To Örebro University

Introduction & Objectives: Tobacco smoking and occupational exposure to carcinogens constitute well-established risk factors for bladder cancer (BC), while limited evidence suggest a possible effect of dietary factors and inflammation on BC risk. Dietary patterns with impact on systemic levels of inflammation have further been proposed and investigated as possible determinants of cancer risk. In this cohort study, we evaluated the association between the anti-inflammatory potential of diet and the risk of BC.

Materials & Methods: Using the Swedish Infrastructure for Medical Population-Based Life-Course and Environmental Research (SIMPLER), we identified a study population of N=79,292 men and women derived from the two original cohorts Cohort of Swedish Men (COSM, established in 1997) and Swedish Mammography Cohort (SMC, established in 1987). We used a 96-item food frequency questionnaire (FFQ), completed at baseline in 1997 and repeated in 2009, to calculate the Anti-Inflammatory Diet Index (AIDI) for all participants. AIDI is a previously developed, empirically derived composite measure of dietary anti-inflammatory potential, based on the food groups previously found to have the strongest association with levels of systemic inflammation. The index comprises 16 food groups: 11 with proposed anti-inflammatory and 5 with proposed pro-inflammatory potential. We used ICD-10 code C67 to identify incident BC cases op to year 2020 in the Swedish National Cancer Register, and we used baseline study questionnaire to assess covariates, including smoking status and socioeconomic measures. We further used Cox proportional hazards regression models to estimate unadjusted and multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between quartiles of AIDI in the population and later BC diagnosis – overall as well as with outcome separated into non-muscle invasive (NMIBC: Ta or T1 or CIS and N0, M0) and muscle invasive (MIBC: ≤T2 or N1 or M1) BC for cases occurring after year 2004.

Results: During follow-up until 2020, 1165 BC cases occurred, of which 249 were non-muscle invasive, 201 muscle invasive and 715 of unknown stage. Overall, we observed an inverse association between the highest quartile of AIDI (Q4 vs. Q1, representing most anti-inflammatory diet compared to most pro-inflammatory) and later BC diagnosis (multivariable-adjusted HR 0.74, 95% CI 0.61-0.89, p-trend: 0.01). When separating outcome by stage, we observed an association for MIBC (HR 0.35, 95% CI 0.22-0.57), but not for NMIBC (HR 0.86, 95% CI 0.57-1.28).

Conclusions: We observed an inverse association between a measure of dietary anti-inflammatory potential and BC risk, particularly the risk of MIBC. Our observations support a possible implication of the inflammatory potential of diet in BC development and the more pronounced association observed for MIBC may hint at a true biological association.

INTRODUCTION: A diet rich in fruits, vegetables, coffee, and tea, limited red meat, and moderate alcohol intake may reduce the risk of renal cell carcinoma (RCC). The anti-inflammatory potential of diet has been proposed as a mechanism influencing cancer risk. This study assessed the association between an anti-inflammatory diet and RCC risk.

METHODOLOGY: Data from two Swedish cohorts, the Swedish-Mammography-Cohort and the Cohort-of-Swedish-Men, were analysed. Dietary habits were assessed using a 96-item food frequency questionnaire. The Anti-Inflammatory Diet Index (AIDI), composed of 16 food groups (11 anti-inflammatory and 5 pro-inflammatory), was used to score dietary patterns. RCC cases were identified from the Swedish Cancer Register using ICD-10 codes, and Cox proportional hazards models were used to estimate hazard ratios based on AIDI quartiles.

RESULTS: Among 71,421 participants, 431 RCC cases were identified during a 19.7-year follow-up. Higher AIDI scores were associated with a lower RCC risk (HR for Q4 vs. Q1: 0.68, CI: 0.52-0.89). In sex-stratified analyses (p-for heterogeneity = 0.006), the association was stronger in among women (HR: 0.47, CI: 0.30-0.75) but less clear in among men (HR: 0.83, CI: 0.63-1.24).

CONCLUSION: These data suggest that adherence to an anti-inflammatory diet may confer a reduced risk for RCC, especially among women.

