69 years, P < 0.001). Localized cancer cases increased from 44% (N = 983) in 1992-1996 to 70% (N = 2,766) in 2017-2021, while metastatic cases declined from 29% (N = 640) to 17% (N = 652). Median survival for metastatic RCC improved from 4.1 months in 1992-1996 to 13.3 months in 2017-2021. Over three decades, RCC incidence in Denmark has grown, particularly among men, largely due to localized disease, adding pressure on urological departments. The number of metastatic cases remained stable, but survival improved, reflecting advances in early detection and treatment.
Hoogendijk EO, van Schoor NM, Qi Y
… +15 more, Visser M, Swinkels JC, Broese van Groenou MI, Kok AAL, Holwerda TJ, Pasman HRW, Onwuteaka-Philipsen BD, Remmelzwaal S, van Ingen E, van Tilburg TG, van Haaster AC, van der Horst M, Poppelaars J, Deeg DJH, Huisman M
Eur J Epidemiol
· 2025 Jun · PMID 40366610
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The Longitudinal Aging Study Amsterdam (LASA) is an ongoing prospective cohort study of older adults in the Netherlands, with data on multiple domains of functioning available over a period of more than 30 years of follo...The Longitudinal Aging Study Amsterdam (LASA) is an ongoing prospective cohort study of older adults in the Netherlands, with data on multiple domains of functioning available over a period of more than 30 years of follow-up. The study started in 1992 with a nationally representative sample of older adults aged 55-84 years. Over the years, three refresher cohorts (two cohorts aged 55-64 years in 2002 and in 2012, and one cohort aged 60-86 years in 2024) were added. The main aim of LASA was to describe determinants, trajectories and consequences of (changes in) physical, cognitive, emotional and social functioning. LASA has multiple strengths, including its multidisciplinary character, the very long period of follow-up, and the cohort-sequential design which enables the study of longitudinal changes as well as historical time trends in functioning. So far, findings based on data from LASA have been reported in more than 800 scientific publications (see www.lasa-vu.nl ). In this article, we provide an update of the design and methods of LASA, including a description of several ancillary studies such as the Loneliness study and the COVID-19 study.
Mou Y, Kusters MSW, Robinson O
… +17 more, Maitre L, McEachan RRC, Yuan WL, Hjertager Krog N, Andrušaitytė S, Bustamante M, de Castro Pascual M, Dedele A, Wright J, Grazuleviciene R, Aasvang GM, Lepeule J, Nieuwenhuijsen M, Tiemeier H, Vrijheid M, Thomson EM, Guxens M
Eur J Epidemiol
· 2025 May · PMID 40366609
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Emerging evidence suggests that exposure to air pollutants and road traffic noise triggers stress responses, which mediate physiological responses in multiple organs and tissues. However, epidemiological study in childre...Emerging evidence suggests that exposure to air pollutants and road traffic noise triggers stress responses, which mediate physiological responses in multiple organs and tissues. However, epidemiological study in children is sparse. We aimed to evaluate whether outdoor air pollution and road traffic noise are associated with physiological response measured by allostatic load in children. We studied 919 children aged 6-11 years from the HELIX (Human Early Life Exposome) cohort in 6 European countries with 19 biomarkers assessed in four physiological systems-cardiovascular, metabolic, immune/inflammation, and neuroendocrine systems. We then calculated both count-based and continuous scores for each physiological system and generated allostatic load scores (range 0-19). Exposure to air pollution (NO, PM, PM, PMabsorbance) and road traffic noise (L) based on participants' home, school, and commuting route addresses were estimated for the year prior to outcome assessment. Higher exposure to all air pollutants was associated with a higher allostatic load, although only the association of PM survived correction for multiple testing (for count-based allostatic load score: RR = 1.27, 95%CI: 1.08, 1.48; for continuous allostatic load score: β = 0.56, 95% CI: 0.27-0.84, per each 10 µg/m increase in PM). Examining physiological systems separately, higher exposure to air pollution was mainly associated with higher allostatic load in the immune/inflammatory and metabolic systems. No associations between road traffic noise and allostatic load were observed. Our findings suggest that air pollution act as a chronic stressor in manifesting multi-systemic physiological dysregulation in childhood, which may be a precursor of air pollution-related diseases.
