Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries.

BACKGROUND: Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups. METHODS: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS). RESULTS: Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban. CONCLUSION: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Applying an equity lens to tobacco-control policies and their uptake in six Western-European countries.

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

[Professional status and development of morbidity of health insurance patients in the period 1990 to 2003. A longitudinal Analysis of Routine Data from the Gmünder Ersatzkasse]. / Berufsstatus und Morbiditätsentwicklung von Krankenversicherten im Zeitraum 1990 bis 2003. Eine Längsschnittsanalyse mit Routinedaten der Gmünder Ersatzkasse.

In Germany there are only insufficient data both with regard to general morbidity events as well as with regard to the effects of specific professions on the morbidity process. For this reason the data of the Gmuender Ersatzkasse (GEK) have been analysed with a longitudinal design for the period 1990 to 2003. Our sample includes all employed members of the GEK who had been insured as of January 1, 1990 and were between 30 and 59 years old at this baseline. The total sample comprises 129,173 men and 13,567 women. The statistical analysis was performed with the statistical package "Transitional Data Analysis" (TDA) which was developed especially for longitudinal data. The analysis includes both cumulated morbidity rates as well as transition rates (Cox regression). The analysis shows that the cumulated morbidity rates of the seven diseases are higher for women than for men in the age category 30-39 years. In the age categories 40-49 and 50-59 years the cumulated morbidity rates are higher for men than for women. With regard to the occupations, the highest morbidity rates are found for manual occupations and services without special skills. The lowest rates are found for professions with high skills, engineers and managers. The results of the longitudinal analysis show distinctive social gradients. For occupations with lower skills the morbidity rates are about 100 percent higher than those of occupations with higher skills. Longitudinal analyses on the basis of health insurance fund data can make an important contribution to the monitoring of health and morbidity and should therefore be conducted also by other health insurance funds.

The prevalence of fullness, heartburn and nausea among persons with and without diabetes mellitus in Germany.

BACKGROUND: Gastrointestinal symptoms are commonly reported among persons with diabetes mellitus and are attributed to gastropathy as an expression of autonomic neuropathy. These symptoms are also frequent in the general population. The goal of this study was to compare the prevalence of fullness, heartburn and nausea in the German population among persons with and without diabetes mellitus. METHODS: A cross-sectional study was performed using the German Federal Health Surveys 1987, 1991 and 1998, and involving a representative random sample of German citizens (n = 18 411) aged 25 to 69 years. A comparison was made of the prevalence of self-reported symptoms among persons with and without self-reported diabetes mellitus. RESULTS: Diabetes mellitus is significantly associated only with nausea in males (OR, 1.75) and in females (OR, 1.88). In both groups, persons with or without diabetes, the prevalence of fullness (28 vs. 21 %) and heartburn (23 vs. 18 %) are about the same, whereas nausea is much less common (12 vs. 6 %). Women suffered more often from nausea than men in people with diabetes and from fullness and nausea in non-diabetic patients. No correlation between age group and the percentage of persons (both sexes) suffering from a certain complaint can be found in persons with diabetes. CONCLUSIONS: The prevalence of some gastrointestinal symptoms is higher in persons with diabetes. It is related to gender, but not to age. The association with diabetic gastropathy remains unclear.

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education.

OBJECTIVE: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. DESIGN: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. SETTING: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. PARTICIPANTS: 451 386 non-institutionalised men and women 25-79 years old. MAIN OUTCOME MEASURES: Smoking status, daily quantity of cigarettes consumed by smokers. RESULTS: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. CONCLUSIONS: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

[The changing role of the state in health care systems in OECD countries--research questions, research design and first results]. / Der Wandel der Staatlichkeit im Gesundheitswesen von OECD-Ländern -- Fragestellungen, Untersuchungsdesign und erste Ergebnisse.

