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1.  IQ in childhood and vegetarianism in adulthood: 1970 British cohort study 
BMJ : British Medical Journal  2006;334(7587):245.
Objective To examine the relation between IQ in childhood and vegetarianism in adulthood.
Design Prospective cohort study in which IQ was assessed by tests of mental ability at age 10 years and vegetarianism by self-report at age 30 years.
Setting Great Britain.
Participants 8170 men and women aged 30 years participating in the 1970 British cohort study, a national birth cohort.
Main outcome measures Self-reported vegetarianism and type of diet followed.
Results 366 (4.5%) participants said they were vegetarian, although 123 (33.6%) admitted eating fish or chicken. Vegetarians were more likely to be female, to be of higher social class (both in childhood and currently), and to have attained higher academic or vocational qualifications, although these socioeconomic advantages were not reflected in their income. Higher IQ at age 10 years was associated with an increased likelihood of being vegetarian at age 30 (odds ratio for one standard deviation increase in childhood IQ score 1.38, 95% confidence interval 1.24 to 1.53). IQ remained a statistically significant predictor of being vegetarian as an adult after adjustment for social class (both in childhood and currently), academic or vocational qualifications, and sex (1.20, 1.06 to 1.36). Exclusion of those who said they were vegetarian but ate fish or chicken had little effect on the strength of this association.
Conclusion Higher scores for IQ in childhood are associated with an increased likelihood of being a vegetarian as an adult.
PMCID: PMC1790759  PMID: 17175567
2.  Association of maternal and paternal IQ with offspring conduct, emotional and attention problem scores: trans-generational evidence from the 1958 British birth cohort study 
Archives of general psychiatry  2011;68(10):1032-1038.
Lower IQ individuals have an increased risk of psychological disorders, mental health problems, and suicide; similarly, children with low IQ scores are more likely to have behavioural, emotional and anxiety disorders. However, very little is known about the impact of parental IQ on the mental health outcomes of their children.
To determine whether maternal and paternal IQ score is associated with offspring conduct, emotional and attention scores.
General population.
Members of 1958 National Child Development Study and their offspring. Of 2,984 parent-offspring pairs, with non-adopted children aged 4+ years, 2,202 pairs had complete data on all variables of interest and were included in the analyses.
Outcome measure
Offspring conduct, emotional and attention scores based on Behavioural Problems Index for children aged 4-6 years or the Rutter A scale for children aged 7 and over.
There was little evidence of any association of parental IQ with conduct or emotional problems in younger (aged 4-6) children. However, among children aged 7+, there was strong evidence from age- and sex-adjusted models to support a decrease in conduct, emotional and attention problems in those whose parents had higher IQ scores. These associations were linear across the full IQ range. Individual adjustments for socioeconomic status and child’s own IQ had limited impact while adjustments for Home Observation for Measurement of the Environment (HOME) scores and parental malaise attenuated associations with mother’s IQ but, again, had little impact on associations with father’s IQ. Strong associations were no longer evident in models that simultaneously adjusted for all four potential mediating variables.
Children whose parents score poorly on IQ tests may have an increased risk of conduct, emotional and attention problems. Home environment, parental malaise, and child’s own IQ may have a role in explaining these associations.
PMCID: PMC4170778  PMID: 21969461
5.  Socioeconomic status as a risk factor for dementia death: individual participant meta-analysis of 86 508 men and women from the UK* 
Life-course socioeconomic factors may have a role in dementia aetiology but there is a current paucity of studies. Meta-analyses of individual participant data would considerably strengthen this evidence base.
To examine the association between socioeconomic status in early life and adulthood with later dementia death.
Individual participant meta-analysis of 11 prospective cohort studies (1994-2004, n = 86 508).
Leaving full-time education at an earlier age was associated with an increased risk of dementia death in women (fully adjusted hazard ratio (HR) for age ⩽14 v. age ⩾16: HR = 1.76, 95% CI 1.23-2.53) but not men. Occupational social class was not statistically significantly associated with dementia death in men or women.
Lower educational attainment in women was associated with an increased risk of dementia-related death independently of common risk behaviours and comorbidities.
