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Concept: Attributable risk


Despite convincing evidence in the Mediterranean region, the cardiovascular benefit of the Mediterranean diet is not well established in non-Mediterranean countries and the optimal criteria for defining adherence are unclear. The population attributable fraction (PAF) of adherence to this diet is also unknown.

Concepts: Epidemiology, Mediterranean Sea, Attributable risk, Mediterranean diet, Mediterranean Basin, History of the Mediterranean region


To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom.

Concepts: Statistics, Insulin, Diabetes mellitus type 2, Obesity, United States, United Kingdom, Poverty in the United States, Attributable risk


Objectives The aim of this study was to characterize the descriptive epidemiology of insomnia in midlife and explore the relative importance of different occupational risk factors for insomnia among older workers. Methods A questionnaire was mailed to all adults aged 50-64 years registered with 24 English general practices. Insomnia was defined as having at least one of four problems with sleep severely in the past three months. Subjects were also asked about employment conditions, feelings concerning work, and their health. Associations were assessed by logistic regression and population attributable fractions (PAF) calculated. Results Analysis was based on 8067 respondents (5470 in paid work), 18.8% of whom reported insomnia. It was more common among women, smokers, obese individuals, those living alone, and those in financial hardship, and less prevalent among the educated, those in South-East England, and those with friendships and leisure-time pursuits. Occupational risk factors included unemployment, shift working, lack of control and support at work, job insecurity, job dissatisfaction and several of its determinants (lacking a sense of achievement, feeling unappreciated, having difficult work colleagues, feeling unfairly criticized). Population burden of insomnia was associated more strongly with difficulties in coping with work demands, job insecurity, difficult colleagues, and lack of friendships at work [population attributable fraction (PAF) 15-33%] than shift work and lack of autonomy or support (PAF 5-7%). It was strongly associated with seven measures of poorer self-assessed health. Conclusions Employment policies aimed at tackling insomnia among older workers may benefit from focusing particularly on job-person fit, job security and relationships in the workplace.

Concepts: Regression analysis, Epidemiology, Sleep deprivation, Sleep disorder, Employment, Shift work, Attributable risk, Fraction


Cardiovascular factors and low education are important risk factors of dementia. We provide contemporary estimates of the proportion of dementia cases that could be prevented if modifiable risk factors were eliminated, i.e., population attributable risk (PAR). Furthermore, we studied whether the PAR has changed across the last two decades.

Concepts: Epidemiology, Incidence, Cultural studies, Attributable risk


The proportion of cancer deaths in the contemporary United States caused by cigarette smoking (the population attributable fraction [PAF]) is not well documented.

Concepts: Cancer, United States, Smoking, Tobacco, Tobacco smoking, Cigarette, Nicotine, Attributable risk


Hepatocellular carcinoma (HCC) incidence has been increasing in the United States for several decades; and, as the incidence of hepatitis C virus (HCV) infection declines and the prevalence of metabolic disorders rises, the proportion of HCC attributable to various risk factors may be changing.

Concepts: United States, Hepatitis C, Hepatitis C virus, Attributable risk


Although people will most likely adjust to warmer temperatures, it is still difficult to assess what this adaptation will look like. This scenario-based integrated health impacts assessment explores baseline (1981-2010) and future (2050) population attributable fractions (PAF) of mortality due to heat (PAFheat) and cold (PAFcold), by combining observed temperature-mortality relationships with the Dutch KNMI'14 climate scenarios and three adaptation scenarios. The 2050 model results without adaptation reveal a decrease in PAFcold (8.90% at baseline; 6.56%-7.85% in 2050) that outweighs the increase in PAFheat (1.15% at baseline; 1.66%-2.52% in 2050). When the 2050 model runs applying the different adaptation scenarios are considered as well, however, the PAFheat ranges between 0.94% and 2.52% and the PAFcold between 6.56% and 9.85%. Hence, PAFheat and PAFcold can decrease as well as increase in view of climate change (depending on the adaptation scenario). The associated annual mortality burdens in 2050-accounting for both the increasing temperatures and mortality trend-show that heat-related deaths will range between 1879 and 5061 (1511 at baseline) and cold-related deaths between 13,149 and 19,753 (11,727 at baseline). Our results clearly illustrate that model outcomes are not only highly dependent on climate scenarios, but also on adaptation assumptions. Hence, a better understanding of (the impact of various) plausible adaptation scenarios is required to advance future integrated health impact assessments.

Concepts: Health, Evaluation, Demography, Assessment, Heat, Climate change, Attributable risk, Scenario


To assess the epidemiological association of smoking status and tinnitus with a systematic review and meta-analysis and to estimate the population attributable risk in Germany.

Concepts: Epidemiology, Statistics, Incidence, Educational psychology, Meta-analysis, Estimation, Attributable risk


OBJECTIVES: In a large population-based study among adults in northern Europe the relation between occupational exposure and new-onset asthma was studied. METHODS: The study comprised 13 284 subjects born between 1945 and 1973, who answered a questionnaire 1989-1992 and again 1999-2001. Asthma was defined as ‘Asthma diagnosed by a physician’ with reported year of diagnose. Hazard ratios (HR), for new-onset adult asthma during 1980-2000, were calculated using a modified job-exposure matrix as well as high-risk occupations in Cox regression models. The analyses were made separately for men and women and were also stratified for atopy. RESULTS: During the observation period there were 429 subjects with new-onset asthma with an asthma incidence of 1.3 cases per 1000 person-years for men and 2.4 for women. A significant increase in new-onset asthma was seen for men exposed to plant-associated antigens (HR = 3.6; 95% CI [confidence interval] = 1.4-9.0), epoxy (HR = 2.4; 95% CI = 1.3-4.5), diisocyanates (HR = 2.1; 95% CI = 1.2-3.7) and accidental peak exposures to irritants (HR = 2.4; 95% CI = 1.3-4.7). Both men and women exposed to cleaning agents had an increased asthma risk. When stratifying for atopy an increased asthma risk were seen in non-atopic men exposed to acrylates (HR = 3.3; 95% CI = 1.4-7.5), epoxy compounds (HR = 3.6; 95% CI = 1.6-7.9), diisocyanates and accidental peak exposures to irritants (HR = 3.0; 95% CI = 1.2-7.2). Population attributable risk for occupational asthma was 14% for men and 7% for women. CONCLUSIONS: This population-based study showed that men exposed to epoxy, diisocyanates and acrylates had an increased risk of new-onset asthma. Non-atopics seemed to be at higher risk than atopics, except for exposure to high molecular weight agents. Increased asthma risks among cleaners, spray painters, plumbers, and hairdressers were confirmed.

Concepts: Regression analysis, Epidemiology, Asthma, Risk, Incidence, Plastic, Epoxy, Attributable risk


Population attributable risk percent (PAR%) is an epidemiological tool that provides an estimate of the percent reduction in total disease burden if that disease could be entirely eliminated among a subpopulation. As such, PAR% is used to efficiently target prevention interventions. Due to significant limitations in current Clostridium difficile Infection (CDI) prevention practices and the development of new approaches to prevent CDI, such as vaccination, we determined the PAR% for CDI in various subpopulations in the Medicare 5% random sample.

Concepts: Public health, Epidemiology, Disease, Infectious disease, Infection, Prevention, Clostridium difficile, Attributable risk