Viral hepatitis in all its forms is a major public health problem throughout the world, affecting several hundreds of millions of people. Viral hepatitis is a cause of considerable morbidity and mortality both from acute infection and chronic sequelae which include, in the case of hepatitis B, C and D, chronic active hepatitis and cirrhosis. Hepatocellular carcinoma, which is one of the 10 commonest cancers worldwide, is closely associated with hepatitis B and, at least in some regions of the world, with hepatitis C virus. This timely monograph is a distillation of knowledge of hepatitis B, C and D, based on a review of 1000 studies by a small group of scientists. (It is interesting to note in passing that some 5000 papers on viral hepatitis are published annually in the world literature.) The epidemiological, clinical and experimental data on the association between infection with hepatitis B virus and primary liver cancer in humans are reviewed in a readable and succinct format. The available information on hepatitis C and progression to chronic infection is also evaluated and it is concluded (perhaps a little prematurely) that hepatitis C virus is carcinogenic. However, it is concluded that hepatitis D virus, an unusual virus with a number of similarities to certain plant viral satellites and viroids, cannot be classified as a human carcinogen. There are some minor criticisms: there are few illustrations and some complex tabulations (for example, Table 6) and no subject index. A cumulative cross index to IARC Monographs is of little value and occupies nearly 30 pages. This small volume is a useful addition to the overwhelming literature on viral hepatitis, and the presentation is similar to the excellent World Health Organisation Technical Reports series on the subject published in the past. It is strongly recommended as a readable up-to-date summary of a complex subject; and at a cost of 65 Sw.fr (approximately £34) is excellent value. A J ZUCKERMAN

https://jcp.bmj.com/content/jclinpath/48/7/691.1.full.pdf

IARC Monographs on the Evaluation of Carcinogenic Risks to Humans

Tobacco use is the leading cause of preventable disease and death in the United States, resulting in more than 480,000 premature deaths and $289 billion in direct health care expenditures and productivity losses each year. Despite progress over the past several decades, millions of adults still smoke cigarettes, the most commonly used tobacco product in the United States. To assess progress made toward the Healthy People 2020 target of reducing the proportion of U.S. adults who smoke cigarettes to ≤12.0% (objective TU-1.1), CDC used data from the 2013 National Health Interview Survey (NHIS) to provide updated national estimates of cigarette smoking prevalence among adults aged ≥18 years. Additionally, for the first time, estimates of cigarette smoking prevalence were assessed among lesbian, gay, or bisexual persons (LGB) using NHIS data. The proportion of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 17.8% in 2013, and the proportion of daily smokers declined from 16.9% to 13.7%. Among daily cigarette smokers, the proportion who smoked 20-29 cigarettes per day (CPD) declined from 34.9% to 29.3%, and the proportion who smoked ≥30 CPD declined from 12.7% to 7.1%. However, cigarette smoking remains particularly high among certain groups, including adults who are male, younger, multiracial or American Indian/Alaska Native, have less education, live below the federal poverty level, live in the South or Midwest, have a disability/limitation, or who are LGB. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free policies in worksites and public places, high-impact anti-tobacco mass media campaigns, and easy access to smoking cessation assistance, are critical to reducing cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the greatest burden.

/pdf/current-cigarette-smoking-among-adults-united-states-2016-43a09jm2d1.pdf

Current Cigarette Smoking Among Adults - United States, 2016.

Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

/pdf/suicide-and-suicidal-behavior-41x9ufvkfm.pdf

Suicide and Suicidal Behavior

This article highlights disparities in cancer incidence, mortality, and survival in relation to race/ethnicity, and census data on poverty in the county or census tract of residence. The incidence and survival data derive from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; mortality data are from the National Center for Health Statistics (NCHS); data on the prevalence of major cancer risk factors and cancer screening are from the National Health Interview Survey (NHIS) conducted by NCHS. For all cancer sites combined, residents of poorer counties (those with greater than or equal to 20% of the population below the poverty line) have 13% higher death rates from cancer in men and 3% higher rates in women compared with more affluent counties (less than 10% below the poverty line). Differences in cancer survival account for part of this disparity. Among both men and women, five-year survival for all cancers combined is 10 percentage points lower among persons who live in poorer than in more affluent census tracts. Even when census tract poverty rate is accounted for, however, African American, American Indian/Alaskan Native, and Asian/Pacific Islander men and African American and American Indian/Alaskan Native women have lower five-year survival than non-Hispanic Whites. More detailed analyses of selected cancers show large variations in cancer survival by race and ethnicity. Opportunities to reduce cancer disparities exist in prevention (reductions in tobacco use, physical inactivity, and obesity), early detection (mammography, colorectal screening, Pap tests), treatment, and palliative care.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.54.2.78

