Showing papers by "Frank E. Speizer published in 2015"

Smoking and mortality--beyond established causes.

Abstract: BACKGROUND Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if smoking causes additional diseases, these official estimates may significantly underestimate the number of deaths attributable to smoking. METHODS We pooled data from five contemporary U.S. cohort studies including 421,378 men and 532,651 women 55 years of age or older. Participants were followed from 2000 through 2011, and relative risks and 95% confidence intervals were estimated with the use of Cox proportional-hazards models adjusted for age, race, educational level, daily alcohol consumption, and cohort. RESULTS During the follow-up period, there were 181,377 deaths, including 16,475 among current smokers. Overall, approximately 17% of the excess mortality among current smokers was due to associations with causes that are not currently established as attributable to smoking. These included associations between current smoking and deaths from renal failure (relative risk, 2.0; 95% confidence interval [CI], 1.7 to 2.3), intestinal ischemia (relative risk, 6.0; 95% CI, 4.5 to 8.1), hypertensive heart disease (relative risk, 2.4; 95% CI, 1.9 to 3.0), infections (relative risk, 2.3; 95% CI, 2.0 to 2.7), various respiratory diseases (relative risk, 2.0; 95% CI, 1.6 to 2.4), breast cancer (relative risk, 1.3; 95% CI, 1.2 to 1.5), and prostate cancer (relative risk, 1.4; 95% CI, 1.2 to 1.7). Among former smokers, the relative risk for each of these outcomes declined as the number of years since quitting increased. CONCLUSIONS A substantial portion of the excess mortality among current smokers between 2000 and 2011 was due to associations with diseases that have not been formally established as caused by smoking. These associations should be investigated further and, when appropriate, taken into account when the mortality burden of smoking is investigated. (Funded by the American Cancer Society.)

Passive smoking, gas cooking, and respiratory health of children living in six cities.

Abstract: As part of a longitudinal study of the respiratory health effects of indoor and outdoor air pollutants, pulmonary function, respiratory illness history, and symptom history were recorded at 2 successive annual examinations of 10,106 white children living in 6 cities in the United States. Parental education, illness history, and smoking habits also were recorded, along with the fuel used for cooking in the child's home. Maternal cigarette smoking was associated with increases of 20 to 35% in the rates of 8 respiratory illnesses and symptoms investigated, and paternal smoking was associated with smaller but still substantial increases. Illness and symptom rates were linearly related to the number of cigarettes smoked by the child's mother. Illness rates were higher for children of current smokers than for children of ex-smokers. The associations between maternal smoking status and childhood respiratory illnesses and symptoms were reduced but not eliminated by adjustment for parental illness history. Levels of forced expiratory volume in one second (FEV1) were significantly lower for children of current smokers than for children of nonsmokers at both examinations and highest for children of ex-smokers. Levels of forced vital capacity (FVC) were lower for children of nonsmokers than for children of current smokers at both examinations, but the difference was statistically significant only at the first examination. Both the increase in mean FVC and the decrease in mean FEV1 among children of current smokers were linearly related to daily cigarette consumption. None of the respiratory illnesses and symptoms studied was significantly associated with exposure to gas cooking in the child's home.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship between respiratory illness in childhood and chronic air-flow obstruction in adulthood.

Abstract: This review evaluates the hypothesis that lower respiratory infection in childhood is a risk factor for chronic air-flow obstruction (CAO) in adulthood. Clinical CAO appears to result from a lengthy and initially asymptomatic loss of function that correlates with the development of peripheral airways abnormalities and emphysema. The relative functional silence of the small airways, the apparent vulnerability of the child's lung to injury, and the demonstration of functional abnormalities after several types of viral respiratory infection are consistent with the proposed role of lower respiratory infection. Relevant epidemiologic studies, however, have provided conflicting results, and many are flawed by recall bias. The observed association in children between lower respiratory infection and impaired ventilatory function may be noncausal and not a direct consequence of infection. A complete test of the hypothesis would require follow-up of study subjects from birth to adulthood with monitoring of respiratory infections and pulmonary function.

Respiratory disease rates and pulmonary function in children associated with NO2 exposure.

Abstract: As part of a long-range, prospective study of the health effects of air pollution, approximately 8,000 children from 6 yrs to 10 yrs of age from 6 communities had questionnaires completed by their parents and had simple spirometry performed in school. Comparisons were made between children living in homes with gas stoves and those living in homes with electric stoves. Children from households with gas stoves had a greater history of respiratory illness before age 2 (average difference, 32.5/1,000 children) and small but significantly lower levels of FEV1 and FVC corrected for height (average difference, 16 ml and 18 ml, respectively). These findings were not explained by differences in social class or by parental smoking habits. Measurements taken in the homes for 24-h periods showed that NO2 levels were 4 to 7 times higher in homes with gas stoves than in homes with electric stoves. However, these 24-h measurements were generally well below the current federal 24-h outdoor standard of 100 micrograms/m3. Short-term peak exposures, which were in excess of 1,100 micrograms/m3, regularly occurred in kitchens. Further work will be required to determine the importance of these short-term peaks in explaining the effects noted.

