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  • Kaiser Permanente Institutional Review Board, Oakland

    Topic

    Protection of human subjects of research

    Populations Served

    Subscribers of Kaiser Permanente and others involved in KP research projects

    Location

    Bay Area

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Chronic disease epidemiology, particularly cancer, cardiovascular disease, adverse effects of smoking, alcohol and pharmaceuticals, evaluation of screening tests.
Most of my career has been in the Kaiser Permanente Division of Research where I was Director for 7 years and am still active. I especially enjoy mentoring students and trainees at Stanford.

Teaching

2013-14 Courses


Graduate and Fellowship Programs


Publications

Journal Articles


  • Antidepressants and testicular cancer. Cancer causes & control Friedman, G. D., Schwalbe, J., Achacoso, N., Meng, M. V., Kroenke, C. H., Habel, L. A. 2014; 25 (2): 251-258

    Abstract

    Re-examine association of fluoxetine and paroxetine with risk of testicular cancer noted in drug screening, with 4 years more follow-up and expanded study of these and other antidepressant drugs.In the Kaiser Permanente Medical Care Program in Northern California, 906 men with testicular cancer diagnosed August 1996-December 2010 were compared with 38,253 matched controls with race/ethnicity recorded regarding receipt of antidepressant drugs at least 2 years before diagnosis or control index date. Analyses emphasized duration of use and histological subgroups.With control for race/ethnicity and use of other antidepressant drugs, odds ratios (OR) and 95 % confidence intervals (CI) for associations with testicular cancer were as follows: fluoxetine 1.22 (0.88-1.71), paroxetine 1.19 (0.78-1.83), and 1.21 (0.92-1.58) for all serotonin reuptake inhibitors. There was no statistically significant association with risk of all testicular cancers or their histological subtypes for any individual drug or for tricyclics or all antidepressants combined except for citalopram with all testicular cancers 2.55 (1.43-4.52) and those of mixed histology 4.36 (1.50-12.68) and nefazodone with embryonal cancers 9.79 (1.85-51.81). These could readily be chance findings in the context of the many analyses that were performed. Duration of use was not associated with risk of the drugs and drug groups with sufficient numbers of exposed cases for analysis.We found little evidence to support a testicular carcinogenic effect of fluoxetine, paroxetine, or other antidepressant drugs, but a weakly positive association is not ruled out. The signals in prior screening may have been due to chance and/or uncontrolled confounding.

    View details for DOI 10.1007/s10552-013-0327-5

    View details for PubMedID 24276357

  • Predictors of lung cancer: noteworthy cell type differences. The Permanente journal Tran, H. N., Li, Y., Siu, S., Baer, D., Friedman, G. D., Udaltsova, N., Klatsky, A. L. 2013; 17 (2): 23-29

    Abstract

    To study risk factors for cell types of lung cancer.Cohort study of 126,293 persons with 1852 subjects with incident cancer. We performed Cox proportional hazards models (8 covariates) to estimate risk of the 4 most numerous specific cell types: adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and bronchioloalveolar carcinoma.Smoking 1 or more cigarette packs per day was a powerful predictor (p < 0.0001) of all cell types, with hazard ratios ranging from 5.8 for bronchioloalveolar to 62.7 for squamous cell carcinoma. Other hazard ratio ranges included male/female from 0.6 (bronchioloalveolar, p < 0.05) to 2.0 (squamous, p < 0.001); black/white from 0.8 (small cell, p < 0.05) to 1.7 (squamous, p < 0.001); Asian/white from 0.8 (small cell) to 1.9 (bronchioloalveolar); and alcohol intake of 3 or more drinks per day from 1.0 (squamous) to 1.5 (adenocarcinoma, p < 0.01). College graduation and increasing body mass index were inversely related to risk of several cell types. Noteworthy sex-specific associations included increased risk of Asian vs white women for adenocarcinoma, squamous cell carcinoma and bronchioloalveolar carcinoma and substantially increased risk of adenocarcinoma in women with alcohol intake of 3 or more drinks per day.These risk factor disparities for lung cancer cell types presumably reflect biologic differences. Future investigation may contribute to increased understanding of tumorigenesis and optimal treatment.

    View details for DOI 10.7812/TPP/12-104

    View details for PubMedID 23704839

  • Risk of Coronary Disease in South Asian Americans. Journal of the American College of Cardiology Hajra, A., Li, Y., Siu, S., Udaltsova, N., Armstrong, M. A., Friedman, G. D., Klatsky, A. L. 2013

    View details for PubMedID 23770164

  • Antihypertensive Drugs and Lip Cancer in Non-Hispanic Whites ARCHIVES OF INTERNAL MEDICINE Friedman, G. D., Asgari, M. M., Warton, E. M., Chan, J., Habel, L. A. 2012; 172 (16): 1246-1251

    Abstract

    In screening pharmaceuticals for possible carcinogenic effects we noted an association between lip cancer risk and the photosensitizing antihypertensive drugs hydrochlorothiazide and nifedipine. In this study, we further characterized the risk of lip cancer associated with these and other commonly used antihypertensive drugs.In a comprehensive medical care program, we evaluated prescriptions dispensed and cancer occurrence from August 1, 1994, to February 29, 2008. We identified 712 patients with lip cancer (cases) and 22,904 comparison individuals (controls) matched for age, sex, and cohort year of entry in the susceptible group, non-Hispanic whites. We determined use, at least 2 years before diagnosis or control index date, of the commonly prescribed diuretics hydrochlorothiazide and hydrochlorothiazide combined with triamterene, the angiotensin-converting enzyme inhibitor lisinopril, the calcium channel blocker nifedipine, and the ?-adrenergic blocker atenolol, the only nonphotosensitizer agent studied. We analyzed the use of each drug exclusively and regardless of use of the others, and focused on duration of use. Conditional logistic regression was used for analysis of matched case-control sets, with control for cigarette smoking.At least a 5-year supply of a drug yielded the following odds ratios (95% CIs), respectively, compared with no use: hydrochlorothiazide, 4.22 (2.82-6.31); hydrochlorothiazide-triamterene, 2.82 (1.74-4.55); lisinopril, 1.42 (0.95-2.13); nifedipine, 2.50 (1.29-4.84); and atenolol, 1.93 (1.29-2.91). When the other drugs were excluded, the odds ratio for atenolol was reduced to 0.54 (0.07-4.08).These data support an increased risk of lip cancer in non-Hispanic whites receiving treatment for hypertension with long-term use of photosensitizing drugs.

    View details for DOI 10.1001/archinternmed.2012.2754

    View details for Web of Science ID 000308616800012

    View details for PubMedID 22869299

  • Risk of cancer in patients exposed to gabapentin in two electronic medical record systems PHARMACOEPIDEMIOLOGY AND DRUG SAFETY Irizarry, M. C., Webb, D. J., Boudiaf, N., Logie, J., Habel, L. A., Udaltsova, N., Friedman, G. D. 2012; 21 (2): 214-225

    Abstract

    High doses of gabapentin were associated with pancreatic acinar cell tumors in male Wistar rats, but there is little published epidemiological data regarding gabapentin and carcinogenicity. We explored the association between gabapentin and cancer in a US medical care program and followed up nominally significant associations in a UK primary care database.In the US Kaiser Permanente Northern California (KPNC) health system, we performed nested case-control analyses of gabapentin and 55 cancer sites and all cancers combined using conditional logistic regression. Up to 10 controls were matched to each case on year of birth, sex, and year of cohort entry. No other covariates were included in models. Only dispensings for gabapentin 2?years or more before index date were considered. Nominally significant associations with an OR?>?1.00 and p??1.00 and p?

    View details for DOI 10.1002/pds.2266

    View details for Web of Science ID 000299549600013

    View details for PubMedID 22144034

  • Supplement use and risk of cutaneous squamous cell carcinoma JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Asgari, M. M., Chren, M., Warton, E. M., Friedman, G. D., White, E. 2011; 65 (6): 1145-1151

    Abstract

    Laboratory and epidemiologic studies suggest that certain dietary supplements may alter risk of cutaneous squamous cell carcinoma (SCC).We sought to examine the association between supplement use and SCC risk.Cases (n = 415) were defined as Kaiser Permanente Northern California members with a pathology-verified SCC in 2004 and control subjects (n = 415) were age-, sex-, and race-matched members with no history of skin cancer. Supplement use and SCC risk factors were ascertained by questionnaire. Associations of SCC with use of multivitamins; vitamins A, C, D, and E; and grape seed extract were estimated as odds ratios and 95% confidence intervals using conditional logistic regression. Models were adjusted for SCC risk factors and other supplement use.Grape seed extract users had a significantly decreased risk of cutaneous SCC (adjusted odds ratio 0.26, confidence interval 0.08-0.89, P = .031). Multivitamin use was associated with a borderline significant reduction in SCC risk (adjusted odds ratio 0.71, confidence interval 0.51-1.00, P = .049). Use of vitamins A, C, D, and E was not associated with SCC risk.The data may be prone to recall and selection bias because of the case-control design. No information was obtained on dose or duration of supplement use.Use of grape seed extract may be associated with a decreased risk of cutaneous SCC. The other supplements included in our study did not reveal clear associations with SCC risk.

    View details for DOI 10.1016/j.jaad.2010.09.009

    View details for Web of Science ID 000297717200008

    View details for PubMedID 21664718

  • Re: A Case-Control Study of Levothyroxine and the Risk of Colorectal Cancer JOURNAL OF THE NATIONAL CANCER INSTITUTE Friedman, G. D., Schwalbe, J. S., Habel, L. A. 2011; 103 (21): 1637-U81

    View details for DOI 10.1093/jnci/djr374

    View details for Web of Science ID 000296662700013

    View details for PubMedID 22010174

  • Systolic blood pressure and mortality in prevalent haemodialysis patients in the HEMO study JOURNAL OF HUMAN HYPERTENSION Chang, T. I., Friedman, G. D., Cheung, A. K., Greene, T., Desai, M., Chertow, G. M. 2011; 25 (2): 98-105

    Abstract

    Previous studies of blood pressure and mortality in haemodialysis have yielded mixed results, perhaps due to confounding by comorbid conditions. We hypothesized that after improved accounting for confounding factors, higher systolic blood pressure (SBP) would be associated with higher all-cause mortality. We conducted a secondary analysis of data from the haemodialysis study, a randomized trial in prevalent haemodialysis patients. We used three proportional hazard models to determine the relative hazard at different levels of SBP: (1) Model-BL used baseline SBP; (2) Model-TV used SBP as a time-varying variable; and (3) Model-TV-Lag added a 3-month lag to Model-TV to de-emphasize changes in SBP associated with acute illness. In all the models, pre-dialysis SBP <120?mm?Hg was associated with a higher risk of mortality compared with the referent group (140-159?mm?Hg); higher pre-dialysis SBP was not associated with higher risk of mortality. In conclusion, we observed a robust association between lower pre-dialysis SBP and higher risk for all-cause and cardiovascular mortality in a well-characterized cohort of prevalent haemodialysis patients. Randomized clinical trials are needed to define optimal blood pressure targets in the haemodialysis population.

    View details for DOI 10.1038/jhh.2010.42

    View details for Web of Science ID 000286179500005

    View details for PubMedID 20410919

  • Norepinephrine antagonists and cancer risk INTERNATIONAL JOURNAL OF CANCER Friedman, G. D., Udaltsova, N., Habel, L. A. 2011; 128 (3): 737-738

    View details for DOI 10.1002/ijc.25351

    View details for Web of Science ID 000285264000026

    View details for PubMedID 20333678

  • Association of Tea Consumption and Cutaneous Squamous Cell Carcinoma NUTRITION AND CANCER-AN INTERNATIONAL JOURNAL Asgari, M. M., White, E., Warton, E. M., Hararah, M. K., Friedman, G. D., Chren, M. 2011; 63 (2): 314-318

    Abstract

    Laboratory and epidemiologic studies suggest a protective effect of tea consumption on risk of cutaneous squamous cell carcinoma (SCC). We designed a case-control study to examine the association between putative protective exposures, including tea consumption, and SCC risk using a large health maintenance organization population. Cases (n=415) were defined as Kaiser Permanente Northern California (KPNC) members with a pathology-verified SCC in 2004 and controls (n=415) were age-, gender-, and race-matched members with no previous history of skin cancer. Tea consumption and SCC risk factors were ascertained by questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using conditional logistic regression to estimate the association of SCC with regular use, as well as dose and duration of tea consumption. Risk factor adjusted models included education, smoking, hair and eye color, skin type, family history of skin cancer, and history of freckling, sunburns, sun exposure, and tanning bed use. Adjusted analyses showed no reduction in SCC risk with regular consumption of tea (OR=1.11, 95% CI: 0.81-1.54). Examining duration, dose, and combined duration and dose exposure variables did not alter findings. We found no evidence that tea consumption was associated with cutaneous SCC risk.

    View details for DOI 10.1080/01635581.2011.523496

    View details for Web of Science ID 000287489900019

    View details for PubMedID 21240832

  • Lipophilic Statin Use and Risk of Breast Cancer Subtypes CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Woditschka, S., Habel, L. A., Udaltsova, N., Friedman, G. D., Sieh, W. 2010; 19 (10): 2479-2487

    Abstract

    Statins are widely used and of high interest as potential chemopreventive agents for cancer. Preclinical studies suggest that lipophilic statins have anticancer properties targeting hormone receptor (HR)-negative breast cancer. Few epidemiologic studies have investigated the relationship between lipophilic statin use and risk for breast cancer, stratified by HR status. We conducted a large case-control study within Kaiser Permanente of Northern California (KPNC) to determine whether chronic use of lipophilic statins is associated with decreased risk of HR-negative breast cancer or other breast cancer subtypes.We identified 22,488 breast cancer cases diagnosed from 1997 to 2007, and 224,860 controls matched to cases based upon birth year and duration of KPNC pharmacy coverage. Use of lipophilic statins was ascertained using the comprehensive electronic pharmacy records of KPNC.We found no association between lipophilic statin use (?2 y versus never) and overall breast cancer risk (odds ratio(adj), 1.02; 95% CI, 0.97-1.08) in conditional logistic regression models adjusted for oral contraceptive and hormone therapy use. Women who used lipophilic statins did not have a decreased risk of HR-negative breast cancer (odds ratio(adj), 0.98; 95% CI, 0.84-1.14) nor altered risk of HR-positive disease (odds ratio(adj), 1.03; 95% CI, 0.97-1.10). Furthermore, lipophilic statin use was not associated with risk of any of the intrinsic subtypes, luminal A, luminal B, human epidermal growth factor receptor 2 positive/estrogen receptor negative, or triple negative.Our results do not support an association of lipophilic statin use with the risk for breast cancer in general or with risks of HR-negative or other breast cancer subtypes specifically.These findings do not confirm previous reports of a possible preventive association.

    View details for DOI 10.1158/1055-9965.EPI-10-0524

    View details for Web of Science ID 000282590500009

    View details for PubMedID 20729289

  • Association of Prediagnostic Serum Vitamin D Levels with the Development of Basal Cell Carcinoma JOURNAL OF INVESTIGATIVE DERMATOLOGY Asgari, M. M., Tang, J., Warton, M. E., Chren, M., Quesenberry, C. P., Bikle, D., Horst, R. L., Orentreich, N., Vogelman, J. H., Friedman, G. D. 2010; 130 (5): 1438-1443

    Abstract

    We investigated the association between serum 25-hydroxyvitamin D (25(OH)D) levels and basal cell carcinoma (BCC) risk in a nested case-control study at Kaiser Permanente Northern California (KPNC). A total of 220 case patients with BCC diagnosed after serum collection were matched to 220 control subjects. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression. Fully adjusted models included body mass index (BMI), smoking, education, sun-exposure variables, X-ray exposure, and personal history of cancer. For each measure of serum 25(OH)D (continuous, clinically relevant tertiles, quintiles), we found an increased risk of BCC in unadjusted models (OR=1.03, 95% CI 1.00-1.05, P<0.05; OR=3.98, 95% CI: 1.31-12.31, deficient vs. sufficient, test for trend P-value <0.01; OR=2.32, 95% CI: 1.20-4.50, 1st vs. 5th quintile, test for trend P-value 0.03). In fully adjusted models, the values attenuated slightly (OR=1.02, 95% CI 1.00-1.05, P<0.05; OR=3.61, 95% CI: 1.00-13.10, deficient vs. sufficient, t-trend P=0.03; OR=2.09 1st vs. 5th quintile, 95% CI: 0.95-4.58, t-trend P=0.11). Our findings suggest that higher prediagnostic serum 25(OH)D levels may be associated with increased risk of subsequent BCC. Further studies to evaluate the effect of sun exposure on BCC and serum 25(OH)D levels may be warranted.

    View details for DOI 10.1038/jid.2009.402

    View details for Web of Science ID 000276972300031

    View details for PubMedID 20043012

  • Association Between Nonsteroidal Anti-inflammatory Drug Use and Cutaneous Squamous Cell Carcinoma ARCHIVES OF DERMATOLOGY Asgari, M. M., Chren, M., Warton, E. M., Friedman, G. D., White, E. 2010; 146 (4): 388-395

    Abstract

    To examine the association between nonsteroidal anti-inflammatory drug (NSAID) use and cutaneous squamous cell carcinoma (SCC).Retrospective case-control study.Kaiser Permanente Northern California (KPNC), a large population based-health maintenance organization.Random sample of 415 KPNC members diagnosed as having a pathologically verified SCC in 2004 and 415 age-, sex-, and race-matched controls with no history of skin cancer. MAIN EXPOSURE MEASURE: Self-reported NSAID use in the 10 years prior to baseline. Use of NSAIDs was categorized based on type (any NSAIDs, aspirin, ibuprofen, and nonaspirin NSAIDs). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression to estimate the association of SCC with regular use, dose, and duration of exposure to the different NSAID types. Information on pharmacy-dispensed NSAIDs was also examined to assess its association with SCC risk. Models were adjusted for all ascertained SCC risk factors (fully adjusted model) and only those variables associated with both SCC risk and NSAID use (parsimonious model).Fully adjusted analyses showed no statistically significant reduction in SCC risk with self-reported regular use of any NSAID (OR, 1.32; 95% CI, 0.92-1.89), aspirin (OR, 1.38; 95% CI, 0.96-1.97), ibuprofen (OR, 0.74; 95% CI, 0.46-1.19), or nonaspirin NSAIDs (OR, 0.84; 95% CI, 0.56-1.26). Analyses examining duration, dose, and variables combining duration and dose of NSAID exposure did not appreciably change results. An analysis using the parsimonious model showed similar results. The data on pharmacy-dispensed NSAIDs also showed no association with SCC risk.Neither self-reported nor pharmacy-dispensed NSAID exposure was associated with cutaneous SCC risk.