PMCID: PMC3696876  PMID: 23818534
6.  Socioeconomic and Psychosocial Adversity in Midlife and Depressive Symptoms Post Retirement: A 21-year Follow-up of the Whitehall II Study 
We examined whether socioeconomic and psychosocial adversity in midlife predicts post-retirement depressive symptoms.
Design and Setting
A prospective cohort study of British civil servants who responded to a self-administered questionnaire in middle-age and at older ages, 21 years later.
The study sample consisted of 3,939 Whitehall II Study participants (2,789 men, 1,150 women; mean age 67.6 years at follow-up) who were employed at baseline and retired at follow-up.
Midlife adversity was assessed by self-reported socioeconomic adversity (low occupational position; poor standard of living) and psychosocial adversity (high job strain; few close relationships). Symptoms of depression post-retirement were measured by the Center for Epidemiologic Studies Depression scale.
After adjustment for sociodemographic and health-related covariates at baseline and follow-up, there were strong associations between midlife adversities and post-retirement depressive symptoms: low occupational position (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.15–2.51), poor standard of living (OR: 2.37, 95% CI: 1.66–3.39), high job strain (OR: 1.52, 95% CI: 1.09–2.14), and few close relationships (OR: 1.51, 95% CI: 1.12–2.03). The strength of the associations between socioeconomic, psychosocial, work-related, or non-work related exposures and depressive symptoms was similar.
Robust associations from observational data suggest that several socioeconomic and psychosocial risk factors for symptoms of depression post-retirement can be detected already in midlife.
PMCID: PMC4270962  PMID: 24816123
Depression; elderly; inequalities; life course; mood disorders; old age; prospective; stress
7.  Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals 
Working long hours might have adverse health effects, but whether this is true for all socioeconomic status groups is unclear. In this meta-analysis stratified by socioeconomic status, we investigated the role of long working hours as a risk factor for type 2 diabetes.
We identified four published studies through a systematic literature search of PubMed and Embase up to April 30, 2014. Study inclusion criteria were English-language publication; prospective design (cohort study); investigation of the effect of working hours or overtime work; incident diabetes as an outcome; and relative risks, odds ratios, or hazard ratios (HRs) with 95% CIs, or sufficient information to calculate these estimates. Additionally, we used unpublished individual-level data from 19 cohort studies from the Individual-Participant-Data Meta-analysis in Working-Populations Consortium and international open-access data archives. Effect estimates from published and unpublished data from 222 120 men and women from the USA, Europe, Japan, and Australia were pooled with random-effects meta-analysis.
During 1·7 million person-years at risk, 4963 individuals developed diabetes (incidence 29 per 10 000 person-years). The minimally adjusted summary risk ratio for long (≥55 h per week) compared with standard working hours (35–40 h) was 1·07 (95% CI 0·89–1·27, difference in incidence three cases per 10 000 person-years) with significant heterogeneity in study-specific estimates (I2=53%, p=0·0016). In an analysis stratified by socioeconomic status, the association between long working hours and diabetes was evident in the low socioeconomic status group (risk ratio 1·29, 95% CI 1·06–1·57, difference in incidence 13 per 10 000 person-years, I2=0%, p=0·4662), but was null in the high socioeconomic status group (1·00, 95% CI 0·80–1·25, incidence difference zero per 10 000 person-years, I2=15%, p=0·2464). The association in the low socioeconomic status group was robust to adjustment for age, sex, obesity, and physical activity, and remained after exclusion of shift workers.
In this meta-analysis, the link between longer working hours and type 2 diabetes was apparent only in individuals in the low socioeconomic status groups.
Medical Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), Economic and Social Research Council, US National Institutes of Health, and British Heart Foundation.
PMCID: PMC4286814  PMID: 25262544
8.  Influence of maternal and paternal IQ on offspring health and health behaviours: evidence for some trans-generational effects using the 1958 British birth cohort study 
Individuals scoring poorly on tests of intelligence (IQ) have been reported as having increased risk of morbidity, premature mortality, and risk factors such as obesity, high blood pressure, poor diet, alcohol and cigarette consumption. Very little is known about the impact of parental IQ on the health and health behaviours of their offspring.