Carlsson LM, Peltonen M, Jacobson P
… +13 more, Andersson-Assarsson JC, Svensson PA, Taube M, Karlsson C, Ahlin S, Kristensson FM, Perkins R, Arnetorp I, Carlsson A, Admeus L, Langegård E, Carlsson B, Sjöholm K
Eur J Epidemiol
· 2025 Jul · PMID 40353980
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Some studies of obesity treatments use control groups identified from real-world registers, which may differ from people with obesity in the general population. We evaluated whether such control groups affect the results...Some studies of obesity treatments use control groups identified from real-world registers, which may differ from people with obesity in the general population. We evaluated whether such control groups affect the results. The SOS study examines long-term mortality post-bariatric surgery. Among volunteers with obesity, 2,007 individuals underwent surgery, while a control group of 2,040 individuals was matched using 18 variables. Age was 37-60 years and BMI was ≥ 34/≥38 kg/m for men and women, respectively. We subdivided the control group into those with an obesity diagnosis (n = 177) and those without an obesity diagnosis (n = 1,863) in the Swedish National Patient Register prior to study inclusion. Mortality was determined over a median follow-up period of 26 years. The controls with a prior obesity diagnosis had a higher mortality rate than the controls without a prior obesity diagnosis, with 19.7 (95% CI, 15.5-25.1) and 14.4 (95% CI, 13.3-15.7) deaths per 1000 person-years, respectively. This corresponds to a hazard ratio of 1.45 (95% CI, 1.12-1.89; p = 0.005) and a 3.4-year shorter life expectancy. These results were confirmed in another cohort (n = 2,759, HR = 1.82 [95% CI, 1.47-2.25; p<0.001] and a 6.1-year shorter life expectancy). Controls with obesity identified from real-world datasets may be in poorer health than those who voluntarily participate in clinical studies. Consequently, selection bias could lead to an overestimation of the survival benefits of obesity treatments in research using controls identified by prior obesity diagnosis.
Simojoki M, Kaartinen NE, Maukonen M
… +8 more, Harald K, Tapanainen H, Albanes D, Eriksson JG, Jousilahti P, Koskinen S, Pajari AM, Männistö S
Eur J Epidemiol
· 2025 May · PMID 40353979
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A shift towards more plant-based diets may promote human and planetary health. This modelling study aimed to assess the impact of moderate partial substitution of red or processed meat with plant-based foods on cardiovas...A shift towards more plant-based diets may promote human and planetary health. This modelling study aimed to assess the impact of moderate partial substitution of red or processed meat with plant-based foods on cardiovascular disease (CVD) risk. We used pooled data from five Finnish cohorts (42,868 participants aged ≥ 25 years, 78% men). Median follow-up time was 12.7 years, with 11,031 incident CVD cases. Diet was assessed by a validated food frequency questionnaire. We modelled substitutions of red meat (100 g/week) or processed meat (50 g/week) with corresponding amounts of plant-based foods. Cohort-specific hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards multivariate models adjusted for relevant confounding factors and pooled together using a random effects model. There was a suggestive reduction in CVD risk in men when processed meat was substituted with vegetables or the combination of plant-based foods (HR 0.99, 95% CI 0.99-1.00, P < 0.05). In women, there was an increase in CVD risk when red meat was substituted with legumes (HR 1.10, 95% CI 1.01-1.20, P < 0.05). However, when all cohorts were followed for the same length of time (7.9 years), several plant-based foods reduced CVD risk and none of them increased the risk when partially replacing red or processed meat. Even a small, easily implemented change towards a more plant-based diet may contribute to cardiovascular health at the population level. These findings support global strategies towards healthy and environmentally sustainable diets.
