Occupational disparities in survival from common cancers in Japan: Analysis of Kanagawa cancer registry

BackgroundLittle is known about occupational disparities in survival for common cancer sites in Japan.MethodsUsing data from a population-based cancer registry, we identified 32,870 cancer patients diagnosed during 1992–2011. We followed the patients for 5 years (median follow-up time 5.0 years). For each individual, we classified their longest-held occupation into 5 classes (upper non-manual, lower non-manual, manual, farmer, and others) following the Erikson-Goldthorpe-Portocarero scheme. Poisson regression models were used to estimate overall and site-specific mortality rate ratios (MRRs) and 95% confidence intervals (CI) for each occupational class, adjusted for sex, age, and diagnosis year. Upper non-manual workers served as the reference group. Additionally, using a binary categorization of occupations (manual workers versus non-manual workers), a causal mediation analysis with 4-way decomposition was performed to investigate the potential mediation of the association between occupation and overall mortality by cancer stage.ResultsOverall prognosis was good in this population (5-year overall survival was 81.7%). Compared with upper non-manual workers, both overall and cancer-specific mortality was higher in lower non-manual workers (MRR=1.14, 95% CI 1.05–1.24) and manual workers (MRR=1.40, 95% CI 1.29–1.53). After adjusting for the mediating influence of prognostic factors (stage and treatment), the observed occupational differences were attenuated but remained significant in manual workers: MRR = 1.23 (95% CI 1.08–1.39). Observed occupational disparities tended to be attributable to common cancers, i.e., stomach and lung among men and female breast cancer. Additionally, manual workers had 1.25 times higher odds for advanced stage. In the mediation analysis, the overall proportion explained by mediating effect of cancer stage was 29% (4% due to mediated interaction and 25% due to pure indirect effect).ConclusionWe documented occupational disparities in survival from commonly-occurring cancers in Japan. Occupational differences in cancer stage may explain one-third of the survival disparities.     

Inequalities in women's health: looking at mortality differentials using an alternative approach

Data obtained from follow up of the 1971 census sample in the Office of Population Censuses and Surveys longitudinal study of England and Wales were used to look at women''s mortality differentials at ages 15-59. Women were grouped by combining information on marital state, own occupation, husband''s occupation (if married), economic activity, and indicators of household wealth (housing tenure and access to a car). Large groups were found with considerable differences in mortality. High mortality was associated with working in manual occupations and living in rented housing with no car in the household. In contrast, low mortality was associated with non-manual occupations and living in owner occupied housing with a car. Among married housewives and single women these extreme groups contributed 44% of expected deaths, the disadvantaged group experiencing death rates two and a half times that of the advantaged group. Smaller differences were found among married women with an occupational class.These findings are further evidence of the “health divide” in England and Wales and show that accurately to reflect the relation between a woman''s life circumstances and mortality it is necessary to utilise other measures than those based solely on occupation.     

Exploring the relationship between entheseal changes and physical activity: A multivariate study

Analyses of entheseal changes (EC) in identified skeletal samples employ a common research strategy based on the comparison between occupations grouped on the basis of shared biomechanical and/or social characteristics. Results from this approach are often ambiguous, with some studies that point to differences in EC between occupational samples and others failing to provide evidence of behavioral effects on EC. Here we investigate patterns of EC among documented occupations by means of a multivariate analysis of robusticity scores in nine postcranial entheses from a large (N = 372) contemporary skeletal sample including specimens from one Italian and two Portuguese identified collections. Data on entheseal robusticity, analyzed by pooled sides as well by separated sides and levels of asymmetry, are converted in binary scores and then analyzed through nonlinear principal component analysis and hierarchical cluster analysis. Results of these analyses are then used for the classification of occupations. Differences between occupational classes are tested by MANOVA and pairwise Hotelling's test. Results evidence three classes which separate occupations related to farming, physically demanding but generalized occupation, and physically undemanding occupations, with the more consistent differences between the first and the last classes. Our results are consistent with differences in biomechanical behavior between the occupations included in each class, and point to the physical and social specificity of farming activities. On the other hand, our study exemplifies the usefulness of alternative analytical protocols for the investigation of EC, and the value of research designs devoid of a priori assumptions for the test of biocultural hypotheses. Am J Phys Anthropol 156:215–223, 2015. © 2014 Wiley Periodicals, Inc.     