In the framework of the DFG-Research-Unit 597 "Transformation of the State" is Project C3 investigating the change of the role of the state in health care systems in OECD-countries between 1970 and 2000. The primary research hypothesis is, that a tendency of convergence exists regarding the role of the state for the three main dimensions of health care systems, namely service provision, financing and regulation. This is carried out firstly based on a quantitative oriented analysis for 23 OECD-countries, utilising the data set "OECD Health Data 2002", and secondly with qualitative oriented country-studies for England, Germany and the U.S. Findings for the qualitative country-studies give some hints of convergence regarding the "private-public-mix" between the health system types "social insurance" (Germany), "national health system" (England), and "market oriented health system" (USA). First quantitative results concerning the changing role of the state in relation to the health care systems in OECD-countries provide evidence for a convergence process between these states in the financing dimension. For the dependent variable "total health care costs in % of gross domestic product" a trend of convergence is observed for the members states of the European Union (n = 12), while in the remaining Non-EU countries (n = 11) a trend of divergence is identified. For the same parameter we found a convergence for OECD-countries of the type "national health system" (n = 14). For OECD-countries of the type "social insurance" (n = 8) this convergence process is observed only for the time period 1970 - 1980. Some results confirm the hypothesis of the "growth to limits" (Flora). But it appears to us that in future other significant factors like globalisation processes, the increasing potentials of the medical technology and demographic changes may play an important role for the overall health budget and specific needs of the population in the OECD-states.

[The development of obesity in Germany in the period from 1985 until 2000]. / Die Entwicklung der Adipositas in Deutschland im Zeitraum von 1985 bis 2002.

Due to the great increase in the prevalence of obesity in the industrialised countries during the last two decades we examined the development of this prevalence in Germany between 1985 and 2002. Data sources are four national health surveys conducted between 1985 and 1998 and three surveys of the "Bertelsmann Health Monitor" in 2002 and 2003. Included in these representative cross-sectional surveys were all persons aged 25-69 years. The total number of study participants was 12 984 males and 13 630 females. Based on recommendations of the WHO, moderate obesity is defined as body-mass-index > or = 30 and pronounced obesity as body-mass-index > or = 35. From 1985 to 2002, there was an increase in the prevalence of moderate obesity in males from 16.2 to 22.5 % and in females from 16.2 % to 23.5 %, whereas the increase in the prevalence of pronounced obesity in males was from 1.5 to 5.2 % and in females from 4.5 to 7.5 %. The most important social characteristics related to pronounced obesity prevalences are low educational status, low occupational status and low household income. Thus, the quality of future preventive measures aiming at reducing obesity prevalence among the general population should be evaluated inter alia in respect of their ability to cope with the social origins of obesity.

[Changes in smoking habits in Germany between 1985 and 2002]. / Die Veränderung des Rauchverhaltens in Deutschland von 1985 bis 2002.

Due to the great impact of smoking on health this study investigates secular trends in smoking habits in Germany between 1985 and 2002. Special emphasis is on social characteristics which are related to the pattern of the smoking habits in the general population. Data sources are four national health surveys, conducted between 1985 and 1998, and three waves of the 'Bertelsmann-Health-Monitor' in 2002 and 2003. Included from these representative cross-sectional surveys are only persons aged 25-69 years. The total number of study participants are 13,079 males and 13,732 females. Independent variables included are schooling, occupational status, household equivalent income, occupational status, family status, community size and a social risk indicator. The analysis shows convergence in the secular trend in smoking behaviour between males and females, with decreasing rates for males and increasing rates for females. Overall, no noteworthy success of preventive measures to reduce smoking in Germany can be seen. The marked social polarisation of smoking which already existed in 1985 continued. In comparison to other European countries there is a great need for enhancing activities regarding prevention of smoking by adults in Germany.

[Individual risk factors, health behaviour and mortality developments in Germany from 1984 to 1998]. / Individuelle Risikofaktoren, Gesundheitsverhalten und Mortalitätsentwicklung in Deutschland im Zeitraum 1984 bis 1998.