Hernáez Á, Camps-Vilaró A, Polo-Alonso S
… +84 more, Subirana I, Ramos R, de Cid R, Rodríguez-Artalejo F, Elosua R, Chirlaque MD, Amiano P, Bermúdez-López M, Guevara M, Cinza-Sanjurjo S, Sánchez MJ, de León AC, Laclaustra M, Rojo-Martínez G, Guembe-Suescun MJ, Pérez-Gómez B, Vega-Alonso T, Torán-Monserrat P, Lora-Pablos D, Huerta JM, Valdivielso JM, Dégano IR, Félix-Redondo FJ, Gandarillas AM, Valdés S, Mundet-Tuduri X, Sánchez PL, Martín-Sánchez V, Rigo F, Alonso-Sampedro M, Moreno-Iribas C, Martín-Escudero JC, Delgado E, Grau M, Urrutia I, Ovejero D, Quintela I, Martí-Lluch R, Blay N, Banegas JR, Tizón-Marcos H, Gómez JH, Aizpurua A, Castro-Boqué E, Delfrade J, Prieto-Díaz MÁ, Rodríguez-Barranco M, Almeida-González D, Moreno-Franco B, Oualla-Bachiri W, Sayón-Orea C, Plans-Beriso E, Lozano JE, López-Lifante VM, Cancelas-Navia P, Cabrera-Castro N, Cambray S, Zacarías-Pons L, Fernández-Bergés D, Donoso-Navarro E, Maldonado-Araque C, Franch-Nadal J, Dorado-Díaz PI, Villarín-Castro A, Frontera-Juan G, Gude F, Andueza N, Téllez-Plaza M, Ares-Blanco J, Cruz R, Ribas-Aulinas M, Barretina J, Guallar-Castillón P, Caínzos-Achirica M, Colorado-Yohar SM, Llorente A, Diaz-Tocados JM, Ardanaz E, Micó-Pérez RM, Fernandez-Martinez NF, Del Cristo Rodríguez-Pérez M, Cenarro A, Calle-Pascual AL, Marrugat J
Eur J Epidemiol
· 2025 May · PMID 40353978
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The CORDELIA Study (Collaborative Cohorts Reassembled Data to Study Mechanisms and Long-term Incidence of Chronic Diseases) combines 35 Spanish population cohorts to investigate the clinical, environmental, genetic, and...The CORDELIA Study (Collaborative Cohorts Reassembled Data to Study Mechanisms and Long-term Incidence of Chronic Diseases) combines 35 Spanish population cohorts to investigate the clinical, environmental, genetic, and omics determinants of cardiovascular disease in the Southern European population. It aims to conduct the largest genome-wide association study to date on cardiovascular disease in this population, improve predictions of cardiovascular incidence using genomic and clinical data, and identify subgroups that would benefit most from targeted pharmacological and lifestyle interventions. CORDELIA includes 196,632 individuals (ages 18-84, 54% female, 96% born in Spain, 20% with higher education, recruited from 1989 to 2020, with follow-up periods ranging from 5 to 30 years), with DNA samples available for 117,342 participants (60%). Of the participants, 24% were current smokers, 43% hypertensive, 11% diabetic, 15% medicated with lipid-lowering drugs, 44% overweight, and 27% obese. If not already available, genotyping is being performed using the Axiom™ Spain Biobank array (~ 750,000 variants, including 115,000 specific and 50,000 rare functional variants from the Spanish population). The cohort also includes incident events (coronary heart disease, stroke, heart failure, peripheral artery disease, hypertension, diabetes); date and cause of death; and harmonized data on risk factors (body mass index, waist circumference, lipid profile, blood pressure, glucose, creatinine), lifestyle (smoking, physical activity, diet, alcohol), and socioeconomic status. 99,019 participants (50%) also provide plasma samples. CORDELIA will significantly contribute to understanding the complex interplay of risk factors contributing to cardiovascular disease and advance the fields of precision medicine and public health in Southern European individuals.
