bluuebunny/crossref_metadata_2025_split huggingface dataset:
OP41 Birth Size and Mortality in Breast Cancer Patients
Authors: Sovio U , Jones R , Koupil I 
Published: September 2012

BackgroundPrevious studies suggest that larger birth size is associated with a higher breast cancer incidence, but the few studies of birth measures and mortality in breast cancer cases have been inconclusive. The aim of this study was to investigate survival of women after breast cancer diagnosis (N=436) in the Uppsala Birth Cohort born in 1915–1929, who had detailed obstetric records available.MethodsCox regression was used to calculate hazard ratios (HR) and their 95% confidence intervals (CIs) for death from any cause after a breast cancer diagnosis until the end of 2010. Cancer register diagnoses were available from 1958. The main exposures were birth measures: gestational age (GA), birth length (BL), and birth weight (BW) for GA. They were converted to standard deviation (SD) scores to ensure comparability of the effect sizes. Analyses were performed with and without adjustment for own adult socio-economic position (SEP) measured by education, occupation and income. Analyses were additionally adjusted for age at breast cancer diagnosis, decade of diagnosis, and age at first birth. Adjustment for family SEP at birth was considered but omitted since it did not affect the estimates and was not related to mortality after adjustment for other confounders.ResultsIn adjusted analyses, one SD increase in GA was associated with 7% (95% CI 2–12%) lower mortality and this association did not change after additional adjustments for BL or BW. There was no association between BL and mortality (adjusted HR=1.02 (0.91–1.16)). One SD increase in BW for GA was associated with 14% (1–29%) and 26% (9–46%) higher mortality without and with an additional adjustment for BL, respectively. Adjustment for SEP or other confounders did not substantially alter the estimates.ConclusionOur results suggest that both low GA and high BW for GA predict a higher mortality in breast cancer cases. This study strengthens the current evidence that size at birth is related to breast cancer mortality as well as incidence. It also brings in new evidence of the inverse relationship between GA and breast cancer mortality that has not been reported before. The observed associations persisted after an adjustment for SEP, although breast cancer cases from lower SEP are known to have a poorer survival and also birth measures are socially patterned. Further studies are needed to investigate how the observed associations are mediated.
OP42 Lifecourse Socioeconomic Position and Cognitive Function in Later Life in Central and Eastern Europe: Preliminary Findings from the Hapiee Study
Authors: Horvat P , Richards M , Bobak M 
Published: September 2012

BackgroundSocioeconomic position (SEP) across the lifecourse is positively associated with cognitive function in later life in studies of Western populations, with later SEP likely mediating the effect of early life factors. However, it remains to be seen whether similar associations are observed in settings with markedly different social histories with apparently smaller income inequalities. This study aims to investigate the association between measures of SEP reflective of the lifecourse and cognitive function in mid and later life in three Central and Eastern European populations.MethodsCross-sectional analysis of 7,990 men and women aged 45–69 years in 2002 from the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study recruited in Novosibirsk (Russia), Krakow (Poland), and six Czech towns using random probability sampling. Measures of lifecourse SEP included self-reported childhood socioeconomic conditions (parental education, ownership of household amenities at age 10), own education and current material circumstances. Linear regression was used to estimate the associations between lifecourse SEP measures and three cognitive tests: verbal memory (recall of 10 words), verbal fluency (naming animals) and letter search speed. Fully adjusted models included health and lifestyle covariates (medical history, depression, alcohol, physical activity).ResultsBroadly similar patterns of associations were observed across countries. Indicators of SEP across the lifecourse made independent contributions to cognition, with stronger contributions from education and current asset ownership (an indicator of contemporary material circumstances), than from childhood socioeconomic conditions. Socioeconomic advantage was associated with higher levels of cognitive functioning. For example, in fully adjusted models, university education was associated with 3.9 (SE 0.7) word recall advantage in memory performance in Czech men and 2.2 (SE 0.5) and 2.7 (SE 0.3) word advantage in Russian and Polish men; in women these figures were 3.7 (SE 0.4), 3.0 (SE 0.5) and 3.2 (SE 0.3), respectively. The effect of childhood socioeconomic conditions on cognition was largely attenuated after adjustment for education and current material circumstances, suggesting mediation by later SEP measures.ConclusionSocioeconomic position across the lifecourse is an important predictor of cognition in mid and later life in these Eastern European populations. The attenuation of the effects of childhood SEP after adjustment for own education and current material circumstances supports the model where this association is, at least partly, mediated through later life measures of SEP. Future research should focus on lifecourse influences on cognitive aging trajectories as long-term follow-up of this cohort and other studies in Eastern European populations become available.