Effect of obesity on the reliability of age-at-death indicators of the pelvis

During medicolegal investigations, forensic anthropologists commonly use morphological changes in the auricular surface of the ilium and the symphyseal face of the pubis to estimate age. However, obesity may impact the reliability of age estimations based on pelvic joints. Over the past several decades, the prevalence of obesity has dramatically increased in the United States (US). Since the rate of progression through age-related stages of weight-bearing joints may be influenced by excessive body mass, it is important that anthropologists understand how obesity affects age-related morphological changes in the skeleton. This study investigates the effects of obesity on the validity of the estimated age-at-death based on the Buckberry–Chamberlin and Suchey–Brooks methods by comparing US adults considered normal BMI (BMI 18.5–24.9) and obese (BMI ≥ 30). The obese group exhibits overall greater bias (overestimation of age) and inaccuracy, less precision, and lower correlations between estimated and known age than the normal BMI group using both methods, although differences in the pubic symphysis are not statistically significant. For the auricular surface the age of transition from one phase to the next is lower and the standard deviations are greater for the obese as compared to normal weight individuals. This study helps to elucidate how obesity affects the rate of age-related skeletal change of the human pelvis, and shows that the pubic symphysis may be a more reliable indicator of age in obese individuals and that greater standard deviations are needed for obese individuals when estimating age-at-death from the pelvis. Am J Phys Anthropol 156:595–605, 2015. © 2014 Wiley Periodicals, Inc.     

Social class differences in secular trends in established coronary risk factors over 20 years: a cohort study of British men from 1978-80 to 1998-2000

Background

Coronary heart disease (CHD) mortality in the UK since the late 1970s has declined more markedly among higher socioeconomic groups. However, little is known about changes in coronary risk factors in different socioeconomic groups. This study examined whether changes in established coronary risk factors in Britain over 20 years between 1978–80 and 1998–2000 differed between socioeconomic groups.

Methods and Findings

A socioeconomically representative cohort of 7735 British men aged 40–59 years was followed-up from 1978–80 to 1998–2000; data on blood pressure (BP), cholesterol, body mass index (BMI) and cigarette smoking were collected at both points in 4252 survivors. Social class was based on longest-held occupation in middle-age. Compared with men in non-manual occupations, men in manual occupations experienced a greater increase in BMI (mean difference = 0.33 kg/m²; 95%CI 0.14–0.53; p for interaction = 0.001), a smaller decline in non-HDL cholesterol (difference in mean change = 0.18 mmol/l; 95%CI 0.11–0.25, p for interaction≤0.0001) and a smaller increase in HDL cholesterol (difference in mean change = 0.04 mmol/l; 95%CI 0.02–0.06, p for interaction≤0.0001). However, mean systolic BP declined more in manual than non-manual groups (difference in mean change = 3.6; 95%CI 2.1–5.1, p for interaction≤0.0001). The odds of being a current smoker in 1978–80 and 1998–2000 did not differ between non-manual and manual social classes (p for interaction = 0.51).

Conclusion

Several key risk factors for CHD and type 2 diabetes showed less favourable changes in men in manual occupations. Continuing priority is needed to improve adverse cardiovascular risk profiles in socially disadvantaged groups in the UK.     

Different Occupations Associated with Amyotrophic Lateral Sclerosis: Is Diesel Exhaust the Link?

The cause of sporadic amyotrophic lateral sclerosis (SALS) remains unknown. We attempted to find out if occupational exposure to toxicants plays a part in the pathogenesis of this disease. In an Australia-wide case-control study we compared the lifetime occupations of 611 SALS and 775 control individuals. Occupations were coded using country-specific as well as international classifications. The risk of SALS for each occupation was calculated with odds ratios using logistic regression. In addition, the literature was searched for possible toxicant links between our findings and previously-reported occupational associations with SALS. Male occupations in our study that required lower skills and tasks tended to have increased risks of SALS, and conversely, those occupations that required higher skills and tasks had decreased risks of SALS. Of all the occupations, only truck drivers, where exposure to diesel exhaust is common, maintained an increased risk of SALS throughout all occupational groups. Another large case-control study has also found truck drivers to be at risk of SALS, and almost two-thirds of occupations, as well as military duties, that have previously been associated with SALS have potential exposure to diesel exhaust. In conclusion, two of the largest case-control studies of SALS have now found that truck drivers have an increased risk of SALS. Since exposure to diesel exhaust is common in truck drivers, as well as in other occupations that have been linked to SALS, exposure to this toxicant may underlie some of the occupations that are associated with SALS.     