    View details for Web of Science ID 000276813500005

    View details for PubMedID 20157019

  • Potential Risk Factors for Cutaneous Squamous Cell Carcinoma include Oral Contraceptives: Results of a Nested Case-Control Study INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Asgari, M. M., Efird, J. T., Warton, E. M., Friedman, G. D. 2010; 7 (2): 427-442

    Abstract

    Recently, a population-based case-control study observed a 60% increased odds ratio (OR) for cutaneous squamous cell carcinoma (SCC) among women who had ever used oral contraceptives (OCs) compared with non users (95% confidence interval (CI) = 1.0-2.5). To further characterize the putative association between OC use and SCC risk, we conducted a nested case-control study using a large retrospective cohort of 111,521 Kaiser Permanente Northern California members. Multivariable conditional logistic regression was used to estimate ORs and CIs adjusting for known and hypothesized SCC risk factors. Pre-diagnostic OC use was associated with a statistically significant increased OR for SCC in univariate analysis (OR = 2.4, CI = 1.2-4.8), with borderline statistical significance in multivariable analysis (CI = 2.0, CI = 0.91-4.5). Given the high incidence of SCC in the general population and the prevalent use of OCs among women in the United States, there is a need for more large, carefully designed epidemiologic studies to determine whether the observed association between OC use and SCC can be replicated and to better understand the etiologic basis of an association if one exists.

    View details for DOI 10.3390/ijerph7020427

    View details for Web of Science ID 000274972000007

    View details for PubMedID 20616983

  • Screening pharmaceuticals for possible carcinogenic effects: initial positive results for drugs not previously screened CANCER CAUSES & CONTROL Friedman, G. D., Udaltsova, N., Chan, J., Quesenberry, C. P., Habel, L. A. 2009; 20 (10): 1821-1835

    Abstract

    To screen commonly used prescription drugs for possible carcinogenic effects.In a large health care program we identified 105 commonly used drugs, not previously screened. Recipients were followed for up to 12½ years for incident cancer. Nested case-control analyses of 55 cancer sites and all combined included up to ten matched controls per case, with lag of at least 2 years between drug dispensing and cancer. Positive associations entailed a relative risk of 1.50, with p ? 0.01 and higher risk for three or more, than for one prescription. Evaluation included further analyses, searches of the literature, and clinical judgment.There were 101 associations of interest for 61 drugs. Sixty-six associations were judged to have involved substantial confounding. We found evidence that of the remaining 35, the following associations may not be due to chance: sulindac with gallbladder cancer and leukemia, hyoscyamine with nonHodgkin lymphoma, nortriptyline with esophageal and hepatic cancer, oxazepam with lung cancer, both fluoxetine and paroxetine with testicular cancer, hydrochlorothiazide with renal and lip cancer, and nifedipine with lip cancer.These preliminary findings suggest that further studies are indicated regarding sulindac, hyoscyamine, nortriptyline, oxazepam, fluoxetine, paroxetine, hydrochlorothiazide, and nifedipine.

    View details for DOI 10.1007/s10552-009-9375-2

    View details for Web of Science ID 000271809000004

    View details for PubMedID 19582585

  • Epidemiologic evaluation of pharmaceuticals with limited evidence of carcinogenicity INTERNATIONAL JOURNAL OF CANCER Friedman, G. D., Jiang, S., Udaltsova, N., Quesenberry, C. P., Chan, J., Habel, L. A. 2009; 125 (9): 2173-2178

    Abstract

    Thorough review by the International Agency for Research on Cancer (IARC) has resulted in classifying many substances, including pharmaceuticals, as probably or possibly carcinogenic to humans, based on experiments on animals or limited data on humans. We evaluated 9 such pharmaceuticals for evidence of carcinogenicity in patients receiving them in a large medical care program with automated pharmacy records and a cancer registry. Nested case-control analyses were performed in a cohort of 6.5 million subscribers with up to 12 years of follow-up, focusing on cancer sites suggested by previous evidence and other sites with odds ratio of at least 1.50, p < 0.01 and some evidence of dose-response. Unmeasured confounding was estimated in sensitivity analyses. We found some supportive evidence for carcinogenicity of griseofulvin, metronidazole and phenytoin and for the known carcinogen, cyclophosphamide, which was added for validation of our data and analyses. Findings for chloramphenicol, iron-dextran complex, phenoxybenzamine and phenobarbital were essentially non-contributory. Confounding by cigarette smoking and prior thyroid disease could account, respectively, for associations of oxazepam with lung cancer and propylthiouracil with thyroid cancer. Although not definitive, these findings should be considered in the evaluations of these pharmaceuticals.

    View details for DOI 10.1002/ijc.24545

    View details for Web of Science ID 000270750000023

    View details for PubMedID 19585498

  • Alcohol Consumption and Risk of Hematologic Malignancies ANNALS OF EPIDEMIOLOGY Klatsky, A. L., Li, Y., Baer, D., Armstrong, M. A., Udaltsova, N., Friedman, G. D. 2009; 19 (10): 746-753

    Abstract

    Limited data suggest that alcohol drinking may have an inverse relation to risk of non-Hodgkin's lymphoma (NHL). Prospective data about alcohol, NHL, and other hematologic malignancies (HM) are sparse.We carried out a cohort study in a multiethnic population of 126,293 adults who supplied baseline information at health examinations. There were subsequent HM diagnoses in 1244 persons. We used Cox proportional hazards models with seven covariates. The role of beverage types was studied by comparing groups with preponderant choices and by studying the role of frequency of drinking beverage types.Using lifelong abstainers plus infrequent drinkers as referent, adjusted relative risks (95% confidence intervals) for HM follow: less than one drink per day=1.0 (0.9-1.2), one to two drinks per day=0.9 (0.7-1.0), greater than three drinks per day=0.7 (0.6-0.9, p=0.008). For 673 NHL these were 1.2 (1.0-1.5), 0.9 (0.7-1.2), and 0.9 (0.6-1.2). Persons reporting greater than three drinks/day had inverse relations to lymphocytic (n= 146) and myelocytic (n= 169) leukemias, with relative risk of 0.5 (0.2-1.0, p<0.05) for each. No major independent relation was seen for choice of wine, liquor, or beer.Alcohol drinking is associated with slightly lower risk of HM, due largely to inverse relations to lymphocytic and myelocytic leukemia.

    View details for DOI 10.1016/j.annepidem.2009.03.005

    View details for Web of Science ID 000270192000009

    View details for PubMedID 19394864

  • Statin use and risk of basal cell carcinoma JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Asgari, M. A., Tang, J., Epstein, E. H., Chren, M., Warton, E. M., Quesenberry, C. P., Go, A. S., Friedman, G. D. 2009; 61 (1): 66-72

    Abstract

    We examined the association between statin use and basal cell carcinoma (BCC) risk.We identified all members of a large integrated health care delivery system with a diagnosis of a histologically proven BCC in 1997. Subsequent BCCs were identified through 2006 from health plan electronic pathology records. Longitudinal exposure to statins and other lipid-lowering agents was determined from automated pharmacy records. We used extended Cox regression to examine the independent association between receipt of statin therapy (ever vs never, cumulative duration) and risk of subsequent BCC. To minimize confounding by indication, we conducted sensitivity analyses in the subset of individuals considered eligible for lipid-lowering therapy based on national guidelines.Among 12,123 members given a diagnosis of BCC who had no prior statin exposure, 6381 developed a subsequent BCC during follow-up. Neither "ever use of statins" (adjusted hazard ratio 1.02, 95% confidence interval: 0.92-1.12) or cumulative duration of statin (adjusted hazard ratio 1.02/year, 95% confidence interval: 0.99-1.11) was associated with subsequent BCC after adjustment for age, sex, and health care use. Risk estimates did not change appreciably when the analysis was limited to the subset of individuals who met eligibility criteria for initiating statin therapy. There was also no significant association between use of non-statin antilipemics and subsequent BCC (adjusted hazard ratio 1.10, 95% confidence interval: 0.76-1.58).No information was available for BCC risk factors, such as sun sensitivity and sun exposure.Among a large cohort of individuals with BCC, statin therapy was not significantly associated with risk of subsequent BCC.

    View details for DOI 10.1016/j.jaad.2009.02.011

    View details for Web of Science ID 000267325000010

    View details for PubMedID 19464071

  • Pharmaceuticals that cause mammary gland tumors in animals: findings in women BREAST CANCER RESEARCH AND TREATMENT Friedman, G. D., Jiang, S., Udaltsova, N., Chan, J., Quesenberry, C. P., Habel, L. A. 2009; 116 (1): 187-194

    Abstract

    Risk of breast cancer in women was assessed for eight pharmaceuticals that produce mammary tumors in experimental animals, using nested case-control analyses in two cohorts with prescription records in a comprehensive medical care program. The two cohorts were: (1) earlier cohort: 78,118 female members who received prescriptions in 1969-1973, of whom 2,467 developed breast cancer, and (2) later cohort: 3,289,408 female members who received prescriptions in 1994-2006 of whom 24,528 developed breast cancer. Longest follow-up was until June 30, 2006. Ten randomly selected concurrent control women were age-matched to almost every case. Relative risks were estimated by conditional logistic regression. Case ascertainment was lagged by 2 years, or unlagged and subdivided by number of prescriptions received. Some analyses were controlled for hormone use and sensitivity analyses were conducted to estimate the effects of uncontrolled confounding. In the later cohort furosemide, and metronidazole showed statistically significant but very small increases in relative risk (ranging from 1.07 to 1.13). Of these, only furosemide showed increased risk in the earlier cohort: 2-year lag relative risk 1.66 (95% confidence interval 1.23-2.24) or as low as 0.97, assuming uncontrolled positive confounding. Griseofulvin showed significant increases in the later cohort: relative risk for three or more prescriptions 1.48 (1.08-2.03) or as low as 1.23 assuming uncontrolled positive confounding and non-significant increases were noted in the earlier cohort. Our findings are limited by their inconsistency across the two cohorts and our inability to directly control for most established breast cancer risk factors. Although inconclusive, our findings suggest a need for more research on furosemide and griseofulvin.

    View details for DOI 10.1007/s10549-008-0123-1

    View details for Web of Science ID 000266946700020

    View details for PubMedID 18629631

  • Wine, liquor, beer and risk of breast cancer in a large population EUROPEAN JOURNAL OF CANCER Li, Y., Baer, D., Friedman, G. D., Udaltsova, N., Shim, V., Klatsky, A. L. 2009; 45 (5): 843-850

    Abstract

    Population studies show a relation of alcohol drinking to an increased risk of breast cancer (BrCa). Aiming to investigate uncertainties about a risk threshold, the role of beverage type and interactions with other BrCa predictors, we performed a cohort study among 70,033 women, 2,829 of whom developed BrCa. Using Cox proportional hazards models with 8 covariates, the following relative risks (95% confidence intervals) for BrCa versus lifelong abstainers were found: 1.08 (0.95-1.22) at <1 drink per day, 1.21 (1.05-1.40, p=0.01) at 1-2 drinks daily and 1.38 (1.13-1.68, p=0.002) at > or = 3 drinks daily. Increased BrCa risk was concentrated in women with oestrogen receptor positive tumours with no major disparity related to choice of wine, liquor, beer or type of wine (red, white, etc). We conclude that with a threshold below 1-2 drinks daily, a hormone-related mechanism mediates a relation of alcohol drinking to an increased BrCa risk.

    View details for DOI 10.1016/j.ejca.2008.11.001

    View details for Web of Science ID 000266205900026

    View details for PubMedID 19095438

  • Hypnotics and skin cancer: hint at drug carcinogenesis, coincidence, or benefit of more sleep? JOURNAL OF SLEEP RESEARCH Friedman, G. D. 2008; 17 (3): 243-244
  • Erratum: Screening statins for possible carcinogenic risk: up to 9 years of follow-up of 361 859 recipients. Pharmacoepidemiology and drug safety Friedman, G. D., Flick, E. D., Udaltsova, N., Chan, J., Quesenberry, C. P., Habel, L. A. 2008; 17 (7): 751-?

    View details for DOI 10.1002/pds.1629

    View details for PubMedID 18613276

  • Helicobacter pylori infection and development of pancreatic cancer CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION de Martel, C., Llosa, A. E., Friedmana, G. D., Vogelman, J. H., Orentreich, N., Stolzenberg-Solomon, R. Z., Parsonnet, J. 2008; 17 (5): 1188-1194

    Abstract

    Infection with Helicobacter pylori is an established risk factor for gastric cancer. Results from two studies suggest that it may also be a risk factor for pancreatic cancer.We conducted a nested case control study among 128,992 adult subscribers to the Kaiser Permanente Medical Care Program who had been enrolled in a multiphasic health checkup from 1964 to 1969. Serum collected during the checkup was maintained frozen, and subjects were followed for cancer. Cases consisted of 104 randomly selected subjects among 507 who developed pancreatic cancer in the cohort. Controls consisted of 262 pancreatic cancer-free subjects from a pool of 730 controls previously tested for studies conducted on this cohort. Controls were individually matched to cases on age, gender, race, site, and date of multiphasic health checkup. Control sera were compared with cases for antibodies to H. pylori and the CagA protein. The effects of smoking, alcohol consumption, obesity, and years of education were also investigated.Neither H. pylori [odds ratio (OR), 0.85; 95% confidence interval (95% CI), 0.49-1.48] nor its CagA protein (OR, 0.96; 95% CI, 0.48-1.92) was associated with subsequent development of pancreatic cancer. Smoking (OR, 2.09; 95% CI, 1.17-3.74) and greater number of years of education (OR, 2.13; 95% CI, 1.23-3.69) were risk factors for pancreatic cancer, whereas alcohol consumption and obesity were not.Our results suggest that H. pylori infection is not associated with development of pancreatic cancer.

    View details for DOI 10.1158/1055-9965.EPI-08-0185

    View details for Web of Science ID 000256012800024

    View details for PubMedID 18483341

  • The confounded relation of coffee drinking to coronary artery disease AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Koplik, S., Kipp, H., Friedman, G. D. 2008; 101 (6): 825-827

    Abstract

    After decades of conflicting studies, the relation of coffee drinking to coronary artery disease (CAD) risk remains unresolved. Using Cox proportional-hazards models with 5 covariates, 127,212 subjects who supplied baseline data at voluntary health examinations from 1978 to 1985 were studied. Subsequently, 8,357 subjects were hospitalized for CAD. Coffee drinking was unrelated to CAD risk in 58,888 never smokers, but in ex-smokers and current baseline smokers, daily coffee intake was associated with higher CAD risk. This disparity was generally consistent in stratified subgroups. In conclusion, this relation of coffee consumption to increased CAD risk only in smokers could be explained by incomplete control for smoking, by other traits of smokers, or by an adverse biologic interaction of a coffee ingredient with smoking effect on CAD.

    View details for DOI 10.1016/j.amjcard.2007.11.022

    View details for Web of Science ID 000254024000016

    View details for PubMedID 18328848

  • Screening statins for possible carcinogenic risk: up to 9 years of follow-up of 361 859 recipients PHARMACOEPIDEMIOLOGY AND DRUG SAFETY Friedman, G. D., Flick, E. D., Udaltsova, N., Chan, J., Quesenberry, C. P., Habel, L. A. 2008; 17 (1): 27-36

    Abstract

    Determine the risk of cancer in statin users.Risk of cancer in up to 9.4 years after first recorded receipt of statins was evaluated in subscribers of an integrated health care program in northern California. Statin use and cancer development were ascertained from the program's pharmacy records and cancer registry from August 1994 to December 2003.Most of the 361,859 statin users received lovastatin, simvastatin or both. Results are presented from analyses with 2-year lag and use for over 5 years. Most of the observed associations were likely due to chance or confounding. The few associations that seemed less readily explainable were increased risk of cancers of the thyroid, esophagus and urinary tract and decreased risk of colon cancer in men. Increased risk of lung cancer was the only nominally statistically significant positive association in women and could be partially attributable to their smoking habits.Overall this study provided no strong evidence of either causation or prevention of cancer by statins.