Corsi DJ, Morris TT, Reed ZE
… +1 more, Davey Smith G
Eur J Epidemiol
· 2025 May · PMID 40353977
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Maternal cannabis use in pregnancy is reported to be associated with perinatal and neurodevelopmental outcomes in offspring. Such associations, however, may be biased by residual confounding by socioeconomic position (SE...Maternal cannabis use in pregnancy is reported to be associated with perinatal and neurodevelopmental outcomes in offspring. Such associations, however, may be biased by residual confounding by socioeconomic position (SEP). To assess confounding, we use paternal cannabis use in pregnancy as a negative control exposure. We use data from 15,013 mother-father-child trios from the ALSPAC birth cohort, with participants initially recruited between 1990 and 1992. Exposures were maternal and paternal cannabis use during pregnancy. Neonatal anthropometry, perinatal, cognitive, and neurodevelopmental outcomes were modelled as a function of maternal and paternal cannabis use in pregnancy, adjusting for household-level SEP markers and maternal and paternal tobacco, alcohol, and drug use in pregnancy. We compared the strength of the association between maternal and paternal cannabis on outcomes using Wald tests. 5 and 13% of mothers and fathers reported cannabis use, which was inversely related to measures of SEP. Maternal cannabis use during pregnancy was associated with decreased infant birth weight (b = - 110.2 g, 95% CI - 185.1 to - 35.3 for any cannabis use) and length (b = - 0.45 cm, 95% CI - 0.84 to - 0.07). Maternal cannabis during pregnancy was also associated with neonatal special care admission (odds ratio 1.64, 95% CI 1.05 to 2.56) and lower education achievement scores at age 16 (b = - 19.2, 95% CI - 32.0 to - 6.3). Maternal cannabis use in pregnancy was modestly associated with perinatal outcomes and markers of cognitive development. However, most associations were attenuated after controlling for potential confounders, including SEP, and associations were not quantitatively different from paternal cannabis use. The association of maternal cannabis use in pregnancy with perinatal or cognitive outcomes in offspring may be driven by residual confounding, including SEP, rather than causal biological effects.
Kowall B, Ahrenfeldt LJ, Basten J
… +27 more, Becher H, Brand T, Braun J, Casjens S, Claessen H, Denz R, Diebner HH, Diexer S, Eisemann N, Furrer E, Galetzka W, Girschik C, Karch A, Mikolajczyk R, Peters M, Rospleszcz S, Rücker V, Stang A, Stolpe S, Taylor KJ, Timmesfeld N, Tokic M, Zeeb H, Berg-Beckhoff G, Behrens T, Ittermann T, Rübsamen N
Eur J Epidemiol
· 2025 May · PMID 40323573
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In multi-analyst studies, several analysts use the same data to independently investigate identical research questions. Multi-analyst studies have been conducted mainly in psychology, social sciences, and neuroscience, b...In multi-analyst studies, several analysts use the same data to independently investigate identical research questions. Multi-analyst studies have been conducted mainly in psychology, social sciences, and neuroscience, but rarely in epidemiology. Sixteen analyst groups (24 researchers) with backgrounds mainly in statistics, mathematics, and epidemiology were asked to independently perform an analysis on the influence of marital status (never married versus cohabiting married) on cardiovascular outcomes. They were asked to use data from the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study of 140,000 persons aged 50 years and above from 28 European countries and Israel, and to provide an effect estimate, a comment on their results, and the full syntax of their analyses. In additional analyses beyond the multi-analyst approach, one group selected an exemplary regression model and varied definitions of exposure and outcome and the confounder adjustment set. Each analysis was unique. The size of the 16 datasets used for the analyses ranged from 15,592 to 336,914 observations. The effect estimates (odds ratios, hazard ratios, or relative risks) ranged from 0.72 to 1.02 (reference: cohabiting married) in strictly or partly cross-sectional analyses and from 0.95 to 1.31 in strictly longitudinal analyses. The choice of regression models, adjustment sets for confounding, and variations in the precise definition of exposure and outcome, all had only small effects on the effect estimates. The range of results was mainly due to differences from cross-sectional versus longitudinal analyses rather than to single analytical decisions each of which had less influence.