OBJECTIVE: To investigate whether degree of asymmetric hearing impairment influences patient-reported outcome measures and objective hearing results in primary stapedotomy. STUDY DESIGN: Register study.

SETTING: Data from the Swedish Quality Register for Otosclerosis Surgery consisting of 90% of stapes operations performed in Sweden.

MAIN OUTCOME MEASURE: The 984 patients eligible for inclusion were categorized on the basis of preoperative hearing impairment: unilateral, bilateral asymmetric, or bilateral symmetric. Pure-tone audiometry and patient-reported outcome measures were analyzed, and Glasgow benefit plots were constructed. Ordinal logistics regression analyses were performed to adjust for factors influencing PROMs associated with degree of asymmetric hearing.

RESULTS: Over 90% of patients across all groups reported improved or much improved hearing ability post-surgery. Ninety-five percent of patients who rated their hearing as worse or much worse after surgery had an air-conductive gain of <20 dB PTA4. Individuals with unilateral hearing impairment were more likely to report lower satisfaction with hearing function and daily life activities after surgery compared with those with bilateral hearing impairment, especially bilateral symmetric hearing impairment. In terms of hearing function, the bilateral symmetric hearing impairment group showed a significant decrease in the log odds of reporting lower satisfaction with a coefficient of -0.71 (95% confidence interval, -1.13 to -0.33), whereas the bilateral asymmetric hearing impairment group showed a nonsignificant decrease with a coefficient of -0.14 (95% confidence interval, -0.41 to 0.14) compared with the unilateral hearing impairment group. Tinnitus was more frequent in those with unilateral hearing impairment.

CONCLUSION: Those with preoperative unilateral hearing impairment were more likely to express lower satisfaction with the results, compared with patients with bilateral impairment. Our findings suggest that the degree of bilateral hearing impairment should be considered in preoperative counseling, to better align with patient expectations regarding the benefit of surgery. An estimated air-conductive gain of at least 20 dB PTA4 was favorable for patient satisfaction.

This study aimed to investigate epidemiology, injury characteristics, treatment, mortality and patient-reported outcome measures in patients with a distal radial fracture and Parkinson's disease. The patient population was obtained from the Swedish Fracture Register, and patients with Parkinson's disease were identified by data from the National Board of Health and Welfare. A total of 3179 cases were identified and matched with controls. Most fractures took place in the patient's home after a simple fall and were managed non-operatively. An anterior locking plate was the most common surgical intervention. The 1 year mortality was significantly higher among men with Parkinson's disease than in controls. Patient-reported outcome measures at the 1 year follow-up deteriorated significantly more for patients with Parkinson's disease than in controls, and patients with Parkinson's disease also experienced more problems with reoperations, pain, mobility and carrying out their usual activities. Level of evidence: III.

BACKGROUND: Perfluoroalkyl substances (PFAS) constitute a diverse group of chemical compounds used in various consumer products. While the associations between PFAS and certain adverse human health effects are well-documented, their impact on kidney function remains less known.

OBJECTIVE: The main aim of this study is to investigate the relationship between PFAS levels and kidney function (estimated glomerular filtration rate [eGFR]) utilizing a longitudinal design.

METHODS: The population-based Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study included 997 individuals at baseline (all aged 70 years, 50% females). Follow-up investigations were performed at 75 and 80 years of age. Seven major PFAS were determined in plasma using ultra-high performance liquid chromatography-mass spectrometry. Longitudinal and cross-sectional associations between PFAS and eGFR were analyzed using linear regression and mixed effects models following adjustment for sex, HDL and LDL-cholesterol, triglycerides, glucose, BMI, statin use and smoking.

RESULTS: Longitudinal models demonstrated statistically significant positive associations between perfluoroundecanoic acid (PFUnDA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA)and eGFR (all P < 0.001). The associations between linear perfluorooctane sulfonic acid (PFOS) and perfluorohexanesulfonic acid (PFHxS) followed a similar trend. In contrast, an inverse relationship between perfluoroheptanoic acid (PFHpA) and perfluorooctanesulfonamide (PFOSA) with eGFR was observed. The findings were largely corroborated by cross-sectional analyses.