    View details for DOI 10.1002/pds.1507

    View details for Web of Science ID 000252535300004

    View details for PubMedID 17944002

  • Methylphenidate use in children and risk of cancer at 18 sites: results of surveillance analyses PHARMACOEPIDEMIOLOGY AND DRUG SAFETY Oestreicher, N., Friedman, G. D., Jiang, S., Pharm, J. C., Quesenberry, C., Habel, L. A. 2007; 16 (12): 1268-1272

    Abstract

    A recent report linked methylphenidate (MPH) use in children to cytologic abnormalities in plasma lymphocytes, a possible cancer biomarker. The purpose of this study was to investigate the association of MPH use and childhood cancer risk.Using automated pharmacy databases and the SEER-affiliated cancer registry of the Kaiser Permanente Medical Care Program (KPMCP), we compared cancer rates at 18 sites among 35,400 MPH users who received it before age 20 to rates among KPMCP membership (age, sex, and calendar year standardized). Medical records of MPH exposed cancer cases were reviewed to identify the presence of established risk factors.There were 23 cancers among MPH users, versus 20.4 expected (standardized morbidity ratio, SMR = 1.13, 95% confidence interval (0.72, 1.70)). Given the small number of cancers, site-specific SMR estimates were imprecise. Only one SMR was statistically significant at the p < 0.05 level, which given the number of comparisons is consistent with the absence of a true association at any site. MPH use was associated with increased risk of lymphocytic leukemia (SMR = 2.64 (1.14, 5.20)), based on eight observed cases). The medical records of these exposed cases did not reveal any lymphocytic leukemia risk factors (prior cancer, radiotherapy or chemotherapy, or Down syndrome).Our results are consistent with no moderate or strong association between MPH use and cancer risk in children, although our ability to examine dose and duration of use or risk at specific sites was limited by small numbers. Further study of MPH use and lymphocytic leukemia risk is needed to determine whether our results are due to chance alone.

    View details for DOI 10.1002/pds.1519

    View details for Web of Science ID 000251886700002

    View details for PubMedID 18041106

  • Antibiotics and breast cancer CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Danby, F. W. 2007; 16 (6): 1322-1322
  • Antibiotics and risk of breast cancer: Up to 9 years of follow-up of 2.1 million women CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Friedman, G. D., Oestreicher, N., Chan, J., Quesenberry, C. P., Udaltsova, N., Habel, L. A. 2006; 15 (11): 2102-2106

    Abstract

    Antibiotic use has been associated with risk of breast cancer in previous reports. Using Cox proportional hazards analysis, we evaluated this association in 2,130,829 adult female subscribers of a health care program according to their receipt of prescriptions of antibiotics from outpatient pharmacies. Hormone use was taken into account. Altogether, 18,521 women developed breast cancer in up to 9.4 years of follow-up. Use of any antibiotic was associated with slightly increased risk [hazard ratio (HR), 1.14; 95% confidence interval (95% CI), 1.10-1.18] but there was little, if any, evidence of dose response, with HR of 1.17 (95% CI, 0.97-1.42) for >1,000 days of use compared with no use. The only two weakly associated antibiotic groups (HR >1.10 for >100 days of use) were tetracyclines and macrolides with HRs (95% CI) of 1.23 (1.11-1.36) and 1.16 (0.98-1.36), respectively. An association of lincosamides with breast cancer in an earlier, smaller database was not confirmed, but follow-up was too short in the present data for adequate evaluation. Medical record review suggested that acne and/or rosacea could be the underlying factor, associated with long-term antibiotic therapy and found by others to be associated with risk of breast cancer. Although causality cannot be ruled out, the observed associations of antibiotics overall, tetracyclines, and macrolides with breast cancer were weak and could be explained by uncontrolled confounding by the diseases being treated or by other factors.

    View details for DOI 10.1158/1055-9965.EPI-06-0401

    View details for Web of Science ID 000242150300017

    View details for PubMedID 17119034

  • Sequelae of systemic hypertension in alcohol abstainers, light drinkers, and heavy drinkers AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Koplik, S., Gunderson, E., Kipp, H., Friedman, G. D. 2006; 98 (8): 1063-1068

    Abstract

    A link exists between alcohol intake and increased blood pressure (BP), with many studies showing increased hypertension prevalence in heavy drinkers. The harmful and beneficial effects of alcohol can confound the study of the long-term risks of alcohol-related hypertension. We therefore studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers among 127,212 subjects with BP and alcohol intake ascertained at 1978 to 1985 health examinations. Subsequent cardiovascular end points included mortality risk, hospitalization risk, and outpatient diagnosis of hypertension. Analyses were performed for all subjects and stratified by 5 alcohol-drinking categories (from never drinkers to >or=3 drinks/day). With <120/80 mm Hg as the referent, Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for 3 higher BP categories (120 to 129/80 to 84, 130 to 139/85 to 89, and >or=140/90 mm Hg). The covariates were age, gender, race, body mass index, education, and smoking. The risk of all outcomes was progressively higher for increasing BP categories, with a similarly increased risk for abstainers, light drinkers, and heavy drinkers. The interaction tests for alcohol and BP were not statistically significant for the mortality and hospitalization outcomes. Interpretation was limited by an inability to separate subjects with increased BP from alcohol consumption from those with other etiologies. In conclusion, the data indicate that the risks of hypertension are similar regardless of the amount of alcohol consumption.

    View details for DOI 10.1016/j.amjcard.2006.05.029

    View details for Web of Science ID 000241427400015

    View details for PubMedID 17027572

  • Coffee, cirrhosis, and transaminase enzymes ARCHIVES OF INTERNAL MEDICINE Klatsky, A. L., Morton, C., Udaltsova, N., Friedman, G. D. 2006; 166 (11): 1190-1195

    Abstract

    A minority of persons at risk develop liver cirrhosis, but knowledge of risk modulators is sparse. Several reports suggest that coffee drinking is associated with lower cirrhosis risk.We studied 125,580 multiethnic members of a comprehensive prepaid health care plan without known liver disease who supplied baseline data at voluntary health examinations from 1978 to 1985. Subsequently, through 2001, 330 of them were diagnosed with liver cirrhosis. Review of medical records confirmed the diagnosis of cirrhosis and ascertained probable etiology. The association of coffee drinking with cirrhosis was estimated by Cox proportional hazards models with 7 covariates. We also did a cross-sectional analysis of baseline aspartate aminotransferase and alanine aminotransferase levels, studied by logistic regression.In the cohort study, relative risks of alcoholic cirrhosis (199 subjects) for coffee drinking (vs none) were less than 1 cup per day, 0.7 (95% confidence interval [CI], 0.4-1.1); 1 to 3 cups, 0.6 (95% CI, 0.4-0.8; P<.001); and 4 or more cups, 0.2 (95% CI, 0.1-0.4; P<.001). For 131 subjects with nonalcoholic cirrhosis, relative risks were less than 1 cup, 1.2 (95% CI, 0.6-2.2); 1 to 3 cups, 1.3 (95% CI, 0.8-2.1); and 4 or more cups, 0.7 (95% CI, 0.4-1.3). These relative risks for coffee drinking were consistent in subsets. Tea drinking was unrelated to alcoholic or nonalcoholic cirrhosis. In the cross-sectional analyses, coffee drinking was related to lower prevalence of high aspartate aminotransferase and alanine aminotransferase levels; for example, the odds ratio of 4 or more cups per day (vs none) for a high aspartate aminotransferase level was 0.5 (95% CI, 0.4-0.6; P<.001) and for a high alanine aminotransferase level, 0.6 (95% CI, 0.6-0.7; P<.001), with stronger inverse relations in those who drink large quantities of alcohol.These data support the hypothesis that there is an ingredient in coffee that protects against cirrhosis, especially alcoholic cirrhosis.

    View details for Web of Science ID 000238198200006

    View details for PubMedID 16772246

  • Higher prevalence of systemic hypertension among moderate alcohol drinkers: An exploration of the role of underreporting JOURNAL OF STUDIES ON ALCOHOL Klatsky, A. L., Gunderson, E. P., Kipp, H., Udaltsova, N., Friedman, G. D. 2006; 67 (3): 421-428

    Abstract

    Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), but the relationship between moderate drinking and HTN remains unclear. We explored the possible role of underreporting among moderate drinkers.In a cross-sectional analysis of 105,378 persons, we defined a subset among persons reporting three or fewer drinks per day that was likely to include a disproportionate number of underreporters. This subset included persons who, on another occasion, indicated intake of three or more drinks per day or who ever had a diagnosis of an alcohol-related condition; these persons are called "positive." Persons who never reported three or more drinks per day and who had no alcohol-related diagnosis were called "negative." Logistic regression models estimated the odds ratios (ORs) for prevalent HTN (140/90 mm Hg or greater) in the positive and negative subgroups, compared with lifelong abstainers as referent. All persons and four race-gender groups were studied, and they were controlled for age, education, smoking, and body mass index. We also studied the relationship of blood liver transaminase enzyme levels in the positive and negative subgroups at specific alcohol intake strata.For persons reporting one to two drinks per day, the OR (95% confidence interval) of HTN was 1.32 (1.21-1.43) for positive persons and 1.16 (1.09-1.25) for negative persons. For those reporting less than one drink per day, the ORs were 0.97 (0.89-1.06) for positives and 0.92 (0.87-0.98) for negatives. For those reporting one to two drinks per day, positive/negative comparisons showed approximately a 75% increased prevalence of high liver transaminase enzymes. For those reporting less than one drink per day, the positive/negative difference was approximately 30%.In these data, increased prevalence of HTN among persons reporting one to two drinks per day appears to be partially due to underreporting of alcohol intake.

    View details for Web of Science ID 000236676600011

    View details for PubMedID 16608152

  • Short-term chloral hydrate administration and cancer in humans DRUG SAFETY Haselkorn, T., Whittemore, A. S., Udaltsova, N., Friedman, G. D. 2006; 29 (1): 67-77

    Abstract

    Chloral hydrate, used as a hypnosedative in adults and children, has been shown to be genotoxic and carcinogenic in animal studies. We investigated the potential causal association between chloral hydrate exposure and cancer risk in humans.Cancer incidence was previously determined via biennial screening analyses of the 215 most commonly used drugs between 1976 and 1998 for a cohort of 143,574 outpatients at Kaiser Permanente who had prescriptions filled between 1969 and 1973. Among users of chloral hydrate, statistically significant elevations in standardised morbidity ratios were observed during various years for cancer at five anatomical sites, including the lung, stomach, prostate, skin melanoma and mouth floor. In this analysis, these associations were investigated using: (i) a dose-response analysis among exposed subjects; and (ii) a two-stage design with exposed and non-exposed persons.There was evidence of an increasing risk of prostate cancer with increasing number of dispensings of chloral hydrate, which persisted after controlling for benign prostatic hypertrophy, vasectomy and obesity; however, the trend was not statistically significant. There was no evidence of a dose-response relationship between chloral hydrate and risk of any of the other four cancers. In the two-stage design, analyses comparing exposed and unexposed subjects showed no increased risk of cancer after controlling for confounding variables; however, the data were suggestive for prostate cancer, where the increased risk associated with chloral hydrate exposure after adjustment for confounding variables persisted. No dose-response relationship was seen for any of the other four cancer sites.To our knowledge, this is the first study to examine the relationship between chloral hydrate exposure and cancer risk in humans. There was no persuasive evidence to support a causal relationship between chloral hydrate exposure in humans and the development of cancer. However, statistical power was low for weak associations, particularly for some of the individual cancer sites. Although animal data using much higher doses of chloral hydrate have demonstrated its genotoxicity and carcinogenicity, the effects of chloral hydrate in humans are still uncertain.

    View details for Web of Science ID 000235639000005

    View details for PubMedID 16454535

  • Smoking and cryptococcosis in AIDS patients MYCOSES Friedman, G. D., Fessel, J., Udaltsova, N., Hurley, L. B. 2006; 49 (1): 68-69

    View details for Web of Science ID 000233655400014

    View details for PubMedID 16367823

  • Early symptoms of ovarian cancer: a case-control study without recall bias FAMILY PRACTICE Friedman, G. D., Skilling, J. S., Udaltsova, N. V., Smith, L. H. 2005; 22 (5): 548-553

    Abstract

    Ovarian cancer is usually diagnosed after it has spread and is difficult to cure. Previous attempts to identify early symptoms have either lacked a control group or have been based on interviews of cases, with possible recall bias.The purpose of this study was to identify early symptoms of ovarian cancer by reviewing prediagnostic medical records, free of recall bias, and comparing women with and without ovarian cancer.In an integrated health care delivery system, symptoms recorded in medical records of 102 women with ovarian cancer during the two years before diagnosis were compared with those of 102 matched control women.More cases than controls complained of several symptoms up to one year before diagnosis. Most of these symptoms were abdominal or gastrointestinal in nature and were more prevalent in the advanced stage cases. Other symptom sites included pelvic, urinary, back, and systemic. Because case-control differences were not large and prevalence is low, positive predictive values were generally quite low.Previous reports of early symptoms of ovarian cancer were confirmed in a study with a control group and free of recall bias. It is not clear that these symptoms occurred while the disease was still localized. Because hundreds of women would have to be investigated to detect one case of ovarian cancer, the clinical utility of these symptoms is uncertain. Nevertheless, health care providers should keep ovarian cancer in mind, when women present with symptoms such as abdominal pain and bloating.

    View details for DOI 10.1093/fampra/cmi044

    View details for Web of Science ID 000231922300015

    View details for PubMedID 15964871

  • Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Chartier, D., Udaltsova, N., Gronningen, S., Brar, S., Friedman, G. D., Lundstrom, R. J. 2005; 96 (3): 346-351

    Abstract

    Myocardial damage from heavy alcohol intake can cause the heart failure (HF) syndrome, but the relation of lighter alcohol intake to HF has rarely been studied. We examined the risk of HF hospitalization among 126,236 subjects who supplied data about alcohol during health examinations from 1978 to 1985. Among 2,594 subjects who were subsequently hospitalized for HF, record review established an association between coronary artery disease (CAD) and HF (CAD-HF) in 1,559 patients. Among the remaining 1,035 subjects who had HF (non-CAD-HF), we attempted determination of preponderant etiologic and contributory factors. Analyses used Cox models that were controlled for 7 covariates, with usual alcohol intake studied categorically compared with that in subjects who did not drink alcohol. Heavier drinkers (> or =3 drinks/day) but not light to moderate drinkers had increased risk of non-CAD-HF; e.g., relative risk for subjects who reported > or =6 drinks/day was 1.7 (95% confidence interval 1.1 to 2.6). This association of non-CAD-HF with heavy drinking was limited to subsets with cardiomyopathy or of unclear preponderant etiology. Alcohol drinking was inversely related to risk of CAD-HF (e.g., at 1 to 2 drinks/day, relative risk 0.6, 95% confidence interval 0.5 to 0.7), with consistency across subgroups of age, gender, ethnicity, education, smoking status, interval to diagnosis, and presence or absence of baseline heart disease or systemic hypertension. Moderate drinking was inversely related to non-CAD-HF only in subjects who had diabetes mellitus (n = 252). In conclusion, heavy, but not light, alcohol drinking is associated with increased risk of non-CAD-HF and that apparent protection by alcohol drinking against CAD-HF risk provides confirmation of a protective effect of alcohol against CAD.

    View details for DOI 10.1016/j.amjcard.2005.03.073

    View details for Web of Science ID 000231057000005

    View details for PubMedID 16054455

  • Cryptococcosis: the 1981-2000 epidemic MYCOSES Friedman, G. D., Fessel, W. J., Udaltsova, N. V., Hurley, L. B. 2005; 48 (2): 122-125

    Abstract

    The annual incidence of cryptococcosis during 1981-2000 was determined in subscribers of a large integrated health care program in Northern California and in those among them who were HIV positive. The incidence of cryptococcosis had been measured in this setting in the previous decade. The 20-year incidence per million person-years was 19.0 in males and 2.6 in females. In males, annual incidence rose sharply but irregularly from 1981 to 1992, then decreased irregularly. In females, trends were less marked, with maximum incidence in 1997. In HIV-positive patients cryptococcosis incidence was highest in 1981-85 and decreased thereafter in men. In women, maximum incidence occurred in 1986-90 and was followed by a decrease. Cryptococcosis was rare in the non-predisposed. Thus, cryptococcosis incidence increased markedly in men early in the AIDS epidemic, and began to decrease in both male and female HIV-positive patients well before highly active antiretroviral therapy became available.

    View details for Web of Science ID 000227381100007

    View details for PubMedID 15743430

  • Helicobacter pylori infection and the risk of development of esophageal adenocarcinoma JOURNAL OF INFECTIOUS DISEASES de Martel, C., Llosa, A. E., Farr, S. M., Friedman, G. D., Vogelman, J. H., Orentreich, N., Corley, D. A., Parsonnet, J. 2005; 191 (5): 761-767

    Abstract

    An increase in the incidence of esophageal adenocarcinoma has coincided with a decrease in the prevalence of Helicobacter pylori infection. Whether these 2 phenomena are associated is unknown.We conducted a nested case-control study of 128,992 members of an integrated health care system who had participated in a multiphasic health checkup (MHC) during 1964-1969. During follow-up, 52 patients developed esophageal adenocarcinoma. Three randomly chosen control subjects from the MHC cohort were matched to each case subject, on the basis of age at the MHC, sex, race, and the date and site of the MHC. Data on cigarette smoking, alcohol consumption, body mass index (BMI), and education level were obtained at the MHC. Serum samples collected at the MHC were tested for IgG antibodies to H. pylori and to the H. pylori CagA protein.Subjects with H. pylori infections were less likely than uninfected subjects to develop esophageal adenocarcinoma (odds ratio [OR], 0.37 [95% confidence interval (CI), 0.16-0.88]). This significant association was restricted to case subjects and control subjects <50 years old at the MHC (OR, 0.20 [95% CI, 0.06-0.68]). In patients with H. pylori infections, the OR for those who tested positive for IgG antibodies to the CagA protein was similar to that for those who tested negative for it. BMI >/=25 and cigarette smoking were strong independent risk factors for development of esophageal adenocarcinoma.The absence of H. pylori infection, independent of cigarette smoking and BMI, is associated with a markedly increased risk of development of esophageal adenocarcinoma.