A Graphical Analysis of Mortality Rates and Years of Potential Life Lost

One challenge in assessing occupational fatal injuries is choosing a summary measure of the impact of these injuries. Each metric emphasizes different aspects of health risk, and fatal injury reports often focus on only one summary measure at a time. Deaths from the National Traumatic Occupational Fatality database were combined into external cause of death (e-code) groups. Graphs comparing average years of potential life lost (YPLL), mortality rate, and their product, “YPLL-rate”, are presented for e-code groups overall, industries and occupations, and e-code groups within selected industries and occupations. This integrated analysis of fatal injury characteristics allows identification of the portion of the workforce at highest risk. Homicides and electrocutions (e-code groups) had high mortality rates, average YPLL, and YPLL-rates, both overall, and within several of the industries and occupations examined. The industry and occupation of Agriculture, Forestry, and Fishing experienced a very high mortality rate and the lowest average YPLL for both industries and occupations. Laborer was the most hazardous occupation for young workers with an average YPLL near 40, and a mortality rate greater than 15 deaths per 100,000 worker-years.     

Factors affecting outdoor exposure in winter: population-based study

The extent of outdoor exposure during winter and factors affecting it were examined in a cross-sectional population study in Finland. Men and women aged 25–74 years from the National FINRISK 2002 sub-study (n=6,591) were queried about their average weekly occupational, leisure-time and total cold exposure during the past winter. The effects of gender, age, area of residence, occupation, ambient temperature, self-rated health, physical activity and education on cold exposure were analysed. The self-reported median total cold exposure time was 7 h/week (8 h men, 6 h women),<1 h/week (2 h men, 0 h women) at work, 4 h/week (5 h men, 4 h women) during leisure time and 1 h/week (1 h men, 1.5 h women) while commuting to work. Factors associated with increased occupational cold exposure among men were: being employed in agriculture, forestry and industry/mining/construction or related occupations, being less educated and being aged 55–64 years. Factors associated with increased leisure-time cold exposure among men were: employment in industry/mining/construction or related occupations, being a pensioner or unemployed, reporting at least average health, being physically active and having college or vocational education. Among women, being a housewife, pensioner or unemployed and engaged in physical activity increased leisure-time cold exposure, and young women were more exposed than older ones. Self-rated health was positively associated with leisure time cold exposure in men and only to a minor extent in women. In conclusion, the subjects reported spending 4% of their total time under cold exposure, most of it (71%) during leisure time. Both occupational and leisure-time cold exposure is greater among men than women.     

Outcome of respiratory illness occurring in the first year of life.

This paper describes the outcome of respiratory illness presented by a birth cohort of infants in the first year of life who were born to mothers in two inner London group general practices in terms of the ventilatory capacity measured at their fifth birthday. A history of two or more episodes of "lower" respiratory illness in the first year of life was associated with a significant reduction in peak expiratory flow when compared with those who had no such history. Boys had significantly higher peak flow rates than girls; those whose parents were in manual occupations had significantly lower peak flow rates than those whose parents were in non-manual occupations. There was a significant interaction between sex and social class.     

Population variation in osteological aging criteria: an example from the pubic symphysis

A fundamental assumption made by skeletal biologists is that both the pattern and rate of age-related morphological changes observed in modern reference populations are not significantly different than in past populations. In this brief exploration, the composition of a single reference and two independent, known-age, target samples are evaluated for the pubic symphysis. Differences in the timing of age-progressive changes between the reference and target samples are observed, and in particular, females demonstrated a pattern that was fundamentally different from the reference sample. These results serve as a cautionary note for the use of osteological aging criteria and issues of representativeness for modern standards.     

