Smoking and Risk of Kidney Failure in the Singapore Chinese Health Study

Background:The relationship between smoking and risk of kidney failure, especially in people of Chinese origin, is not clear. We analyzed data from the Singapore Chinese Health Study to investigate whether smoking increases the risk of kidney failure.Methods:The Singapore Chinese Health Study is a population-based cohort of 63,257 Chinese adults enrolled between 1993 and 1998. Information on smoking status was collected at baseline. Incidence of kidney failure was identified via record linkage with the nationwide Singapore Renal Registry until 2008. Kidney failure was defined by one of the following: 1) serum creatinine level of more than or equal to 500 μmol/l (5.7 mg/dl), 2) estimated glomerular filtration rate of less than 15 ml/min/1.73 m2, 3) undergoing hemodialysis or peritoneal dialysis, 4) undergone kidney transplantation. Cox proportional hazard regression analysis was performed for the outcome of kidney failure after adjusting for age, education, dialect, herbal medications, body mass index, sex, physician-diagnosed hypertension and diabetes mellitus.Results:The mean age of subjects was 55.6 years at baseline, and 44% were men. Overall 30.6% were ever smokers (current or former) at baseline. A total of 674 incident cases of kidney failure occurred during a median follow-up of 13.3 years. Among men, smokers had a significant increase in the adjusted risk of kidney failure [hazard ratio (HR): 1.29; 95% CI: 1.02-1.64] compared to never smokers. There was a strong dose-dependent association between number of years of smoking and kidney failure, (p for trend = 0.011). The risk decreased with prolonged cessation (quitting ≥10 years since baseline). The number of women smokers was too few for conclusive relationship.Limitation:Information on baseline kidney function was not available.Conclusions:Cigarette smoking is associated with increased risk of kidney failure among Chinese men. The risk appears to be dose- and duration-dependent and modifiable after long duration of cessation. © 2013 Jin et al

Assessing risk of breast cancer in an ethnically South-East Asia population (results of a multiple ethnic groups study)

10.1186/1471-2407-12-529BMC Cancer12-BCMA

Incidence, Trends and Ethnic Differences of Oropharyngeal, Anal and Cervical Cancers: Singapore, 1968-2012.

In recent decades, several Western countries have reported an increase in oropharyngeal and anal cancers caused by human papillomavirus (HPV). Trends in HPV-associated cancers in Asia have not been as well described. We describe the epidemiology of potentially HPV-related cancers reported to the Singapore Cancer Registry from 1968-2012. Analysis included 998 oropharyngeal squamous cell carcinoma (OPSCC), 183 anal squamous cell carcinoma (ASCC) and 8,019 invasive cervical cancer (ICC) cases. Additionally, 368 anal non-squamous cell carcinoma (ANSCC) and 2,018 non-oropharyngeal head and neck carcinoma (non-OP HNC) cases were included as comparators. Age-standardized incidence rates (ASR) were determined by gender and ethnicity (Chinese, Malay and Indian). Joinpoint regression was used to evaluate annual percentage change (APC) in incidence. OPSCC incidence increased in both genders (men 1993-2012, APC = 1.9%, p<0.001; women 1968-2012, APC = 2.0%, p = 0.01) and was 5 times higher in men than women. In contrast, non-OP HNC incidence declined between 1968-2012 among men (APC = -1.6%, p<0.001) and women (APC = -0.4%, p = 0.06). ASCC and ANSCC were rare (ASR = 0.2 and 0.7 per 100,000 person-years, respectively) and did not change significantly over time except for increasing ANSCCs in men (APC = 2.8%, p<0.001). ICC was the most common HPV-associated cancer (ASR = 19.9 per 100,000 person-years) but declined significantly between 1968-2012 (APC = -2.4%). Incidence of each cancer varied across ethnicities. Similar to trends in Western countries, OPSCC incidence increased in recent years, while non-OP HNC decreased. ICC remains the most common HPV-related cancer in Singapore, but Pap screening programs have led to consistently decreasing incidence

Timing of commencement of maintenance dialysis and mortality in young and older adults in Singapore

Abstract Background The benefit of early dialysis initiation remains controversial with a paucity of data in Asians. Therefore, we undertook this study to investigate the association between timing of initiation of dialysis and mortality in Singapore. Methods The study used data from the Singapore Renal Registry database on 3286 patients with incident end-stage renal disease (ESRD) who commenced maintenance dialysis between January 2008 and December 2011. The data was further linked with the National Death Registry to acquire survival information until December 2013. We classified serum creatinine-based, estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation at the start of dialysis into 3 categories: Early (≥10 ml/min/1.73m2), intermediate (5 to <10 ml/min/1.73m2) and late (<5 ml/min/1.73m2). Results In the unadjusted analysis, both early and intermediate dialysis initiation groups were at greater risk of death relative to late dialysis (Early: HR = 2.47; Intermediate: HR = 1.54). In the multivariate model, a significant interaction was detected between age and eGFR at dialysis initiation (p = 0.04). Adjusted mortality risk progressively increased with earlier initiation of dialysis for patients aged 18–54 years (p = 0.006) and aged 55 to 64 years (p < 0.001), and no statistically significant difference was observed for patients aged 65 years or older (p = 0.12). Conclusions Early versus later initiation of dialysis was associated with significantly higher risk of mortality in Singapore’s non-elderly population, and appeared to offer no survival advantage among the elderly

Age-standardized incidence rates (ASR) per 100,000 person years for each cancer, by gender and ethnicity, from 1968 to 2012 in Singapore.

<p>Age-standardized incidence rates (ASR) per 100,000 person years for each cancer, by gender and ethnicity, from 1968 to 2012 in Singapore.</p

Trends in crude cancer incidence over time, by type and gender, from 1968 to 2012 in Singapore^a.

<p>Trends in crude cancer incidence over time, by type and gender, from 1968 to 2012 in Singapore<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0146185#t001fn001" target="_blank">^a</a>.</p

Incidence of invasive cervical cancer in Singapore, 1968–2012, by ethnicity.

<p>Incidence trends are based on incidence rates for 5-year time periods that were age-adjusted to the WHO standard population. Annual percent change (APC) was calculated using Joinpoint regression analysis. APC = annual percent change. An asterisk (*) indicates an APC value that is statistically significant at p≤0.05.</p

Incidence of invasive anal cancer in Singapore, 1968–2012, by gender and histology.

<p>Incidence trends are based on incidence rates for 5-year time periods that were age-adjusted to the WHO standard population. Annual percent change (APC) was calculated using Joinpoint regression analysis. APC = annual percent change. An asterisk (*) indicates an APC value that is statistically significant at p≤0.05. Abbreviations: SCC = squamous cell carcinoma, non-SCC = non-squamous cell carcinoma</p

Deciphering the Epidemiology of Hepatocellular Carcinoma Through the Passage of Time: A Study of 1,401 Patients Across 3 Decades

10.1002/hep4.1059HEPATOLOGY COMMUNICATIONS16564-57