We explored associations of maternal and paternal IQ scores with offspring television viewing, injuries, hospitalisations, long standing illness, height and BMI at ages 4 to 18 using data from the National Child Development Study (1958 birth cohort).
Data were available for 1,446 mother-offspring and 822 father-offspring pairs. After adjusting for potential confounding/mediating factors, the children of higher IQ parents were less likely to watch TV (odds ratio (95% confidence interval) for watching 3+ vs. <3 hours per week associated with a standard deviation increase in maternal or paternal IQ: 0.75 (0.64, 0.88) or 0.78 (0.64, 0.95) respectively) and less likely to have one or more injuries requiring hospitalisation (0.77 (0.66, 0.90) or 0.72 (0.56, 0.91) respectively for maternal or paternal IQ).
Children whose parents have low IQ scores may have poorer selected health and health behaviours. Health education might usefully be targeted at these families.
PMCID: PMC3696866  PMID: 22541368
Intelligence; Life course; Birth cohort; Trans-generational
9.  Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden 
BMC Medicine  2014;12(1):151.
The prevalence of multimorbidity (the presence of two or more long-term conditions) is rising internationally. Multimorbidity affects patients by increasing their burden of symptoms, but is also likely to increase the self-care demands, or treatment burden, that they experience. Treatment burden refers to the effort expended in operationalising treatments, navigating healthcare systems and managing relations with healthcare providers. This is an important problem for people with chronic illness such as stroke. Polypharmacy is an important marker of both multimorbidity and burden of treatment. In this study, we examined the prevalence of multimorbidity and polypharmacy in a large, nationally representative population of primary care patients with and without stroke, adjusting for age, sex and deprivation.
A cross-sectional study of 1,424,378 participants aged 18 years and over, from 314 primary care practices in Scotland that were known to be demographically representative of the Scottish adult population. Data included information on the presence of stroke and another 39 long-term conditions, plus prescriptions for regular medications.
In total, 35,690 people (2.5%) had a diagnosis of stroke. Of the 39 comorbidities examined, 35 were significantly more common in people with stroke. Of the people with a stroke, the proportion that had one or more additional morbidities present (94.2%) was almost twice that in the control group (48%) (odds ratio (OR) adjusted for age, sex and socioeconomic deprivation 5.18; 95% confidence interval (CI) 4.95 to 5.43). In the stroke group, 12.6% had a record of 11 or more repeat prescriptions compared with only 1.5% of the control group (OR adjusted for age, sex, deprivation and morbidity count 15.84; 95% CI 14.86 to 16.88). Limitations include the use of data collected for clinical rather than research purposes, a lack of consensus in the literature on the definition of certain long-term conditions, and the absence of statistical weighting in the measurement of multimorbidity, although the latter was deemed suitable for descriptive analyses.
Multimorbidity and polypharmacy were strikingly more common in those with a diagnosis of stroke compared with those without. This has important implications for clinical guidelines and the design of health services.
Electronic supplementary material
The online version of this article (doi:10.1186/s12916-014-0151-0) contains supplementary material, which is available to authorized users.
PMCID: PMC4220053  PMID: 25280748
10.  Examining Psychiatric Disorder as a Risk Factor for Cancer in a Prospective Cohort Study of 1,165,039 Swedish Men: Different Analytical Strategies Reveal Different Findings 
Epidemiology (Cambridge, Mass.)  2012;23(4):543-550.
Associations between psychiatric disorders and cancer incidence are inconsistent, with studies reporting cancer rates in psychiatric patients that are higher, similar, or lower than the general population. Exploration of these associations is complicated by difficulties in establishing the timing of onset of psychiatric disorders and cancer, and the associated possibility of reverse causality. Some studies have dealt with this problem by excluding patients with cancers pre-dating their psychiatric illness; others have not considered the issue.
We examined associations between psychiatric hospitalization and cancer incidence in a cohort of 1,165,039 Swedish men, and explored the impact of different analytical strategies on these associations using real and simulated data.
