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Stang A. Correspondence (reply): In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:808. [PMID: 19578444 PMCID: PMC2699884 DOI: 10.3238/arztebl.2008.0808b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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352
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Stang A, Kluttig A. Etiologic insights from surface adjustment of colorectal carcinoma incidences: an analysis of the U.S. SEER data 2000-2004. Am J Gastroenterol 2008; 103:2853-61. [PMID: 18759825 DOI: 10.1111/j.1572-0241.2008.02087.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The subsite-specific comparison of the incidence of carcinoma within the colorectum is complicated because the mucosal surface, and therefore the amount of epithelial cells at risk, varies among the subsites. The aim of this study was to provide the subsite-specific estimates of the colon mucosal surface and the mucosal surface-adjusted carcinoma incidence estimates of colon subsites that allow a more valid comparison of the subsite-specific incidences. METHODS We extracted subsite-specific incidence rates of colorectal carcinoma from the Surveillance, Epidemiology, and End Results (SEER) Program of the years 2000-2004. The rates were age-standardized to the U.S. standard population in the year 2000. We estimated the mucosal surface of each segment of the colorectum and calculated the surface-adjusted incidence rates by dividing the observed age-standardized incidence rates by the estimated surface areas. RESULTS After adjustment for surface area, the incidence relations among the colorectal subsites changed. Within the colon, the surface-adjusted rates tend to be highest in the cecum, followed by the vermiform appendix, ascending colon, and sigmoid colon. The rates of the transverse and descending colon are considerably lower. The surfaced-adjusted incidence of rectal carcinoma is about 12- to 23-fold higher than the rate of carcinoma of the transverse colon. CONCLUSIONS The distribution of the incidence of carcinomas is markedly influenced by the adjustment of surface area of the colorectum. Similar surface-adjusted rates of the vermiform appendix and ascending colon may implicate that these subsites share a similar etiology. Considerable differences of the surface-adjusted rates of the sigmoid colon and rectum may indicate different etiologies of carcinomas of these subsites.
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Erbel R, Delaney JAC, Lehmann N, McClelland RL, Möhlenkamp S, Kronmal RA, Schmermund A, Moebus S, Dragano N, Stang A, Jöckel KH, Budoff MJ. Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). Eur Heart J 2008; 29:2782-91. [PMID: 18845666 PMCID: PMC2582985 DOI: 10.1093/eurheartj/ehn439] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/10/2008] [Accepted: 09/12/2008] [Indexed: 12/20/2022] Open
Abstract
AIMS Modern imaging technology allows us the visualization of coronary artery calcification (CAC), a marker of subclinical coronary atherosclerosis. The prevalence, quantity, and risk factors for CAC were compared between two studies with similar imaging protocols but different source populations: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). METHODS AND RESULTS The measured CAC in 2220 MESA participants were compared with those in 3,126 HNR participants with the inclusion criteria such as age 45-75 years, Caucasian race, and free of baseline cardiovascular disease. Despite similar mean levels of CAC of 244.6 among participants in MESA and of 240.3 in HNR (P = 0.91), the prevalence of CAC > 0 was lower in MESA (52.6%) compared with HNR (67.0%) with a prevalence rate ratio of CAC > 0 of 0.78 [95% confidence interval (CI): 0.72-0.85] after adjustment for known risk factors. Consequently, among participants with CAC > 0, the participants in MESA tended to have higher levels of CAC than those in HNR (ratio of CAC levels: 1.39; 95% CI: 1.19-1.63), since many HNR participants have small (near zero) CAC values. CONCLUSIONS The CAC prevalence was lower in the United States (MESA) cohort than in the German (HNR) cohort, which may be explained by more favourable risk factor levels among the MESA participants. The predictors for increased levels of CAC were, however, similar in both cohorts with the exception that male gender, blood pressure, and body mass index were more strongly associated in the HNR cohort.
