Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort

Lindqvist, Pelle G.; Epstein, Elisabeth; Nielsen, Kari; Landin‐Olsson, Mona; Ingvar, Christian; Olsson, Håkan

doi:10.1111/joim.12496

Cited by 116 publications

(92 citation statements)

References 52 publications

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“…For example, nonsmokers and smokers aged 60 years avoiding sun exposure had 1.3-and 2.1-year shorter life expectancy, respectively, as compared to those with the greatest sun exposure (19).…”

Section: The Risk Of All-cause Death Due To Cardiovascular Disease (Cmentioning

confidence: 98%

“…Subdistribution Cox regression analysis showed that for CVD death, avoidance of sun exposure was related to a 60% increased risk of death and the relationship was dose-dependent with subdistributional HR (sHR)=1.46 (95% CI=1.2-1.8) and sHR=2.3 (95% CI=1.8-3.1), for moderate and highest sun exposure groups, respectively. The corresponding sHR data for death due to non-CVD/noncancer were 1.57 (95% CI=1.3-1.9) and 2.1 (95% CI=1.7-2.8) and for death due to cancer 1.1 (95% CI=0.9-1.4) and 1.4 (95% CI=1.04-1.6) respectively (19).The main findings of this analysis are displayed in Figure 2: the cumulative probability of death due to CVD, cancer, and non-CVD/noncancer death by sun exposure groups. The three bottom graphs show the relative contribution of CVD, cancer, and non-CVD/non-cancer to the all-cause mortality (19).…”

mentioning

confidence: 99%

“…The corresponding sHR data for death due to non-CVD/noncancer were 1.57 (95% CI=1.3-1.9) and 2.1 (95% CI=1.7-2.8) and for death due to cancer 1.1 (95% CI=0.9-1.4) and 1.4 (95% CI=1.04-1.6) respectively (19).The main findings of this analysis are displayed in Figure 2: the cumulative probability of death due to CVD, cancer, and non-CVD/noncancer death by sun exposure groups. The three bottom graphs show the relative contribution of CVD, cancer, and non-CVD/non-cancer to the all-cause mortality (19).…”

mentioning

confidence: 99%

“…All-cause mortality is usually divided into three major causes: cancer, cardiovascular disease (CVD), and non-CVD/non-cancer disease (19). If mortality is reduced in one of these, the proportion of deaths in the others will naturally increase.…”

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confidence: 99%

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The Winding Path Towards an Inverse Relationship Between Sun Exposure and All-cause Mortality

Lindqvist

2018

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Both UV exposure and fair skin are major contributors to skin cancer. Non-melanoma skin cancer (NMSC) (i.e. basal cell carcinoma and squamous cell carcinoma) is mainly related to cumulative UV radiation and has a good prognosis. Malignant melanoma is related to episodic overexposure to UV radiation and increased mortality (3). Since heavy skin coloration is selected for close to the equator and fair skin coloration at higher latitudes there is speculation of an evolutionary advantage to having skin coloration appropriate for the regional sun intensity. However, evidence is lacking.The aim of this review was to present how we came to the conclusion that there is an inverse relationship between sunexposure habits and all-cause mortality. Venous thromboembolism (VTE) and sun exposure.There is a great demand for lifestyle advice from women at increased risk of VTE (4, 5). There have been reports of seasonal changes in VTE incidence, with a nadir in summer (6-8). In addition, vitamin D deficiency is an inflammatory condition and all inflammatory conditions increase the risk of VTE (1, 9). The Melanoma in Southern Sweden (MISS) cohort was drawn from the Swedish population registry by computerized random selection in 1990. Approximately 40,000 women with no history of cancer were invited to participate and 29,518 answered an initial written questionnaire. The questionnaire detailed sun exposure habits, aiming to identify those with extremely high sun exposure habits. With interest in the opposite, namely those with the lowest sun exposure habits, in whom vitamin D-deficient women would be over-represented, four questions were identified that could be used to identify those with low sun exposure habits: (i) How often do you sunbathe during the summertime? (never, 1-14 times, 15-30 times, >30 times); (ii) Do you sunbathe during the winter, such as on holiday to the mountains? (no; 1-3 days, 4-10 days; >10 days); (iii) Do you use tanning beds? (never; 1-3 times/year; 4-10 times/year; >10 times/year); and (iv) Do you go abroad on holiday to swim and sunbathe? (never; once/1-2 years; once/year; two or more times/year). The four questions were 1173

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Section: The Risk Of All-cause Death Due To Cardiovascular Disease (Cmentioning

confidence: 98%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Winding Path Towards an Inverse Relationship Between Sun Exposure and All-cause Mortality

Lindqvist

2018

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“…5,6 Los estudios disponibles en población pediátrica muestran datos de 25(OH) D sérica que oscilan en el rango entre 24,5 nmol/L (Ushuaia, Argentina) y 116 nmol/L (Teherán, Irán). 7 La magnitud del problema en niños y adolescentes en América Latina es desconocida; solo México presenta datos representativos nacionales, que muestran entre un 54% y un 28% de prevalencia de déficit/insuficiencia de VD en preescolares y escolares, respectivamente.…”

Section: Deficiencia De Vitamina D En Niños Y Adolescentesunclassified

Deficiencia de vitamina D en la práctica clínica pediátrica

2018

Arch Argent Pediatr

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Primary tumor sites in relation to ultraviolet radiation exposure and skin visibility correlate with survival in cutaneous melanoma

Gordon

Hansson

Eloranta

et al. 2017

Intl Journal of Cancer

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The prognostic value of detailed anatomic site and ultraviolet radiation (UVR) exposure patterns has not been fully determined in cutaneous melanoma. Thus, we reviewed medical records for detailed site in a population-based retrospective Swedish patient cohort diagnosed with primary invasive melanoma 1976-2003 (n = 5,973). We followed the patients from date of diagnosis until death, emigration or December 31 2013, and evaluated melanoma-specific survival by subsite in a multivariable regression model adjusting for established prognostic factors. We found that melanoma on chronic UVR exposure sites (face, dorsum of hands; adjusted HR 0.6; CI 0.4-0.7) and moderately intermittent UVR sites (lateral arms, lower legs, dorsum of feet; HR 0.7; CI 0.6-0.8) were associated with a favorable prognosis compared with highly intermittent sites (chest, back, neck, shoulders and thighs). Further, melanoma on poorly visible skin sites upon self-examination (scalp, retroauricular area, back, posterior upper arms and thighs, buttocks, pubic area; HR 1.3; CI 1.1-1.5) had a worse prognosis than those on easily visible sites (face, chest, abdomen, anterior upper arms and thighs, lower arms and legs, dorsum of hands and feet, palms). In conclusion, highly intermittent UVR exposure sites and poor skin visibility presumably correlate with reduced melanoma survival, independent of established tumor characteristics. A limitation of the study was the lack of information on actual individual UVR exposure.

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Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort

Abstract: The longer life expectancy amongst women with active sun exposure habits was related to a decrease in CVD and noncancer/non-CVD mortality, causing the relative contribution of death due to cancer to increase.

Cited by 116 publications

References 52 publications

The Winding Path Towards an Inverse Relationship Between Sun Exposure and All-cause Mortality

The Winding Path Towards an Inverse Relationship Between Sun Exposure and All-cause Mortality

Deficiencia de vitamina D en la práctica clínica pediátrica

Primary tumor sites in relation to ultraviolet radiation exposure and skin visibility correlate with survival in cutaneous melanoma

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