Relative to men without psychiatric hospitalization, we observed consistent increases in smoking-related cancers in those with psychiatric hospitalizations, regardless of analytical approach (for example, hazard ratio (95% confidence interval): 1.73 (1.52, 1.96)). However, associations with nonsmoking-related cancers were highly dependent on analytical strategy. In analyses based on the full cohort, we observed no association or a modest increase in cancer incidence in those with psychiatric hospitalizations (1.14 (1.07, 1.22)). In contrast, analyses excluding men whose cancer predated their psychiatric hospitalizations, resulted in a reduction in future cancer incidence in psychiatric patients (0.72; 0.67, 0.78). Results from simulated data suggest that even modest exclusions of this type can lead to strong artefactual associations.
Psychiatric disorder-cancer incidence associations are complex and influenced by analytical strategy. A greater understanding of the temporal relationship between psychiatric disorder and cancer incidence is required.
PMCID: PMC4176762  PMID: 22488410
11.  Oral disease in relation to future risk of dementia and cognitive decline: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial 
Examine the association of oral disease with dementia/cognitive decline in a cohort of people with type 2 diabetes.
A total of 11,140 men and women aged 55-88 years with type 2 diabetes participated in a baseline medical examination when they reported the number of natural teeth and days of bleeding gums. Dementia and cognitive decline were ascertained periodically during a 5 year follow-up.
Relative to the group with the greatest number of teeth (>=22), having no teeth was associated with the highest risk of both dementia (hazard ratio; 95% confidence interval: 1.48; 1.24, 1.78) and cognitive decline (1.39; 1.21, 1.59). Number of days of bleeding gums was unrelated to these outcomes.
Tooth loss was associated with an increased risk of both dementia and cognitive decline.
PMCID: PMC4170753  PMID: 21964484
cognitive decline; cohort study; dementia; oral disease
12.  Associations of Diabetes Mellitus with Site-Specific Cancer Mortality in the Asia-Pacific Region 
Owing to the increasing prevalence of obesity and diabetes in Asia, and the paucity of studies, we examined the influence of raised blood glucose and diabetes on cancer mortality risk.
Thirty-six cohort Asian and Australasian studies provided 367,361 participants (74% from Asia); 6% had diabetes at baseline. Associations between diabetes and site-specific cancer mortality were estimated using time-dependent Cox models, stratified by study and sex, and adjusted for age.
During a median follow-up of 4.0 years, there were 5,992 deaths due to cancer (74% Asian; 41% female). Participants with diabetes had 23% greater risk of mortality from all-cause cancer compared with those without: hazard ratio (HR) 1.23 (95% CI 1.12, 1.35). Diabetes was associated with mortality due to cancer of the liver (HR 1.51, 95% CI 1.19, 1.91), pancreas (HR 1.78, 95% CI 1.20, 2.65), and, less strongly, colorectum (HR 1.32, 95% CI 0.98, 1.78). There was no evidence of sex- or region-specific differences in these associations. The population attributable fractions for cancer mortality due to diabetes were generally higher for Asia compared with non-Asian populations.
Diabetes is associated with increased mortality from selected cancers in Asian and non-Asian populations.
PMCID: PMC4170754  PMID: 20705912
Diabetes Mellitus; Cancer Mortality; Epidemiology; Asia-Pacific
13.  Mental disorders in early adulthood and later psychiatric hospital admissions in relation to mortality in a cohort study of a million men 
Archives of general psychiatry  2012;69(8):823-831.
Mental disorders have been associated with increased mortality, but the evidence is primarily based on hospital admissions for psychoses. The underlying mechanisms are unclear.
To investigate whether the risks of death associated with mental disorders diagnosed in young men are similar to those associated with admission for these disorders, and to examine the role of confounding or mediating factors.
Prospective cohort study in which mental disorders were assessed by psychiatric interview during a medical examination on conscription for military service at a mean age of 18.3 years and data on psychiatric hospital admissions and mortality during a mean 22.6 years of follow-up were obtained from national registers.
1,095,338 men conscripted between 1969 and 1994.