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Dragano N, Hoffmann B, Stang A, Moebus S, Verde PE, Weyers S, Möhlenkamp S, Schmermund A, Mann K, Jöckel KH, Erbel R, Siegrist J. Subclinical coronary atherosclerosis and neighbourhood deprivation in an urban region. Eur J Epidemiol 2008; 24:25-35. [PMID: 18931923 DOI: 10.1007/s10654-008-9292-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 09/26/2008] [Indexed: 01/29/2023]
Abstract
Inhabitants of deprived neighbourhoods are at higher risk of coronary heart disease. In this study we investigate the hypothesis that social inequalities at neighbourhood level become already manifest in subclinical coronary atherosclerosis, as defined by electron-beam computed tomography derived measures. Coronary artery calcification was assessed as a marker of atherosclerosis in a population based sample of 4301 men and women (45-75 years) without a history of coronary heart disease. Participants lived in three adjacent cities in Germany and were examined between 2000 and 2003 as part of the Heinz Nixdorf Recall Study. Individual level data was combined with neighbourhood level information about unemployment, welfare and living space per inhabitant. This dataset was analysed with descriptive and multilevel regression methods. An association between neighbourhood deprivation and subclinical coronary calcification was observed. After adjustment for age and individual socioeconomic status male inhabitants of high unemployment neighbourhoods had an odds ratio of 1.45 (1.11, 1.96) of exhibiting a high calcification score (>75th percentile) compared to men living in low unemployment areas. The respective odds for women was 1.29 (0.97, 1.70). Additional explorative analyses suggest that clustering of unhealthy lifestyles in deprived neighbourhoods contributes to the observed association. In conclusion, findings suggest that certain neighbourhood characteristics promote the emergence of coronary atherosclerosis. This might point to a pathway from neighbourhood deprivation to manifest coronary heart disease.
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Stang A. Quotations From Anticipated Coronary Heart Disease Mortality Trends. J Am Coll Cardiol 2008; 52:498. [DOI: 10.1016/j.jacc.2008.02.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 01/28/2008] [Accepted: 02/12/2008] [Indexed: 11/25/2022]
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356
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Andrich S, Moebus S, Dragano N, Stang A, Erbel R, Jöckel KH, Siegrist J. Qualitätsmanagement im Rahmen einer prospektiven Kohortenstudie am Beispiel des standardisierten Interviews zu gesundheitsbezogenen Themen in der Heinz Nixdorf Recall Studie. DAS GESUNDHEITSWESEN 2008. [DOI: 10.1055/s-0028-1086291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jöckel KH, Hoffmann B, Stang A. Discussing the benefit-harm debate. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:420-422. [PMID: 19626168 PMCID: PMC2696852 DOI: 10.3238/arztebl.2008.0421a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Stang A. Decline in hormone replacement prescription and fall in breast cancer incidence: an epidemiological discourse. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:303-9. [PMID: 19629226 DOI: 10.3238/arztebl.2008.0303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 12/10/2007] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Between 2002 and 2003 the incidence of invasive breast cancer among women aged 50 to 69 years declined considerably in the US. This decline was accompanied by a substantial fall in prescription rates of estrogen-progestin (EG-HRT). METHODS Selective literature search in PubMed from 01/2003 to 12/2007 using the key words "hormone replacement therapy," "incidence," and "breast cancer." RESULTS The parallel decline in EG-HRT and breast cancer suggests a causal link. Up to now, alternative explanations for the decline of the incidence can either be refuted or revealed as implausible. DISCUSSION Detailed incidence trend analyses in the coming years and a close monitoring of EG-HRT prescription rates in and beyond the US. promise important insights. If EG-HRTs are carcinogenic, the extent of this effect remains unclear. If cessation of EG-HRT therapy only delays the appearance of detectable breast cancer, a long-term increase in incidence would be expected in women of age 50 and older, even with low prescription rates. However, if cessation of EG-HRT also stops tumor growth, the anticipated incidence will be permanently lower in the future.