    View details for Web of Science ID 000226862400018

    View details for PubMedID 15688293

  • Risk of hemorrhagic stroke in Asian American ethnic groups NEUROEPIDEMIOLOGY Klatsky, A. L., Friedman, G. D., Sidney, S., Kipp, H., Kubo, A., Armstrong, M. A. 2005; 25 (1): 26-31

    Abstract

    The sparseness of prospective data about hemorrhagic stroke (HS) risk among Asian American ethnic groups led to the investigation of 128,934 persons with self-classified ethnicity at health examinations in 1978-1985. Subsequently, 431 persons were hospitalized for HS; 31% for subarachnoid hemorrhage (SAH) and 69% for intracerebral hemorrhage (ICH). Ethnic predictors of HS were studied by Cox proportional hazard models with 7 covariates. With whites as reference, the adjusted relative risk (95% CI) of all Asians for HS was 1.6 (1.1-2.3, p = 0.01), due substantially to increased risks of SAH in Japanese people and ICH in Filipinos. These data mandate emphasis upon preventive measures in these groups.

    View details for DOI 10.1159/000085310

    View details for Web of Science ID 000229743800005

    View details for PubMedID 15855802

  • The risk for malignant primary adult-onset glioma in a large, multiethnic, managed-care cohort: cigarette smoking and other lifestyle behaviors JOURNAL OF NEURO-ONCOLOGY Efird, J. T., Friedman, G. D., Sidney, S., Klatsky, A., Habel, L. A., Udaltsova, N. V., Van den Eeden, S., Nelson, L. M. 2004; 68 (1): 57-69

    Abstract

    To determine the risk for malignant primary adult-onset glioma (MPAG) associated with cigarette smoking and other lifestyle behaviors in a large, multiethnic, managed-care cohort.The study population included a cohort of 133,811 subscribers to the Kaiser Permanente Medical Care Program of Northern California who had received a multiphasic health checkup and questionnaire between 1977 and 1985, were at least 25 years old at their start of follow-up, and had no prior history of benign or malignant brain tumors. In this cohort, patients were followed for up to 21 years for the development of MPAG.Risk for MPAG among women increased with increasing packs of cigarettes smoked per day (p-for-trend = 0.04), adjusting for cigar and pipe smoking, patient age, sex, race, education, alcohol use and coffee consumption. A similar pattern was not observed for men. Individuals who smoked marijuana at least once a month, adjusting for cigarette smoking (packs smoked per day) and for the factors noted above, had a 2.8-fold (CI = 1.3-6.2) increased risk for MPAG. Relative risk for MPAG increased with increasing consumption of coffee (p-for-trend = 0.05).Cigarette smoking was associated with an increased risk for MPAG among women but not among men. Individuals who smoked marijuana at least once a month had an increased risk for MPAG, although no dose-response relation was observed. Drinkers of >7 cups of coffee per day had a 70% increased risk for MPAG and smaller risk elevation for lower consumption. Alcohol usage was not associated with an increased risk for MPAG.

    View details for Web of Science ID 000220928400009

    View details for PubMedID 15174522

  • Primer of Epidemiology, 5th edition Friedman GD 2004
  • Cohort study of exposure to environmental tobacco smoke and risk of first ischemic stroke and transient ischemic attack NEUROEPIDEMIOLOGY Iribarren, C., Darbinian, J., Klatsky, A. L., Friedman, G. D. 2004; 23 (1-2): 38-44

    Abstract

    The independent effect of exposure to environmental tobacco smoke (ETS; passive smoking) on the risk of stroke is not well established. We performed a cohort study among 27,698 lifelong nonsmokers with no prior history of stroke, 62% women, aged 30-85 years at enrollment (1979-1985). Self-reported ETS exposure at home and outside home (in hours/week) and stroke risk factors were collected at a health plan in San Francisco and Oakland. Follow-up for hospitalization and death was available through the end of 2000 (median = 16 years). In multivariate analysis adjusting for age, race/ethnicity, educational attainment, marital status, hypertension, diabetes and serum total cholesterol, ETS exposure at home of 20 h or more/week (in relation to <1 h/week) was associated with a 1.29-fold (95% CI 0.75-2.20) and a 1.50-fold (95% CI 1.07-2.09) increased risk of first ischemic stroke among men and women, respectively. No significant associations were found between ETS exposure outside home and ischemic stroke or between exposure to ETS at home or out of home and the risk of transient ischemic attack. Although potentially important confounders (such as dietary habits) were not included in the analysis, high-level ETS exposure at home was independently associated with increased risk of first ischemic stroke among never-smoking women.

    View details for DOI 10.1159/000073973

    View details for Web of Science ID 000188326100005

    View details for PubMedID 14739566

  • Wine, liquor, beer, and mortality AMERICAN JOURNAL OF EPIDEMIOLOGY Klatsky, A. L., Friedman, G. D., Armstrong, M. A., Kipp, H. 2003; 158 (6): 585-595

    Abstract

    A substantially increased risk for heavy drinkers and a slightly reduced risk for lighter drinkers results in the J-shaped alcohol-mortality curve. Limited data suggest a more favorable mortality experience for drinkers of wine than for drinkers of liquor or beer. To examine these relations, the authors performed a cohort study of participants in a large Northern California prepaid health care program. Demographic and history data were collected from 128,934 adults undergoing health evaluations in 1978-1985, with subsequent death ascertained by an automated linkage system. Cox proportional hazards models with eight covariates were used to determine relative risk estimates according to total alcohol intake and days per week of drinking wine, wine types, beer, or liquor. The J-shaped alcohol-mortality relation was stable for 20 years. Independently, frequency of wine drinking was associated with lower mortality risk (p<0.001) largely because of lower coronary disease risk. Similar risk reductions were associated with red wine, white wine, other types of wine, and combinations of wine types. Much of the lower risk associated with light drinking was related to wine drinking. The authors conclude that drinkers of any type of wine have a lower mortality risk than do beer or liquor drinkers, but it remains unclear whether this reduced risk is due to nonalcoholic wine ingredients, drinking pattern, or associated traits.

    View details for DOI 10.1093/aje/kwg184

    View details for Web of Science ID 000185310800011

    View details for PubMedID 12965884

  • C-reactive protein, Helicobacter pylori, Chlamydia pneumoniae, cytomegalovirus and risk for myocardial infarction ANNALS OF EPIDEMIOLOGY Witherell, H. L., Smith, K. L., Friedman, G. D., Ley, C., Thom, D. H., Orentreich, N., Vogelman, J. H., Parsonnet, J. 2003; 13 (3): 170-177

    Abstract

    C-reactive protein (CRP), Chlamydia pneumonia, Helicobacter pylori, and cytomegalovirus (CMV) have each been associated with atherosclerosis. We assessed how infection and CRP related to risk for subsequent myocardial infarction (MI).Using a nested case-control design, we assessed how these factors independently and jointly affected risk for myocardial infarction (MI). Cases of first MI (N = 121) were identified from among participants in a multiphasic health check-up cohort. Controls without MI (N = 204) were matched to cases by gender, age, race, and date of serum collection. Sera collected at enrollment were tested for antibodies to infection and for CRP.In multivariate analysis (mean follow-up of 5.1 years), CRP was associated with MI only in subjects older than 51 years (p = 0.004). Although H. pylori infection increased risk for MI, this association was modest (OR = 1.90, 95% CI = 0.97-3.71) and was not evident in non-smokers or when adjusted for education. No association between C. pneumoniae or cytomegalovirus and MI was observed, nor was the association between CRP and MI explained by these infections.Elevated CRP is a risk factor for subsequent MI in older individuals. The relationship between Hp and MI may be due to confounding or co-linearity with socioeconomic status.

    View details for Web of Science ID 000181526000004

    View details for PubMedID 12604160

  • Risk of subsequent cancer following invasive or in situ squamous cell skin cancer ANNALS OF EPIDEMIOLOGY Efird, J. T., Friedman, G. D., Habel, L., Tekawa, I. S., Nelson, L. M. 2002; 12 (7): 469-475

    Abstract

    Determine the risk of subsequent cancer following squamous cell skin cancer.Using computerized surgical pathology records and membership data from a health maintenance organization, we retrospectively identified 822 individuals with primary squamous cell skin cancer (SCSC) and 3662 comparison subjects matched for age, sex, race, residence area, and length of membership. Patients were included in the study if they had no prior history of cancer, and received at least one multiphasic health checkup and questionnaire (MHC). Patients were followed for subsequent invasive cancer up to 24 years, with a mean follow-up time of 7.8 years.SCSC patients had a significantly greater risk [adjusted for body mass index (BMI) and education] for subsequent cancer overall (excluding non-melanoma skin cancer) [risk ratio (RR) = 1.4, 95% confidence interval (CI) = 1.2-1.6], and for basal cell skin cancer (RR = 13.8, 95% CI = 8.8-21.9), digestive (RR = 1.6, 95% CI = 1.1-2.4), and genitourinary cancers (RR = 1.5, 95% CI = 1.0-2.0). An increased, but not statistically significant, adjusted risk (RR > or = 1.4) was also observed for lip, oral cavity, and pharynx cancer (RR = 3.9, 95% CI = 0.6-25.0); non-cutaneous squamous cell cancer (RR = 1.9, 95% CI = 0.9-4.4); and respiratory and intrathoracic cancer (RR = 1.4, 95% CI = 0.8-2.6). The addition of alcohol consumption, combined occupational exposure, marital status, and smoking history to the multivariate model did not materially change any significant positive associations with SCSC.Our results suggest that patients diagnosed with SCSC may be at an increased risk of subsequent cancer at many sites, although several estimated risk estimates were within the limits of chance given no true association.

    View details for Web of Science ID 000178041400005

    View details for PubMedID 12377424

  • Alcohol drinking and risk of hospitalization for ischemic stroke AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Armstrong, M. A., Friedman, G. D., Sidney, S. 2001; 88 (6): 703-706

    View details for Web of Science ID 000170927500026

    View details for PubMedID 11564405

  • Cohort study of thyroid cancer in a San Francisco Bay area population INTERNATIONAL JOURNAL OF CANCER Iribarren, C., Haselkorn, T., Tekawa, I. S., Friedman, G. D. 2001; 93 (5): 745-750

    Abstract

    Using data from a large health plan, we performed a cohort study of thyroid cancer among 204,964 persons (aged 10--89 at baseline in 1964--1973, 54% female) followed for a median of 20 years. There were 196 incident thyroid cancers (73 in men, 123 in women). Risk was independently and positively related to female gender [relative risk (RR) = 1.56, 95% confidence interval (CI) = 1.12--2.19], Asian race (RR = 2.86, 95% CI = 1.76--4.65), completed college or post-graduate education (RR = 1.76, 95% CI = 1.20--2.59), history of goiter (RR = 3.36, 95% CI = 1.82--6.20), radiation of the neck region (RR = 2.33, 95% CI = 1.28--4.23) and family history of thyroid disease (RR = 2.18, 95% CI = 1.17--4.05). An inverse association was found for black race (RR = 0.55, 95% CI = 0.33--0.91). Cigarette smoking, alcohol consumption, personal history of hyperthyroidism, hypothyroidism, overweight or obesity, weight gain since age 20, height, occupational exposures, reproductive factors, oral contraceptives and hormone use did not show statistically significant relations to thyroid cancer. These results provide further evidence for a role of female gender, radiation, goiter, Asian race, high educational attainment and family history of thyroid disease in the etiology of thyroid cancer.

    View details for Web of Science ID 000170180300022

    View details for PubMedID 11477590

  • Concomitant medication use in postmenopausal women using estrogen therapy MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Small, R., Friedman, G. D., Ettinger, B. 2001; 8 (2): 120-126

    Abstract

    To determine whether long-term postmenopausal estrogen therapy is associated with use of other prescription medications.Using computer pharmacy records from 1969 to 1973 for members of the Kaiser Permanente Medical Care Program in San Francisco, we identified the 215 most commonly used prescription medications in the pharmacy database and recorded their use by 232 postmenopausal long-term estrogen users and by 222 postmenopausal age-matched nonusers. These medications were grouped into 39 therapeutic classes. Classes of medications used by estrogen users and nonusers were compared.A statistically significant difference in use was seen for 21 of the 39 medication classes; of these 21 classes, 20 (95%) were used more frequently and 1 less frequently by estrogen users. Differences between estrogen users and nonusers were greatest for thyroid hormone preparations (estrogen user/nonuser multivariate odds ratio = 25.6, 95% confidence interval 5.9-112) and antimigraine preparations (11 recipients among estrogen users, none among nonusers). Postmenopausal women using estrogen were more likely than nonusers to use additional medications.Greater use of certain prescription medications by estrogen users than by nonusers should be considered in studying the health effects of estrogen replacement therapy.

    View details for Web of Science ID 000167342600007

    View details for PubMedID 11256872

  • Ascertainment bias in case-control studies of cancer screening JOURNAL OF CLINICAL EPIDEMIOLOGY Selby, J. V., Friedman, G. D., Quesenberry, C. P., Weiss, N. S. 2001; 54 (2): 215-215

    View details for Web of Science ID 000166819400019

    View details for PubMedID 11233067

  • Association of basal cell skin cancers with other cancers (United States) CANCER CAUSES & CONTROL Friedman, G. D., Tekawa, I. S. 2000; 11 (10): 891-897

    Abstract

    Persons with basal cell skin cancer (BCSC) have shown increased risk of developing cancer at several other sites.We identified 3164 persons with BCSC and 15,730 comparison subjects matched for age, sex, race, residence area and length of membership in a health maintenance organization.In retrospective follow-up for up to 24 years (mean 11.3 years), BCSC patients experienced statistically significant increases in the incidence of all cancer (relative risk [RR] = 1.2, 95% confidence interval [CI] = 1.1-1.4) lung cancer (RR = 1.4, CI = 1.0-1.8) and melanoma (RR = 2.2, CI = 1.6-3.0). Women experienced significantly increased risk for all cancer, lung cancer, melanoma and thyroid cancer, increases of borderline significance in breast cancer, non-Hodgkin's lymphoma and leukemia, and increased pre-existing bladder cancer. Men showed statistically significant increases in all cancer, melanoma, and kidney cancers, and mouth and throat cancers. Multivariate analysis incorporating available risk factor data did not weaken positive associations with BCSC except slightly for melanoma and for bladder cancer in women. Other previously reported associations were not confirmed.Periodic skin examinations appear well justified after removal of BCSC to detect new skin cancers including melanoma. Given the relatively weak, unexplained associations of BCSC with internal cancers, the costs vs. benefits of extra efforts to detect the latter still need to be determined.

    View details for Web of Science ID 000165486400002

    View details for PubMedID 11142523

  • Colon cancer screening, lifestyle, and risk of colon cancer CANCER CAUSES & CONTROL Slattery, M. L., Edwards, S. L., Ma, K. N., Friedman, G. D. 2000; 11 (6): 555-563

    Abstract

    Sigmoidoscopy screening and fecal occult blood (FOB) tests have been demonstrated as effective ways to reduce mortality from colorectal cancer. However, most studies of colorectal cancer screening and cancer mortality have not taken into consideration lifestyle factors that could account for the observed associations. The purpose of this study was to determine the association between screening and incidence of colon cancer, taking into consideration important lifestyle factors.We estimated the association between screening and colon cancer after taking into consideration health and lifestyle factors using data obtained as part of population-based case-control study of incident colon cancers.Sigmoidoscopy screening, especially as part of a checkup, was protective against incident colon cancer in both men (OR 0.56, 95% CI 0.44-0.77) and women (OR 0.53, 95% CI 0.33-0.77) after adjusting for other risk factors for colon cancer. For men, associations were stronger for distal tumors (OR 0.48, 95% CI 0.31-0.71) than for proximal tumors (OR 0.67, 95% CI 0.45-1.11). We did not observe significant associations between FOB test and colon cancer. Differences in characteristics between those who were screened and not screened were also observed. Men were more likely to report having a sigmoidoscopy as part of a checkup than were women, as were people with higher levels of education. People who reported having a sigmoidoscopy as part of a checkup also reported eating diets lower in fat and higher in fiber, folate, and vegetables. Men were more likely to report higher levels of physical activity, and women were more likely to report taking hormone replacement therapy (HRT) if they also reported a sigmoidoscopy. Both men and women who reported a sigmoidoscopy for screening purposes were more likely to have a family history of colorectal cancer.These data provide additional support for the benefits of having a screening sigmoidoscopy. The associations between screening sigmoidoscopy and colon cancer do not appear to be the result of lifestyle factors.

    View details for Web of Science ID 000088994400009

    View details for PubMedID 10880038

  • Body size, age at shaving initiation, and prostate cancer in a large, multiracial cohort PROSTATE Habel, L. A., Van Den Eeden, S. K., Friedman, G. D. 2000; 43 (2): 136-143

    Abstract

    The purpose of this study was to examine the potential relationship between body size, self-reported age at initiation of shaving, and subsequent risk of prostate cancer in a large, racially diverse cohort of men followed for up to 32 years.The study population included 70,712 male subscribers to the Kaiser Permanente Medical Care Program who had received a multiphasic health checkup between 1964-1973. This general health checkup consisted of a number of laboratory tests and physical measurements, as well as a self-completed health questionnaire that included a request for men to record the age when they began shaving. Subjects were followed for the development of prostate cancer, using the local tumor registry. Cox regression was used to estimate relative risks (RR) and 95% confidence intervals (CI).Altogether, 2, 079 men in the study cohort were diagnosed with prostate cancer. There was a very strong positive association between prostate cancer risk and birth cohort. After adjusting for race, age, and birth year, there was no association between height, weight, body mass index, or several other anthropometric measures and prostate cancer risk in the full cohort. There was a suggestion of a very weak positive association between height and prostate cancer risk among white men. There also was no overall association between age at shaving initiation and prostate cancer risk, although nonwhite men who started shaving at a young age (

    View details for Web of Science ID 000086505000008

    View details for PubMedID 10754529

  • Cimetidine use and risk of breast, prostate, and other cancers PHARMACOEPIDEMIOLOGY AND DRUG SAFETY Habel, L. A., Levin, T. R., Friedman, G. D. 2000; 9 (2): 149-155

    Abstract

    Purpose - The study was conducted to examine whether use of cimetidine is associated with the risk of cancer, with special attention to cancers of the breast and prostate because cimetidine increases estradiol levels and interferes with androgen binding. Methods - Individuals who received a prescription of cimetidine were identified from two computerized pharmacy databases of medications dispensed at Northern California Kaiser Permanente between 1982 and 1987. Users of ranitidine, a histamine-2 receptor antagonist that does not appear to influence estrogen levels or androgen binding, and non-users of either cimetidine or ranitidine, were also identified from these databases. Study subjects were followed through December 1995 for new diagnoses of cancer. Cox regression was used to estimate relative risks of cancer associated with use of cimetidine and ranitidine. Non-users of cimetidine and ranitidine were the referent group for all analyses. Result - While there were very modest increases and decreases in risk for some cancer sites among cimetidine users, most were within the limits of chance given no true association. Furthermore, similar risks of these cancers were also observed among ranitidine users. Conclusions - Although our results do not support an association between cancer risk and cimetidine use, it is one of the most widely prescribed drugs in the US and may now be purchased over-the-counter. The potential effect of cimetidine on risk of cancer, especially those that are hormone-related, should continue to be monitored, preferably in larger study populations. Copyright (c) 2000 John Wiley & Sons, Ltd.