Ferguson EL, Zimmerman SC, Jiang C
… +12 more, Choi M, Meyers TJ, Hoffmann TJ, Gilsanz P, Wang J, Oni-Orisan A, Whitmer RA, Risch N, Krauss RM, Patel CJ, Schaefer CA, Glymour MM
Eur J Epidemiol
· 2025 Apr · PMID 40317408
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Mixed evidence on how statins affect dementia risk may reflect variability in model specifications. Alternate specifications are rarely systematically compared. Using an emulated trial design framework, we investigated v...Mixed evidence on how statins affect dementia risk may reflect variability in model specifications. Alternate specifications are rarely systematically compared. Using an emulated trial design framework, we investigated variation in the estimated effect of statin initiation on dementia across alternative (1) eligibility criteria, (2) confounding variable sets, and (3) outcome definitions. Kaiser Permanente Northern California members' linked electronic health records from 1996 to 2020 were used to identify statin initiation and dementia diagnoses. Statin initiators were matched on age and low-density lipoprotein cholesterol with up to 5 non-initiators. Possible covariates included clinical (n = 1.4 million); socioeconomic and behavioral (n = 265,224); and genetic (n = 69,573) variables. Using Cox proportional-hazards models, we estimated variation across 1.27 million intent-to-treat estimates for statin initiation varying specification of eligibility, outcome definition, and covariates. Estimated hazard ratios (HRs) for statin initiation on dementia across all specifications ranged from 0.93 to 1.47. The variance of estimates due to model specification differences was 7.6 times larger than the average variance of specific estimates due to finite sample size. Three modeling decisions notably attenuated coefficients [ln(HR)]: requiring a run-in period prior to the emulated trial start date (0.034); adjustment for diabetes (0.030) and cardiovascular disease (0.039); and excluding the first year of follow-up (0.041). HRs from models with all three specifications ranged from 0.99 to 1.15. No specification we evaluated consistently generated protective effects. Estimates of the association between statin initiation and dementia leveraging real world data are sensitive to model specification, especially decisions related to clinical covariates and time-at-risk.
Liljedahl ER, Engfeldt M, Nielsen K
… +2 more, Jöud A, Nielsen C
Eur J Epidemiol
· 2025 Apr · PMID 40278967
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The prevalence of tattoos in western countries is about 20%. Tattoo ink may contain carcinogenic compounds. The aim of this study was to investigate if tattoo exposure is associated with an increased risk of cutaneous sq...The prevalence of tattoos in western countries is about 20%. Tattoo ink may contain carcinogenic compounds. The aim of this study was to investigate if tattoo exposure is associated with an increased risk of cutaneous squamous cell carcinoma in individuals. In this population-based case-control study, 2857 cases aged 20 to 60 years, diagnosed between 2014 and 2017, were identified in the Swedish Cancer Registry. Statistics Sweden identified 3 random age- and sex-matched controls per case from the Swedish Total Population Register using incidence-density sampling. In 2019, participants answered a questionnaire regarding lifestyle factors, including tattoos and sun habits. We used logistic regression to investigate if tattoo exposure was associated with the relative risk of cutaneous squamous cell carcinoma. 61% of the cases and 53% of the controls replied to the questionnaire. Among the 1600 cases and the 4551 controls that participated, 15.1% and 17.6% had at least one tattoo before the index date. We found no increased risk of cutaneous squamous cell carcinoma in tattooed compared with non-tattooed individuals (incidence rate ratio, 0.95; 95% confidence interval, 0.78-1.15). Tattoo exposure was not associated with the risk of cutaneous squamous cell carcinoma in this first study of the association. However, more epidemiologic studies are needed before consensus regarding a lack of association can be reached.