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Wessendorf T, Wessendorf T, Erdmann T, Moebus S, Stang A, Beck E, Möhlenkamp S, Jöckel K, Erbel R, Teschler H. Schlafapnoe-Screening in epidemiologischen Untersuchungen: Der Einsatz des ApneaLink® in der Heinz Nixdorf Recall Studie. Pneumologie 2008. [DOI: 10.1055/s-2008-1074173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wege N, Dragano N, Erbel R, Jockel KH, Moebus S, Stang A, Siegrist J. When does work stress hurt? Testing the interaction with socioeconomic position in the Heinz Nixdorf Recall Study. J Epidemiol Community Health 2008; 62:338-41. [DOI: 10.1136/jech.2007.062315] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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361
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Valiukeviciene S, Gollnick H, Stang A. Body-site distribution of common acquired melanocytic nevi associated with severe sunburns among children in Lithuania. Int J Dermatol 2008; 46:1242-9. [PMID: 18173516 DOI: 10.1111/j.1365-4632.2007.03369.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this cross-sectional study is to provide information on subsite-specific densities of melanocytic nevi by age, sex, and in relation to the history of severe sunburns. MATERIALS AND METHODS This study was conducted in Kaunas, Lithuania, on a sample of 484 children aged 1-2 years, 4-5 years, 9-10 years, and 14-15 years. The questionnaire provided information about the history of severe sunburns since birth. Site-specific numbers and densities of melanocytic nevi of all sizes and nevi 2 mm or greater were studied. We used log-linear and Poisson regression models to estimate the effects of age, sex, and severe sunburns on the nevus density. RESULTS The predicted total body density of nevi shows a considerable increase up to the age of roughly 10 years. Thereafter, the density increase tapered off. Median densities of nevi were highest on the face. The median density of nevi on the upper arms is higher than on the forearms. Similarly, the median density of nevi on the thighs is higher than on the lower legs. Estimates of the relative nevus densities related to the history of severe sunburns tend to be small with the exception of the legs for nevi 2 mm or greater (relative nevus density = 2.09, 95% CI 1.49-2.93). CONCLUSION Nevus densities are highest on maximally or intermittently sun-exposed skin areas. With the exception of the legs among women, the subsite-specific ranking of nevus densities among adolescents follows a similar ranking as the skin melanoma incidence in Lithuania.
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Stang A, Moebus S, Möhlenkamp S, Erbel R, Jöckel KH. Gender-specific associations of short sleep duration with prevalent hypertension. Hypertension 2008; 51:e15-6; author reply e17. [PMID: 18227401 DOI: 10.1161/hypertensionaha.107.108456] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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363
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Abstract
The metabolic syndrome is a heterogeneous complex that is clinically interpreted as an indicator of an increased risk of diabetes mellitus, cardiovascular morbidity and mortality. The diagnosis of metabolic syndrome is made, if at least three out of five factors - dysglycemia, visceral obesity, increased triglycerides, decreased HDL cholesterol, arterial hypertension - are present. Both the popularity and criticism of the metabolic syndrome have increased over recent years. One crucial problem are the currently existing definitions. This is illustrated on the basis of recent primary-care data from Germany, showing a prevalence ranging from 19% to 31% depending on the definition used. The debate about the rationale of the concept in terms of risk prediction for cardiovascular diseases points at one weakness of the concept. The entire discussion is mainly influenced by different approaches: a simple pedagogic approach, a pathophysiological approach, with insulin resistance as main focus of research, and a clinical-epidemiologic approach, where a cluster of different risk factors for cardiovascular disease risk prediction forms the initial scientific interests. Acknowledging these different perspectives might help reduce the confusion associated with the meaning and usefulness of the metabolic syndrome.
