Are psychosocial stressors associated with the relationship of alcohol consumption and all-cause mortality?

BACKGROUND: Several studies have shown a protective association of moderate alcohol intake with mortality. However, it remains unclear whether this relationship could be due to misclassification confounding. As psychosocial stressors are among those factors that have not been sufficiently controlled for, we assessed whether they may confound the relationship between alcohol consumption and all-cause mortality. METHODS: Three cross-sectional MONICA surveys (conducted 1984-1995) including 11,282 subjects aged 25-74 years were followed up within the framework of KORA (Cooperative Health Research in the Region of Augsburg), a population-based cohort, until 2002. The prevalences of diseases as well as of lifestyle, clinical and psychosocial variables were compared in different alcohol consumption categories. To assess all-cause mortality risks, hazard ratios (HRs) were estimated by Cox proportional hazards models which included lifestyle, clinical and psychosocial variables. RESULTS: Diseases were more prevalent among non-drinkers than among drinkers: Moreover, non-drinkers showed a higher percentage of an unfavourable lifestyle and were more affected with psychosocial stressors at baseline. Multivariable-adjusted HRs for moderate alcohol consumption versus no consumption were 0.74 (95% confidence interval (CI): 0.58-0.94) in men and 0.87 (95% CI: 0.66-1.16) in women. In men, moderate drinkers had a significantly lower all-cause mortality risk than non-drinkers or heavy drinkers (p=0.002) even after multivariable adjustment. In women, moderate alcohol consumption was not associated with lowered risk of death from all causes. CONCLUSIONS: The present study confirmed the impact of sick quitters on mortality risk, but failed to show that the association between alcohol consumption and mortality is confounded by psychosocial stressors.

Determinants of heavy cigarette smoking: are there differences in men and women? Results from the population-based MONICA/KORA Augsburg surveys.

INTRODUCTION: Heavy cigarette smoking is more frequent in men than in women. So far, little is known whether this sex-specific difference in cigarette consumption is modified by age at smoking onset, sociodemographical, and lifestyle factors. Therefore, we aimed to identify sex-specific characteristics associated with heavy daily cigarette smoking. METHODS: The study population consisted of 3,178 daily smokers aged 25-74 years from the population-based MONICA/KORA Augsburg surveys conducted between 1984 and 1995. Subjects consuming at least 20 cigarettes daily were defined as heavy smokers. Multivariate logistic regression was used to identify sociodemographical, smoking-related, and lifestyle characteristics of heavy smokers. RESULTS: A number of 1,576 subjects (49.6%) were identified as heavy smokers. Men were significantly more often heavy smokers than women with the exception of those women who have started smoking at an early age. Multivariate logistic regression revealed early age at smoking onset determines heavy smoking in women but not in men. While younger age at study examination and low educational level was associated with heavy smoking in men only, current employment was associated with heavy smoking in women only. Moreover, living alone, high alcohol or coffee consumption, and low physical leisure activity were associated with heavy smoking behavior in both sexes. Survey, obesity and parental history of smoking showed no association with heavy smoking. CONCLUSIONS: The present study revealed sex-specific differences in heavy smoking by age at smoking onset, which was not shown before so far. These findings should be further investigated and addressed in future prevention campaigns.

Do common genetic variants in endotoxin signaling pathway contribute to predisposition to alcoholic liver cirrhosis?

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta), produced by endotoxin-activated Kupffer cells, play a key role in the pathogenesis of alcoholic liver cirrhosis (ALC). Alleles TNFA -238A, IL1B -31T and variant IL1RN*2 of repeat polymorphism in the gene encoding the IL-1 receptor antagonist increase production of TNF-alpha and IL-1beta, respectively. Alleles CD14 -159T, TLR4 c.896G and TLR4 c.1196T modify activation of Kupffer cells by endotoxin. We confirmed the published associations between these common variants and genetic predisposition to ALC by means of a large case-control association study conducted on two Central European populations. METHODS: The study population comprised a Czech sample of 198 ALC patients and 370 controls (MONICA project), and a German sample of 173 ALC patients and 331 controls (KORA-Augsburg), and 109 heavy drinkers without liver disease. RESULTS: Single locus analysis revealed no significant difference between patients and controls in all tested loci. Diplotype [IL1RN 2/ 2; IL1B -31T+] was associated with increased risk of ALC in the pilot study, but not in the validation samples. CONCLUSIONS: Although cytokine mediated immune reactions play a role in the pathogenesis of ALC, hereditary susceptibility caused by variants in the corresponding genes is low in Central European populations.

Sex- and age-related increase in prevalence rates of death wishes and suicidal ideation in the community: results from the KORA-F3 Augsburg Study with 3,154 men and women, 35 to 84 years of age.

Among risk factors for suicide, suicidal ideation (SID) is of paramount importance. This study sought to determine sex- and age-related SID point prevalence rates in the general population. A population-based survey of 3154 subjects, 35 to 84 years, conducted in 2004/05 in southern Germany, identified 170 subjects (5.4%; 95% CI 4.6-6.2) suffering from SID within the last 14 days. Age-adjusted short-term period prevalence in women (6.0%, 95% CI 4.9.-7.2) was higher than in men (4.0%, 95% CI 3.1-5.1). Among 10-year age groups, sex-related differences were only significant in middle-aged subjects (55-64 years). Prevalence increased significantly with age, leading to a prevalence of >10% in the oldest age group (75-84 years). The population-based approach demonstrates a substantial proportion of subjects suffering from SID, particularly in older age groups.

Time trends in suicide mortality vary in choice of methods: an analysis of 145,865 fatal suicide cases in Germany 1991-2002.

BACKGROUND: Overall, decreasing suicide mortality rates were observed in the last decades in most Western populations. However, it remains unclear, whether these favourable trends occurred uniformly in particular suicide methods. Therefore, the present study evaluated time trends of suicide mortality by method in Germany over the period 1991-2002. METHODS: A total of 145,865 fatal suicide cases of men and women aged >or=15 years and with available suicide method were recorded by the Federal Statistical Office of Germany (suicides coded "death following a suicide attempt" were excluded). Based on these data, seven different suicide methods were defined. Poisson regression was used to estimate the age-adjusted annual percentage change (AAPC) of the number of each suicide method. RESULTS: The most frequently used suicide methods in both sexes were hanging, strangling or suffocation (HSS) with 55.8% in men and 39.9% in women, followed by self-poisoning. Statistically significant declines of the number of suicides were observed, in descending order, for self-poisoning, drowning and HSS in both sexes. In contrast, methods using firearm discharges or stab with a sharp object remained in roughly constant level. Modifications of time trends were observed for several methods by age classes. CONCLUSIONS: The present study demonstrates different time trends for suicide methods. Further examinations are recommended in particular concerning possible reasons for the choice of a suicidal method.