Age estimation from the auricular surface of the ilium: a revised method

A revised method for estimating adult age at death using the auricular surface of the ilium has been developed. It is based on the existing auricular surface aging method of Lovejoy et al. ([1985] Am. J. Phys. Anthropol. 68:15-28), but the revised technique is easier to apply, and has low levels of inter- and intraobserver error. The new method records age-related stages for different features of the auricular surface, which are then combined to provide a composite score from which an estimate of age at death is obtained. Blind tests of the method were carried out on a known-age skeletal collection from Christ Church, Spitalfields, London. These tests showed that the dispersion of age at death for a given morphological stage was large, particularly after the first decade of adult life. Statistical analysis showed that the age-related changes in auricular surface are not significantly different for males and females. The scores from the revised method have a slightly higher correlation with age than do the Suchey-Brooks pubic symphysis stages. Considering the higher survival rates of the auricular surface compared with the pubic symphysis, this method promises to be useful for biological anthropology and forensic science.     

Work-Related Fatal-Injury Risk of Construction Workers by Occupation and Cause of Death

To assess cause- and occupation-specific risks of work related fatal injuries among U.S. construction workers, the National Traumatic Occupational Fatalities (NTOF) surveillance system and Current Population Survey were used to obtain injury and employment data for the years 1990 through 1994. Risks were assessed by both rate and working lifetime risk. The occupation found to have the highest fatal-injury rate in construction was electrical-power installers and repairers (96.6 deaths/100,000 workers), followed by structural-metal workers (86.4) and operating engineers (41.0). The occupation found to have the largest numbers of fatalities was construction laborers (1133 deaths), followed by carpenters (408), and construction supervisors (392). The leading causes of death varied by occupation. Construction in general has experienced a decline in fatal-injury rates over the years; however, this decline did not occur equally across occupations and causes of death. The presentation of working lifetime injury risks provides a measure of risk for occupational injuries that can be compared with occupational illness risk assessments. This study is the first to provide a comprehensive national profile of work-related fatal-injury risks among United States construction workers by occupation and cause of death. The results will be useful in focusing research and prevention efforts on specific hazards in high-risk construction occupations.     

Lifetime socioeconomic position and mortality: prospective observational study.

OBJECTIVES: To assess the influence of socioeconomic position over a lifetime on risk factors for cardiovascular disease, on morbidity, and on mortality from various causes. DESIGN: Prospective observational study with 21 years of follow up. Social class was determined as manual or non-manual at three stages of participants'' lives: from the social class of their father''s job, the social class of their first job, and the social class of their job at the time of screening. A cumulative social class indicator was constructed, ranging from non-manual social class at all three stages of life to manual social class at all three stages. SETTING: 27 workplaces in the west of Scotland. PARTICIPANTS: 5766 men aged 35-64 at the time of examination. MAIN OUTCOME MEASURES: Prevalence and level of risk factors for cardiovascular disease; morbidity; and mortality from broad causes of death. RESULTS: From non-manual social class locations at all three life stages to manual at all stages there were strong positive trends for blood pressure, body mass index, current cigarette smoking, angina, and bronchitis. Inverse trends were seen for height, cholesterol concentration, lung function, and being an ex-smoker. 1580 men died during follow up. Age adjusted relative death rates in comparison with the men of non-manual social class locations at all three stages of life were 1.29 (95% confidence interval 1.08 to 1.56) in men of two non-manual and one manual social class; 1.45 (1.21 to 1.73) in men of two manual and one non-manual social class; and 1.71 (1.46 to 2.01) in men of manual social class at all three stages. Mortality from cardiovascular disease showed a similar graded association with cumulative social class. Mortality from cancer was mainly raised among men of manual social class at all three stages. Adjustment for a wide range of risk factors caused little attenuation in the association of cumulative social class with mortality from all causes and from cardiovascular disease; greater attenuation was seen in the association with mortality from non-cardiovascular, non-cancer disease. Fathers having a manual [corrected] occupation was strongly associated with mortality from cardiovascular disease: relative rate 1.41 (1.15 to 1.72). Participants'' social class at the time of screening was more strongly associated than the other social class indicators with mortality from cancer and from non-cardiovascular, non-cancer causes. CONCLUSIONS: Socioeconomic factors acting over the lifetime affect health and risk of premature death. The relative importance of influences at different stages varies for the cause of death. Studies with data on socioeconomic circumstances at only one stage of life are inadequate for fully elucidating the contribution of socioeconomic factors to health and mortality risk.     