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Erbel R, Möhlenkamp S, Jöckel KH, Lehmann N, Moebus S, Hoffmann B, Schmermund A, Stang A, Siegrist J, Dragano N, Grönemeyer D, Seibel R, Mann K, Bröcker-Preuss M, Kröger K, Volbracht L. Cardiovascular risk factors and signs of subclinical atherosclerosis in the Heinz Nixdorf Recall Study. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:1-8. [PMID: 19578446 DOI: 10.3238/arztebl.2008.0001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 08/07/2007] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Modern investigation modalities allow markers of atherosclerosis to be detected at a subclinical stage. The aim of the study was to analyze the prevalence of these markers in relation to traditional risk factors. METHODS The population based study included 4814 participants, aged 45 to 75 years, with a response rate of 55.8% of those contacted. The patients' history, psychosocial and environmental risk factors were assessed. RESULTS The prevalence of obesity was 26.2% in men and 28.1% in women, 26% of men and 21% of women were smokers. Hypertension was found in 46% of men and 31% of women, diabetes in 9.3% of men and 6.3% of women. Markers of subclinical peripheral arterial disease were found in 6.4% of men and 5.1% of women, of subclinical carotid artery disease in 43.2% and 30.7%, and of subclinical coronary artery calcification in 82.3% and 55.2%, respectively. The prevalence of coronary calcification measured using an Agatston Score >100 was in 40% in men and 15% in women, using a score >400, 16.8% and 4.5%, respectively. DISCUSSION A high prevalence of subclinical atherosclerosis was found in the older population. The follow-up period will demonstrate whether the detection of markers of subclinical atherosclerosis will improve risk stratification beyond that offered by traditional risk factors.
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365
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Stang A, Thomssen C. Decline in breast cancer incidence in the United States: what about male breast cancer? Breast Cancer Res Treat 2008; 112:595-6. [PMID: 18176840 DOI: 10.1007/s10549-007-9882-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 12/19/2007] [Indexed: 12/01/2022]
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366
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Moebus S, Stang A, Möhlenkamp S, Slomiany U, Bauer M, Bröcker-Preuss M, Erbel R, Mann K, Jöckel KH. Assoziation zwischen erhöhter Nüchternglucose und subklinischer Atherosklerose der Koronargefäße – Ergebnisse der Heinz Nixdorf Recall Studie. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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367
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Stang A, Rusner C, Eisinger B, Stegmaier C, Kaatsch P. Subtype-specific incidence of testicular cancer in Germany: a pooled analysis of nine population-based cancer registries. ACTA ACUST UNITED AC 2007; 32:306-16. [PMID: 18179558 DOI: 10.1111/j.1365-2605.2007.00850.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Comparisons of incidence estimates of testicular cancer subtypes beyond seminoma and non-seminoma are virtually missing in the epidemiologic literature. We analysed incidence data from population-based German cancer registries to provide subtype-specific incidences of testicular cancer. We pooled data from nine cancer registries from 1998 to 2003. We estimated incidence and mortality time trends of West and East Germany. Incidence and mortality were standardized by the European standard population. The annual percentage incidence change from 1961 through 1989 was 4.9% in East Germany and 3.0% from 1970 through 2004 in Saarland. Incidence increases were the most pronounced among adolescents and young men aged 15-49 years. In 1998-2003, the seminoma incidence rate was 5.1 per 100,000; among non-seminomas, the rates were the highest for malignant teratoma (1.6 per 100,000), followed by embryonal carcinoma (1.2 per 100,000). Testicular lymphomas were rare (0.1 per 100,000). The incidence of testicular cancer among children aged 0-14 years was nearly constant from 1987 through 2004. Majority of these cancers were yolk sac tumours (0.1 per 100,000). In East and West Germany, rates of embryonal carcinoma in the early periods were considerably lower than the rates of malignant teratoma. In the most recent periods, rates of embryonal carcinoma became quite similar to the rates of malignant teratoma. The mortality decline started in West Germany roughly 12 years earlier than in East Germany. The later start of the mortality decline in East Germany may be because of a later introduction of platinum-based chemotherapy compared to West Germany.