    View details for Web of Science ID 000087307400009

    View details for PubMedID 19025815

  • Spousal concordance for cancer incidence - A cohort study CANCER Friedman, G. D., Quesenberry, C. P. 1999; 86 (11): 2413-2419

    Abstract

    Because married couples share at least their home environment, spousal aggregation of cancer might provide clues to unsuspected etiologic factors. The authors sought to measure the concordance of cancer occurrence in married couples and explore factors that might explain greater-than-expected concordance.The authors identified 25,670 cancer-free married couples in northern California who were followed for up to 31 years for the development of cancer. In Cox proportional hazards analysis, the development of cancer in a spouse was treated as a time-dependent, independent variable, and spouse-with/spouse-without risk ratios were determined, controlling for age and gender. For selected concordant espoused pairs, additional explanatory information was sought in their medical records.There was no excess concordance for all cancers combined; the spouse-with/spouse-without risk ratio was 0.97 (95% confidence interval, 0.90-1.05). Statistically significant husband-wife associations were found only for cancer of the tongue and stomach and for non-Hodgkin lymphoma. Except for cancer of the penis/endometrium and testis/vulva, based on one couple with each combination, gender specific cancers did not aggregate within married couples. Established and suspected risk factors, not necessarily related to the marriage, were found for some individuals who had concordance with their spouses.Little spousal concordance for cancer occurrence was found. The study of spousal aggregation does not appear useful in identifying unsuspected environmental causes of cancer in heterogeneous populations in urban areas of affluent Western countries. A cohort study would have to be much larger than this one to detect weak spousal concordance reliably.

    View details for Web of Science ID 000084123700032

    View details for PubMedID 10590385

  • Barbiturates and lung cancer: a re-evaluation INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Habel, L. A. 1999; 28 (3): 375-379

    Abstract

    Barbiturates, particularly phenobarbital, have been shown to be a tumour promoter in animal experiments and were found to be associated with increased risk of lung cancer in our cohort follow-up study to screen pharmaceuticals for possible carcinogenic effects. Sixteen more years of follow-up have accumulated permitting a more detailed evaluation of this association.In all, 10,213 subscribers of the Kaiser Permanente Medical Care Program who received barbiturates between 1969 and 1973 from its San Francisco pharmacy were followed up through 1992 and their incidence of lung cancer at biennial intervals was compared with what was expected based on the experience of the entire pharmacy cohort (143,594). Smoking-habit data were available on about half of the barbiturate users and were used to adjust for cigarette smoking in both the observed/expected analysis and in Cox proportional hazards analysis.The initially elevated standard morbidity ratio of 1.55 (95% CI: 1.25-1.91) with 3-7 years of follow-up gradually decreased and stabilized at about 1.3 after 11-15 years of follow-up. This trend for diminishing relative risk over time was more pronounced among the never smokers but their initial excess risk was not statistically significant due to small numbers. A dose-response trend was observed, based on the number of prescriptions dispensed. Analytical control for cigarette smoking reduced but did not eliminate either the association or the dose-response trend. Most of the barbiturate-associated cases in never smokers were women and the predominant histological type was adenocarcinoma.These findings from up to 23 years of follow-up are not conclusive because of the continuing small number of never smokers who developed lung cancer. However, they strengthen and refine previous observations of a barbiturate-lung cancer association, which is probably not fully explained by confounding by cigarette smoking. The diminution of excess risk over time is consistent with a tumour promoter effect. Findings among the never smokers suggest that this possible effect may be greatest on adenocarcinomas in women.

    View details for Web of Science ID 000081298800002

    View details for PubMedID 10405836

  • Digital rectal examination and mortality from prostate cancer UROLOGY Weiss, N. S., Friedman, G. D., Van den Eeden, S. 1999; 53 (4): 863-864

    View details for Web of Science ID 000079559500046

    View details for PubMedID 10197878

  • Cholecystectomy and the risk of colon cancer AMERICAN JOURNAL OF GASTROENTEROLOGY Todoroki, I., Friedman, G. D., Slattery, M. L., Potter, J. D., Samowitz, W. 1999; 94 (1): 41-46

    Abstract

    The relationship between cholecystectomy and the occurrence of subsequent colon cancer has been controversial. Using data collected as part of an incident case-control study of colon cancer conducted in northern California, Minnesota, and Utah, we evaluated this association.Participants were between 30 and 79 yr of age and had a first primary colon cancer diagnosed between October 1, 1991 and September 30, 1994. Analyses were adjusted for age, gender, family history of colorectal cancer, body mass index, dietary energy and fiber intake, use of aspirin or nonsteroidal antiinflammatory drugs, and long-term leisure-time vigorous physical activity.A weak positive association between cholecystectomy and proximal colon cancer (odds ratio [OR] and 95% confidence interval [CI] 1.3 [1.0-1.6]) was observed. This was counterbalanced by a weak, nonsignificant negative association (OR 0.8, 95% CI 0.6-1.1) with distal colon cancer leading to no overall association (OR 1.0, 95% CI 0.9-1.2). The association between colon cancer and cholecystectomy did not differ by gender or race, but it did differ by study area, with most of the increased association being attributed to the Minnesota population. The elevated risk of proximal colon cancer increased after cholecystectomy but disappeared after 14 years.Our results suggest that cholecystectomy or the underlying gallstone disease that prompts it may be related weakly to the risk of subsequent proximal colon cancer. However, the association may differ by geographic area of the country, and may be artifactual at least in part.

    View details for Web of Science ID 000082426600012

    View details for PubMedID 9934729

  • Barbiturates, smoking, and bladder cancer risk CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Habel, L. A., Bull, S. A., Friedman, G. D. 1998; 7 (11): 1049-1050

    Abstract

    Phenobarbital treatment has been observed to be negatively associated with bladder cancer risk in a few studies. It has been suggested that phenobarbital may induce drug-metabolizing enzymes that detoxify the bladder carcinogens found in cigarette smoke. We examined the relationship of barbiturate use to bladder cancer risk and the potential modifying effect of cigarette smoking in a large cohort of Kaiser Permanente Medical Care Program members with computerized pharmacy prescriptions and smoking information. Newly diagnosed bladder cancers were identified among individuals in the study cohort by linkage with data from cancer registries. The overall standardized incidence ratio associated with barbiturate use was 0.71 [95% confidence interval (CI), 0.51-0.99]. Among current smokers, former smokers, and never smokers, the standardized incidence ratios were 0.56 (95% CI, 0.23-1.16), 0.68 (95% CI, 0.27-1.40), and 1.04 (95% CI, 0.48-1.98), respectively. Although our estimates were imprecise, the finding of an inverse association between barbiturate treatment and bladder cancer risk only among current and former cigarette smokers is consistent with the hypothesis that treatment with these medications induces drug-metabolizing enzymes that deactivate bladder carcinogens found in cigarette smoke.

    View details for Web of Science ID 000076877800013

    View details for PubMedID 9829715

  • Cancer among spouses - Review of 195 couples CANCER Friedman, G. D., Quesenberry, C. P. 1998; 83 (5): 1055-1055

    View details for Web of Science ID 000075653200042

    View details for PubMedID 9731915

  • Gastrin and colorectal cancer: A prospective study GASTROENTEROLOGY Thorburn, C. M., Friedman, G. D., Dickinson, C. J., Vogelman, J. H., Orentreich, N., Parsonnet, J. 1998; 115 (2): 275-280

    Abstract

    Gastrin is a putative promoter of colorectal carcinomas. The aim of this study was to evaluate the temporal relationship between gastrinemia and development of colorectal malignancy.We conducted a nested case-control study among 128,992 subscribers to a health maintenance program who had participated in a multiphasic health checkup between 1964 and 1969. Serum had been frozen since the checkup and the cohort followed up for cancer. Of 1881 incident colorectal carcinoma cases, 250 were randomly selected; 1 control without cancer was matched to each case by age, sex, education, and date of serum collection. Stored sera were tested for Helicobacter pylori immunoglobulin G and for gastrin and glycine-extended gastrin.Verified cases included 166 colon cancers, 58 rectal cancers, and 9 with cancer in both locations. A mean of 15.3 years had elapsed between serum collection and diagnosis of cancer. Median gastrin levels were similar in cases and controls (41.7 vs. 40.7 pg/mL). However, a gastrin level above normal was associated with increased risk for colorectal malignancy (odds ratio, 3.9; 95% confidence interval, 1.5-9.8). If this association is causal, 8.6% of colorectal cancers could be attributed to high serum gastrin level.Hypergastrinemia is associated with an increased risk of colorectal carcinoma.

    View details for Web of Science ID 000075293400009

    View details for PubMedID 9679032

  • Drugs and colon cancer PHARMACOEPIDEMIOLOGY AND DRUG SAFETY Friedman, G. D., Coates, A. O., Potter, J. D., Slattery, M. L. 1998; 7 (2): 99-106

    Abstract

    In a case-control study of colon cancer conducted in three geographic regions of the United States, 1993 case subjects and 2410 control subjects were interviewed. In addition to queries regarding other known or suspected risk factors, subjects were asked about their use of eight drugs or drug groups. Two of these, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), have been inversely associated with risk in other studies. Three others--asthma medications, digitalis preparations, and phenmetrazine--were positively associated and the last three--diazepam, penicillin, and phenformin--were negatively associated with risk of colon cancer in an earlier study that screened pharmaceuticals for possible carcinogenic effects. Reported use of aspirin and NSAIDs were both inversely related to risk with essentially the same odds ratios (0.7, 95% confidence interval 0.6-0.8) for both drugs in both univariate and multivariate analyses controlling for use of each other and for other colon cancer risk factors. Subdivision by age at starting the drug, duration of use, latency interval, sex, race, family history of colon cancer, or proximal versus distal cancer revealed no substantial differences among subgroups for either aspirin or NSAIDs, but reduced risk was associated primarily with recent aspirin use. Phenformin showed a strong positive association but the data concerning this drug appeared to be inaccurate. The other drugs and drug groups showed essentially no association with colon cancer risk.

    View details for Web of Science ID 000073854000003

    View details for PubMedID 15073733

  • Mentholated cigarettes and non-lung smoking related cancers in California, USA JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Friedman, G. D., Sadler, M., Tekawa, I. S., Sidney, S. 1998; 52 (3): 202-202

    View details for Web of Science ID 000072362700013

    View details for PubMedID 9616428

  • Reflections and several by other authors in the Gary Friedman Symposium The Permanente Journal Friedman GD, Others 1998; 2: 33-7
  • Cigarette smoking and risk of non-Hodgkin's lymphoma subtypes CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Herrinton, L. J., Friedman, G. D. 1998; 7 (1): 25-28

    Abstract

    We examined the hypothesis that cigarette smoking increases the risk of non-Hodgkin's lymphoma (NHL) subtypes in a cohort of approximately 253,000 members of the Kaiser Permanente Medical Care Program, ages 16-84 years, who completed a self-administered questionnaire during the period 1964-1991 that ascertained smoking history. Using information from the Surveillance, Epidemiology, and End Results cancer registry that operates in the area and the Kaiser Permanente cancer registry, we identified 674 incident cases of NHL through 1993. We observed a positive association between smoking and risk of follicular lymphoma (compared with nonsmokers: former smokers, relative risk = 1.9 with 95% confidence interval = 1.2-2.9; current smokers, relative risk = 1.4 with 95% confidence interval = 0.9-2.2), although the strength of the association did not increase consistently with increasing duration and intensity of smoking. We observed no relationship between smoking status and the risks of small cell lymphocytic, diffuse, or high-grade lymphoma, nor was smoking related to the risk of all histological types of NHL combined. These results give limited evidence for a relationship between smoking and the risk of follicular lymphoma.

    View details for Web of Science ID 000072333800005

    View details for PubMedID 9456239

  • Blood pressure and heart rate: No evidence for a positive association with prostate cancer ANNALS OF EPIDEMIOLOGY Friedman, G. D. 1997; 7 (7): 486-489

    Abstract

    This study aimed to determine whether blood pressure and heart rate are correlated with the development of prostate cancer.A total of 58,704 men whose blood pressure, heart rate, and other characteristics were measured at multiphasic checkups were followed for < or = 30 years. The incidence of, and mortality from, prostate cancer were measured. There were 2297 cases and 464 deaths.No evidence of a positive association of blood pressure or heart rate with subsequent prostate cancer was found.Data from this large population lend no support for concerns that higher levels of blood pressure or heart rate are linked to increased risk of prostate cancer.

    View details for Web of Science ID A1997YC85900010

    View details for PubMedID 9349916

  • Long-term postmenopausal estrogen therapy may be associated with increased risk of breast cancer: A cohort study MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Ettinger, B., Quesenberry, C., Schroeder, D. A., Friedman, G. 1997; 4 (3): 125-129
  • Marijuana use and cancer incidence (California, United States) CANCER CAUSES & CONTROL Sidney, S., Quesenberry, C. P., Friedman, G. D., Tekawa, I. S. 1997; 8 (5): 722-728

    Abstract

    The purpose of this retrospective cohort study was to examine the relationship of marijuana use to cancer incidence. The study population consisted of 64,855 examinees in the Kaiser Permanente multiphasic health checkup in San Francisco and Oakland (California, United States), between 1979-85, aged 15 to 49 years, who completed self-administered questionnaires about smoking habits, including marijuana use. Follow-up for cancer incidence was conducted through 1993 (mean length 8.6 years). Compared with nonusers/experimenters (lifetime use of less than seven times), ever- and current use of marijuana were not associated with increased risk of cancer of all sites (relative risk [RR] = 0.9, 95 percent confidence interval [CI] = 0.7-12 for ever-use in men; RR = 1.0, CI = 0.8-1.1 in women) in analyses adjusted for sociodemographic factors, cigarette smoking, and alcohol use. Marijuana use also was not associated with tobacco-related cancers or with cancer of the following sites: colorectal, lung, melanoma, prostate, breast, cervix. Among nonsmokers of tobacco cigarettes, ever having used marijuana was associated with increased risk of prostate cancer (RR = 3.1, CI = 1.0-9.5) and nearly significantly increased risk of cervical cancer (RR = 1.4, CI = 1.0-2.1). We conclude that, in this relatively young study cohort, marijuana use and cancer were not associated in overall analyses, but that associations in nonsmokers of tobacco cigarettes suggested that marijuana use might affect certain site-specific cancer risks.

    View details for Web of Science ID A1997XX82500006

    View details for PubMedID 9328194

  • The value of routine dilated pupil screening examination ARCHIVES OF OPHTHALMOLOGY Batchelder, T. J., Fireman, B., Friedman, G. D., MATAS, B. R., Wong, I. G., Barricks, M. E., Burke, S., Beasley, L. 1997; 115 (9): 1179-1184

    Abstract

    We evaluated the cost-effectiveness of routine dilated fundus examination in improving visual outcomes. The cost of routine dilated fundus examination was related to the number of preventable cases of vision-threatening peripheral retinal disease. Patients with these diseases who had no risk factors were ascertained in a population of 1.75 million adults for a period of 6 months. Those whose last examination had been undilated were identified because only for them could routine dilated examination (RDE) have been substituted for undilated examination. The number of preventable cases was calculated for multiples of a 10% probability of prevention. The cost of RDE was determined from the number of undilated examinations in the same population and period and the cost of a single RDE. The number of patients who underwent undilated examination was estimated by random medical record review. The additional cost of a single RDE was determined from estimated examination times and payroll costs. Among patients without risk factors, 38 were identified for whom undilated examination rather than RDE had been performed. If prevention had been 10% effective, the substitution of 50,000 RDEs for undilated examinations costing the provider $433,000 would have been required per prevented case. These results suggest that most peripheral retinal diseases cannot be prevented by RDE. Routine dilated examination is an expensive test per prevented case. Published clinical guidelines lack evidence to recommend its use.

    View details for Web of Science ID A1997XV75900014

    View details for PubMedID 9298061

  • Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Armstrong, M. A., Friedman, G. D. 1997; 80 (4): 416-420

    Abstract

    International comparison data suggest that wine may be more protective against coronary artery disease than beer or liquor. There are potentially protective antioxidants in wine, especially red wine. However, prospective population studies suggest that each beverage type may reduce coronary risk. The role of alcoholic beverage choice in coronary risk remains unresolved. We performed a prospective study of coronary disease hospitalizations among 128,934 adult members of a Northern California prepaid comprehensive health care program. Alcohol data were supplied at health examinations. Using Cox proportional-hazards models with 9 covariates, analyses were performed of the roles of each major beverage type (wine, beer, and liquor) and of drinking only table wine (red, white, or both). Generally, coronary risk traits were most favorable for wine drinkers and least favorable for liquor drinkers. Among 3,931 persons hospitalized for coronary disease, total alcohol drinking was inversely related to risk in both sexes. Uncontrolled for total alcohol, each beverage type showed evidence for coronary protection, weakest for liquor and strongest for beer in men and wine in women. Controlled for total alcohol, these relations were much reduced, and lost statistical significance except for beer in men and both red and white wine (combined) in all persons. We conclude that (1) drinking ethyl alcohol apparently protects against coronary disease, and (2) there may be minor additional benefits associated with drinking both beer and wine, but not especially red wine.