OP45 Caesarean Section and Subsequent Fetal Death: Systematic Review and Meta-Analysis
Authors: Neill SM O , Kearney PM , Kenny LC , Khashan AS , Henriksen TB , Lutomski JE , Greene RA 
Published: September 2012

BackgroundSpontaneous miscarriage (the death of a fetus before 20 weeks of pregnancy), occurs in 10–15% of recognised pregnancies. Stillbirth (the death of a fetus after 24 weeks of pregnancy), occurs in approximately one in every 200 deliveries. The cause of miscarriage and stillbirth is frequently unknown. However, there is some evidence to suggest that previous Caesarean delivery may be a risk factor.Objective: to compare the risk of fetal death in subsequent pregnancy by mode of delivery.MethodsThis was a systematic review of relevant studies identified through CINAHL, the Cochrane library, Embase, Medline, PubMed, SCOPUS and Web of Knowledge (1945 - November 2011), using a comprehensive search strategy, and cross-checking of reference lists. Study selection: cohort and case-control studies reporting on Caesarean delivery and spontaneous miscarriage or stillbirth. Two reviewers independently assessed titles, abstracts, and full articles to identify eligible studies, using a standardised data collection form.ResultsMiscarriage:From 6,857 titles identified, eight articles were included, totalling 147,017 women and 12,682 events. Odds ratios (ORs) were combined using a fixed-effect model to estimate the overall association using Review Manager Software. From the meta-analysis, the pooled OR estimate of miscarriage among women who previously delivered by Caesarean versus vaginally, was 1.11 [95% CI 1.06,1.17]. The OR of miscarriage was 1.26 [95% CI 0.54,2.92] for one case-control study, 1.11 [95% CI 1.06,1.17] for seven cohort studies and 1.11 [95% CI 1.06,1.17] for primiparous women (eight studies).Stillbirth:From 6,857 studies identified, seven articles were included, totalling 1,661,335 pregnancies and 5,741 events. ORs were combined using a random effect model (due to the heterogeneity of included studies) to estimate the overall association. From the meta-analysis, the pooled OR estimate of stillbirth among women who previously delivered by Caesarean versus vaginally, was 1.32 [95% CI 1.11,1.57]. The OR of stillbirth was 1.30 [95% CI 1.03,1.64] for primiparous women (five studies), 1.40 [95% CI 1.24,1.59] for multiparous women (two studies), 1.80 [95% CI 1.27,2.55] for studies including all stillbirths (five studies) and, 1.20 [95% CI 1.02,1.42] for studies including only unexplained antepartum stillbirths (three studies).ConclusionCaesarean delivery compared to vaginal delivery is associated with an increased risk of spontaneous miscarriage by 11% and stillbirth by 32% in subsequent pregnancies. In light of the recently published National Institute for Health and Clinical Excellence (NICE) guidelines, which support a woman’s right to request a Caesarean delivery without medical reason, there is an urgent need to establish whether mode of delivery has a causal effect on risk of fetal death.
OP48 Increased Mortality Associated with Weekend Admission; A Result of Higher Severity of Illness at the Time of Admission?