IMPACT STATEMENT: This longitudinal study found that changes in certain PFAS concentrations were positively associated with the change in kidney function, though the direction of association varied across PFAS. These findings were further supported by cross-sectional analysis. The complexity of associations remains incompletely understood as some PFAS showed positive associations while others were inverse. Further longitudinal studies with repeated measures are needed to better elucidate the relationship between PFAS exposure and kidney function.

OBJECTIVES: This study compares hearing outcomes of two prosthesis materials, bone and titanium, used in ossiculoplasty.

DESIGN: This retrospective nationwide registry-based study uses data systematically collected by the Swedish Quality Registry for Ear Surgery (SwedEar). SETTING: The data were obtained from clinics in Sweden that perform ossiculoplasty.

PARTICIPANTS: Patients who underwent ossiculoplasty using either bone or titanium prostheses were registered in SwedEar between 2013 and 2019.

MAIN OUTCOME MEASURES: Hearing outcome expressed as air-bone gap (ABG) gain.

RESULTS: The study found no differences between bone and titanium for ABG or air conduction (AC) for either partial ossicular replacement prostheses (PORP) or total ossicular replacement prostheses (TORP). In a comparison between PORP and TORP for ABG and AC outcomes, regardless of the material used, PORP showed a small advantage, with an additional improvement of 3.3 dB (95% CI [confidence interval], 0.1-4.4) in ABG and 2.2 dB (95% CI, 1.7-4.8) in AC. In secondary surgery using TORP, titanium produced slightly better results for high-frequency pure tone average. The success rate, a postoperative ABG ≤20 dB, was achieved in 62% of the operations for the whole group.

CONCLUSION: Both bone and titanium used to reconstruct the ossicular chain produce similar hearing outcomes for both PORP and TORP procedures. However, titanium may be a preferable option for secondary surgeries involving TORP. The success rate, a postoperative ABG ≤20 dB, is consistent with other studies, but there is room for improvement in patient selection criteria and surgical techniques.

Leukemia and lymphoma are the two most common forms of hematologic malignancy, and their etiology is largely unknown. Pathophysiological mechanisms suggest a possible association with air pollution, but little empirical evidence is available. We aimed to investigate the association between long-term residential exposure to outdoor air pollution and risk of leukemia and lymphoma. We pooled data from four cohorts from three European countries as part of the “Effects of Low-level Air Pollution: a Study in Europe” (ELAPSE) collaboration. We used Europe-wide land use regression models to assess annual mean concentrations of fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), black carbon (BC) and ozone (O₃) at residences. We also estimated concentrations of PM_2.5 elemental components: copper (Cu), iron (Fe), zinc (Zn); sulfur (S); nickel (Ni), vanadium (V),silicon (Si) and potassium (K). We applied Cox proportional hazards models to investigate the associations. Among the study population of 247,436 individuals, 760 leukemia and 1122 lymphoma cases were diagnosed during 4,656,140 person-years of follow-up. The results showed a leukemia hazard ratio (HR) of 1.13 (95% confidence intervals [CI]: 1.01–1.26) per 10 μg/m³ NO₂, which was robust in two-pollutant models and consistent across the four cohorts and according to smoking status. Sex-specific analyses suggested that this association was confined to the male population. Further, the results showed increased lymphoma HRs for PM_2.5(HR = 1.16; 95% CI: 1.02–1.34) and potassium content of PM_2.5, which were consistent in two-pollutant models and according to sex. Our results suggest that air pollution at the residence may be associated with adult leukemia and lymphoma.

AIMS: The aim of the study was to describe child health in relation to housing renovations in more than 800 rental units, consisting of repairs of dilapidated kitchens and bathrooms, in the disadvantaged neighbourhood of Herrgården in Rosengård, Malmö, Sweden.

METHODS: Data on housing conditions and self-reported health were collected during home visits to families living in Herrgården (building renovations area) and a comparison area (neighbouring Törnrosen, with generally better housing conditions). At baseline, 130 families with 359 children participated, while 51 families with 127 children participated at follow-up. All data were collected between 2010 and 2012. Additionally, regional register data on health-care usage/in- and outpatient contacts within the public health-care system between 2008 and 2013 were also collected for all 8715 children registered as living in the two areas.