    View details for Web of Science ID A1997XQ78900004

    View details for PubMedID 9285651

  • Methylergonovine maleate and risk of breast cancer ANNALS OF EPIDEMIOLOGY Herrinton, L. J., Friedman, G. D. 1997; 7 (6): 427-429

    View details for Web of Science ID A1997XR64700008

    View details for PubMedID 9279452

  • Marijuana use and mortality AMERICAN JOURNAL OF PUBLIC HEALTH Sidney, S., Beck, J. E., Tekawa, I. S., Quesenberry, C. P., Friedman, G. D. 1997; 87 (4): 585-590

    Abstract

    The purpose of this study was to examine the relationship of marijuana use to mortality.The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991.Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar.Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women.

    View details for Web of Science ID A1997WY03900013

    View details for PubMedID 9146436

  • Lindane and cancer in humans: A false alarm? PHARMACOEPIDEMIOLOGY AND DRUG SAFETY Friedman, G. D. 1997; 6 (2): 129-134

    Abstract

    In up to 21 years of follow-up in a study to periodically screen pharmaceuticals for possible carcinogenic effects, 1146 persons who received lindane, an established carcinogen in animal experiments, showed for the first time a statistically significant increase in incidence of cancer (43 cases observed, 30.2 expected, standardized morbidity ratio 1.42, 95% confidence interval 1.03-1.92). The computer-stored data on drug dispensing and cancer occurrence also showed some evidence of a dose-response relationship. Review of the complete medical records suggested that at least part of the association was due to confounding by indication. Four of the cancer patients had Kaposi's sarcoma due to AIDS and the acquisition of pediculosis pubis or scabies, commonly treated with lindane, is associated with behaviour that also predisposes to AIDS. Four other patients also had strong risk factors that could readily be blamed for their cancer and one had not used the drug. Also, the location of the skin lesions or infestations treated with lindane seemed to bear no relation to the cancer sites. It is concluded that this study provides no convincing evidence of carcinogenicity of lindane; nor does it rule it out. In pharmacoepidemiology, it is advisable to supplement analyses of routinely collected data on drugs and clinical events with review of medical records when interesting associations are noted.

    View details for Web of Science ID A1997XV16600006

    View details for PubMedID 15073797

  • Risk for gastric cancer in people with CagA positive or CagA negative Helicobacter pylori infection GUT Parsonnet, J., Friedman, G. D., Orentreich, N., VOGELMAN, H. 1997; 40 (3): 297-301

    Abstract

    It is not known why some people with Helicobacter pylori infection develop gastric cancer whereas others do not. Whether the CagA phenotype of H pylori infection affected risk for cancer independently of other posited risk factors was evaluated.242 persons who participated in a previous nested case-control study of gastric cancer. 179 (90 cases and 89 controls) were infected with H pylori as determined by enzyme linked immunosorbent assay (ELISA) in serum and 63 (13 cases and 50 controls) were uninfected.Serum samples from cases and controls, obtained a mean of 14.2 years before diagnosis of cancer in the cases, were tested by ELISA for IgG antibodies against the CagA gene product of H pylori. They had previously been tested for pepsinogen I. Using logistic regression analysis, risk for cancer was compared among infected persons with CagA antibodies, infected persons without CagA antibodies, and uninfected persons.Subjects infected with H pylori who had CagA antibodies were 5.8-fold more likely than uninfected subjects to develop gastric cancer (95% confidence interval (95% CI) = 2.6-13.0). This was true for both intestinal (odds ratio (OR) 5.1, 95% CI = 2.1-12.2) and diffuse type (OR 10.1, 95% CI = 2.2-47.4) cancers. By contrast, H pylori infected subjects without CagA antibodies were only slightly, and not significantly, at increased risk for cancer (OR 2.2, 95% CI = 0.9-5.4) and any possible association was restricted to diffuse type carcinoma (OR 9.0, 95% CI = 1.2-65.8). Pepsinogen 1 < 50 ng/ml significantly increased risk for both cancer types in H pylori infected persons and lessened the magnitude of association between CagA and cancer. Educational attainment, cigarette smoking, and ABO blood group were not associated with malignancy.When compared with uninfected subjects, persons infected with CagA positive H pylori are at considerably increased risk of gastric cancer. CagA negative H pylori are less strongly linked to malignancy and may only be associated with diffuse type disease.

    View details for Web of Science ID A1997WQ75200003

    View details for PubMedID 9135515

  • Physical activity and colon cancer: A public health perspective ANNALS OF EPIDEMIOLOGY Slattery, M. L., Edwards, S. L., Ma, K. N., Friedman, G. D., Potter, J. D. 1997; 7 (2): 137-145

    Abstract

    It has been suggested that performing physical activity for at least 30 min on most days of the week will improve health. The purpose of this study was to assess the association between physical activity and colon cancer as it relates to this public health recommendation.A large population-based case-control study of colon cancer was conducted. Study participants came from three areas of the United States: Northern California, Utah, and the Twin Cities Metropolitan Area in Minnesota.Long-term involvement in high levels of activity, equivalent to > or = 60 min of vigorous activity per session, was associated with decreased risk (odds ration [OR], 0.68; 95% confidence interval [CI] 0.52-0.87). The amount of time involved in the activity appeared to have a greater impact than the number of days per week that activities were performed. Those reporting the highest level of activity, as defined by both duration and vigorous intensity, were at the lowest risk (OR, 0.62; 95% CI, 0.52-0.75) relative to those who were sedentary; associations did not differ by age at diagnosis, site of the tumor within the colon, or sex. The inverse association between colon cancer and long-term vigorous leisure-time activity was slightly stronger among those without a family history of colorectal cancer than among those with a family history of colorectal cancer. From these data we estimate that 13% of colon cancer could be attributed to lack of vigorous leisure-time activity in the population; we estimate that 4.3 cases of colon cancer/100,000 population are prevented each year because people are involved in vigorous leisure-time physical activity.Data from this study suggest that a high level of vigorous leisure-time activity performed over the past 20 years was important in reducing colon cancer risk; the greatest inverse association was observed when activities were performed for longer periods of time per session for the past 20 years. These and other data indicate that it is important to identify ways to facilitate an increase in leisure-time physical activity within the population.

    View details for Web of Science ID A1997WQ52100008

    View details for PubMedID 9099401

  • Tobacco use and colon cancer INTERNATIONAL JOURNAL OF CANCER Slattery, M. L., Potter, J. D., Friedman, G. D., Ma, K. N., Edwards, S. 1997; 70 (3): 259-264

    Abstract

    Smoking cigarettes has been consistently associated with adenomatous polyps. However, only a few studies have reported associations between smoking cigarettes or using other forms of tobacco and colon cancer. A population-based case-control study of colon cancer was conducted in 3 areas in the United States: northern California, Utah and Minnesota. We observed approximately a 50% increase in colon cancer risk from smoking over a pack of cigarettes per day among both men and women. Those who stopped smoking remained at increased risk, even if they stopped over 10 years ago. Our data suggest that the amount smoked may be a more important factor than the total number of years smoked. Smoking neither cigars nor pipes was associated with an increased risk of colon cancer. Among female participants only, those who smoked over 20 cigarettes per day and had a large body mass index were at greater risk of colon cancer than participants who smoked the same amount but were smaller (p for interaction among women = 0.04).

    View details for Web of Science ID A1997WF98900002

    View details for PubMedID 9033624

  • 5 alpha-reductase activity and prostate cancer: A case-control study using stored sera CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Guess, H. A., Friedman, G. D., Sadler, M. C., Stanczyk, F. Z., Vogelman, J. H., IMPERATOMCGINLEY, J., Lobo, R. A., Orentreich, N. 1997; 6 (1): 21-24

    Abstract

    We report a nested case-control study of serum biomarkers of 5 alpha-reductase activity and the incidence of prostate cancer. From a cohort of more than 125,000 members of the Kaiser Permanente Medical Care Program who underwent multiphasic health examinations during 1964-1971, we selected 106 incident prostate cancer cases. A control was pair matched to each case on age, date of serum sampling, and clinic location. Serum levels of total testosterone, free testosterone, androsterone glucuronide, and 5 alpha-androstane-3 alpha,17 beta androstanediol glucuronide (3 alpha-diol G) were measured on the stored samples and scored as quartiles. Potential confounders included alcohol, smoking, and body mass index. The adjusted odds ratios and 95% confidence intervals for a one quartile score increase were 1.00 (0.75-1.34) for total testosterone, 1.14 (0.86-1.50) for free testosterone, 1.13 (0.84-1.53) for androsterone glucuronide, and 1.16 (0.86-1.56) for 3 alpha-diol G. A limitation of this study is that there are two different 5 alpha-reductase isoenzymes, only one of which is expressed in high levels within the prostate, yet both of which may affect serum biomarkers. Since the two isoenzymes are encoded on different chromosomes, variation in one would act as an independent source of measurement error in any analysis of serum biomarker effects of the other. Consequently, the odds ratios may be underestimated and the study, although negative, cannot exclude the previously hypothesized possibility that a positive relationship between intraprostatic 5 alpha-reductase activity and prostate cancer may exist. A clinical trial to test this hypothesis is under way.

    View details for Web of Science ID A1997WB77200005

    View details for PubMedID 8993793

  • Depression, smoking, and lung cancer. American journal of epidemiology Friedman, G. D. 1996; 144 (12): 1104-1106

    View details for PubMedID 8956622

  • Can hematuria pea predictor as well as a symptom or sign of bladder cancer? CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Friedman, G. D., Carroll, P. R., Cattolica, E. V., Hiatt, R. A. 1996; 5 (12): 993-996

    Abstract

    In a case-control study of urinalysis screening in the prevention of death from bladder cancer, hematuria was present in a higher proportion of cases than controls as long as five or six years before the diagnostic evaluation that led to the diagnosis of bladder cancer. In a separate cohort study data base that permitted the follow-up of 1046 persons with a physician's diagnosis of hematuria, 11 cases of bladder cancer were diagnosed more than two (mean 7.4) years after the hematuria diagnosis (4.3 cases expected; age-sex standardized morbidity ratio, 2.5; 95% confidence interval, 1.3-4.5). Bladder cancer was ruled out initially by cystoscopy in 8 of the 11 cases. Although we cannot be certain that preexisting bladder cancer or bladder cancer risk factors did not cause the bleeding, we hypothesize that hematuria can be a predictor as well as a manifestation of bladder cancer, based on a tendency for bladder mucosa with premalignant changes to bleed. The implications for screening and clinical practice remain to be determined.

    View details for Web of Science ID A1996VX38400008

    View details for PubMedID 8959322

  • A description of age, sex, and site distributions of colon carcinoma in three geographic areas CANCER Slattery, M. L., Friedman, G. D., Potter, J. D., Edwards, S., Caan, B. J., Samowitz, W. 1996; 78 (8): 1666-1670

    Abstract

    Site of the carcinoma within the colon in relation to age and sex may provide clues into the etiology of the disease. Incidence of colon carcinoma by age, sex, and tumor site at a population-based level are reported infrequently. The goal of this study was to describe the distribution of colon carcinoma (excluding cancers of the rectosigmoid junction and rectum) by age at diagnosis, sex, and site of the tumor within the colon. These factors were also evaluated in conjunction with disease stage at the time of diagnosis.Data from three geographically distinct populations were used to describe rates of colon carcinoma and the distribution of tumors by age, tumor site, and stage at diagnosis. All colon carcinoma cases diagnosed within a 3-year period within the areas are included.Approximately 50% of all cancers in men and greater than 50% of cancers in women were in the proximal segment of the colon. Men who were diagnosed prior to age 50 and both men and women diagnosed at age 70 or older had predominantly proximal cancers. People with proximal cancers and people diagnosed prior to age 50 were more likely to have more advanced disease.Both men and women have more proximal cancers with advancing age, which are associated with more advanced disease. Observed trends in cancer site distributions could reflect screening practices, environmental and genetic factors, or a combination of these variables.

    View details for Web of Science ID A1996VL24400005

    View details for PubMedID 8859178

  • Risks of non Hodgkin's lymphoma, multiple myeloma, and leukemia associated with common medications EPIDEMIOLOGY Doody, M. M., Linet, M. S., Glass, A. G., Rochelle, R. E., POTTERN, L. M., Rush, B. B., Boice, J. D., Fraumeni, J. F., Friedman, G. D. 1996; 7 (2): 131-139

    Abstract

    We utilized data from two Kaiser Permanente medical care programs to evaluate risks of hematopoietic and lymphoproliferative (HLP) malignancies after use of 14 common medications. The subjects were adult cases of non-Hodgkin's lymphoma (NHL) (N = 94), multiple myeloma (N = 159), and leukemia (N = 257) and individually matched controls (N = 695). Abstractors reviewed medical records and recorded medication notations. Using a minimum 5-year exposure lag between first notation and malignancy diagnosis, the risk of NHL was greater among plan members who were prescribed amphetamines [odds ratio (OR) = 2.2; 95% confidence interval (CI) = 1.1-4.8], lidocaine (OR = 2.6; 95% CI = 1.2-5.5), and meprobamate (OR = 2.1; 95% CI = 1.03-4.3). The risk of NHL rose with increasing number of medical record notations for amphetamines; however, there was no association with number of notations for lidocaine or meprobamate. The odds ratio for total leukemia was decreased among patients who took chloramphenicol (OR = 0.4; 95% CI = 0.2-0.97).

    View details for Web of Science ID A1996TW36200005

    View details for PubMedID 8834551

  • Case-control evaluation of screening JOURNAL OF CLINICAL EPIDEMIOLOGY Selby, J. V., Friedman, G. D., Quesenberry, C. P., Weiss, N. S. 1996; 49 (3): 390-391

    View details for Web of Science ID A1996UF86900020

    View details for PubMedID 8676191

  • Reduced mortality associated with long-term postmenopausal estrogen therapy OBSTETRICS AND GYNECOLOGY Ettinger, B., Friedman, G. D., Bush, T., Quesenberry, C. P. 1996; 87 (1): 6-12

    Abstract

    To compare all-cause and specific-cause mortality rates in women who had or had not used long-term postmenopausal estrogen replacement therapy (ERT).We identified women who used long-term postmenopausal ERT and compared them with a sample of age-matched postmenopausal nonusers. Through linking of these subjects' medical record numbers to various data bases, we examined survivorship and cause of death among estrogen users and nonusers. The risk of death in 232 postmenopausal women who began ERT within 3 years of menopause and used it for at least 5 years was compared with that of 222 age-matched postmenopausal nonusers. In the users, the mean length of estrogen use was 17.1 years.Statistically significant reductions in all-cause mortality were found in users compared with nonusers. For death from any cause, the age-adjusted relative risk (RR) and associated 95% confidence interval (CI) in estrogen users was 0.54 (0.38-0.76). The reduction in all-cause mortality was largely due to reductions in coronary heart disease (RR 0.40, CI 0.16-1.02) and other cardiovascular disease (RR 0.27, CI 0.10-0.71). Overall cancer mortality was similar in the two groups (RR 0.85, CI 0.46-1.58), although estrogen users had a higher risk of death from breast cancer (RR 1.89, CI 0.43-8.36) and lower risk of death from lung cancer (RR 0.22, CI 0.04-1.15).Long-term ERT use is associated with lower all-cause mortality and confers this apparent protection primarily through reduction in cardiovascular disease.

    View details for Web of Science ID A1996TM64500002

    View details for PubMedID 8532268

  • CASE-CONTROL STUDY OF DIGITAL-RECTAL SCREENING IN RELATION TO MORTALITY FROM CANCER OF THE DISTAL RECTUM AMERICAN JOURNAL OF EPIDEMIOLOGY Herrinton, L. J., Selby, J. V., Friedman, G. D., Quesenberry, C. P., Weiss, N. S. 1995; 142 (9): 961-964

    Abstract

    The authors conducted a case-control study to examine the benefit of digital-rectal examination in reducing mortality from distal rectal cancer. The Kaiser Permanente Medical Care Program provides prepaid medical services to approximately 30 percent of the residents in its northern California service area. Members of the program aged 45 years and over who were diagnosed with fatal cancer of the distal rectum during the period 1971-1986 and who died before 1988 as a result of their cancer (n = 172) and matched controls were selected for the study. Information on digital-rectal examinations received in the absence of recorded symptoms during the 10 years prior to the diagnosis date of the case was obtained from medical charts. Similar proportions of cases (20.9%) and controls (23.3%) had been screened during the year before the diagnosis of the case (adjusted odds ratio = 0.96, 95% confidence interval 0.56-1.7) and during longer intervals throughout the 10 years before the diagnosis date of the case. These results suggest no efficacy of digital-rectal examination for preventing mortality from rectal cancer, although a modest effect cannot be ruled out.

    View details for Web of Science ID A1995TC54500010

    View details for PubMedID 7572977

  • TRANSFERRIN SATURATION AND RISK OF CANCER AMERICAN JOURNAL OF EPIDEMIOLOGY Herrinton, L. J., Friedman, G. D., Baer, D., Selby, J. V. 1995; 142 (7): 692-698

    Abstract

    The authors examined the hypothesis that relatively high levels of transferrin saturation increase the risk of cancer. They studied a cohort of prepaid health plan members whose transferrin saturation levels were measured during the period 1969-1971 and who were followed for cancer through 1990. After the exclusion of 10 percent of the subjects who received treatment for one or more of six chronic conditions or who were pregnant when the measurement was made and persons who contributed less than 5 years of follow-up, the authors were left with 38,538 persons who were followed for an average period of 17.7 years. In women, a positive association was observed between transferrin saturation and risk of stomach carcinoma (> or = 34.5% compared with < or = 20.3%: relative risk (RR) = 3.5, 95% confidence interval (CI) 0.98-12). In men, transferrin saturation was inversely associated with risk of colon and rectal carcinoma (> or = 40.7% compared with < or = 26.0%: colon, RR = 0.62, 95% CI 0.35-1.1; rectum, RR = 0.30, 95% CI 0.08-1.1) and with non-Hodgkin's lymphoma (32.1-40.6% compared with < or = 26.0%: RR = 0.31, 95% CI 0.11-0.88; no cases observed with transferrin saturation > or = 40.7%). The authors did not find evidence that the risk of epithelial cancer (all sites combined) was related to transferrin saturation level or to iron deficiency (< or = 15%) or overload (> or = 60%).