Authors: Paudyal P , Shepheard-Walwyn T , Gericke C 
Published: September 2012

BackgroundA number of studies have shown that weekend admissions to hospital are associated with significantly higher mortality compared with weekday admissions. Previous studies have suggested that the observed variability in weekend-weekday mortality is a consequence of the quality of care provided in hospital. However, little information exists on whether the increased mortality associated with weekend admission is explained by the relative severity of illness at the time of admission.MethodsWe performed a retrospective analysis of all emergency acute care admissions in England between April 2009 and March 2010 using Hospital Episode Statistics data. In-hospital mortality among patients who were admitted as emergency admission on weekends as compared to weekdays was analysed using the following measures: (1) overall deaths in hospital; (2) deaths in hospital within and after 3 days of admission (3) deaths in hospital among patients with ‘higher risk’ conditions and ‘lower risk’ conditions. The ‘higher risk’ conditions consisted of 103 Primary Diagnosis codes (ICD–10), which accounted for the 74% of in-hospital deaths in the UK. The remaining Primary Diagnosis codes were categorised as ‘lower risk’ conditions.ResultsThere were 10,221,500 emergency hospital admissions during the two-year study period; 23.8% of the patients were admitted on weekends. A total of 391,938 patients died in hospital; a quarter of these died within 3 days of admission. Admission on weekends was associated with significantly higher in-hospital deaths as compared to weekday admission (Odds Ratio 1.11, 95% CI 1.10–1.12). Mortality within 3 days of admission (early deaths) was also higher for patients admitted on weekends (OR 1.16, 95%CI (1.14–1.17) and this difference persisted for both ‘higher risk’ and ‘lower risk’ conditions. However, when early deaths were excluded from the analysis, mortality was not affected by weekend admission.ConclusionHigher mortality was seen among patients admitted on weekends compared to those admitted on weekdays. However, as the odds ratio for deaths after 3 days of admission was not affected by day of admission, it is probable that the weekend admission effect on mortality is at least in part due to higher severity of illness at the time of admission rather than purely being a consequence of poorer quality of in hospital care at the weekend, and this warrants further investigation.
OP50 Alcohol Intake, Drinking Behaviour and Drinking Patterns as Predictors Of Employment Status in Working-Age Men in Izhevsk, Russia
Authors: Cook S A , Leon D A 
Published: September 2012

BackgroundHazardous alcohol consumption and unemployment are both associated with high mortality in Russia. Unemployment adversely affects mental and physical health. The relationship between alcohol and employment is complex as alcohol consumption may lead to unemployment but unemployment may also increase hazardous consumption. Very few longitudinal studies have investigated the effects of alcohol use on employment status. The objectives of this study were to investigate alcohol intake, drinking behaviour and drinking patterns as predictors of employment status in a longitudinal study of working-age men in Izhevsk, Russia.MethodsParticipants were 1217 men aged 25–54 resident in Izhevsk, Russia in regular paid employment at baseline (2003–6) who were followed up and re-interviewed (2008–9). Alcohol use was measured by total volume of ethanol consumed from beverage alcohol, drinking behaviour (abstainers, beverage alcohol drinkers with no problem drinking behaviour, beverage alcohol drinkers with problem drinking behaviour and non-beverage alcohol drinkers (e.g. eau de cologne)), and three aspects of drinking pattern (drinking spirits without food, drinking alone and drinking before noon). Problem drinking was defined as twice weekly or more frequency of hangover, excessive drunkenness, sleeping in clothes because of drunkenness or one or more episodes of zapoi in the past year (defined as continuous drunkenness of two or more days during which participants were withdrawn from normal life). Logistic regression was used to investigate whether alcohol use at baseline predicted employment status at follow up after adjusting for socio-demographic variables.ResultsTotal volume of ethanol from beverage alcohol at baseline did not predict whether men were still in regular paid employment at follow-up (P value for linear trend=0.21). Problem drinkers (adjusted odds ratio 2.82 95% CI 1.23, 6.46) and non-beverage alcohol drinkers (adjusted odds ratio 2.42 (95% CI 1.18, 4.93) were more likely not to be in regular employment at follow-up than non-problem beverage alcohol drinkers. Among drinkers drinking spirits without food (adjusted odds ratio 2.13 95% CI 1.28, 3.54), drinking alone (adjusted odds ratio 1.65 95% CI 1.09, 2.50) and drinking before noon (adjusted odds ratio 2.49 95% CI 1.65, 3.78) all predicted employment status at follow-up.ConclusionDrinking behaviour and drinking patterns predicted future employment status in a sample of working-age men in Izhevsk Russia. However the volume of alcohol consumed per year did not, suggesting how alcohol is consumed and whether it leads to problem behaviour is more important than the overall amount consumed when considering the impact of alcohol on employment.