Technical note: Shape variability induced by reassembly of human pelvic bones

In traditional as well as in geometric morphometric studies, the shape of the pelvis is often quantified after the reassembly of the two hip bones and the sacrum. However, on dry bones, the morphology of the cartilaginous tissues that form the two sacroiliac joints and the pubic symphysis before death remains unknown, leading to potential inaccuracies and errors during the reassembly process. A protocol was established to investigate the effects of reassembly on the quantification of pelvis shape. The shape of fresh pelves obtained after dissection, in which the three bones are in an anatomically relevant position, was compared with the shape of different reassemblies based on the individual dry bones of the same individuals. Our results demonstrated a significant effect of the reassembly. Variation in the reassembly process is likely related, first, to the complete absence of cartilaginous tissues on dry bones and, second, to the morphology of the sacroiliac joint which, in vivo, allows physiological movements, resulting in different potential positions of the two sacroiliac surfaces relative to one another. However, the artificial variation introduced by the reassembly process appears small compared with the biological variation between the different individuals.     

Leisure-time physical activity is associated with socio-economic status beyond income – Cross-sectional survey of the Northern Finland Birth Cohort 1966 study

We apply neoclassical economic modelling augmented with behavioral aspects to provide a detailed empirical investigation into indicators of socio-economic status (SES) as determinants of leisure-time physical activity. We utilize the data from the Northern Finland Birth Cohort 1966 obtained at the most recent time point during 2012–2014 (response rate 67 %), at which time the participants were approximately 46 years old. Our final study sample consists of 3,335 employed participants (1520 men, 1815 women; 32.3 % of the target population). We apply logistic regression methods for estimating how the probability of being physically active is related to various indicators of socio-economic status, taking into account physical activity at work and individual lifestyle, family- and health-related factors. Overall, our findings show that belonging to a higher socio-economic group, whether defined by income level, educational attainment, or occupational status, is associated with higher leisure-time physical activity. However, when we analyze different socio-economic groups, defined in terms of education, income and occupation, separately, we find that income is not a significant determinant of leisure-time physical activity within any of the particular SES groups. Further, we find that leisure-time physical activity is negatively associated with higher screen time (i.e., watching TV and sitting at a computer), and other aspects of unhealthy lifestyle, and positively associated with self-assessed health. In addition, we note that proxies for individual motivational factors and childhood physical activity, such as the grade point average and the grade achieved in physical education when leaving basic education, are strongly correlated with leisure-time physical activity in middle age among men, but not among women. Our results are in line with behavioral economics reasoning that social comparisons and environments affect behaviors. We emphasize the importance of considering behavioral economic factors when designing policies to promote physical activity.     

Effects of age and occupation on cortical bone in a group of 18th-19th century British men

The effects of age and occupation on cortical bone in a group of adult males from the 18th-19th century AD skeletal collection from Christ Church Spitalfields, London, were investigated. Cortical bone was monitored using metacarpal radiogrammetry. Individual age at death was known exactly from coffin plates. Occupation for individuals was known from historical sources. Results showed that continued periosteal apposition was evident throughout adult life, but from middle age onwards this was outstripped by about 2:1 by endosteal resorption, so that there was net thinning of cortical bone. The rate of cortical thinning resembled that seen in modern European males. Cross-sectional properties, as measured by second moments of area, bore no relationship to occupation. The results may suggest that, firstly, patterns of loss of cortical bone have remained unchanged in males for at least two centuries in Britain, and secondly, that biomechanical analyses of metacarpal cortical bone may be rather insensitive indicators of intensity of manual activity.     

