ABSTRACT
BACKGROUND: Sunlight exposure and fair skin are major determinants of human vitamin D production, but they are also risk factors for cutaneous malignant melanoma (MM). There is epidemiological evidence that all-cause mortality is related to low vitamin D levels. METHODS: We assessed the avoidance of sun exposure as a risk factor for all-cause mortality for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 and were aged 25 to 64 years at the start of the study. We obtained detailed information at baseline on their sun exposure habits and potential confounders. Multivariable flexible parametric survival analysis was applied to the data. RESULTS: There were 2545 deaths amongst the 29 518 women who responded to the initial questionnaire. We found that all-cause mortality was inversely related to sun exposure habits. The mortality rate amongst avoiders of sun exposure was approximately twofold higher compared with the highest sun exposure group, resulting in excess mortality with a population attributable risk of 3%. CONCLUSION: The results of this study provide observational evidence that avoiding sun exposure is a risk factor for all-cause mortality. Following sun exposure advice that is very restrictive in countries with low solar intensity might in fact be harmful to women's health.
Subject(s)
Cause of Death , Environmental Exposure , Sunbathing , Sunlight , Adult , Environmental Exposure/adverse effects , Environmental Exposure/statistics & numerical data , Female , Humans , Melanoma/etiology , Melanoma/mortality , Middle Aged , Prospective Studies , Risk Factors , Risk Reduction Behavior , Skin Neoplasms/etiology , Skin Neoplasms/mortality , Socioeconomic Factors , Sunbathing/psychology , Sunbathing/statistics & numerical data , Sunlight/adverse effects , Sweden/epidemiology , Vitamin D/metabolismSubject(s)
Health Services Needs and Demand/trends , Morbidity/trends , Mortality/trends , Population Dynamics , Environmental Exposure/adverse effects , Epidemiologic Methods , Forecasting , Humans , Life Style , Occupational Exposure/adverse effects , Prognosis , Risk Factors , Socioeconomic Factors , Sweden/epidemiologySubject(s)
Neoplasms/mortality , Registries , Female , Humans , Male , Prevalence , Sweden/epidemiologySubject(s)
Breast Neoplasms/prevention & control , Mammography , Breast Neoplasms/mortality , Female , Humans , Risk Factors , SwedenSubject(s)
Breast Neoplasms/epidemiology , Adult , Aged , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/mortality , Breast Neoplasms/prevention & control , Cost-Benefit Analysis , Europe/epidemiology , Female , Humans , Incidence , Mammography , Mass Screening/economics , Mass Screening/methods , Middle Aged , Sweden/epidemiologyABSTRACT
The prevalence of cancer in Sweden has increased greatly during the past 30 years. 40-47% of the observed increase can be explained by population dynamics, and 30% by better survival. Hence, only 23-29% is attributable to risk increase.
Subject(s)
Neoplasms/epidemiology , Population Dynamics , Aging , Female , Humans , Male , Neoplasms/etiology , Neoplasms/mortality , Prevalence , Registries , Risk Factors , Survival Rate , Sweden/epidemiologyABSTRACT
BACKGROUND: A very important issue in living kidney donor transplantation is whether the donation is safe for the donor. The aim of this study was to examine survival and causes of death in kidney donors and to assess the renal function in those who had donated a kidney more than 20 years ago. METHODS: A total of 459 living donor nephrectomies were performed in Stockholm from 1964 until the end of 1994. By using national registers, all 430 donors living in Sweden were traced. Donor survival was analysed using the Kaplan-Meier method. Expected survival was computed using the Hakulinens method and was based on national mortality rates. RESULTS: Forty-one subjects had died between 15 months and 31 years after the donation. The mortality pattern was similar to that in the general population, the majority dying of cardiovascular diseases and malignancies. After 20 years of follow-up, 85% of the donors were alive, whereas the expected survival rate was 66%. Survival was thus 29% better in the donor group. One third of the donors (aged 46-91 years) who had donated >20 years ago had hypertension. There was a deterioration in the renal function with increasing age, similar to what is seen among normal healthy subjects. The average glomerular filtration rate in donors aged 75 years and over was 48 ml/min/1.73 m2. CONCLUSIONS: To donate a kidney does not seem to constitute any long-term risk. The better survival among donors is probably due to the fact that only healthy persons are accepted for living kidney donation.
Subject(s)
Life Expectancy , Living Donors , Nephrectomy , Adult , Age Factors , Aged , Aged, 80 and over , Creatinine/blood , Female , Follow-Up Studies , Humans , Male , Middle Aged , Registries , Sex Differentiation , Sweden , Time FactorsABSTRACT
Prevention can reduce the risk of disease, but has other consequences as well. Willingness-to-pay (WTP) is one method to analyse these multi-dimensional consequences, if the stated WTP is assumed to be a function of all the expected positive and negative effects perceived. An interview study of a community-based cardiovascular disease prevention programme in northern Sweden shows that expectations regarding reduced mortality in the community and future savings in public health care spending increase the perceived value of the programme. Among personal benefits, decreased disease risk was not positively associated with WTP, while a low level of anxiety was.