OP63 Associations of All-Cause and Cause-Specific Mortality with body Mass Index in a Large Norwegian Cohort: Use of Offspring Body Mass Index as an Instrumental Variable
Authors: Carslake DJ , Smith G Davey , Gunnell D , Nilsen TIL , Romundstad P 
Published: September 2012

BackgroundPeople with high body mass index (BMI) suffer elevated rates of mortality from a variety of causes, particularly from cardiovascular disease (CVD). Some studies have also found elevated mortality at low BMI, but it is unclear whether this represents a causal association. Potential confounding by existing ill-health is of particular concern. To avoid this problem, we used the BMI of an offspring as an instrument for the parent’s BMI, as well as conducting conventional analyses of parental mortality against their own BMI.MethodsWe extracted 33,011 mother-offspring and 28,142 father-offspring pairs from HUNT, a large prospective cohort study conducted in Nord-Trøndelag county, Norway. Participants’ BMI was adjusted for age, sex, secular trends and smoking status. Associations of parental mortality rates with their own BMI were estimated as hazard ratios using Cox regression. Age was the time axis, and we adjusted for smoking, alcohol, exercise, education and employment. Additionally, adjusted causal hazard ratios between parental mortality and BMI were estimated using offspring BMI as an instrument for parental BMI and cubic splines were fitted to all associations to assess their linearity.ResultsThere were 9,271 maternal and 9,889 paternal deaths within the follow-up period of 1984–2009. The associations of all-cause, CVD and cancer mortality with parents’ own BMI were substantially nonlinear, with elevated mortality at both extremes and minima at 21–25 kg m–2. Hazard ratios for all-cause mortality per standard deviation (4.1 kg m–2) of own BMI were 1.04 (95% CI: 1.02, 1.06) and 1.05 (1.02, 1.08) in mothers and fathers, respectively. In contrast, associations of mortality with offspring BMI were approximately linear and positive. Causal hazard ratios per standard deviation of BMI estimated from the instrumental variable analyses were 1.20 (1.11, 1.30) and 1.11 (1.02, 1.22) for all-cause mortality in mothers and fathers, respectively. For CVD they were 1.26 (1.13, 1.41) and 1.15 (1.01, 1.30), and for cancer they were 1.23 (1.05, 1.45) and 1.07 (0.90, 1.27).ConclusionThese results confirm the elevated mortality from all causes, CVD and cancer in subjects with high or low BMI. The use of an offspring’s BMI as an instrument suggests that the elevated mortality at low BMI in this and other studies may be the result of confounding by existing ill-health, and that the causal relationship between BMI and mortality is positive and approximately linear.
OP67 Do Doctors Contribute to the Social Patterning of Disease? Contrasting Findings from an Epidemiologic Survey and a Decision Making Experiment
Authors: McKinlay J.B. 