Evaluation of the suchey–brooks method of age estimation in an Australian subpopulation using computed tomography of the pubic symphyseal surface

Despite the prominent use of the Suchey–Brooks (S–B) method of age estimation in forensic anthropological practice, it is subject to intrinsic limitations, with reports of differential interpopulation error rates between geographical locations. This study assessed the accuracy of the S–B method to a contemporary adult population in Queensland, Australia and provides robust age parameters calibrated for our population. Three‐dimensional surface reconstructions were generated from computed tomography scans of the pubic symphysis of male and female Caucasian individuals aged 15–70 years (n = 195) in Amira® and Rapidform®. Error was analyzed on the basis of bias, inaccuracy and percentage correct classification for left and right symphyseal surfaces. Application of transition analysis and Chi‐square statistics demonstrated 63.9 and 69.7% correct age classification associated with the left symphyseal surface of Australian males and females, respectively, using the S–B method. Using Bayesian statistics, probability density distributions for each S–B phase were calculated, providing refined age parameters for our population. Mean inaccuracies of 6.77 (±2.76) and 8.28 (±4.41) years were reported for the left surfaces of males and females, respectively; with positive biases for younger individuals (<55 years) and negative biases in older individuals. Significant sexual dimorphism in the application of the S–B method was observed; and asymmetry in phase classification of the pubic symphysis was a frequent phenomenon. These results recommend that the S–B method should be applied with caution in medico‐legal death investigations of Queensland skeletal remains and warrant further investigation of reliable age estimation techniques. Am J Phys Anthropol, 2013. © 2013 Wiley Periodicals, Inc.     

Lesions of the Symphysis in Athletes

In a radiological study of the pubic symphysis in 37 athletes (26 footballers and 11 others) and 156 young men as controls changes similar to those of osteitis pubis were found in 19 (76%) of the footballers and nine of the other athletes (81%) and 70 of the controls (45%). In the controls there was a significant correlation between their athletic ability and these changes.The clinical features consist of pain in the region of the pubis which may radiate to the groin or lower abdomen. Clicking may be present and indicates instability. Local tenderness is the only significant sign. Radiographs may show a combination of marginal irregularity, reactive sclerosis, and instability.A chronic stress lesion in the iliac component of a sacro-iliac joint was found in 20 out of 37 athletes, and 13 of them had instability at the pubic symphysis.It is concluded that repeated minor trauma is the primary aetiological factor. Though the radiological appearance may resemble that of osteitis pubis, there was no evidence that infection caused the lesion in this series. Spontaneous remission of symptoms is the most likely outcome. Rest from physical exertion is the most effective treatment, and stabilization of the pubic symphysis is indicated only rarely.     

Explosive Pleistocene range expansion leads to widespread Amazonian sympatry between robust and gracile capuchin monkeys

Aim Capuchin monkey species are widely distributed across Central and South America. Morphological studies consistently divide the clade into robust and gracile forms, which show extensive sympatry in the Amazon Basin. We use genetic data to test whether Miocene or Plio‐Pleistocene processes may explain capuchin species’ present distributions, and consider three possible scenarios to explain widespread sympatry. Location The Neotropics, including the Amazon and Atlantic Coastal Forest. Methods We sequenced the 12S ribosomal RNA and cytochrome b genes from capuchin monkey specimens. The majority were sampled from US museum collections and were wild‐caught individuals of known provenance across their distribution. We applied a Bayesian discrete‐states diffusion model, which reconstructed the most probable history of invasion across nine subregions. We used comparative methods to test for phylogeographic association and dispersal rate variation. Results Capuchins contained two well supported monophyletic clades, the morphologically distinct ‘gracile’ and ‘robust’ groups. The time‐tree analysis estimated a late Miocene divergence between Cebus and Sapajus and a subsequent Plio‐Pleistocene diversification within each of the two clades. Bayesian analysis of phylogeographic diffusion history indicated that the current wide‐ranging sympatry of Cebus and Sapajus across much of the Amazon Basin was the result of a single explosive late Pleistocene invasion of Sapajus from the Atlantic Forest into the Amazon, where Sapajus is now sympatric with gracile capuchins across much of their range. Main conclusions The biogeographic history of capuchins suggests late Miocene geographic isolation of the gracile and robust forms. Each form diversified independently, but during the Pleistocene, the robust Sapajus expanded its range from the Atlantic Forest to the Amazon, where it has now encroached substantially upon what was previously the exclusive range of gracile Cebus. The genus Cebus, as currently recognized, should be split into two genera to reflect the Miocene divergence and two subsequent independent Pliocene radiations: Cebus from the Amazon and Sapajus from the Atlantic Forest.