G. J. Bourke

Diet and 20-year mortality from coronary heart disease: the Ireland-Boston Diet-Heart Study.

In a prospective epidemiologic study of 1001 middle-aged men, we examined the relation between dietary information collected approximately 20 years ago and subsequent mortality from coronary heart disease. The men were initially enrolled in three cohorts: one of men born and living in Ireland, another of those born in Ireland who had emigrated to Boston, and the third of those born in the Boston area of Irish immigrants. There were no differences in mortality from coronary heart disease among the three cohorts. In within-population analyses, those who died of coronary heart disease had higher Keys (P = 0.06) and modified Hegsted (P = 0.02) dietary scores than did those who did not (a high score indicates a high intake of saturated fatty acids and cholesterol and a relatively low intake of polyunsaturated fatty acids). These associations were significant (P = 0.03 for the Keys and P = 0.04 for the modified Hegsted scores) after adjustment for other risk factors for coronary heart disease. Fiber intake (P = 0.04) and a vegetable-foods score, which rose with increased intake of fiber, vegetable protein, and starch (P = 0.02), were lower among those who died from coronary heart disease, though not significantly so after adjustment for other risk factors. A higher Keys score carried an increased risk of coronary heart disease (relative risk, 1.60), and a higher fiber intake carried a decreased risk (relative risk, 0.57). Overall, these results tend to support the hypothesis that diet is related, albeit weakly, to the development of coronary heart disease.

A case-control study of head and neck cancer in the Republic of Ireland.

A retrospective case-control study of 200 patients with head and neck cancer, and 200 controls matched for age and sex, confirmed the importance of tobacco and alcohol consumption in the aetiology of malignant tumours of the upper gastrointestinal and upper respiratory tracts. A male-female ratio of 3:1 was found, and the association of smoking with laryngeal cancer and of alcohol with cancer of the tongue was particularly strong. A significant excess of alcohol-related occupations was found among the cases. These findings are discussed.

Hypothermia and mortality and morbidity. An epidemiological analysis.

STUDY OBJECTIVE--The aim was to identify socioeconomic variables associated with deaths and hospital admissions due to hypothermia and to quantify the risk due to ambient outside temperature. DESIGN--The study was a survey of deaths and hospital admissions due to hypothermia (ICD 991.6), for the period 1979-85 inclusive, identified from death certificates and Hospital Inpatient Enquiry (HIPE) data. SETTING--The study included all deaths and hospital admissions due to hypothermia (1979-85) in the 26 counties of the Republic of Ireland, population 3.5 million. SUBJECTS--All deaths coded during the study period as being due to hypothermia and all persons admitted to hospital during the study period for whom hypothermia was recorded as a discharge diagnosis in HIPE data. MEASUREMENTS AND MAIN RESULTS--Demographic data and date of death/diagnosis were obtained from both data sets. Complete national temperature records were obtained from the meteorological service and a temperature was assigned to each case representing ambient outside temperature at which hypothermia developed. Risk of hypothermia at a given temperature was obtained by dividing the number of cases at that temperature by the appropriate person-years of exposure of the entire national population. Incidence of and mortality from hypothermia doubled with each 5 degrees C and 4 degrees C fall in temperature respectively; the majority of deaths and hospital admissions occurred between October and March. Incidence and mortality increased with age and men had 30% higher case fatality than women. Single men had four times the incidence and 6.5 times the mortality, and single women had double the incidence and four times the mortality of married men and women respectively. Low population density was also an important risk marker. CONCLUSIONS--The risk of hypothermia due to ambient outside temperature has been quantified and a high risk group was identified. A combination of statutory support measures and good neighbourliness could prevent illness and deaths from hypothermia.

Predictors of first hip fracture and mortality post fracture in older women

BackgroundHip fracture causes significant morbidity and mortality in older women.AimTo document factors contributing to the risk of hip fracture in older women and to assess the effect of hip fracture on subsequent mortality.MethodsCase-control study of 89 women with hip fracture and 89 controls, with two-year follow-up. Singh index and bone mineral density were calculated.ResultsOsteoporotic indices did not differ significantly between cases and controls. Significant predictors of risk were sleeping tablets, perception of health as fair/poor and a lower mental status score. Patients were 3.57 times more likely to die in the first year after fracture, with no difference between the groups in year two. After adjustment, hip fracture did not remain significantly associated with mortality. Inability to walk 100 yards alone prior to fracture and lower social class were significantly associated with mortality at 12 months. Age alone was significantly associated at 12–24 months.ConclusionsFactors related to falls and fracture may be more discriminatory predictors of hip fracture risk than osteoporosis in older females. Medications for sleep should be prescribed with caution. Hip fracture may have an independent effect on one year mortality, this effect is not seen in the second year.