A case-control study of lung cancer and diesel exhaust exposure in railroad workers.

Abstract: A case-control study of deaths among U.S. railroad workers was conducted to test the hypothesis that lung cancer is associated with exposure to diesel exhaust. Employed and retired male workers with greater than or equal to 10 yr of service who were born on or after January 1, 1900 and who died between March 1, 1981 and February 28, 1982 were eligible. We collected 87% of the death certificates from 15,059 deaths reported to the U.S. Railroad Retirement Board (RRB). Cases of lung cancer (1,256) were matched to controls by age (+/- 2.5 yr) and date of death (+/- 31 days). Potential exposure to diesel exhaust was assigned based on an industrial hygiene evaluation of jobs and work areas. Each subject's work history was determined from a yearly job report filed by his employer with the RRB from 1959 until death or retirement. Asbestos exposure prior to 1959 was categorized by the job held in 1959, the end of the steam locomotive era, or by the last job held if retirement occurred before 1959. Smoking histories were obtained by questionnaire from next of kin. Using multiple conditional logistic regression analysis to adjust for smoking and asbestos exposure, workers 64 yr of age or younger at the time of death with work in a diesel exhaust exposed job for 20 yr had a significantly increased relative odds (odds ratio = 1.41, 95% Cl = 1.06, 1.88) of lung cancer. No effect of diesel exhaust exposure was seen in workers 65 yr of age or older because many of these men retired shortly after the transition to diesel-powered locomotives.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of passive smoking on pulmonary function and nonspecific bronchial responsiveness in a population-based sample of children and young adults.

Abstract: Chez les enfants et jeunes adultes asthmatiques il y a une relation entre la reponse bronchique et le tabagisme maternel qui est statistiquement de signification limite. Une telle relation n'a pas ete retrouvee chez les enfants non asthmatiques

Mismatch of Sleep and Work Timing and Risk of Type 2 Diabetes

Abstract: OBJECTIVE To examine whether a mismatch between chronotype (i.e., preferred sleep timing) and work schedule is associated with type 2 diabetes risk. RESEARCH DESIGN AND METHODS In the Nurses’ Health Study 2, we followed 64,615 women from 2005 to 2011. Newly developed type 2 diabetes was the outcome measure ( n = 1,452). A question on diurnal preference ascertained chronotype in 2009; rotating night shift work exposure was assessed regularly since 1989. RESULTS Compared with intermediate chronotypes, early chronotypes had a slightly decreased diabetes risk after multivariable adjustment (odds ratio 0.87 [95% CI 0.77–0.98]), whereas no significant association was observed for late chronotypes (1.04 [0.89–1.21]). Among early chronotypes, risk of type 2 diabetes was modestly reduced when working daytime schedules (0.81 [0.63–1.04]) and remained similarly reduced in women working P trend = 0.014). By contrast, among late chronotypes, the significantly increased diabetes risk observed among day workers (1.51 [1.13–2.02]) appeared largely attenuated if their work schedules included night shifts ( P trend = 0.14). The interaction between chronotype and shift work exposure was significant ( P interaction = 0.0004). Analyses restricting to incident cases revealed similar patterns. CONCLUSIONS In early chronotypes, type 2 diabetes risk increased with increasing duration of shift work exposure, whereas late types had the highest diabetes risk working daytime schedules. These data add to the growing body of evidence that workers could benefit from shift schedules minimizing interference with chronotype-dependent sleep timing.

Effects of Sulfur Oxides and Respirable Particles on Human Health

Abstract: As part of a study of health effects of sulfur dioxide and particulate matter, we have established a cohort of adults 25 to 74 yr of age in 6 communities who will be followed prospectively. At the conclusion of our first cycle of measuring the health of adults in 6 sites we found that, although we used different sampling frames, our samples were close to the distribution shown in the U.S. Census for age, sex, and occupation, with the possible exception of one city. Analysis of the cross-sectional data indicated that for both age- and height-adjusted values for forced expiratory volume in 1 s and for selected rates of various respiratory symptoms standardized for age, differences among smoking groups were apparent. Differences in these parameters between sites suggest trends that were associated with levels of pollution. Further analyses of the prospective data currently being collected will be required before definitive statements can be made about the effect of specific levels of exposure.

Comparison of Three Standardized Questionnaires on Respiratory Symptoms1–3

Abstract: A new questionnaire (ATS-DLD) developed by the American Thoracic Society (ATS) for the Division of Lung Diseases (DLD) of the National Heart, Lung, and Blood Institute, designed to elicit more details about various symptoms and factors associated with chronic obstructive pulmonary diseases, was compared with 2 previous questionnaires, those developed by the British Medical Research Council (MRC) and by the National Heart and Lung Institute (NHLI). From a private census list of residents of Washington County, Md., 6 similar population samples of white men and women 25 to 64 yr of age were selected, one each for administration of the 3 questionnaires by telephone and by mail. A total of 1,004 interviews were obtained. Indicated prevalences of chronic cough and chronic phlegm were essentially the same for all 3 questionnaires; the ATS-DLD elicited significantly more symptoms of any wheeze, whereas the NHLI elicited more mild breathlessness. The MRC and ATS-DLD were virtually identical in indicated prevalence...