Cancer disparities by race/ethnicity and socioeconomic status

Lung Cancer: Epidemiology, Etiology, and Prevention

Background Deaths due to occupational disease and injury place a heavy burden on society in terms of economic costs and human suffering. Methods We estimate the annual deaths due to selected diseases for which an occupational association is reasonably well established and quantifiable, by calculation of attributable fractions (AFs), with full documentation; the deaths due to occupational injury are then added to derive an estimated number of annual deaths due to occupation. Results Using 1997 US mortality data, the estimated annual burden of occupational disease mortality resulting from selected respiratory diseases, cancers, cardiovascular disease, chronic renal failure, and hepatitis is 49,000,with a range from 26,000 to 72,000. The Bureau of Labor Statistics estimates there are about 6,200 work-related injury deaths annually. Adding disease and injury data, we estimate that there are a total of 55,200 US deaths annually resulting from occupational disease or injury (range 32,200‐78,200). Conclusions Ourestimateisintherangereportedbypreviousinvestigators,althoughwe have restricted ourselves more than others to only those diseases with well-established occupational etiology, biasing our estimates conservatively. The underlying assumptions and data used to generate the estimates are well documented, so our estimates may be updatedasnewdataemergesonoccupationalrisksandexposedpopulations,providingan advantageover previous studies. We estimatethatoccupationaldeathsare the8th leading causeofdeathintheUS,afterdiabetes(64,751)butaheadofsuicide(30,575),andgreater than the annual number of motor vehicle deaths per year (43,501). Am. J. Ind. Med. 43:461–482, 2003. 2003 Wiley-Liss, Inc.

Dying for work: The magnitude of US mortality from selected causes of death associated with occupation.

Mortality rates and causes among U.S. physicians

Suicide is the eighth leading cause of death in the United States. Suicide rates have been reported to be particularly high in professional, managerial, and executive groups. We reviewed English language epidemiological studies on suicide and occupation published since 1982. Some studies suggest that workers in a number of occupations, including chemistry, farming, and law enforcement, may have elevated suicide rates. The weight of current evidence supports the conclusion that both male and female physicians have elevated rates of suicide, with females at particularly high risk. Elevated rates of suicide in a particular occupational group may result from a complex interaction between job factors such as work stress and access to means and other risk factors such as age and presence of a mental disorder.

Suicide and occupation: a review of the literature.

Construction, one of the larger industries in the United States, employs 76 million workers, many in skilled trades occupations Previously published data about potential worksite exposures and mortality of construction site workers are limited We analyzed occupation and industry codes on death certificates from 19 US states to evaluate mortality risks among men and women usually employed in construction occupations Proportionate mortality ratios (PMRs) for cancer and several other chronic diseases were significantly elevated among 61,682 white male construction workers who died between 1984 and 1986 Men younger than age 65, who were probably still employed immediately prior to death, had significantly elevated PMRs for cancer, asbestos-related diseases, mental disorders, alcohol-related disease, digestive diseases, falls, poisonings, traumatic fatalities that are usually work-related, and homicides Elevated PMRs for many of the same causes were observed to a lesser degree for black men and white women whose usual industry was construction In addition, women experienced excess cancer of the connective tissue and suicide mortality Various skilled construction trades had elevated PMRs for specific sites, such as bone cancer and melanoma in brickmasons, stomach cancer in roofers and brickmasons, kidney and bone cancer in concrete/terrazzo finishers, nasal cancer in plumbers, pulmonary tuberculosis in laborers, scrotal cancer and aplastic anemia in electricians, acute myeloid leukemia in boilermakers, rectal cancer and multiple sclerosis in electrical power installers, and lung cancer in structural metal workers Using a standard population of blue collar workers did not result in fewer elevated PMRs for construction workers Despite lifestyle differences and other limitations of the study, the large numbers of excess deaths observed in this study indicate the need for preventive action for construction workers

Assessment of mortality in the construction industry in the United States, 1984-1986

Background

Livestock farmers are more likely to be exposed to a variety of different farming hazards than crop farmers. An analysis of occupation and industry-coded U.S. death certificate data from 26 states for the years 1984–1993 was conducted to evaluate mortality patterns among crop and livestock farmers.



Methods

Cause-specific proportionate mortality ratios (PMRs) were calculated using a National Institute for Occupational Safety and Health (NIOSH) computer program designed to calculate sex and race specific PMRs for occupations and industries in population-based data.



Results

Among white male (WM) livestock farmers, there was a significantly higher mortality from cancer of the pancreas, prostate and brain, non-Hodgkin's lymphoma (NHL), multiple myeloma, acute and chronic lymphoid leukemia, and Parkinson's disease. WM crop farmers showed significantly higher mortality risk for cancer of the lip, skin, multiple myeloma, and chronic lymphoid leukemia.



Conclusions

These disease trends suggested that livestock farmers might be exposed to more carcinogens or agricultural chemicals than crop farmers. Am. J. Ind. Med. 42:410–420, 2002. Published 2002 Wiley-Liss, Inc.

Carol A. Burnett

Papers

Dying for work: The magnitude of US mortality from selected causes of death associated with occupation.

Mortality rates and causes among U.S. physicians

Suicide and occupation: a review of the literature.

Assessment of mortality in the construction industry in the United States, 1984-1986

Proportionate mortality of crop and livestock farmers in the United States, 1984-1993.