RESULTS: Self-reported health seemed to somewhat improve in both areas, with 74% versus 86% and 78% versus 88% reporting good or very good health in Herrgården and in the comparison area at baseline and follow-up, respectively. In Herrgården, crowdedness increased, while it decreased in the comparison area. The number of health-care contacts remained stable over time in Herrgården, while it decreased in the comparison area.

CONCLUSIONS: Partial housing renovations did not seem to result in clear health improvements as measured with the indicators used in the present study. This could possibly be due to persisting health effects due to increased crowdedness or persisting poor housing conditions, as only kitchens and bathrooms were renovated.

Background: Exposure to outdoor air pollution is associated with adverse health effects. Previous studies have indicated higher levels of air pollution in socially deprived areas. Aim: To investigate associations between air pollution and socio-demographic variables, comorbidity, stress, and green space at the residence in Denmark.

Methods: We included 2,237,346 persons living in Denmark, aged 35 years or older in 2017. We used the high resolution, multi-scale DEHM/UBM/AirGIS air pollution modelling system to calculate mean concentrations of air pollution with PM_2.5, elemental carbon, ultrafine particles and NO₂ at residences held the preceding five years. We used nationwide registries to retrieve information about socio-demographic indicators at the individual and neighborhood levels. We used general linear regression models to analyze associations between sociodemographic indicators and air pollution at the residence.

Results: Individuals with high SES (income, higher white-collar worker and high educational level) and of nonDanish origin were exposed to higher levels of air pollution than individuals of low SES and of Danish origin, respectively. We found comparable levels of air pollution according to sex, stress events and morbidity. For neighborhood level SES indicators, we found high air pollution levels in neighborhoods with low SES measured as proportion of social housing, sole providers, low income and unemployment. In contrast, we found higher air pollution levels in neighborhoods with higher educational level and a low proportion of manual labor. People living in an apartment and/or with little green space had higher air pollution levels.

Conclusion: In Denmark, high levels of residential air pollution were associated with higher individual SES and non-Danish origin. For neighborhood-level indicators of SES, no consistent pattern was observed. These results highlight the need for analyzing many different socio-demographic indicators to understand the complex associations between SES and exposure to air pollution.

BACKGROUND: Particulate matter (PM) is classified as a group 1 human carcinogen. Previous experimental studies suggest that particles in diesel exhaust induce oxidative stress, inflammation and DNA damage in kidney cells, but the evidence from population studies linking air pollution to kidney cancer is limited.

METHODS: We pooled six European cohorts (N = 302,493) to assess the association of residential exposure to fine particles (PM_2.5), nitrogen dioxide (NO₂), black carbon (BC), warm season ozone (O₃) and eight elemental components of PM_2.5 (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc) with cancer of the kidney parenchyma. The main exposure model was developed for year 2010. We defined kidney parenchyma cancer according to the International Classification of Diseases 9th and 10th Revision codes 189.0 and C64. We applied Cox proportional hazards models adjusting for potential confounders at the individual and area-level.

RESULTS: The participants were followed from baseline (1985-2005) to 2011-2015. A total of 847 cases occurred during 5,497,514 person-years of follow-up (average 18.2 years). Median (5-95%) exposure levels of NO₂, PM_2.5, BC and O₃ were 24.1 μg/m³ (12.8-39.2), 15.3 μg/m³ (8.6-19.2), 1.6 10^-5 m^-1 (0.7-2.1), and 87.0 μg/m³ (70.3-97.4), respectively. The results of the fully adjusted linear analyses showed a hazard ratio (HR) of 1.03 (95% confidence interval [CI]: 0.92, 1.15) per 10 μg/m³ NO₂, 1.04 (95% CI: 0.88, 1.21) per 5 μg/m³ PM_2.5, 0.99 (95% CI: 0.89, 1.11) per 0.5 10^-5 m^-1 BCE, and 0.88 (95% CI: 0.76, 1.02) per 10 μg/m³ O₃. We did not find associations between any of the elemental components of PM_2.5 and cancer of the kidney parenchyma.

CONCLUSION: We did not observe an association between long-term ambient air pollution exposure and incidence of kidney parenchyma cancer.