The role of tobacco and alcohol in the aetiology of lung and larynx cancer.

A RECENT STUDY of head and neck cancer in Ireland (Herity et al., 1981) confirmed that tobacco and alcohol consumption were significant risk factors in the development of cancer of the larynx; a heavy smoker had a risk almost 40 times that of a non-smoker and a heavy drinker had a 3-fold increase in risk over a nondrinker. Many other workers have described similar findings (Wynder et al., 1956, 1976; Vincent & Marchetta, 1963; Rothman & Keller, 1972; Feldman & Hazan, 1975; McMichael, 1978; Ward Hinds et al., 1979). Another neoplasm which has been consistently related to heavy smoking is lung cancer; a comparative study of lung and larynx cancer in relation to tobacco and alcohol consumption is thus of interest. Sixty-eight cases of larynx cancer were included in the sample of 200 headand neck-cancer patients in the abovementioned study 59 males and 9 females-and details of age, marital status, occupation, education and tobacco/ alcohol consumption had been recorded for these patients. A presenting sample of 68 lung-cancer patients matched with the larynx-cancer patients for sex but not for age, was interviewed using the same precoded questionnaire as in the earlier study. The control group for the earlier study was again used. Diagnoses of the control group included cancers of the skin, haemopoietic system, gastrointestinal tract, breast, male and female genital tracts, brain, endocrine system, and connective tissue and preAccepted 23 September 1982

A study of breast cancer in Irish women.

In a study of 100 women with breast cancer and 200 unaffected women the epidemiological characteristic of breast cancer most commonly described--namely, an excess of nonparous women among cases when compared with controls, was not observed. It is suggested that two factors, a dearth of first births born to mothers under 20 years of age and an unusually high proportion of first births when aged 30 years or more, are responsible for this finding. No association was found between breast cancer and socioeconomic status, marital status, age at marriage, age at first pregnancy, parity, or age at menarche. Significant associations with breast cancer included age at natural menopause, hysterectomy, and breast trauma. These findings are discussed.

Anencephaly and potato blight in the Republic of Ireland

National potato tuber blight scores in the Republic of Ireland for the years 1961-70 were ascertained and evaluated in relation to incidence of anencephalic births in the following years. No significant relationship between annual tuber blight scores and incidence of anencephaly one year later could be demonstrated. Examination of the records of a maternity hospital for the years before, during, and after the great midnineteenth century potato famine in Ireland failed to show any appreciable fluctuation in anencephaly/spina bifida incidence during this period.

Epidemiological features of maligant melanoma in Ireland

SummaryIN recent years a number of countries ’ have recorded a marked increase in the incidence of malignant melanoma, resulting in this tumour being relatively common in these countries. Ireland, while having a high incidence of skin carcinoma, was found to have a relatively low incidence of malignant melanoma. Study of the Standardised Mortality Ratio (SMR) over a 20 year period indicated an 88% rise; similar to that recorded elsewhere. An excess in both incidence and mortality figures was found in females in this study.

Trends in Cigarette Smoking among Coronary Patients between 1961 and 1975

Between 1961 and 1975 the proportion of cigarette smokers among male patients with acute coronary heart disease showed a progressive decline from 87.1 to 66.1%. There was a corresponding increase in the proportion of ex-smokers and non-smokers. Factors which might have accounted for this trend were examined. Changing diagnosis, altered prevalence of other risk factors and social class changes in patient referral would not appear to have accounted for the observed smoking trends. It is suggested that the observed trends in cigarette-smoking habits may be real and that they may represent a change in the epidemiological pattern of coronary heart disease in Ireland.

The relationship between blood glucose and prevalence of coronary heart disease: a study in the Republic of Ireland.

Abstract Volunteers in the mass screening program conducted in communities throughout the Republic of Ireland between 1969 and 1972, were invited for a repeat examination in 1974, during which serum glucose was measured 1 hr after a 50-g oral load. For the 3357 men age 40–54 seen at that time, univariate analysis of glucose level and prevalence of ECG abnormalities indicative of coronary heart disease did not indicate a linear relationship. With multivariate analysis, considering also age, systolic blood pressure, relative weight, serum cholesterol and cigarette smoking, no independent association was seen between glucose level and frequency of ECG abnormalities.