We recently reported per-protocol estimates of colonoscopy screening on colorectal cancer incidence and mortality in NordICC, a large-scale randomized trial. Our results may be affected by residual confounding due to lac...We recently reported per-protocol estimates of colonoscopy screening on colorectal cancer incidence and mortality in NordICC, a large-scale randomized trial. Our results may be affected by residual confounding due to lack of detailed information on confounders. Here, we supplement our per-protocol analyses with instrumental variable (IV) estimates whose validity relies on an alternate set of assumptions but does not depend on the availability of confounder data. Individuals in the NordICC trial were randomized at a 1:2 ratio to receive either an invitation to a one-time screening colonoscopy (the invited group) or no invitation (the usual-care group). We used IV analyses to estimate bounds and point estimates of per-protocol effects of colonoscopy screening on colorectal cancer incidence and mortality after 10 years follow-up. Analyses included 28,220 participants in the invited group and 56,365 participants in the usual-care group. Participation in screening was 42%. In IV per-protocol analyses, the 10-year risk of colorectal cancer was 1.13% (95% confidence interval [CI]: 1.04, 1.23) with usual care and, depending on the assumptions, 0.66% (95% CI: 035, 0.95) to 0.74% (95% CI: 0.57, 0.95) in screened individuals (risk ratio of 0.59 [95% CI: 0.30, 0.98] to 0.65 [95% CI: 0.48, 0.87]). The risk of colorectal cancer mortality at 10 years was 0.29% (95% CI: 0.24, 0.33) in the usual-care group and 0.20 (95% CI: 0.09, 0.73) to 0.22% (95% CI: 0.08, 0.37) in the screened group (risk ratio of 0.71 [95% CI: 0.31, 2.89] to 0.79 [95% CI: 0.24, 1.42]). IV estimation of per-protocol effects suggests that colonoscopy screening reduces colorectal cancer incidence by 35 to 41% after 10 years.
Rach S, Sand M, Reineke A
… +39 more, Becher H, Greiser KH, Wolf K, Wirkner K, Schmidt CO, Schipf S, Jöckel KH, Krist L, Ahrens W, Brenner H, Castell S, Gastell S, Harth V, Holleczek B, Ittermann T, Janisch-Fabian S, Karch A, Keil T, Klett-Tammen CJ, Kluttig A, Kuß O, Leitzmann M, Lieb W, Meinke-Franze C, Michels KB, Mikolajczyk R, Moreno Velásquez I, Obi N, Övermöhle C, Peters A, Pischon T, Rospleszcz S, Schmidt B, Schulze MB, Stang A, Teismann H, Töpfer C, Wolff R, Günther K
Eur J Epidemiol
· 2025 Apr · PMID 40259125
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The German National Cohort (NAKO) is the largest population-based epidemiologic cohort study in Germany and investigates the causes of the most common chronic diseases. Between 2014 and 2019, a total of 1.3 million resid...The German National Cohort (NAKO) is the largest population-based epidemiologic cohort study in Germany and investigates the causes of the most common chronic diseases. Between 2014 and 2019, a total of 1.3 million residents aged 20-69 years from 16 German regions were randomly selected from the general population and invited to participate following a highly standardized recruitment protocol. The overall response was 15.6% and differed considerably across study centers (7.6-30.7%). Females were more likely to participate than males (17.5% vs. 14.1%) and participation increased with age (10.2% in age group " < 29 years" up to 20.7% in age group " > 60 years"). Across all study regions, response was highest in rural areas (22.3%), followed by towns and suburbs (17.2%), and was lowest in cities (14.5%). Compared with the general population in the respective study regions, participants with low and medium education are underrepresented in the NAKO sample, while highly educated participants are overrepresented. Participants with non-German nationality and with a migration background are also underrepresented. Participants living in single households are underrepresented, while participants from larger households (2 or more persons) are overrepresented compared to the general population. Survey weights are made available to researchers along with the study data that account for the sampling design and adjust for differences in the distribution of age, sex, nationality (German vs. non-German), migration status, education, and household size.
