Atopic dermatitis and risk of hypertension, type 2 diabetes, myocardial infarction and stroke in a cross-sectional analysis from the Canadian Partnership for Tomorrow Project.

BACKGROUND: Atopic dermatitis (AD) has been associated with cardiovascular risk factors and diseases, but epidemiological studies to date have found conflicting results. OBJECTIVES: To determine the associations of AD with hypertension, type 2 diabetes (T2D), myocardial infarction (MI) and stroke. METHODS: We conducted a cross-sectional analysis of baseline data from the Canadian Partnership for Tomorrow Project, which includes Canadian residents aged 30-74 years living in British Columbia, Alberta, Ontario, Quebec and the Atlantic Provinces. We excluded participants with incomplete data on AD, hypertension, T2D, MI or stroke, who had type 1 or gestational diabetes or who developed any of the outcomes at an age prior to a diagnosis of AD. This left 259 119 participants in our analysis. We used logistic regression to calculate age- and sex-, and multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between AD and subsequent hypertension, T2D, MI and stroke. RESULTS: AD was reported by 21 379 (8·4%) participants. In total, 52 787 cases of hypertension, 12 739 cases of T2D, 4390 cases of MI and 2235 cases of stroke were reported by participants at enrolment. In the multivariable-adjusted model, AD was associated with decreased odds of hypertension (OR 0·87, 95% CI 0·83-0·90), T2D (OR 0·78, 95% CI 0·71-0·84), MI (OR 0·87, 95% CI 0·75-1·00) and stroke (OR 0·79, 95% CI 0·66-0·95). CONCLUSIONS: We did not find evidence of a positive association between AD and subsequent hypertension, T2D, MI or stroke; AD was inversely associated with these outcomes in our study. Given our findings and the conflicting literature, AD is likely not a major risk factor for cardiovascular disease.

A spatial analysis of community level overweight and obesity.

BACKGROUND: Rates of overweight and obesity are now considered to be epidemic. Few studies have examined the spatial distribution of overweight and obesity at the community level, an area of geography recommended for prevention and intervention. Therefore, the present study aimed to examine the spatial variation of overweight and obesity using community geographic boundaries. METHODS: A cross-sectional secondary spatial data analysis was conducted using three combined cycles of Canadian Community Health Survey data for the province of Nova Scotia with community level boundaries. Descriptive rates were calculated using standardised incidence ratio values and spatial analysis was carried out using Global and Local Moran's I and the GetisOrdGi* statistic for cluster identification. RESULTS: Maps illustrating local cluster analysis showed a significant degree of similarity between neighbouring communities in urban areas more so than rural communities. Hot spot analysis maps showed communities clustering together in the urban centre tended to have lower incidence of overweight and obesity ('cool spots'), whereas clustered communities in a more rural area had a higher incidence of overweight and obesity ('hot spots). CONCLUSIONS: The present study showed that there was geographical variation in overweight and obesity between urban and rural communities, and also there was a tendency for communities to cluster based on the incidence of overweight and obesity. This highlights the importance of understanding community level obesity rates and associated behavioural determinants, such as diet and physical activity, as well as the role that urbanisation or rurality may play in intervention initiatives for these behavioural determinants. Specifically, public health nutrition efforts for community level food environments in rural areas should ensure an individualised approach is used, whereas urban areas may be amenable to more general approaches aiming to support healthy weight status among the broader population.

Metabolomics and cancer preventive behaviors in the BC Generations Project.

Metabolomics can detect metabolic shifts resulting from lifestyle behaviors and may provide insight on the relevance of changes to carcinogenesis. We used non-targeted nuclear magnetic resonance to examine associations between metabolic measures and cancer preventive behaviors in 1319 participants (50% male, mean age 54 years) from the BC Generations Project. Behaviors were dichotomized: BMI < 25 kg/m2, ≥ 5 servings of fruits or vegetables/day, ≤ 2 alcoholic drinks/day for men or 1 drink/day for women and ≥ 30 min of moderate or vigorous physical activity/day. Linear regression was used to estimate coefficients and 95% confidence intervals with a false discovery rate (FDR) of 0.10. Of the 218 metabolic measures, 173, 103, 71 and 6 were associated with BMI, fruits and vegetables, alcohol consumption and physical activity. Notable findings included negative associations between glycoprotein acetyls, an inflammation-related metabolite with lower BMI and greater fruit and vegetable consumption, a positive association between polyunsaturated fatty acids and fruit and vegetable consumption and positive associations between high-density lipoprotein subclasses with lower BMI. These findings provide insight into metabolic alterations in the context of cancer prevention and the diverse biological pathways they are involved in. In particular, behaviors related to BMI, fruit and vegetable and alcohol consumption had a large metabolic impact.

