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J Intern Med. 2016 Oct;280(4):375-87. doi: 10.1111/joim.12496. Epub 2016 Mar 16.

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

Author information

1
Clintec, Karolinska Institutet, Department of Obstetrics and Gynecology, Karolinska University Hospital, Huddinge, Stockholm, Sweden. Pelle.lindqvist@ki.se.
2
Department of Obstetrics and Gynecology, Mothers and Childrens Health, Karolinska University Hospital, Solna, Stockholm, Sweden.
3
Department of Dermatology, Helsingborg Hospital, Clinical Sciences, Lund University, Lund, Sweden.
4
Department of Endocrinology, Clinical Sciences, Lund University Hospital, Lund, Sweden.
5
Department of Surgery, Clinical Sciences, University Hospital, Lund, Sweden.
6
Departments of Oncology and Cancer Epidemiology, Lund University Hospital, Lund, Sweden.

Abstract

OBJECTIVE:

Women with active sunlight exposure habits experience a lower mortality rate than women who avoid sun exposure; however, they are at an increased risk of skin cancer. We aimed to explore the differences in main causes of death according to sun exposure.

METHODS:

We assessed the differences in sun exposure as a risk factor for all-cause mortality in a competing risk scenario for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 (aged 25-64 years at the start of the study). We obtained detailed information at baseline on sun exposure habits and potential confounders. The data were analysed using modern survival statistics.

RESULTS:

Women with active sun exposure habits were mainly at a lower risk of cardiovascular disease (CVD) and noncancer/non-CVD death as compared to those who avoided sun exposure. As a result of their increased survival, the relative contribution of cancer death increased in these women. Nonsmokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by 0.6-2.1 years.

CONCLUSION:

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.

KEYWORDS:

CVD; cigarette smoke; cohort study; melanoma; mortality; public health

PMID:
26992108
DOI:
10.1111/joim.12496
[Indexed for MEDLINE]
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