Main outcome measure
All-cause mortality according to diagnoses of schizophrenia, other non-affective psychoses, bipolar or depressive disorders, neurotic/adjustment disorders, personality disorders, alcohol-related or other substance use disorders at conscription and on hospital admission.
Diagnosis of mental disorder at conscription or on hospital admission was associated with increased mortality. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.81 (1.54, 2.10) (depressive disorders) to 5.55 (1.79, 17.2) (bipolar disorders). The equivalent figures according to hospital diagnoses ranged from 5.46 (5.06, 5.89) (neurotic/adjustment disorders) to 11.2 (10.4, 12.0) (other substance use disorders) in men born 1951-8 and increased in men born later. Adjustment for early-life socioeconomic status, body mass index and blood pressure had little effect on these associations, but they were partially attenuated by adjustment for smoking, alcohol intake, intelligence, education and late-life socioeconomic position. These associations were not primarily due to deaths from suicide.
The increased risk of premature death associated with mental disorder is not confined to those whose illness is severe enough for hospitalisation or to those with psychotic or substance-use disorders.
PMCID: PMC4170756  PMID: 22868936
14.  Intelligence in early adulthood and subsequent hospitalisation and admission rates for the whole range of mental disorders: longitudinal study of 1,049,663 men 
Lower intelligence is a risk factor for several specific mental disorders, but it is unclear whether it is a risk factor for all mental disorder or whether it is associated with illness severity. We examined the relation between pre-morbid intelligence and risk of hospital admission and total admission rates for the whole range of mental disorders.
Participants were 1,049,663 Swedish men who took tests of intelligence on conscription into military service and were followed up for hospital admissions for mental disorder for a mean of 22.6 years. International Classification of Diseases diagnoses were recorded at discharge from hospital.
Risk of hospital admission for all categories of disorder rose with each point decrease in the nine-point IQ score. For a standard deviation decrease in IQ, age-adjusted hazard ratios (95% CI) were 1.60 (1.55, 1.65) for schizophrenia, 1.49 (1.45, 1.53) for other non-affective psychoses, 1.50 (1.47, 1.51) for mood disorders, 1.51 (1.48, 1.54) for neurotic disorders, 1.60 (1.56, 1.64) for adjustment disorders, 1.75 (1.70, 1.80) for personality disorders, 1.75 (1.73, 1.77) for alcohol-related and 1.85 (1.82, 1.88) for other substance use disorders. Lower intelligence was associated with greater comorbidity. Associations changed little on adjustment for potential confounders. Men with lower intelligence had higher total admission rates, a possible marker of clinical severity.
Lower intelligence is a risk factor for the whole range of mental disorders and for illness severity. Understanding the underlying mechanisms is crucial if we are to find ways to reduce the burden of mental illness.
PMCID: PMC4170757  PMID: 19907333
16.  Intelligence in early adulthood and subsequent risk of unintentional injury over two decades: cohort study of 1,109,475 Swedish men 
There is growing evidence of an inverse association between intelligence (IQ) and unintentional injuries.
Analyses are based on a cohort of 1,109,475 Swedish men with IQ measured in early adulthood. Men were followed-up for an average 24 years and hospital admissions for unintentional injury were recorded.
198,133 (17.9%) men had at least one hospital admission for any unintentional injury during follow-up. The most common cause of unintentional injury was falling, followed by road accidents, poisoning, fire and drowning. In addition, 14,637 (1.3%) men had at least one admission for complications of medical care. After adjusting for confounding variables, lower IQ scores were associated with an elevated risk of any unintentional injury (Hazard ratio (95% confidence interval) per standard deviation decrease in IQ: 1.15 (1.14, 1.15)), and of cause-specific injuries other than drowning (poisoning (1.53 (1.49, 1.57)), fire (1.36 (1.31, 1.41)), road traffic accidents (1.25 (1.23, 1.26)), medical complications (1.20 (1.18, 1.22)), and falling (1.17 (1.16, 1.18)). These gradients were stepwise across the full IQ range.
Low IQ scores in early adulthood were associated with a subsequently increased risk of unintentional injury. A greater understanding of mechanisms underlying these associations may provide opportunities and strategies for prevention.