Asthma history, job type and job changes among US nurses

Abstract: Objectives Nurses are at increased risk of occupational asthma, an observation that may be related to disinfectants exposure. Whether asthma history influences job type or job changes among nurses is unknown. We investigated this issue in a large cohort of nurses. Methods The Nurses’ Health Study II is a prospective study of US female nurses enrolled in 1989 (ages 24–44 years). Job status and asthma were assessed in biennial (1989–2011) and asthma-specific questionnaires (1998, 2003). Associations between asthma history at baseline (diagnosis before 1989, n=5311) and job type at baseline were evaluated by multinomial logistic regression. The relations of asthma history and severity during follow-up to subsequent job changes were evaluated by Cox models. Results The analytic cohort included 98 048 nurses. Compared with nurses in education/administration (likely low disinfectant exposure jobs), women with asthma history at baseline were less often employed in jobs with likely high disinfectant exposure, such as operating rooms (odds ratio 0.73 (95% CI 0.63 to 0.86)) and emergency room/inpatient units (0.89 (0.82 to 0.97)). During a 22-year follow-up, nurses with a baseline history of asthma were more likely to move to jobs with lower exposure to disinfectants (HR 1.13 (1.07 to 1.18)), especially among those with more severe asthma (HR for mild persistent: 1.13; moderate persistent 1.26; severe persistent: 1.50, compared with intermittent asthma, p trend: 0.004). Conclusions Asthma history was associated with baseline job type and subsequent job changes among nurses. This may partly reflect avoidance of tasks involving disinfectant use, and may introduce bias in cross-sectional studies on disinfectant exposure and asthma in nurses.

Exploring Different Phenotypes of COPD

Abstract: Chronic obstructive pulmonary disease (COPD) is among the five leading causes of death in the developed world and is a rapidly rising cause of death in most other countries.1 Cigarette smoking is clearly the predominant cause of the development of COPD, but there has been speculation for some time that other factors need to be considered in assessing risk of the disease. The report by Lange et al.2 in this issue of the Journal describes results obtained from three longitudinal cohort studies involving adults (age range, 25 to 40 years in two cohorts and 31 to 75 years in the . . .

A Comparison between the Three Largest and Three Last of Five Forced Expiratory Maneuvers in a Population Study1, 2

Abstract: Five acceptable forced expiratory maneuvers were obtained with a portable spirometer from each person in a population of 1,670 selected from a stratified random sample of a community. The largest 3 of 5 tracings were identifiable as a significantly different subset of the 5 tracings. In 83 per cent of comparisons, the variance of the last 3 was greater than that of the largest 3. Among the largest 3 tracings the highest single value was also identified as significantly different from the other two tracings. For epidemiologic purposes the largest 3 of 5 acceptable tracings is preferable to the last 3 of 5.

Risk of Chronic Obstructive Pulmonary Disease

Abstract: Predictors of chronic obstructive pulmonary disease (COPD) have been identified in the prospective epidemiologic study of the population of Tecumseh, Michigan. Risk of developing COPD within 10 yr can be estimated from a profile that includes as risk factors age, sex, cigarette smoking habits, and forced expiratory volume in one second (FEV1. The index of risk placed 63% of male incidence cases and 64% of female incidence cases in the top 10% of the risk distribution and 81% of male and 86% of female COPD cases in the top 20% of the risk distribution for Tecumseh. The validity of the Tecumseh index of risk for other populations was determined in a collaborative investigation of data collected in longitudinal epidemiologic studies in Baltimore, Boston, Framingham, Louisiana, Staveley, and Tucson. The extent to which the risk model fitted these data sets was assessed by comparing predicted (or expected) onsets of COPD in each population with observations made in each study. The predictors of COPD identified...

Assessment of Genetic and Nongenetic Influences on Pulmonary Function

Abstract: To better understand the extent to which familial similarities in pulmonary function (PF) are attributable to genetic rather than to shared environmental influences, we studied the twinship aggregation of PF in 256 monozygotic (MZ) and 158 dizygotic (DZ) adult twin members of the Greater Boston Twin Registry. Genetic influences on various spirometric measures were estimated with twinship intrapair correlations adjusted using a regression model to control for similarities in the anthropomorphic characteristics of twins, and for the effects of a number of environmental factors that included childhood respiratory illness, occupational dust exposure, and smoking history. A significant influence of smoking on all air-flow measures was observed in this population for whom genetic similarities were adjusted. However, highly significant adjusted intrapair correlations for all spirometric measures, ranging from 0.52 to 0.76, were observed for the MZ twins. The intrapair correlations for the DZ twins were approxima...

Spirometry in Children

Abstract: Spirometric methodology for clinical and epidemiologic use in children was evaluated in 123 third and fourth grade school children 8 and 9 yr of age. They performed spirometric testing in the middl...