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Stang A. Genital and Nongenital Nonmelanoma Skin Cancer: More Epidemiological Studies Are Needed. J Invest Dermatol 2007; 127:2296-9. [PMID: 17853917 DOI: 10.1038/sj.jid.5700895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although black men in the United States have a lower mortality of nongenital nonmelanoma skin cancer (NMSC) than white men, they have a higher mortality of genital NMSC than white men. Mortality of NMSC has declined over time. Ethnicity-specific incidence and survival analyses of NMSC can be used to determine to what degree earlier detection and/or more efficient therapies have contributed to these observations.
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Dragano N, Bobak M, Wege N, Peasey A, Verde PE, Kubinova R, Weyers S, Moebus S, Möhlenkamp S, Stang A, Erbel R, Jöckel KH, Siegrist J, Pikhart H. Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany. BMC Public Health 2007; 7:255. [PMID: 17888149 PMCID: PMC2099437 DOI: 10.1186/1471-2458-7-255] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 09/21/2007] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Inequalities in the distribution of behaviour related risk factors are one possible explanation for this trend. In our study, we examined the association between cardiovascular risk factors and neighbourhood characteristics. To assess the consistency of associations the design is cross-national with data from nine industrial towns from the Czech Republic and Germany. Methods We combined datasets from two population based studies, one in Germany ('Heinz Nixdorf Recall (HNR) Study'), and one in the Czech Republic ('Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) Study'). Participation rates were 56% in the HNR and 55% in the HAPIEE study. The subsample for this particular analysis consists of 11,554 men and women from nine German and Czech towns. Census based information on social characteristics of 326 neighbourhoods were collected from local administrative authorities. We used unemployment rate and overcrowding as area-level markers of socioeconomic status (SES). The cardiovascular risk factors obesity, hypertension, smoking and physical inactivity were used as response variables. Regression models were complemented by individual-level social status (education) and relevant covariates. Results Smoking, obesity and low physical activity were more common in deprived neighbourhoods in Germany, even when personal characteristics including individual education were controlled for. For hypertension associations were weak. In the Czech Republic associations were observed for smoking and physical inactivity, but not for obesity and hypertension when individual-level covariates were adjusted for. The strongest association was found for smoking in both countries: in the fully adjusted model the odds ratio for 'high unemployment rate' was 1.30 [95% CI 1.02–1.66] in the Czech Republic and 1.60 [95% CI 1.29–1.98] in Germany. Conclusion In this comparative study, the effects of neighbourhood deprivation varied by country and risk factor; the strongest and most consistent effects were found for smoking. Results indicate that area level SES is associated with health related lifestyles, which might be a possible pathway linking social status and cardiovascular disease. Individual-level education had a considerable influence on the association between neighbourhood characteristics and risk factors.
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Stang A, Dragano N, Poole C, Moebus S, Möhlenkamp S, Schmermund A, Siegrist J, Erbel R, Jöckel KH. Daily siesta, cardiovascular risk factors, and measures of subclinical atherosclerosis: results of the Heinz Nixdorf Recall Study. Sleep 2007; 30:1111-9. [PMID: 17910383 PMCID: PMC1978397 DOI: 10.1093/sleep/30.9.1111] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several studies have assessed the association between siesta and cardiovascular outcomes. Concern exists that confounding might have distorted these results and contributed to discrepancies among them. This report examines the association between siesta habits and cardiovascular risk factors, including sleep disturbances at night, depressed mood, and measures of subclinical atherosclerosis such as coronary calcium score and ankle brachial index. METHODS The baseline examination of 4,797 participants aged 45-74 years included interviews, physical examinations, laboratory tests, and electron beam computed tomography. We compared the baseline prevalence of depressed mood, nighttime sleep disturbances, and health status in 3 categories of siesta habits: irregular or no siestas; daily short siestas (1 hour or less); and daily long siestas (>1 hour). We also characterized cardiovascular risk factor distributions in the 3 siesta groups and conducted a sensitivity analysis of the potential for confounding by these factors in studies of incident cardiovascular disease. RESULTS Depressed mood and poor self-perceived health status at baseline had positive associations with the age-standardized prevalence of daily long siestas among both men and women. Daily takers of long siestas had a considerably higher prevalence of cardiovascular risk factors in both sexes and appreciably worse measures of subclinical atherosclerosis in men only, in comparison with either of the other siesta groups. Daily long siestas had positive associations with prevalence of several cardiovascular risk factors and measures of subclinical atherosclerosis. CONCLUSIONS If uncontrolled, these associations could produce appreciable confounding in studies of siesta habits and incidence of cardiovascular events.