PMCID: PMC4170759  PMID: 19955099
IQ; injury; socioeconomic status; cohort
17.  Physical stature and method-specific attempted suicide: cohort study of one million men 
Psychiatry research  2010;179(1):116-118.
Adult height, a marker of early-life environment, has been sporadically associated with suicide risk. We have examined adult height and attempted suicide risk in a cohort of 1,102,293 Swedish men and, in fully-adjusted analyses, found decreasing stepwise associations between height and attempted suicides by any means and most specific means.
PMCID: PMC4170761  PMID: 20627206
Attempted suicide; Height; Cohort
18.  Obesity and liver cancer mortality in Asia: the Asia Pacific Cohort Study Collaboration 
Cancer epidemiology  2009;33(6):469-472.
While obesity is associated with liver cancer in studies from western societies, the paucity of data from Asia limits insights into its aetiological role in this population. We examined the relationship between body mass index (BMI) and liver cancer using data from the Asia Pacific Cohort Studies Collaboration. In 309,203 Asian study members, four years of follow-up gave rise to 11,135 deaths from all causes, 420 of which were ascribed to liver cancer. BMI, whether categorised according to current guidelines for Asian groups or World Health Organisation recommendations, was not associated with liver cancer in any of our analyses.
PMCID: PMC4170772  PMID: 19900847
19.  Impact of blood pressure lowering on cardiovascular outcomes in normal weight, overweight and obese individuals: the PROGRESS Trial 
Hypertension  2010;55(5):1193-1198.
There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kg/m2) in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 (SE, 0.5/0.3) mmHg, with no difference by body mass index quarters: < 23.1, 23.1-25.3, 25.4-27.8 and ≥ 27.9 kg/m2. A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% confidence intervals): 0.80 (0.62-1.02), 0.78 (0.61-1.01), 0.67 (0.53-0.86), 0.69 (0.54-0.88) and 0.74 (0.66-0.84) (p for heterogeneity = 0.16). Similar results were apparent for stroke and stroke subtypes (all p for heterogeneity ≥ 0.07) or with the standard definitions of overweight and obesity (< 25, 25 to 29 and ≥ 30 kg/m) (all p for heterogeneity ≥ 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over five years, active therapy prevented one major vascular event among every 28, 23, 13 and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass index in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
PMCID: PMC4170774  PMID: 20212271
obesity; blood pressure; perindopril; cardiovascular disease; stroke
20.  Oral disease and cardiovascular disease in people with type 2 diabetes: prospective cohort study based on the ADVANCE trial 
Diabetologia  2010;53(11):2320-2327.
While there are plausible biological mechanisms linking oral health with cardiovascular disease (CVD) and mortality, to our knowledge, no study has examined this association in a representative population of people with type 2 diabetes.
We used the Action in Diabetes and Vascular disease: Preterax and Diamicron Modified-Release Controlled Evaluation study, a large, detailed, randomised controlled trial amongst a general population of individuals with type 2 diabetes. A total of 10,958 men and women, aged 55-88 years, with type 2 diabetes participated in a baseline medical examination when they counted their number of natural teeth and reported the number of days that their gums had bled over the preceding year. Study members were followed up for mortality and morbidity experience over 5 years. For the purposes of the present analyses, data from the trial are utilised using a prospective cohort study design.
After control for a range of potential confounding factors, relative to the group with the most teeth (>=22 teeth), the group with no teeth had a marked increased risk of death due to all-causes (hazard ratio; 95% confidence interval: 1.48; 1.24, 1.78), CVD (1.35; 1.05, 1.74) and non-CVD (1.64; 1.26, 2.13). Frequency of bleeding gums was not associated with any of the outcomes of interest. There was no suggestion that either treatment group or gender modified these relationships.
In people with type 2 diabetes, oral disease, as indexed by fewer teeth, was related to an increased risk of total mortality, and death due to both CVD and non-CVD.