    View details for Web of Science ID A1995RW93200003

    View details for PubMedID 7572938

  • SEASONAL-VARIATION IN VITAMIN-D, VITAMIN-D-BINDING PROTEIN, AND DEHYDROEPIANDROSTERONE - RISK OF PROSTATE-CANCER IN BLACK-AND-WHITE MEN CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Corder, E. H., Friedman, G. D., Vogelman, J. H., Orentreich, N. 1995; 4 (6): 655-659

    Abstract

    Our previous study provided evidence that higher serum levels of the active form of vitamin D, 1,25-dihydroxyvitamin D (1, 25-D), might possibly slow the progression of subclinical to clinically significant prostate cancer in both black and white men, especially after age 57. This paper extends the prior study by contrasting seasonal variation in 1,25-D and its precursor, 25-hydroxyvitamin D (25-D), in case and control subjects. In addition, the risk of prostate cancer is related to serum levels of vitamin D-binding protein (VDBP) and total dehydroepiandrosterone and to polymorphic variation in VDBP. The expected elevated summer levels of 25-D were seen in case and control subjects and, as expected, 1,25-D did not vary throughout the year in the control subjects. Unexpectedly, lower case levels of 1,25-D were limited largely to the summer months (P = 0.01) in both black and white cases and to cases greater than or equal to the median age of 57 years. Levels of VDBP and dehydroepiandrosterone and the frequencies of VDBP polymorphisms were similar in case and control subjects, although striking differences were seen in allelic frequencies in black and white men. These observations provide additional evidence that vitamin D metabolism may impact the risk of prostate cancer.

    View details for Web of Science ID A1995RU35000013

    View details for PubMedID 8547833

  • CHOLECYSTECTOMY NOT CONFIRMED AS A RISK FACTOR FOR PANCREATIC-CANCER INTERNATIONAL JOURNAL OF CANCER Friedman, G. D. 1995; 61 (5): 745-746

    View details for Web of Science ID A1995RB28300025

    View details for PubMedID 7768651

  • MENTHOLATED CIGARETTE USE AND LUNG-CANCER ARCHIVES OF INTERNAL MEDICINE Sidney, S., Tekawa, I. S., Friedman, G. D., Sadler, M. C., Tashkin, D. P. 1995; 155 (7): 727-732

    Abstract

    Menthol combustion produces carcinogenic compounds such as benzo[a]pyrenes. Mentholated cigarettes are much more commonly smoked by black individuals than by white individuals. The incidence of lung cancer is much higher (60%) in black men than in white men, but it differs little by race in women. We examined the association of mentholated cigarette use with lung cancer in men and women because mentholated cigarette use could help to explain the higher incidence rate of lung cancer in black men than in white men.The study population consisted of 11,761 members of the Northern California Kaiser Permanente Medical Care Program, Oakland (5771 men and 3990 women), aged 30 to 89 years, who underwent a multiphasic health checkup in 1979 through 1985 and reported that they were current cigarette smokers who had smoked for at least 20 years. Data were collected about current cigarette brand, duration of mentholated cigarette use, and other smoking characteristics. Follow-up for incident lung cancer cases (n = 318) was carried out through 1991.The relative risk of lung cancer associated with mentholation compared with nonmentholated cigarettes was 1.45 in men (95% confidence interval, 1.03 to 2.02) and it was 0.75 in women (95% confidence interval, 0.51 to 1.11), adjusted for age, race, education, number of cigarettes smoked per day, and duration of smoking. Further adjustment for tar content and self-reported smoking intensity characteristics did not substantially alter the estimate of relative risk. A graded increase in risk of lung cancer with increasing duration of mentholated cigarette use was present in men.This study suggests that there is an increased risk of lung cancer associated with mentholated cigarette use in male smokers but not in female smokers.

    View details for Web of Science ID A1995QQ38000010

    View details for PubMedID 7695461

  • PROSTATE-SPECIFIC ANTIGEN AS PREDICTOR OF PROSTATE-CANCER IN BLACK-MEN AND WHITE MEN JOURNAL OF THE NATIONAL CANCER INSTITUTE Whittemore, A. S., Lele, C., Friedman, G. D., Stamey, T., Vogelman, J. H., Orentreich, N. 1995; 87 (5): 354-360

    Abstract

    The increasing incidence of prostate cancer creates complex issues in health care management and cost containment. There is a need to evaluate serial measurements of prostate-specific antigen (PSA) as a marker for long-term risk of clinically important prostate cancer (stages B through D).We used a nested case-control design within a retrospective cohort study to evaluate serial PSA concentrations in relation to subsequent prostate cancer diagnoses.Participants included 40 black and 96 white men with subsequent diagnoses of prostate cancer and 84 black and 100 white men without such diagnoses (control subjects) in a multiphasic health screening program conducted by the Kaiser Permanente Medical Care Program of Northern California. Serial serum samples were collected 1.5-23 years before prostate cancer diagnosis.Median serum PSA concentrations, specific for age and subsequent cancer status, were similar in blacks and whites. Concentrations in control subjects increased exponentially with age, with a doubling time of 24.9 years. Concentrations in men with stage A cancer were similar to those in control subjects. Until about 13 years before diagnosis, PSA in men with subsequent cancer stages B through D increased exponentially with age, with a doubling time similar to that of control subjects. Thereafter, the PSA concentrations increased exponentially, with a doubling time of 4.3 years. Rapid increase in PSA concentration started about 1.5 years earlier for men with stage D cancer than for men with stage B or C cancer. The single PSA measurement drawn closest to diagnosis was a more sensitive marker of stages B through D cancer within the next 7 years than was any index of change that also took account of earlier PSA readings.These data suggest that 1) age-specific PSA concentrations are similar in black men and white men and 2) current PSA concentration, specific for age, outperforms changes in past concentrations in identifying the man who will develop stage B, C, or D cancer within 7 years, albeit at the cost of a slightly higher rate of false-positive results. This interpretation needs confirmation in other data containing many serial PSA measurements within a few years of diagnosis.

    View details for Web of Science ID A1995QH57000008

    View details for PubMedID 7531773

  • SERUM-CHOLESTEROL CONCENTRATION AND RISK OF BRAIN CANCER BRITISH MEDICAL JOURNAL Herrinton, L. J., Friedman, G. D. 1995; 310 (6976): 367-368

    View details for Web of Science ID A1995QG72100019

    View details for PubMedID 7866214

  • ALCOHOL AND LONGEVITY AMERICAN JOURNAL OF PUBLIC HEALTH Klatsky, A. L., Friedman, G. D. 1995; 85 (1): 16-18

    View details for Web of Science ID A1995QD55900004

    View details for PubMedID 7832254

  • Problems in assessing screening experience in observational studies of screening efficacy: example of urinalysis screening for bladder cancer. Journal of medical screening Friedman, G. D., Hiatt, R. A., Quesenberry, C. P., Selby, J. V., Weiss, N. S. 1995; 2 (4): 219-223

    Abstract

    To evaluate screening urinalysis for its efficacy in preventing fatal bladder cancer.A case-control study of 290 case subjects with fatal bladder cancer upsilon 290 age and sex matched control subjects, with ascertainment of urinalyses by medical record review.In the five years before the symptoms that led to the detection of bladder cancer, case subjects had significantly fewer routine (screening) urinalyses than controls (matched odds ratio for one or more urinalyses upsilon none = 0.60 [95% confidence interval (CI) 0.41 to 0.87], adjusted for cigarette smoking and occupational bladder cancer risk). However urinalyses for urinary symptoms and problems before those that led to bladder cancer diagnosis were more frequent in the cases; hence there was only a small statistically non-significant deficit in cases of urinalyses for all reasons combined (corresponding adjusted odds ratio 0.94, 95% CI 0.61 to 1.46). Since urinalyses for symptoms and problems could have led to the detection of bladder cancer, the latter finding appears more applicable. Methodological problems included: difficulty in assigning the reason for urinalysis; the possibility that clinically indicated urinalyses led to a reduction in screening urinalyses; and difficulty in identifying the detectable and curable preclinical phase for targeting ascertainment of urinalyses. Reducing potential efficacy, haematuria on urinalysis, particularly transient or mild asymptomatic microhaematuria, was often not followed up by cystoscopy.This study did not show that ordinary urinalysis was effective in preventing fatal bladder cancer but because of methodological problems a clear answer may require a randomised controlled trial.

    View details for PubMedID 8719152

  • Prescription drug screening for subsequent carcinogenicity Pharmacoepidemiol Drug Saf Van Den Eeden SK, Friedman GD 1995; 4: 275-87
  • OBESITY AND MULTIPLE-MYELOMA CANCER CAUSES & CONTROL Friedman, G. D., Herrinton, L. J. 1994; 5 (5): 479-483

    Abstract

    An exploratory study was conducted of common clinical conditions as predictors of subsequent cancer in 143,574 outpatients of a health maintenance organization (in California, USA). An association was noted between obesity, diagnosed in 14,388 patients, and the subsequent development of multiple myeloma (MM) in up to 21 years (33 cases observed, 21.3 expected based on the experience of the entire cohort; standardized morbidity ratio = 1.55, 95 percent confidence interval [CI] = 1.06-2.17). This association was evaluated further in a second cohort of 163,561 multiphasic-checkup examinees followed up for as many as 24 years. Body mass index (BMI) at entry examination was associated positively with the incidence of MM in White men (e.g., relative risk [RR] = 1.07, CI = 1.01-1.15 per unit increase in BMI; and RR = 1.68, CI = 0.75-3.78, comparing the highest with lowest quartile). This association was absent in White women, partially confirmed in Black men and women (BMI quartiles two, three, and four showed higher risk than quartile one), and not explained by the presence of diabetes mellitus. The association was reduced or absent with BMI based on reported greatest adult-weight, and in White women was inverse with BMI based on reported lowest adult-weight. Among subjects with more than one checkup, increased risk was associated directly with weight loss among White men and associated inversely with weight gain among Black women. These findings suggest that body build or nutritional status may be involved in the development of MM by mechanisms that are presently unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1994PM16600011

    View details for PubMedID 7999970

  • Opportunities for research in dermatologic epidemiology. journal of investigative dermatology Friedman, G. D. 1994; 102 (6): 57S-58S

    Abstract

    This report is based on a number of papers presented at the March 1993 Scientific Workshop on the Epidemiology of Skin Diseases, sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. It focuses on opportunities in dermatologic epidemiology identified at the workshop and discusses these opportunities in the context of health maintenance organizations as sites for data collection, problems to be expected, and the potential contribution of dermatologic epidemiology.

    View details for PubMedID 8006440

  • HELICOBACTER-PYLORI INFECTION AND GASTRIC LYMPHOMA NEW ENGLAND JOURNAL OF MEDICINE Parsonnet, J., Hansen, S., Rodriguez, L., Gelb, A. B., Warnke, R. A., Jellum, E., Orentreich, N., Vogelman, J. H., Friedman, G. D. 1994; 330 (18): 1267-1271

    Abstract

    Helicobacter pylori infection is a risk factor for gastric adenocarcinoma. We examined whether this infection is also a risk factor for primary gastric non-Hodgkin's lymphoma.This nested case-control study involved two large cohorts (230,593 participants). Serum had been collected from cohort members and stored, and all subjects were followed for cancer. Thirty-three patients with gastric non-Hodgkin's lymphoma were identified, and each was matched to four controls according to cohort, age, sex, and date of serum collection. For comparison, 31 patients with nongastric non-Hodgkin's lymphoma from one of the cohorts were evaluated, each of whom had been previously matched to 2 controls. Pathological reports and specimens were reviewed to confirm the histologic type of the tumor. Serum samples from all subjects were tested for H. pylori IgG by an enzyme-linked immunosorbent assay.Thirty-three cases of gastric non-Hodgkin's lymphoma occurred a median of 14 years after serum collection. Patients with gastric lymphoma were significantly more likely than matched controls to have evidence of previous H. pylori infection (matched odds ratio, 6.3; 95 percent confidence interval, 2.0 to 19.9). The results were similar in both cohorts. Among the 31 patients with nongastric lymphoma, a median of six years had elapsed between serum collection and the development of disease. No association was found between nongastric non-Hodgkin's lymphoma and previous H. pylori infection (matched odds ratio, 1.2; 95 percent confidence interval, 0.5 to 3.0).Non-Hodgkin's lymphoma affecting the stomach, but not other sites, is associated with previous H. pylori infection. A causative role for the organism is plausible, but remains unproved.

    View details for Web of Science ID A1994NJ51200003

    View details for PubMedID 8145781

  • PSYCHIATRICALLY-DIAGNOSED DEPRESSION AND SUBSEQUENT CANCER CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Friedman, G. D. 1994; 3 (1): 11-13

    Abstract

    In a follow-up of up to 19 years, 923 patients with some form of depression diagnosed in a psychiatry clinic showed a slightly elevated risk of developing cancer in comparison with the other members of a cohort of 143,574 persons who received prescriptions from a pharmacy (Standardized morbidity ratio, 1.21; 95% confidence interval 0.95-1.53). When cancers diagnosed in the first 2 years after the diagnosis of depression were ignored, the risk increased somewhat (Standard morbidity ratio, 1.38; 95% confidence interval, 1.06-1.76). A subgroup of these depressed patients who had multiphasic health checkups were more apt to be of white race, unmarried, and users of postmenopausal estrogens if females than a matched comparison group of multiphasic examinees. These differences probably explain much of the group's excess cancers, most of which were located in the breast, endometrium, and skin (both melanoma and nonmelanoma). This study lends little if any support to the hypothesis that depression predisposes to cancer occurrence.

    View details for Web of Science ID A1994MR39100003

    View details for PubMedID 8118378

  • IS ALCOHOL GOOD FOR YOUR HEALTH NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D., Klatsky, A. L. 1993; 329 (25): 1882-1883

    View details for Web of Science ID A1993ML58800010

    View details for PubMedID 8247041

  • ALCOHOL-CONSUMPTION AND INSULIN CONCENTRATIONS - ROLE OF INSULIN IN ASSOCIATIONS OF ALCOHOL INTAKE WITH HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL AND TRIGLYCERIDES CIRCULATION Mayer, E. J., Newman, B., Quesenberry, C. P., Friedman, G. D., Selby, J. V. 1993; 88 (5): 2190-2197

    Abstract

    The relation between alcohol intake and insulin levels may explain, in part, the reported associations of alcohol with cardiovascular disease risk factors, including high-density lipoprotein (HDL) cholesterol, triglycerides, blood pressure, and glucose levels, each of which has been recognized as a component of the insulin resistance syndrome.Subjects included nondiabetic participants of the Kaiser Permanente Women Twins Study (1989 through 1990). Usual alcohol intake was assessed as part of a food frequency questionnaire. For women from twin pairs in which both twins drank (n = 338), an increment of 12 g of alcohol per day (about one drink) was associated with an 8% lower 2-hour post-glucose-load insulin (P < .01) in a multiple regression analysis for twin data, adjusted for age, body mass index, waist-to-hip ratio, total caloric intake, and family history of diabetes. With genetic influences removed by matched analysis of the subset of 98 monozygotic twin pairs, an intrapair difference of 12 g of alcohol per day was associated with a 12.4% intrapair decrement in postload insulin (P < .01). Inverse associations were also seen for fasting insulin. Alcohol consumption was inversely associated with postload glucose but not with fasting glucose in unmatched (P = .05) and matched (P = .005) analyses. A significant positive association of alcohol intake with high-density lipoprotein cholesterol and an inverse relation of alcohol intake with triglycerides were each independent of insulin levels (P < or = .02 in the matched models). Neither systolic nor diastolic blood pressures were related to alcohol consumption in this sample, perhaps because of the rather low level of alcohol intake in the study population (median, 4 g/d).Within the range of light to moderate drinking habits, alcohol consumption was inversely related to fasting and postload insulin levels. This relation did not explain associations of alcohol intake with lipid levels and may instead reflect an additional mechanism by which moderate alcohol consumption impacts cardiovascular disease risk.

    View details for Web of Science ID A1993ME83300025

    View details for PubMedID 8222114

  • LONG-TERM RISK OF HYSTERECTOMY AMONG 80,007 STERILIZED AND COMPARISON WOMEN AT KAISER PERMANENTE, 1971-1987 AMERICAN JOURNAL OF EPIDEMIOLOGY Goldhaber, M. K., Armstrong, M. A., Golditch, I. M., Sheehe, P. R., Petitti, D. B., Friedman, G. D. 1993; 138 (7): 508-521

    Abstract

    To study the long-term risk of hysterectomy after tubal sterilization, the authors analyzed historical hospital discharge data on 39,502 parous women sterilized during 1971-1984 and 40,505 comparison women matched on age, race, parity, and interval since last birth. Sterilized women were significantly more likely than were comparison women to undergo hysterectomy (relative risk (RR) = 1.35, 95% confidence interval (CI) 1.26-1.44), especially for diagnoses of menstrual dysfunction and pelvic pain (RR = 1.88, 95% CI 1.65-2.13). Higher relative risks were not associated with greater tissue-destructive methods of tubal occlusion. Relative risks were highest for women who were young on the reference date (RR = 2.45, 95% CI 1.79-3.36 for women aged 20-24 years), but declined steadily as age increased (RR = 0.96, 95% CI 0.72-1.28 for women aged 40-49 years). In all age groups, relative risks were significantly above 1.00 after 7 years of follow-up. Reasons for elevated risks may be related to a greater willingness of sterilized women to forgo their uteruses. The emergence of greater risk in all age groups, however, prevents the authors from ruling out a possible latent biologic effect of tubal sterilization.