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Hoffmann B, Moebus S, Möhlenkamp S, Stang A, Lehmann N, Dragano N, Schmermund A, Memmesheimer M, Mann K, Erbel R, Jöckel KH. Residential Exposure to Traffic Is Associated With Coronary Atherosclerosis. Circulation 2007; 116:489-96. [PMID: 17638927 DOI: 10.1161/circulationaha.107.693622] [Citation(s) in RCA: 357] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Long-term exposure to fine-particulate-matter (PM
2.5
) air pollution may accelerate the development and progression of atherosclerosis. We investigated the associations of long-term residential exposure to traffic and fine particulate matter with the degree of coronary atherosclerosis.
Methods and Results—
We used baseline data on 4494 participants (age 45 to 74 years) from the German Heinz Nixdorf Recall Study, a population-based, prospective cohort study that started in 2000. To assess exposure differences, distances between residences and major roads were calculated, and annual fine particulate matter concentrations, derived from a small-scale dispersion model, were assigned to each address. The main outcome was coronary artery calcification (CAC) assessed by electron-beam computed tomography. We evaluated the association between air pollution and CAC with logistic and linear regression analyses, controlling for individual level risk factors of coronary atherosclerosis. Compared with participants living >200 m away from a major road, participants living within 50, 51 to 100, and 101 to 200 m had odds ratios of 1.63 (95% CI, 1.14 to 2.33), 1.34 (95% CI, 1.00 to 1.79), and 1.08 (95% CI, 0.85 to 1.39), respectively, for a high CAC (CAC above the age- and gender-specific 75th percentile). A reduction in the distance between the residence and a major road by half was associated with a 7.0% (95% CI, 0.1 to 14.4) higher CAC. Fine particulate matter exposure was associated with CAC only in subjects who had not been working full-time for at least 5 years.
Conclusions—
Long-term residential exposure to high traffic is associated with the degree of coronary atherosclerosis.
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Schmidt-Pokrzywniak A, Stang A, Bornfeld N, Jöckel KH. Risk of uveal melanoma. Ophthalmology 2007; 114:1418; author reply 1418. [PMID: 17613340 DOI: 10.1016/j.ophtha.2007.03.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 03/28/2007] [Indexed: 10/23/2022] Open
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Stang A, Stausberg J, Boedeker W, Kerek-Bodden H, Jöckel KH. Nationwide hospitalization costs of skin melanoma and non-melanoma skin cancer in Germany. J Eur Acad Dermatol Venereol 2007; 22:65-72. [DOI: 10.1111/j.1468-3083.2007.02334.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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374
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Kluttig A, Trocchi P, Heinig A, Holzhausen HJ, Taege C, Hauptmann S, Boecker W, Decker T, Loening T, Schmidt-Pokrzywniak A, Thomssen C, Lantzsch T, Buchmann J, Stang A. Reliability and validity of needle biopsy evaluation of breast-abnormalities using the B-categorization--design and objectives of the Diagnosis Optimisation Study (DIOS). BMC Cancer 2007; 7:100. [PMID: 17570833 PMCID: PMC1913923 DOI: 10.1186/1471-2407-7-100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Accepted: 06/14/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The planned nationwide implementation of mammography screening 2007 in Germany will increase the occurrence of mammographically detected breast abnormalities. These abnormalities are normally evaluated by minimal invasive core biopsy. To minimize false positive and false negative histological findings, quality assurance of the pathological evaluation of the biopsies is essential. Various guidelines for quality assurance in breast cancer diagnosis recommend applying the B-classification for histopathological categorization. However, to date there are only few studies that reported results about reliability and validity of B-classification. Therefore, objectives of our study are to determine the inter- and intraobserver variability (reliability study) and construct and predictive validity (validity study) of core biopsy evaluation of breast abnormalities. This paper describes the design and objectives of the