The aim of the study is to investigate the contribution by the risk factors smoking, overweight, high blood pressure, physical inactivity and regular alcohol consumption to the total mortality development of the general population in Germany. Data are a mortality follow-up conducted by the Federal Institute for Population Research during 1984 - 1998 in West Germany and 1991-1998 in East Germany. 8474 persons participated at baseline in West Germany in the age group 31-69 years, and 1546 persons participated at baseline in East Germany in the age-group 40-79 years. The vital status in the year 1998 could be determined in West Germany for 86.5% and in East Germany for 97.0%. In the observation period 1986-1998 for West Germany 17.2% of the males died and 8.6% of the females. In East Germany between 1991-1998 9.6% of the males died and 6.7% of the females. The statistical analysis, based on the Cox regression showed for West Germany except for overweight in males throughout a significant contribution of the risk factor load on total mortality. The highest relative risks were found for strong smokers (males: RR = 3.47, p < 0.001, females: RR = 3.62, p < 0.001). The relative mortality risk for persons with three and more risk factors yielded in males 4.88 (p < 0.001) and in females 5.05 (p < 0.001). These findings clearly demonstrate that already a few risk markers of the individual health behaviour have a strong impact on the total mortality development in Germany. The mortality risk is about five times higher for persons with three and more risk factors. This indicates the need for preventive measures targeting high-risk population groups.

[Perceived general health and mortality]. / Subjektive Einschätzung der Gesundheit und Mortalitätsentwicklung.

Many international studies underline the importance of the health indicator "perceived general health" (PGH). For Germany, only few Longitudinal studies are available from recent years, dealing with the question whether PGH is a predictor for overall mortality. Based on a Mortality-Follow-up Study (n = 7212) under the auspices of the Federal Institute for Population Research the importance of the indicator PGH for the prediction of the mortality experience in the general population has been analysed for the period 1984 - 1998. The age-adjusted relative risk of "less than good health" for overall mortality is 2.11 (p <0.001) for males and 2.05 (p <0.001) for females (reference category: "good/very good health"). The relative risks for "poor health" are 4.32 (p <0,001) in males and 3.07 (p <0.001) in females. An inclusion of several control variables remarkably reduces these relative risks. The results indicate that the indicator "perceived general health" is an important predictor of overall mortality in Germany.

[Social characteristics influencing the mortality of male members of an insurance company in the years 1989 to 2000 -- A longitudinal study for the birth cohorts 1940-1949 of the Gmuend statutory insurance body]. / Soziale Einflussfaktoren für die Mortalität von männlichen Krankenversicherten in den Jahren 1989 bis 2000 - Eine Kohortenstudie der Geburtsjahrgänge 1940 bis 1949 der Gmünder Ersatzkasse.

The study goal is to analyse the association between social and occupational characteristics and mortality. Data are from a longitudinal register for the members of a statutory insurance body 'Gmuender Ersatzkasse' (GEK) for the period 1989 to 2000. Included are males, born 1940 - 1949, who were GEK-members on January 1, 1989 (n = 58 705). The dependent variable is defined as 'reason for end of health insurance: deceased' (n = 2283). Independent variables are: age, occupational group, family status, nationality and insurance status. The statistical analysis was performed with the software package 'Transitional Data Analysis' (TDA). It included cumulative mortality rates based on the Kaplan-Meier method and the multivariate analysis in order to assess hazard rates (maximum likelihood estimation). Statistically significant increased mortality rates for the 12-year observation period were found for non-married persons, for persons with less qualified occupations, and for mandatory health insurance members. No significant difference was observed between study subjects with and without German nationality. The observed strong social gradient in the overall mortality rates for male members of the GEK underline the challenge to reduce the social inequities in health chances which has recently been placed on the political agenda for the German health insurance companies.

[Social determinants of smoking behavior in Germany: results of a 1995 micro-census]. / Soziale Determinanten des Rauchverhaltens in Deutschland: Ergebnisse des Mikrozensus 1995.