PMCID: PMC4170775  PMID: 20700576
cardiovascular disease; coronary heart disease; epidemiology; oral disease; stroke
21.  Adult height and cancer mortality: The Asia Pacific Cohort Studies Collaboration 
The observation that taller people experience an increased risk of selected cancers is largely restricted to Caucasian cohorts. These associations may plausibly differ in Asian populations. For the first time, we make direct comparison of the associations between height and a series of malignancies in Australasian (Caucasian) and Asian populations.
Analyses were based on the Asia Pacific Cohort Studies Collaboration of 506, 648 male and female study participants (408,381 Asia, 98267 Australasia) drawn from 38 population-based cohort studies. Cox proportional hazards regression was used to estimate the relationship between height and cancer rates.
A total of 3,272,600 person years of follow-up gave rise to 7497 cancer deaths (5232 in men, 2265 in women). After multiple adjustments and left censoring, taller individuals experienced increased rates of carcinoma of the intestine (men and women); all cancers, liver, lung, breast, ‘other’ malignancies (all women); and prostate and bladder (men). No consistent regional (Asia vs. Australasia) or sex-differences were observed.
In the present study, taller men and women had an elevated risk of selected malignancies. These associations did not differ appreciably between Asian and Caucasian populations.
PMCID: PMC4170779  PMID: 19889610
Asia; body height; stature; cancer; malignancy
22.  Intelligence in early adulthood and subsequent risk of assault: cohort study of 1,120,998 Swedish men 
Psychosomatic medicine  2010;72(4):390-396.
There is growing evidence of an association between low intelligence (IQ) and increased risk of assault. However, previous studies are relatively small, do not adjust for socioeconomic status, and have not examined method-specific assaults.
Cox proportional hazards regression was used to explore IQ associations with assault by any means and by four specific methods in a large prospective cohort of 1,120,988 Swedish men. Study members had IQ measured in early adulthood and were well characterised for socioeconomic status in childhood and adulthood. Men were followed-up for an average of 24 years and hospital admissions for injury due to assault were recorded.
16,512 (1.5%) men had at least one hospital admission for injury due to assault by any means during follow-up. The most common assault was during a fight (N=13,144), followed by stabbing (N=1,211), blunt instrument (N=352), and firearms assaults (N=51). After adjusting for confounding variables, lower IQ scores were associated with an elevated risk of hospitalisation for assaults by any means (Hazard ratio (95% confidence interval) per standard deviation decrease in IQ: 1.51 (1.49, 1.54)), and for each of the cause-specific assaults (fight: 1.48 (1.45, 1.51); stabbing: 1.68 (1.58, 1.79); blunt instrument: 1.65 (1.47, 1.85); and firearms: 1.34 (1.00, 1.80)). These gradients were stepwise across the full IQ range.
Low IQ scores in early adulthood were associated with a subsequently increased risk of assault. A greater understanding of mechanisms underlying these associations may provide opportunities and strategies for prevention.
PMCID: PMC4170781  PMID: 20190131
IQ; assault; socioeconomic status; cohort
23.  Obesity, overweight and cancer mortality in the Asia-Pacific Cohort Studies Collaboration: pooled analyses of 424 519 participants 
The Lancet. Oncology  2010;11(8):741-752.
Excess weight is an established risk factor for several cancers but there are sparse data from Asian populations in whom overweight and obesity is increasing rapidly and adiposity can be substantially greater for the same body mass index (BMI) compared to Caucasians.
We examined associations of adult BMI with cancer mortality (overall and 20 sites) in geographic populations from Asia and Australia/New Zealand (ANZ) within the Asia Pacific Cohort Studies Collaboration using Cox regression. Pooled data from 39 cohorts (recruitment 1961-99, median follow-up 4 years) were analyzed for 424 519 participants (77% Asian; 41% female; mean recruitment age 48 years) with individual data on BMI.