DIOS Study. METHODS/DESIGN All consecutive asymptomatic and symptomatic women with breast imaging abnormalities who are referred to the University Hospital of Halle for core breast biopsy over a period of 24 months are eligible. According to the sample size calculation we need 800 women for the study. All patients in the study population underwent clinical and radiological examination. Core biopsy is performed by stereotactic-, ultrasound- or magnetic resonance (MR) guided automated gun method or vacuum assisted method. The histopathologic agreement (intra- and interobserver) of pathologists and the histopathologic validity will be evaluated. Two reference standards are implemented, a reference pathologist and in case of suspicious or malignant findings the histopathologic result of excision biopsy. Furthermore, a self administrated questionnaire which contains questions about potential risk factors of breast cancer, is sent to the participants approximately two weeks after core biopsy. This enables us to run a case-control-analysis (woman with breast cancer histological verified after excision are defined as cases, woman without malignant breast lesions are defined as controls) to investigate the predictive values of various risk factors on breast cancer risk. CONCLUSION The analysis of reliability and validity of the histopathological evaluation of core biopsy specimens of breast abnormalities is intended to provide important information needed for a high quality in breast cancer diagnostic and for planning of treatment strategies.
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MESH Headings
- Biopsy, Needle/standards
- Breast Diseases/diagnosis
- Breast Diseases/pathology
- Breast Neoplasms/diagnosis
- Breast Neoplasms/pathology
- Calcinosis/diagnosis
- Calcinosis/pathology
- Carcinoma in Situ/diagnosis
- Carcinoma in Situ/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/pathology
- Diagnosis, Differential
- False Negative Reactions
- False Positive Reactions
- Female
- Germany
- Humans
- Immunohistochemistry
- Mammography
- Mass Screening/methods
- Observer Variation
- Reference Standards
- Reproducibility of Results
- Retrospective Studies
- Sensitivity and Specificity
- Stereotaxic Techniques
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375
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Stang A, Ziegler S, Büchner U, Ziegler B, Jöckel KH, Ziegler V. Malignant melanoma and nonmelanoma skin cancers in Northrhine-Westphalia, Germany: a patient- vs. diagnosis-based incidence approach. Int J Dermatol 2007; 46:564-70. [PMID: 17550552 DOI: 10.1111/j.1365-4632.2006.03056.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dermatologists have repeatedly criticized that the public health importance of nonmelanoma skin cancers is not appropriately reflected by the patient-based cancer incidence rates of population-based cancer registries. The aims of this study were to estimate the patient incidence rates of squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and skin melanoma, and to study the effect of multiple primary skin tumors on the incidence rates. METHODS We used a network of physicians covering a population of about 75,000 individuals to register all newly diagnosed invasive skin cancers (996 diagnoses in 796 patients), including BCC, SCC, and skin melanoma, from July 1998 to June 2003. We calculated age-standardized (world standard population) incidence rates (cases per 100,000 person-years) for the first diagnoses (called "patient incidence") and for any diagnoses of BCC, SCC, and skin melanoma (called "case incidence"). RESULTS The patient incidence rates of BCC were 63.6 in men and 54.0 in women, and the case incidence rates of BCC were 82.7 and 71.1, respectively. The patient incidence rates of SCC were 17.4 in men and 9.7 in women, and the case incidence rates were 20.4 and 10.2, respectively. The patient and case incidence rates of skin melanoma were about the same at 13.6 in men and 18.5 in women. Twenty-five per cent of the BCC patients and 14% of the SCC patients suffered from more than one BCC and SCC, respectively, during the 5-year period. CONCLUSIONS Patient incidence rates of BCC and SCC substantially underestimate the burden of nonmelanoma skin cancer in the population.
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