OBJECTIVES: The negative health effects of cigarette smoking are nowadays well known. An important prerequisite for the implementation of rewarding health promotion campaigns aiming at reducing the tobacco dependency in the general population is the knowledge about smoking prevalences in different social population groups, and specific information about social factors and determinants influencing smoking behaviour. METHODS: In this regard, the Microcensus is a very valuable data source for Germany. Included in the present analysis are persons aged 18 years and older, which are present in the "Microcensus Public Use File 1995" and had answered the questions about their smoking behaviour (N = 186,424). The dependent study variable is current cigarette smoking. Independent study variables are sociodemographic factors (age, sex, family status), occupational status, unemployment, socio-economic situation and regional-specific variables (size of community, East vs West Germany). RESULTS: All together, 30.5% of the males and 18.0% of the females were current smokers. Significantly higher smoking rates were observed for persons living in metropolitan areas, persons with low educational achievement and low occupational status, for people being divorced, unemployed, and living on social welfare. In a second step, we analysed the cumulative effect of these social factors for current smoking status. In summary, it was found that the cumulation of social determinants explained a great part of the variance in smoking prevalence. Current smoking was four to six times more prevalent in population groups characterised by several unfavourable social conditions compared to more privilege population groups. CONCLUSIONS: Thus, smoking related prevention activities should be evaluated, among others, regarding their potential to reduce the social polarisation of the smoking epidemic.

[Correlation between educational status, chronic diseases and cardiovascular risk factors in young adults 18-29 years of age: results of a 1998 comprehensive German health survey]. / Der Zusammenhang zwischen Bildungsstatus, chronischen Krankheiten und kardiovaskulären Risikofaktoren bei jungen Erwachsenen im Alter von 18 bis 29 Jahren: Ergebnisse des Bundesgesundheitssurveys 1998.

OBJECTIVES: The aim of the study is to investigate the association between educational attainment and the prevalence of chronic diseases and cardiovascular risk factors for the German population aged 18-29 years. METHODS: The data source is the Federal Health Survey 1998 (BGS98), which is representative for Germany. The response rate for the survey is 61.4%. Included in the analysis are 616 females and 637 males. Indicator for educational atteinment is the highest achieved school degree ("Abitur" n = 375, "mittlere Reife" n = 566, "Hauptschule" n = 312). RESULTS: For eight of the 43 items for self-reported diseases in the BGS98-questionnaire persons in the age group 18-29 yielded a higher prevalence than older adults. For altogether 11 diseases, which showed a prevalence greater than 3% in the age group 18-29 years, only minor associations with educational attainment were observed. Statistically significantly increased prevalences are observed for allergic disorders in persons with higher education and for long-term headache in persons with lower education. Regarding smoking, obesity and lack of sports activities remarkably and statistically significant education related differences are observed. The percentage of persons showing simultaneously two or three of these risk factors was 33% for study subjects with "Hauptschulabschluss" compared to only 8% for study subjects with "Abitur". CONCLUSIONS: Educational attainment is still a strong predictor for health behaviour. This finding should be considered in future health promotion compaigns.

Association between malignant tumors of the thyroid gland and exposure to environmental protective and risk factors.