Manke-Reimers F, Brugger V, Bärnighausen T
… +1 more, Kohler S
Eur J Epidemiol
· 2025 Mar · PMID 40249515
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Transportability methods can improve the external validity of estimated effects by accounting for effect heterogeneity due to differently distributed covariates between populations. This scoping review aims to provide an...Transportability methods can improve the external validity of estimated effects by accounting for effect heterogeneity due to differently distributed covariates between populations. This scoping review aims to provide an overview of when, why and how transportability methods have been applied. We systematically searched MEDLINE (Ovid), Embase, Web of Science, EconLit and Google Scholar for studies published between 2010 and December 18, 2024. Studies using transportability methods in a numerical application for at least partly non-overlapping source and target populations were included. We identified 3432 unique studies and included 64 studies applying transportability methods. Over two thirds of the included studies (44/64) introduced new methods. Less than one third of the included studies (20/64) were pure applications of transportability methods. Most applied studies (17/20) transported effect estimates from randomized controlled trials. Effects were transported to target populations with either complete (9/20) or no (9/20) treatment and outcome data or both (2/20). The most frequent aims of applied studies were to transport estimated effects to new populations (10/20) and to assess effect heterogeneity explainable by measured covariates (8/20). How transportability methods were applied varied widely between studies, for instance in the covariate selection approach and sensitivity analysis. Methodological studies with a transportability application presented new transportability estimators for randomized data (5/44), specific transportability applications (e.g., meta-analysis, mediation analysis; 21/44) and other methodological aspects (e.g., covariate selection, missing data handling; 18/44). Transportability methods are a useful tool for knowledge transfer between populations. More applications of transportability methods and guidance for their use are desirable.
Kou M, Li X, Ma H
… +4 more, Wang X, Heianza Y, Manson JE, Qi L
Eur J Epidemiol
· 2025 Apr · PMID 40195207
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BACKGROUND: Emerging evidence suggests a role of psychological well-being in the development of cardiovascular disease (CVD), but supportive data remain limited. This study assessed the prospective associations between l...BACKGROUND: Emerging evidence suggests a role of psychological well-being in the development of cardiovascular disease (CVD), but supportive data remain limited. This study assessed the prospective associations between life satisfaction and incident CVD, as well as the relative importance of life satisfaction compared to traditional risk factors. METHODS: The study included 153,810 participants free of CVD at baseline, with measurements of life satisfaction on general happiness, personal health, family relationships, friendships, and financial situation, followed up until December 31, 2022. Cox proportional hazards models were used to estimate associations between life satisfaction and incident CVD. The relative importance of life satisfaction in predicting CVD was measured by explained R values. RESULTS: During a median follow-up of 12.9 years, 14,370 incident CVD events occurred, including 10,070 CHD and 2,895 strokes. Individuals with low life satisfaction had an 80% higher risk of CVD compared to those with high life satisfaction (hazard ratio [95% confidence interval], 1.84 [1.63-2.07] for CVD, 1.83 [1.59-2.10] for CHD, and 1.74 [1.31-2.31] for stroke). Life satisfaction was ranked as the fourth-strongest CVD risk factor, following hypertension, race, and income. Low satisfaction with all individual aspects was significantly associated with higher risks of CVD and CHD (P < 0.05), while satisfaction with personal health showing the strongest association. CONCLUSIONS: This study indicates that life satisfaction is robustly associated with incident CVD and may be considered one of the strongest predictors of CVD risk, alongside traditional risk factors. Our findings support the inclusion of life satisfaction in cardiovascular health metrics.
This study aimed to investigate the association between aspirin use and the incidence of nonalcoholic fatty liver disease (NAFLD). We included 53,490 participants from the Nurses' Health Study II, a prospective US cohort...This study aimed to investigate the association between aspirin use and the incidence of nonalcoholic fatty liver disease (NAFLD). We included 53,490 participants from the Nurses' Health Study II, a prospective US cohort study. Cox proportional hazard regression analyses were performed to assess the association between time-updated aspirin use and the risk of incident NAFLD. The exposure data included the status, duration, frequency and dosage of aspirin use. Data on the use of nonaspirin nonsteroidal anti-inflammatory drugs and acetaminophen were also collected. Over 1.1 million person-years of follow-up and 3,640 cases of incident NAFLD were documented. Compared with nonusers, current aspirin users had a significantly greater risk of NAFLD (HR: 1.17, 95% CI: 1.05 - 1.29). The current use of nonsteroidal nonaspirin anti-inflammatory drugs was also positively associated with NAFLD risk (HR: 1.29, 95% CI: 1.11 - 1.50). There were no significant associations with the use of acetaminophen. Aspirin use was associated with a modestly increased risk of incident NAFLD. These findings need to be confirmed in future studies.