Gender differences in lung cancer epidemiology - do Austrian male lung cancer patients still die earlier in life?

Objective: Previous analyses reported an unexpected decline of mean age of death of Austrian male lung cancer patients until 1996 and a subsequent turnaround of this epidemiological trend after the mid-1990s until 2007. In light of ongoing changes in smoking behavior of men and women, this study aims to investigate the development of mean age of death from lung cancer in Austria during the past three decades. Materials and methods: This study used data about the annual mean age of death from lung cancer, including malignant neoplasm of trachea, bronchus and lung, between 1992 and 2021 obtained from Statistics Austria, Federal Institution under Public Law. One-way analysis of variance (ANOVA) and independent samples t-tests were applied to explore any significant differences of mean values in the course of time as well as between men and women. Results: Overall, mean age of death of male lung cancer patients increased consistently throughout the observed time periods, whereas women did not show any statistically significant change in the last decades. Conclusion: Possible reasons for the reported epidemiological development are discussed in this article. Research and Public Health measures should increasingly focus on smoking behaviors of female adolescents.

Anticholinergic and Sedative Medications Are Associated With Neurocognitive Performance of Well Treated People With Human Immunodeficiency Virus.

Background: We previously showed that anticholinergic (ACH) medications contribute to self-reported neurocognitive impairment (NCI) in elderly people with human immunodeficiency virus (PWH). The current cross-sectional study further evaluated the effect of ACH and sedative drugs on neurocognitive function in PWH who underwent comprehensive neuropsychological evaluation. Methods: A medication review was performed in PWH enrolled in the prospective Neurocognitive Assessment in Metabolic and Aging Cohort within the Swiss HIV Cohort Study. Neurocognitive functions were analyzed in 5 domains (motor skills, speed of information, attention/working memory, executive functions, and verbal learning memory). The effect of ACH and sedative medications on neurocognitive functioning was evaluated using linear regression models for the continuous (mean z-score) outcome and multivariable logistic regression models for the binary (presence/absence) outcome. Results: A total of 963 PWH (80% male, 92% Caucasian, 96% virologically suppressed, median age 52) were included. Fourteen percent of participants were prescribed ≥1 ACH medication and 9% were prescribed ≥1 sedative medication. Overall, 40% of participants had NCI. Sedative medication use was associated with impaired attention/verbal learning and ACH medication use with motor skills deficits both in the continuous (mean z-score difference -0.26 to -0.14, P < .001 and P = .06) and binary (odds ratio [OR], ≥1.67; P < .05) models. Their combined use was associated with deficits in overall neurocognitive functions in both models (mean z-score difference -0.12, P = .002 and OR = 1.54, P = .03). These associations were unchanged in a subgroup analysis of participants without depression (n = 824). Conclusions: Anticholinergic and sedative medications contribute to NCI. Clinicians need to consider these drugs when assessing NCI in PWH.

Trends in mortality and mean age at death from lung cancer in Austria (1975-2007).

OBJECTIVE: To investigate trends in mortality and mean age at death from lung cancer (MADLC) compared to mean age at death from all causes (MAD) over the period 1975 - 2007 in Austria. Results are assessed with respect to secular trends in smoking habits. METHODS: MAD and MADLC were computed by year and gender as the expected value of a fitted Weibull distribution. Age-period-cohort effects on lung cancer death rates were estimated by hierarchical Poisson models. RESULTS: In females MADLC was on average about 2 years higher than in males and tended to decrease since the mid 1980s, while after the mid 1990s MADLC in males increased such that the difference between men and women shrank to about half a year in 2007. Females dying from lung cancer lost about 6 years of life during the late 1970s but more than 10 years after 2000, while males lost 2 years in the 1970s and 5 years after 2000. Males demonstrated a decreasing risk with increasing year of birth, with the exception of cohorts born during or immediately after the World Wars that showed peak relative risks (RR). Females did not show pronounced birth cohort effect except for a peak RR for cohorts born during and after World War II. CONCLUSIONS: MADLC provides additional information about secular trends in addition to incidence data. The declining trend of MADLC in females and in males up to the mid 1990s points to a change of smoking habits with an earlier onset of smoking in both genders. The subsequent increase in males during the last decade may be attributed to an increasing proportion of quitters because smoking cessation delays onset of lung cancer.

Assessing smoking behaviour among medical students by the measurement of expired carbon monoxide (CO).

Smoking behaviour and prevalence rates among medical students and medical professionals are important public health issues, as physicians' attitudes and interventions are decisive for the patients' success in quitting smoking. Studies dealing with prevalence rates of smoking usually use only face-to-face interviews or self-administered questionnaires, which may induce vague findings. Additional measurement of exhaled carbon monoxide is an objective, easy, immediate, non-invasive and inexpensive mode of indicating smoking behaviour and will complement and at some stage replace the usual question regarding the number of cigarettes consumed. CO-measurement of 260 medical students was taken during compulsory public health training at the Medical University Vienna. Definite indication of active smoking was found in 12% of the students, 9.5% showed CO-levels between 6 and 10 ppm and 78% were definitely non-smokers with a CO level between 0 and 5 ppm. The students had the opportunity to get to know an important diagnostic technique and additionally learned about their own smoking habits.

Nocturnal sleep-disturbing nicotine craving and accomplishment with a smoking cessation program.

AIMS: To study nocturnal sleep-disturbing nicotine craving (NSDNC), described as a symptom of nicotine dependence, in 2884 patients. METHODS: All patients were part of a smoking cessation program of the Nicotine Institute in collaboration with the general sick fund of Lower Austria. During the study period, the program (which is ongoing) lasted five weeks and included individual counseling. At all appointments, patients received a questionnaire about smoking habits, illnesses, previous experience in smoking cessation and their motivation to complete the program with the help of an assistant. Carbon monoxide levels in expired air were also measured. RESULTS: Analysis of NSDNC showed that 22.4% (n = 647) of patients suffered from this symptom with varying intensity: 77.1% (n = 499) awoke rarely; 9.4% (n = 61) awoke several times per week; 6.8% (n = 44) awoke most days and 6.6% (n = 43) awoke daily. NSDNC was associated with nicotine dependence, the number of cigarettes smoked per day, CO level and the craving for cigarettes in general. Consequences for smoking cessation programs are complex. Success rates were influenced by the intensity of NSDNC. Patients who awoke most days or daily had the lowest chance to quit smoking and the lowest compliance with the program. CONCLUSIONS: Patients suffering from NSDNC, especially those who awoke most days or daily, formed a specific group among cigarette smokers. They can be classified as highly dependent smokers who have special needs regarding treatment strategies and medication. Further developments of specific cessation programs and strategies of tobacco harm reduction are recommended.

Breast Cancer and Socioeconomic Status in Austria.

With 28% of all cancers, breast cancer is the most common cancer in the Austrian female population (also worldwide), and incidence has shown a development similar to that in most of the Western European countries. Several studies reveal a higher incidence of breast cancer in women of higher socioeconomic status (SES) compared to women of lower SES. Later age of first childbearing, low total parity, significantly greater use of hormone replacement therapy, and a greater use of mammography screening by women of higher SES are possible explanations for these trends. Socioeconomic inequalities have a strong influence on the subjective perception of health, but also on objective indicators of the health situation. The health behavior of the Austrian population is, of course, determined by social factors. People with a higher socioeconomic status not only live longer than people with a lower SES, they also have a healthier lifestyle and they better assess their own health status. These inequalities can also be observed in significant differences in life expectancy between university graduates and low-educated people (6.2 years for men and 2.6 years for women).