After excluding follow-up < 3 years, 4872 cancer deaths occurred in 401 215 participants. Hazard ratios (95% CI) for cancer sites with increased mortality risk in the obese (≥30 kg/m2) relative to the normal weight (18.5-24.9 kg/m2) were: 1.21 (1.09-1.36) for all-cause cancer (excluding lung and upper-aero digestive tract), 1.50 (1.13-1.99) for colon, 1.68 (1.06-2.67) for rectum, 1.63 (1.13-2.35) for breast in women aged ≥ 60 years, 2.62 (1.57-4.37) for ovary, 4.21 (1.89-9.39) for cervix, 1.45 (0.97-2.19) for prostate, and 1.66 (1.03-2.68) for leukaemia with the increased risk associated with a 5-unit increment in BMI ≥ 18.5 kg/m2 ranging from 1.13 (0.91-1.40) for rectum to 1.45 (1.00-2.11) for cervix. There was little evidence of regional differences in relative risk except for oropharynx and larynx where the association was inverse in ANZ but absent in Asia.
Overweight and obese individuals in populations across the Asia-Pacific region are at significantly increased risk of mortality from cancer. Strategies to prevent overweight and obesity across Asia are required to reduce the burden of cancer expected to occur if the obesity epidemic continues.
The APCSC has been funded by the National Health and Medical Research Council of Australia, the Health Research Council of New Zealand and Pfizer Inc., through an unrestricted medical grant.
PMCID: PMC4170782  PMID: 20594911
body mass index; obesity; overweight; cancer; mortality; Asia-Pacific
24.  Comparison of waist-to-hip ratio and other obesity indices as predictors of cardiovascular disease risk in people with type 2 diabetes: a prospective cohort study from ADVANCE 
The aim of this study was to compare the strength of associations and discrimination capability of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with cardiovascular disease risk in individuals with type-2-diabetes.
Methods and results
11,140 men and women were followed for a mean of 4.8 years. Cox proportional hazard models were used to compute the hazard ratios (HR) and 95% confidence intervals (95% CI) for one standard deviation (SD) increase in baseline BMI (SD: 5 kg/m2), WC (SD: 13 cm) and WHR (SD: 0.08) with cardiovascular disease risk. After adjustment, HR (95% CI) for WC were 1.10 (1.03-1.18) for cardiovascular events, 1.13 (1.03-1.24) for coronary events, and 1.08 (0.98-1.19) for cardiovascular deaths. Estimates for WHR were 1.12 (1.05-1.19), 1.17 (1.08-1.28) and 1.19 (1.09-1.31). BMI was not related to any of these outcomes. While the receiver operating characteristic curve could not differentiate between anthropometric variables (p-values ≥ 0.24), the relative integrated discrimination improvement statistic showed an enhancement in the discrimination capabilities of models using WHR for cardiovascular outcomes, except for cerebrovascular events.
Strengths of associations and discrimination statistics suggested that WHR was the best predictor of cardiovascular events and mortality in patients with type-2-diabetes and BMI the worst.
PMCID: PMC4170784  PMID: 20628304
body mass index; waist circumference; waist-to-hip ratio; type 2 diabetes; cardiovascular disease
25.  Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE trial 
This study sought to examine the relationship between erectile problems and cardiovascular disease mortality.
While there are plausible mechanisms linking erectile dysfunction with coronary heart disease and stroke, studies are scarce.
Methods and Results
In a cohort analysis of a trial population (‘ADVANCE’), 6304 men aged 55-88 years with type 2 diabetes participated in a baseline medical examination when enquiries were made about erectile dysfunction. Over 5 years of follow-up, during which study members attended repeat clinical examinations, the presence of fatal and non-fatal cardiovascular disease outcomes, cognitive decline and dementia were ascertained. After adjusting for a range of covariates including existing illness, psychological health and classic cardiovascular disease risk factors, relative to those who were free of the condition, baseline erectile dysfunction was associated with an elevated risk of all cardiovascular disease events (hazard ratio; 95% confidence interval: 1.19; 1.08, 1.32), coronary heart disease (1.35; 1.16, 1.56) and cerebrovascular disease (1.36; 1.11, 1.67). Additionally, men who experienced erectile dysfunction at baseline and at two year follow-up had the highest risk of these outcomes.
In this cohort of men with type 2 diabetes, erectile dysfunction was associated with a range of cardiovascular disease events.
PMCID: PMC4170755  PMID: 21109113
coronary heart disease; epidemiology; erectile dysfunction; stroke

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