Risk factors for thyroid carcinomas and adenomas were investigated using a standard questionnaire in a case-control study in Southwestern Germany, a known iodine deficiency area. A clinical registry, set up after the Chernobyl accident at the University hospital Mannheim, served as the basis for 174 incident cases of each diagnostic group. Interview data were compared within and with prevalences from a population-based matched control group of equal size from the entire area. The protective role of coffee drinking and the consumption of cruciferous vegetables, such as broccoli, were confirmed for both genders. A high consumption of tomatoes (> 200/year) was associated with an elevated risk of > 2.5 for malignant tumors but not for benign tumors in both genders. In both genders, both treatment for goiter (hyperthyroidism) and decaffeinated coffee consumption were associated with an increased risk for malignant tumors, but less so for adenomas. In women, early menarche (< 13 years) and stillbirth after first pregnancy, as well as hysterectomy, were substantial risk factors. Occupational variables and radiation, including medical indications and mammography, did not reveal particular risks. We did not address the role of regular iodine substitution, but did analyze the consumption of freshwater fish and seafood. Multivariate analyses of the most prominent risk factors confirmed the persistence of tomato consumption as a risk factor. In view of experimental evidence on the carcinogenicity of organophosphates and the neurotoxicant effect of certain agrochemicals on neuroendocrinologically regulated organs, we postulate that in Germany, importing off-season tomatoes from areas with a known history of possible inexperienced use of agrochemicals may be associated with a promoting effect for malignant neoplasias of the thyroid gland in terms of promoting already existent proliferating tissue growth.

Persistent variations in average height between countries and between socio-economic groups: an overview of 10 European countries.

PRIMARY OBJECTIVES: This paper aims to provide an overview of variations in average height between 10 European countries, and between socio-economic groups within these countries. DATA AND METHODS: Data on self-reported height of men and women aged 20-74 years were obtained from national health, level of living or multipurpose surveys for 1987-1994. Regression analyses were used to estimate height differences between educational groups and to evaluate whether the differences in average height between countries and between educational groups were smaller among younger than among older birth cohorts. RESULTS: Men and women were on average tallest in Norway, Sweden, Denmark and the Netherlands and shortest in France, Italy and Spain (range for men: 170-179 cm; range for women: 160-167 cm). The differences in average height between northern and southern European countries were not smaller among younger than among older birth cohorts. In most countries average height increased linearly with increasing birth-year (approximately 0.7-0.8 cm/5 years for men and approximately 0.4 cm/5 years for women). In all countries, lower educated men and women on average were shorter than higher educated men (range of differences: 1.6-3.0 cm) and women (range of differences: 1.2-2.2 cm). In most countries, education-related height differences were not smaller among younger than among older birth cohorts. CONCLUSIONS: The persistence of international differences in average height into the youngest birth cohorts indicates a high degree of continuity of differences between countries in childhood living conditions. Similarly, the persistence of education-related height differences indicates continuity of socio-economic differences in childhood living conditions, and also suggests that socio-economic differences in childhood living conditions will continue to contribute to socio-economic differences in health at adult ages.

[Risk factors for urothelial carcinoma: drinking measures, smoking and other life style-related risk factors--results of the Berlin Urothelial Study (BUS)]. / Risikofaktoren für das Urothelkarzinom: Trinkmenge, Rauchen und andere lebensstilbezogene Risikofaktoren--Ergebnisse der Berliner Urothelstudie (BUS).

With the exception of smoking and several occupational exposures there is little knowledge about risk factors for urothelial cancer. A case control study in the area of former West Berlin was performed from 1990-1995 to investigate the role of several lifestyle risk factors, such as smoking, drinking behaviour and regular intake of analgesics and laxatives. The study includes 647 hospital-based incident cases with bladder cancer (n = 571), renal pelvis cancer (n = 51), and ureter cancer (n = 25), and 647 population-based controls which were matched individually by sex and age. Data analyses were carried out using standard methods for case control studies (conditional multiple logistic regression analysis). Odds ratios (OR) and 95% confidence intervals (CI) were applied as effect parameter. Statistically significantly increased odds ratios were observed for current smoking (OR: 3.46, 95% CI: 2.50-4.78), previous but now abandoned smoking (OR: 1.51, 95% CI: 1.09-2.81), and for regular intake of laxatives (OR: 2.52, 95% CI: 1.56-4.09). Furthermore, an increased risk for urothelial cancer was observed for daily consumption of three and more litres of cold drinks (OR: 2.65 95% CI: 1.12-6.24). The results underline that lifestyle factors other than smoking may contribute to a higher risk of urothelial cancer.

Educational differences in smoking: international comparison.

