Red and processed meat consumption and the risk of esophageal and gastric cancer subtypes in The Netherlands Cohort Study.

BACKGROUND: Prospective data on red and processed meat in relation to risk of subtypes of esophageal and gastric cancer are scarce. We present analyses of association between red and processed meat and the risk of esophageal and gastric cancer subtypes within The Netherlands Cohort Study on Diet and Cancer. DESIGN: 120 852 individuals aged 55-69 years were recruited in 1986, and meat intake was assessed using a 150-item food frequency questionnaire. After 16.3 years of follow-up, 107 esophageal squamous cell carcinomas, 145 esophageal adenocarcinomas, 163 gastric cardia adenocarcinomas, 489 gastric non-cardia adenocarcinomas, and 3923 subcohort members were included in a case-cohort analysis. RESULTS: Processed as well as red meat intake was positively associated with esophageal squamous cell carcinoma in men. Hazard ratios for highest versus lowest quintile of processed and red meat were 3.47 [95% confidence intervals (CI): 1.21-9.94; P for trend: 0.04] and 2.66 (95% CI: 0.94-7.48; P for trend: 0.06), respectively. No association was seen for adenocarcinomas or gastric cancer subtypes or for any of the four subtypes among women. CONCLUSION: Our findings suggest that red and processed meat consumption is associated with increased risk of esophageal squamous cell carcinoma in men but not with cancers of other esophageal and gastric subtypes.

Socio-economic gradients in the presence of musculoskeletal and other chronic diseases: results from a cross-sectional study in the Netherlands.

Socio-economic gradients in occurrence of diseases have been reported for many chronic conditions. However, whether the magnitude of socio-economic gradients differs across diseases and the extent to which lifestyle mediates such relationships are not known. Cross-sectional data from The National Monitor on Musculoskeletal System was used. Respondents (> 18 years) completed a questionnaire including gender, education, social status, lifestyle, and physician-diagnosed diseases. Logistic regressions investigated the relationship between education and the major chronic diseases (musculoskeletal diseases (MSKD), diabetes, cardiovascular (CVD), cancer, mental, respiratory, any disease). Next, analyses were repeated in individuals with potential to have paid work (i.e., those < 65 having paid work, being unemployed, or receiving living allowance (minimum income)). The mediating role of smoking and BMI between education and occurrence of diseases was assessed by testing indirect effects. From 8904 individuals (mean age 54 years, 46% male), 4378 (49%) had at least one disease. Gradients in occurrence of disease by education were present for all diseases except cancer and mental disease, with the strongest gradient in diabetes (OR 2.0 [95%CI 1.4;2.8]). Unemployment and especially living on minimum income were associated with increased odds to have MSKD and mental and respiratory disease, after adjusting for education. Smoking and obesity mediated part of the relationship between education and disease, with obesity playing more pronounced role. Association between deprivation and occurrence of all major chronic diseases is of comparable magnitude, with education having most consistent contribution. Our results support the notion of the generic (i.e., non-disease specific) mechanisms underlying socio-economic gradients in health.

Socioeconomic inequities in perceived health among patients with musculoskeletal disorders compared with other chronic disorders: results from a cross-sectional Dutch study.

OBJECTIVES: To explore the impact of socioeconomic factors on physical and mental health of patients with musculoskeletal disorders (MSKDs) and compare it across patients with other disorders. METHODS: A representative sample of the Dutch population (n=8904) completed a survey on sociodemographics, physician-diagnosed (co-) morbidities, and physical (physical component summary, PCS) and mental (mental component summary, MCS) subscales of SF-12 (outcome variables). Regression models were computed first in the total group of patients with MSKDs, with education, age, gender, origin and place of residence as independent variables, and, second, in individuals expected to have paid work, adding a variable on social status. Models were repeated for five other subgroups of chronic disorders (cardiovascular (CVD), diabetes, cancer, mental and respiratory) and for healthy individuals. RESULTS: MSKDs confirmed by a physician were reported by 1766 (20%) participants (mean age 59 years, 38% male), 547 (6%) respondents reported to have diabetes, 1855 (21%) CVD, 270 (3%) cancer, 526 (6%) mental disorders, 679 (8%) respiratory disorders and 4525 (51%) did not report any disease. In patients with MSKDs, (primary school vs university education (-5.3 (PCS) and -3.3 (MCS)) and having a state subsidy vs paid work (-5.3 (PCS) and -4.7 (MCS)) were consistently associated with worse physical and mental health. Gender was only relevant for PCS (female vs male -2.1). Comparable differences in health by education and social status were observed in the other diseases, except for cancer. CONCLUSIONS: Education and social status in MSKD have the same strong and independent association with health as in other chronic diseases. These health gradients are unfair and partly avoidable, and require consorted attention and action in and outside healthcare.