Mapping dietary habits may provide clues about the factors that determine food choice.

BACKGROUND: Food deserts are thought to be a barrier to making healthier food choices. This concept has been challenged. The interaction between the physical environment and children's food choice has received little attention. The present study used food intake data to generate hypotheses concerning the role of the physical environment in food choice. METHODS: A cross-sectional analysis was conducted of the dietary habits of Year 5 (9-10-year-old) children from 90 of Liverpool's 118 primary schools. Individuals with the 'best' and 'worst' food choices were mapped and two areas associated with these extreme choices located. RESULTS: One thousand five hundred and thirty-five children completed the dietary questionnaire and supplied a full and valid postcode. Two adjacent areas with relatively large numbers of children in the 'best' and 'worst' food choice groups were chosen. Both areas had very similar socio-economic profiles. The contrast in the physical environments was striking, even on visual inspection. CONCLUSIONS: Food deserts as a cause of poor food choice did not stand scrutiny; the area located by the worst food choices had a plethora of shops selling food (better termed a food prairie), whereas the area located by the best food choices had no shops in evidence but did have more 'space'.

Geostatistical modelling of arsenic in drinking water wells and related toenail arsenic concentrations across Nova Scotia, Canada.

Arsenic is a naturally occurring class 1 human carcinogen that is widespread in private drinking water wells throughout the province of Nova Scotia in Canada. In this paper we explore the spatial variation in toenail arsenic concentrations (arsenic body burden) in Nova Scotia. We describe the regional distribution of arsenic concentrations in private well water supplies in the province, and evaluate the geological and environmental features associated with higher levels of arsenic in well water. We develop geostatistical process models to predict high toenail arsenic concentrations and high well water arsenic concentrations, which have utility for studies where no direct measurements of arsenic body burden or arsenic exposure are available. 892 men and women who participated in the Atlantic Partnership for Tomorrow's Health Project provided both drinking water and toenail clipping samples. Information on socio-demographic, lifestyle and health factors was obtained with a set of standardized questionnaires. Anthropometric indices and arsenic concentrations in drinking water and toenails were measured. In addition, data on arsenic concentrations in 10,498 private wells were provided by the Nova Scotia Department of Environment. We utilised stepwise multivariable logistic regression modelling to develop separate statistical models to: a) predict high toenail arsenic concentrations (defined as toenail arsenic levels ≥0.12 µg g(-1)) and b) predict high well water arsenic concentrations (defined as well water arsenic levels ≥5.0 µg L(-1)). We found that the geological and environmental information that predicted well water arsenic concentrations can also be used to accurately predict toenail arsenic concentrations. We conclude that geological and environmental factors contributing to arsenic contamination in well water are the major contributing influences on arsenic body burden among Nova Scotia residents. Further studies are warranted to assess appropriate intervention strategies for reducing arsenic body burden among human populations.

Adverse pregnancy outcomes around incinerators and crematoriums in Cumbria, north west England, 1956-93.

STUDY OBJECTIVE: To investigate the risk of stillbirth, neonatal death, and lethal congenital anomaly among babies of mothers living close to incinerators and crematoriums in Cumbria, north west England, 1956-93. DESIGN: Retrospective cohort study. Logistic regression was used to investigate the risk of each outcome in relation to proximity at birth to incinerators and crematoriums, adjusting for social class, year of birth, birth order, and multiple births. Continuous odds ratios for trend with proximity to sites were estimated. SETTING: All 3234 stillbirths, 2663 neonatal deaths, and 1569 lethal congenital anomalies among the 244 758 births to mothers living in Cumbria, 1956-1993. MAIN RESULTS: After adjustment for social class, year of birth, birth order, and multiple births, there was an increased risk of lethal congenital anomaly, in particular spina bifida (odds ratio 1.17, 95% CI: 1.07 to 1.28) and heart defects (odds ratio 1.12, 95% CI: 1.03 to 1.22) around incinerators and an increased risk of stillbirth (odds ratio 1.04, 95% CI: 1.01 to 1.07) and anencephalus (odds ratio 1.05, 95% CI: 1.00 to 1.10) around crematoriums. CONCLUSIONS: The authors cannot infer a causal effect from the statistical associations reported in this study. However, as there are few published studies with which to compare our results, the risk of spina bifida, heart defects, stillbirth, and anencephalus in relation to proximity to incinerators and crematoriums should be investigated further, in particular because of the increased use of incineration as a method of waste disposal.