OBJECTIVE: To investigate international variations in smoking associated with educational level. DESIGN: International comparison of national health, or similar, surveys. SUBJECTS: Men and women aged 20 to 44 years and 45 to 74 years. SETTING: 12 European countries, around 1990. MAIN OUTCOME MEASURES: Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. RESULTS: In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. CONCLUSIONS: These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries.

Urothelial cancer at different tumour sites: role of smoking and habitual intake of analgesics and laxatives. Results of the Berlin Urothelial Cancer Study.

BACKGROUND: In Germany about 20000 new cases of urothelial cancer (UC) and about 7500 deaths from bladder cancer alone occur each year. Among the manifold risk factors, little research has been done on the role of smoking and the habitual intake of analgesics and laxatives-practices that are common in parts of the German population. The aim of this study is to define the proportion of risk derived from these preventable habits for the development of UC at its different sites. Subjects and methods. A case-control study in the area of the former West Berlin was performed from 1990 to 1995 including all newly diagnosed incident cases of UC from the eight hospitals of the study area. Study subjects and population-based controls individually matched by age (+/-2 years) and sex were evaluated by a standardized face-to-face interview about the lifelong exposure to cigarette smoking, analgesics, and laxatives. Adjusted risk analysis was carried out for the main exposure variables in relation to the different sites of UC in the bladder, ureter, and renal pelvis. RESULTS: Six hundred and forty-seven cases of UC (571 bladder, 25 ureter, and 51 renal pelvis) and an identical number of controls were included in the analysis (response rate in cases, 84.6%; in controls, 70.2%). Smoking increased the risk of bladder cancer (BC) by an odds ratio (OR) of 3.22 (95% confidence interval (CI) 2.29-4.52), that of ureter (URC) or renal pelvis cancer (RPC) together by OR 6.20 (95% CI 2.04-18.81), and that of RPC alone by OR 5.91 (95% CI 1.47-23.66). Ex-smoking was associated with an increased risk for BC (OR 1.55, 95% CI 1.10-2.19). Intake of more than 1 kg of phenacetin in analgesic mixtures was associated with an OR of 5.28 for RPC (intake of > or = 1 kg paracetamol, OR 3.27; > or = 1 kg pyrazolones, 1.12) and 0.75 for BC (not significant). Laxatives significantly increased the risk of BC (OR 2.14, 95% CI 1.26-3.63) and RPC/URC (OR 9.62, 95% CI 1. 01-91.24) in both sexes. CONCLUSION: Habitual risks from smoking and intake of laxatives significantly contribute to the development of UC, especially of the renal pelvis and ureter cancer. Intake of at least 1 kg of analgesic substances (anilides, pyrazolones) as calculated from this study base is associated with increased but not significant risks for RPC. These data underline that restrictive and educational measurements focusing on common habits would have a strong impact on preventing UC in Germany.

[Analgesics and laxatives as risk factors for cancer in the efferent urinary tract--results of the Berlin Urothelial Carcinoma Study]. / Analgetika und Laxantien als Risikofaktoren für Krebs der ableitenden Harnwege--Ergebnisse der Berliner Urothelkarzinom-Studie (BUS).

A retrospective case-control study (1990-1995), the Berlin Urothelial Cancer Study (BUS), examined analgesics and laxatives as risks for the induction of urothelial cancer in renal pelvis, ureter and bladder. Especially for renal pelvis cancer could observe substance and dose specific risk of compound analgesics. The analgesic substances Phenacetin, Paracetamol, Acetylsalicylic acid (ASA) and Pyrazolones were assessed. Besides a risk of contact laxatives (chemical or anthranoide ingredients) for urothelial cancer was found, not yet described. The highest risk shows the anthranoide plant Senna. Thus this study confirms the risk of specific analgesic ingredients and found an evidence for a new risk of contact laxatives. As both, analgesics and contact laxatives, are typical OTC--("Over the counter") products, a severe controlling is demanded and for laxatives further studies are needed.