Published: September 2012

BackgroundThat type 2 diabetes mellitus (T2DM) varies significantly by race and ethnicity is a widely accepted fact. It is often invoked as a base rate (a prioriprobability) during the process of clinical reasoning. Epidemiological studies repeatedly show undiagnosed T2DM varies more by socioeconomic status (SES), than by race/ethnicity. This study seeks to understand the discrepancy between the true prevalence of undiagnosed T2DM by SES and its continually reported prevalence by race/ethnicity.MethodsData from two different but complementary studies are employed: a) a large Boston Area Community Health (BACH) survey; and b) a factorial experiment conducted with primary care doctors to examine variations in clinical decision making. The BACH epidemiologic survey (n=5502) employed a stratified, multi-stage cluster sample design and used multivariable techniques including logistic regression. The factorial experiment concerning decision making employed clinically authentic videotaped scenarios presented to primary care doctors (n=192), and used ANCOVA analyses.ResultsResults from the epidemiologic survey show that both undiagnosed signs and symptoms and diagnosed T2DM vary similarly by socio-economic status (SES). This finding is independently corroborated by National Health and Nutrition Examination Survey (NHANES) data for diagnosed T2DM. Complementary data from the clinical decision making experiment show the diagnosis of T2DM varies significantly by a patients’ race/ethnicity, controlling for SES, age and gender in the design. While undiagnosed signs and symptoms of T2DM in the community vary significantly by SES, rather than race/ethnicity, following diagnosis by primary care doctors they vary more by race/ethnicity, rather than by SES.ConclusionRace/ethnicity and SES in the US are almost totally confounded, such that measuring one is essentially also measuring the other. Consequently, doctors generally get the social patterning of T2DM right, but for entirely the wrong reason. Continued patterning of T2DM by race/ethnicity motivates the search for genetic and biophysiologic explanations and distracts attention from the more important and potentially modifiable contribution of SES circumstances to the prevalence of T2DM.
OP79 Youth Exposure to Television Alcohol Advertising in the UK
Authors: Patil S , Elliott M N , Winpenny E M , Rohr C , Nolte E 
Published: September 2012

BackgroundIncreasing evidence suggests that exposure to alcohol marketing increases the likelihood that adolescents will start to drink alcohol and that among those who already consume alcohol exposure to alcohol advertising is likely to increase its use. Existing research in Europe has tended to focus on the content of alcohol marketing and advertising but our understanding of the actual levels of exposure remains inadequate. This study aims to contribute to filling this gap by analysing youth exposure to television alcohol advertising in the UK.MethodsWe obtained data on viewership and on alcohol advertising volume for the top ten television channels with the highest number of viewers in the UK by age (4–9, 10–15, 16–24, 25 plus) for December 2010 to May 2011. Data were analysed descriptively to characterise youth viewership by channel, month and time of the day (‘daypart’) and alcohol advertising exposure. We then used a negative binomial regression model to measure incidental youth exposure to alcohol advertising relative to adults over 25 years of age. We applied sensitivity analyses to test robustness of the model.ResultsViewership and alcohol advertising volume varied substantially across the 10 channels, months and dayparts. Children and adolescents (10–15 years) constituted about 4% of the total audience and young people (16–24 years) 8%, yet their exposure to alcohol commercials was 5% and 50%, respectively. Relative to adults 25 years of age and older, the regression analysis found advert intensity was higher where children and adolescents constituted a greater proportion of the viewership (incident rate ratio (IRR) 1.09, 95% CI 1.02, 1.17, p =0.013). This relationship was particularly strong for commercials of beer and cider (IRR =1.14, 95% CI 1.06, 1.23, p =0.000), super market brands (IRR =1.16, 95% CI 1.07, 1.28, p =0.000), and ready-mix drinks (IRR =1.51, 95% CI 1.27, 1.78, p =0.000). In contrast, although the IRR for those aged 16 to 24 years also differed significantly from that observed for older adults, the difference was small (1.02, 95% CI 1.01, 1.04, p =0.003 ). There were no statistically significant associations for wine and spirit advert incidence and viewership for any of the younger population groups.ConclusionOur findings suggest that young people in the UK have a disproportionately higher exposure to television alcohol (except wine and spirits) advertising than would be expected from general viewership patterns. Alcohol advertising practices should be modified to limit exposure of underage viewers.