Death in 12-24-Year-Old Youth in Nova Scotia: High Risk of Preventable Deaths for Males, Socially Deprived and Rural Populations-A Report from the NSYOUTHS Program.

Deaths from avoidable causes represent the largest component of deaths in young people in Canada and have a considerable social cost in relation to years of potential life lost. We evaluated social and demographic determinants of deaths in youth aged 12-24 years in Nova Scotia for the period 1995-2004. Youth most at risk of death were males, the more socially deprived, and those living in rural areas. There was a five-fold increase in suicides and a three-fold increase in injury deaths in males compared to females and a substantial component of these deaths were amongst males living in rural areas. Initiatives and prevention policies should be targeted towards specific at-risk groups, particularly males living in rural areas. Published vital statistics hide these important trends and thus provide only limited evidence with which to base-prevention initiatives.

Changing socioeconomic inequality in infant mortality in Cumbria.

AIMS: To investigate infant deaths in Cumbria, 1950-93, in relation to individual and community level socioeconomic status. METHODS: Retrospective birth cohort study of all 283,668 live births and 4889 infant deaths in Cumbria, 1950-93. Community deprivation (Townsend score) and individual social class were used to estimate socioeconomic status. Logistic regression was used to investigate risk of infant death (early neonatal, neonatal, and postneonatal) in relation to social class and Townsend deprivation score, adjusting for year of birth, birth order, multiple births, and stratified by time period, 1950-65, 1966-75, 1976-85, 1986-93. RESULTS: The risk of infant death in all categories was higher in the lower social classes and more deprived communities, although inequality in risk of neonatal death declined after 1975 to such an extent that there was no significant difference in neonatal death rates by socioeconomic status in the most recent time period. By contrast, there was no narrowing in socioeconomic inequality in postneonatal death risk over the study period. Community deprivation was associated with a significant increased risk of postneonatal death after adjusting for individual level socioeconomic status. CONCLUSIONS: Postneonatal deaths remain higher in the most deprived communities and in the more disadvantaged social classes. The social, lifestyle, and environmental determinates of adverse health outcomes for children need to be fully understood, and interventions should be designed and targeted at the more socially deprived sectors of our community.

Hospital accessibility and infant death risk.

This study of all 4889 infant deaths within the cohort of all 287 993 births in Cumbria, northwest England (1950-93), found no evidence of an increased risk of infant death with greater travel time to hospitals.

Childhood leukaemia and non-Hodgkin's lymphoma in relation to proximity to railways.

We investigated whether living close to railway lines is a risk factor for childhood leukaemia and non-Hodgkin's lymphoma in electoral wards in England and Wales, 1966-1987. The national rail network, 1966-1987, was digitised and the numbers of cases in each ward were related to two measures of environmental exposure to railways: a proximity and a density function, contributions to these functions being weighted by the frequency of use and time in use of each stretch of railway. Poisson regression was used to derive rate ratios in relation to these measures of exposure to railways, both unadjusted and adjusted for population mixing. We found no association between risk of leukaemia and railway proximity (unadjusted rate ratio for trend from the lowest to the median value=1.006, 95% CI: 0.998 - 1.013, P=0.14) and a very small association with railway density, of marginal statistical significance (rate ratio for trend=1.001, 95% CI: 1.000 - 1.003, P=0.05). This effect depended on two deprived, urban wards with high railway density and high population mixing and became nonsignificant (P=0.09) after allowing for population mixing. The very weak association between railway density and risk of childhood leukaemia is likely to be a consequence of the association between population mixing and proximity to railways in very deprived, urban wards.