    View details for Web of Science ID A1993MC31100005

    View details for PubMedID 8213755

  • INCONSISTENT ASSOCIATIONS OF CAFFEINE-CONTAINING BEVERAGES WITH BLOOD-PRESSURE AND WITH LIPOPROTEINS - THE CARDIA STUDY AMERICAN JOURNAL OF EPIDEMIOLOGY Lewis, C. E., Caan, B., Funkhouser, E., Hilner, J. E., Bragg, C., Dyer, A., Raczynski, J. M., Savage, P. J., Armstrong, M. A., Friedman, G. D. 1993; 138 (7): 502-507

    Abstract

    The authors examined associations of caffeine and caffeinated beverage intakes with blood pressure and with lipoproteins in 5,115 black and white men and women aged 18-30 years during 1985-1986. Caffeine and beverage intakes were not consistently associated with blood pressure in analyses controlling for race, sex, Keys score, sucrose intake, physical activity, oral contraceptive use, body mass index, alcohol use, age, and smoking. Associations of caffeine and beverage intakes with cholesterol, triglycerides, high-density lipoprotein cholesterol, and high-density lipoprotein2 cholesterol were also inconsistent. There is little or no association of caffeine with lipoproteins or with blood pressure in this cohort of healthy young adults.

    View details for Web of Science ID A1993MC31100004

    View details for PubMedID 8213754

  • HELICOBACTER-PYLORI, PEPSINOGEN, AND RISK FOR GASTRIC ADENOCARCINOMA CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Parsonnet, J., Samloff, I. M., Nelson, L. M., Orentreich, N., Vogelman, J. H., Friedman, G. D. 1993; 2 (5): 461-466

    Abstract

    The objective of this project was to determine the association of Helicobacter pylori infection and serum pepsinogen levels on subsequent risk for gastric adenocarcinoma. This nested case-control study was set in a large health maintenance organization. One hundred thirty-six cases of gastric adenocarcinoma and 136 matched controls without adenocarcinoma from a large cohort that had contributed serum in the 1960's were studied. The presence of IgG against H. pylori had previously been determined by enzyme-linked immunosorbent assay. Serum levels of pepsinogens I and II were ascertained by radioimmunoassay. In a sample of subjects, the presence of antiparietal cell antibodies was determined by immunofluorescent antibody assay (Nichols Laboratory). There were 98 cases of adenocarcinoma of the antrum, body, or fundus (distal cancers) and 30 of the cardia or gastroesophageal junction (proximal cancers). By univariate analysis, H. pylori infection [odds ratio (OR), 3.6; P < 0.001] and serum pepsinogen I < 50 ng/ml (OR = 2.9; P = 0.003) were both associated with development of distal cancer. In multivariate analysis, there was interaction between the two variables; H. pylori in the absence of low pepsinogen I was independently associated with cancer (OR, 2.4; P = 0.04) but low pepsinogen I in the absence of H. pylori infection was not associated with cancer (OR, 0.8; P > 0.5). In combination, however, H. pylori infection and a low pepsinogen I were associated with a marked increase in the risk of developing distal malignancy (OR, 10.0; P = 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1993LX26100010

    View details for PubMedID 8220091

  • VITAMIN-D AND PROSTATE-CANCER - A PREDIAGNOSTIC STUDY WITH STORED SERA CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Corder, E. H., Guess, H. A., Hulka, B. S., Friedman, G. D., Sadler, M., Vollmer, R. T., Lobaugh, B., Drezner, M. K., Vogelman, J. H., Orentreich, N. 1993; 2 (5): 467-472

    Abstract

    This study evaluates the risk of prostate cancer in relation to serum levels of the major vitamin D metabolites, 25-hydroxyvitamin D (25-D3) and 1,25-dihydroxyvitamin D (1,25-D). Between 1964 and 1971, more than 250,000 serum samples were collected from members of the Kaiser Permanente Medical Care Plan in Oakland and San Francisco and stored for future use. Levels of 25-D and 1,25-D were measured in samples from 90 black and 91 white men diagnosed with prostate cancer before December 31, 1987 and controls individually matched on age, race, and day of serum storage. Mean serum 1,25-D was 1.81 pg/ml lower in cases than in matched controls (P = 0.002). Risk of prostate cancer decreased with higher levels of 1,25-D especially in men with low levels of 25-D. However, mean 25-D was not significantly different in cases and controls. The association of lower 1,25-D with prostate cancer was found in men above the median age of 57 years at serum storage but not younger men and was similar in black and white men. In men > or = 57 years of age, 1,25-D was an important predictor of risk for palpable and anaplastic tumors but not for tumors incidentally discovered during surgery to treat the symptoms of benign prostatic hyperplasia or well differentiated tumors.

    View details for Web of Science ID A1993LX26100011

    View details for PubMedID 8220092

  • Coffee, tea, and mortality. Annals of epidemiology Klatsky, A. L., Armstrong, M. A., Friedman, G. D. 1993; 3 (4): 375-381

    Abstract

    Except for conflicting evidence about coffee and risk of coronary disease, coffee and tea are not linked to major causes of death. Because of widespread use of both beverages and limitations of prior studies, concern persists. Using Cox models (ten covariates) we studied relations in 128,934 persons to 4501 subsequent deaths. Except for slightly increased risk from acute myocardial infarction among heavier (> or = 4 cups/d) coffee users (relative risk versus nondrinkers = 1.4, 95% confidence interval = 1.0 to 1.9, P = 0.07), there was no increased risk of mortality for all deaths (relative risk per cup of coffee per day = 0.99, 95% confidence interval = 0.97 to 1.01; relative risk per cup of tea per day = 0.98, 95% confidence interval = 0.96 to 1.00) or major causes in adjusted analyses. Coffee was related to lower risk of liver cirrhosis death (relative risk per cup of coffee per day = 0.77, 95% confidence interval = 0.67 to 0.89). Use of both beverages was related to a lower risk of suicide, progressively lower at higher coffee intake (relative risk per cup of coffee per day = 0.87, 95% confidence interval = 0.77 to 0.98). We conclude that coffee and tea have no overall relation to mortality risk. If coffee increases coronary risk, this is balanced by an unexplained lower risk of other conditions, notably cirrhosis and suicide.

    View details for PubMedID 8275213

  • Cigarette smoking, leukemia, and multiple myeloma. Annals of epidemiology Friedman, G. D. 1993; 3 (4): 425-428

    Abstract

    To evaluate previously reported associations with cigarette smoking, the incidence of leukemia and multiple myeloma was determined with follow-up of up to 24 years of 57,224 never-smokers, 20,928 former smokers, and 64,839 current cigarette smokers who received multiphasic health checkups. Cigarette smoking was associated with the development of acute nonlymphocytic leukemia in men only (relative risk, 2.8; 95% confidence interval, 1.2 to 6.4). Chronic myeloid leukemia showed an association with smoking of borderline significance in men only. Chronic lymphocytic leukemia and multiple myeloma were not related to cigarette smoking. In the men with acute nonlymphocytic leukemia there was a suggestion of a dose-response relation but it was not statistically significant. The association of cigarette smoking with acute nonlymphocytic leukemia was not explained by alcohol or coffee consumption or exposure to occupational hazards. This study adds to the growing body of evidence that cigarette smoking predisposes to acute nonlymphocytic leukemia in men.

    View details for PubMedID 8275220

  • HEALTH-CARE USE BY FREQUENT MARIJUANA SMOKERS WHO DO NOT SMOKE TOBACCO WESTERN JOURNAL OF MEDICINE Polen, M. R., Sidney, S., Tekawa, I. S., Sadler, M., Friedman, G. D. 1993; 158 (6): 596-601

    Abstract

    Even though marijuana smoke contains carcinogens and more tar than tobacco smoke and marijuana intoxication has been implicated as a risk factor for injuries, relatively little epidemiologic evidence has identified marijuana use as a risk factor for ill health. This study is the first to examine the health effects of smoking marijuana by comparing the medical experience of "daily" marijuana smokers who never smoked tobacco (n = 452) with a demographically similar group of nonsmokers of either substance (n = 450). Marijuana smoking status was determined during multiphasic health checkups at Kaiser Permanente medical centers between July 1979 and December 1985. Medical records were reviewed for as long as 2 years after the checkups. Frequent marijuana smokers had small increased risks of outpatient visits for respiratory illnesses (relative risk [RR] = 1.19; 95% confidence interval [CI] = 1.01, 1.41), injuries (RR = 1.32; CI = 1.10, 1.57), and other types of illnesses (RR = 1.09; CI = 1.02, 1.16) compared with nonsmokers; their risk of being admitted to a hospital was elevated but not statistically significant (RR = 1.51; CI = 0.93, 2.46). Analyses were adjusted for sex, age, race, education, marital status, and alcohol consumption. Daily marijuana smoking, even in the absence of tobacco, appeared to be associated with an elevated risk of health care use for various health problems.

    View details for Web of Science ID A1993LG38600003

    View details for PubMedID 8337854

  • COFFEE AND CORONARY HEART-DISEASE ARCHIVES OF INTERNAL MEDICINE Klatsky, A. L., Friedman, G. D., Armstrong, M. A. 1993; 153 (7): 902-902

    View details for Web of Science ID A1993KW47500015

    View details for PubMedID 8466384

  • CASE CONTROL STUDIES OF COLORECTAL-CANCER MORTALITY - IS THE CASE MADE FOR SCREENING SIGMOIDOSCOPY JOURNAL OF THE NATIONAL CANCER INSTITUTE Selby, J. V., Friedman, G. D., Newcomb, P. A., Weiss, N. S. 1993; 85 (6): 503-504

    View details for Web of Science ID A1993KR53700023

    View details for PubMedID 8445679

  • EXPOSURE TO ENGINE EXHAUST AND RISK OF SUBSEQUENT CANCER JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE VANDENEEDEN, S. K., Friedman, G. D. 1993; 35 (3): 307-311

    Abstract

    We evaluated the relation between occupational exposure to engine exhaust fumes and cancer risk among members of a large prepaid health plan who reported on exposure during a routine health examination (n = 160,230). Exposure in the past year was associated with an elevated risk of cancer of the thyroid (relative risk (RR) = 1.99; 95% confidence interval (CI), 1.01-3.92), female breast (RR = 1.53; CI, 1.00-2.33), nonbrain nervous system (RR = 2.26; CI, 1.09-4.67), and lip/tongue (RR = 1.82; CI, 1.09-3.04), and a decreased risk of melanoma (RR = 0.50; CI, 0.27-0.90). However, another measure of exposure that included both exposure prior to 1 year and exposure in the past year was associated only with cancer of the lip/tongue (RR = 1.82; CI, 1.02-3.32). No association was observed for lung, bladder, or larynx cancer or multiple myeloma. Analyses limited to men, or stratified by time since health examination, did not distinguish other effects. Self-reported occupational exposure to engine exhaust fumes was not convincingly associated with most cancers in this cohort.

    View details for Web of Science ID A1993KQ87800010

    View details for PubMedID 7681109

  • RISK-FACTORS FOR PANCREATIC-CANCER - AN EXPLORATORY-STUDY INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Friedman, G. D., VANDENEEDEN, S. K. 1993; 22 (1): 30-37

    Abstract

    An exploratory case-control study to detect risk factors for pancreatic cancer was conducted within a large cohort of people who had received multiphasic health checkups in the San Francisco Bay Area. Four hundred and fifty who later developed pancreatic cancer were compared with 2687 who did not with respect to 779 characteristics recorded at the checkups. There was strong confirmation that cigarette smoking and diabetes mellitus were associated with risk of subsequent pancreatic cancer. Higher levels of serum iron, iron saturation and body weight were also predictive. Less striking associations of interest were with the leukocyte count, pulse rate and certain questionnaire items suggesting non-specific health impairment. Past concerns about alcohol and coffee consumption were not confirmed.

    View details for Web of Science ID A1993KP20300005

    View details for PubMedID 8449644

  • A PROSPECTIVE-STUDY OF CIGARETTE TAR YIELD AND LUNG-CANCER CANCER CAUSES & CONTROL Sidney, S., Tekawa, I. S., Friedman, G. D. 1993; 4 (1): 3-10

    Abstract

    We examined the relationship of cigarette tar yield and other cigarette-usage characteristics in current smokers to the incidence of lung cancer in a study population of 79,946 Kaiser Permanente Medical Care Program members, aged 30-89 years, who completed a detailed, self-administered, smoking-habit questionnaire during the years 1979 through 1985. Mean length of follow-up was 5.6 years. There were 302 incident lung cancers, of which 89 percent occurred in current or former smokers. The tar yield of the current cigarette brand was unassociated with lung cancer incidence (relative risk [RR] = 1.02 per 1 mg tar-yield in men, 95 percent confidence interval [CI] = 0.98-1.05; RR = 0.99, CI = 0.96-1.03 in women). However, in long-term (> 20 years) smokers, the risk of lung cancer was decreased in women who had smoked filtered cigarettes for 20 or more years relative to lifelong smokers of unfiltered cigarettes (RR = 0.36, CI = 0.18-0.75), but not in men who had smoked filtered cigarettes for 20 or more years (RR = 1.04, CI = 0.58-1.87).

    View details for Web of Science ID A1993KM26100001

    View details for PubMedID 8431528

  • EFFECT OF FECAL OCCULT BLOOD TESTING ON MORTALITY FROM COLORECTAL-CANCER - A CASE-CONTROL STUDY ANNALS OF INTERNAL MEDICINE Selby, J. V., Friedman, G. D., Quesenberry, C. P., Weiss, N. S. 1993; 118 (1): 1-6

    Abstract

    To estimate by case-control methods the effect of screening using the fecal occult blood test (FOBT) on mortality from colorectal cancer and to examine the relation of that effect to the interval since the most recent screening test.A case-control study.The Kaiser Permanente Medical Care Program of Northern California.A total of 485 persons who developed fatal colorectal cancer after 50 years of age and 727 age- and sex-matched controls.History of screening FOBTs during the 5 years before case diagnosis.After adjustment for potentially confounding factors, an odds ratio of 0.69 (95% Cl, 0.52 to 0.91) was observed for exposure to at least one screening FOBT during the 5-year interval. The odds ratio was lowest for the first year after the most recent FOBT and rose to 1.00 three years after the last screening examination. False-negative results among cases in the 1 to 2 years before diagnosis contributed substantially to lowering the estimate of efficacy.These data suggest that a program of annual or biennial screening using FOBTs might lower population risk for mortality from colorectal cancer sufficiently to have important public health implications. However, the confidence intervals around our odds ratio estimates were wide. We therefore believe that additional data will be needed before making recommendations that FOBT screening be expanded.

    View details for Web of Science ID A1993KE60500001

    View details for PubMedID 8416152

  • SALT INTAKE AND STOMACH-CANCER - SOME CONTRARY EVIDENCE CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Friedman, G. D., Parsonnet, J. 1992; 1 (7): 607-608

    View details for Web of Science ID A1992JY26400014

    View details for PubMedID 1302576

  • ALCOHOL AND MORTALITY ANNALS OF INTERNAL MEDICINE Klatsky, A. L., Armstrong, M. A., Friedman, G. D. 1992; 117 (8): 646-654

    Abstract

    To study the relation between alcohol intake and mortality in a large ambulatory population with attention to causes of death and differences related to age, sex, race, and baseline risk.Prospective cohort study.Prepaid comprehensive health care program facilities in Oakland and San Francisco, California.Adults (n = 128,934) who supplied data at health evaluations between 1978 and 1985.Demographic data and health history were supplied using questionnaires. Death was ascertained by an automated linkage system and was individually validated. Relative risk for death at various levels of drinking was calculated by Cox proportional hazards models using lifelong nondrinkers as the reference and controlling for eight covariables.Heavier drinkers were at greater risk for death from noncardiovascular causes (relative risk at greater than or equal to 6 drinks per day compared with no alcohol = 1.6, 95% Cl, 1.3 to 2.0) especially cirrhosis, unnatural death, and tobacco-related cancers. This alcohol-associated risk was higher in women (relative risk for death from all causes at greater than or equal to 6 drinks per day = 2.2; Cl, 1.4 to 3.8) and younger persons (for persons less than 50 years of age, relative risk for death from all causes at greater than or equal to 6 drinks per day = 1.9; Cl, 1.3 to 2.9). Lighter drinkers were at lower risk for death from cardiovascular disease, especially coronary heart disease (relative risk at 1 to 2 drinks per day = 0.7; Cl, 0.6 to 0.9), independent of baseline risk, with the greatest reduction of risk in older persons. Lighter drinkers over 60 years of age also had a slightly lower risk for noncardiovascular death, but this finding was not independent of baseline coronary heart disease risk.Women and younger persons appear more susceptible to the increased mortality risk of heavy drinking. The reduced cardiovascular risk of lighter drinkers is more pronounced in older persons. Lower coronary disease prevalence may reduce the noncardiovascular mortality risk of lighter drinkers.

    View details for Web of Science ID A1992JR86100004

    View details for PubMedID 1530196

  • LEUKEMIA, LYMPHOMA, AND MULTIPLE-MYELOMA FOLLOWING SELECTED MEDICAL CONDITIONS CANCER CAUSES & CONTROL Doody, M. M., Linet, M. S., Glass, A. G., Friedman, G. D., POTTERN, L. M., Boice, J. D., Fraumeni, J. F. 1992; 3 (5): 449-456

    Abstract

    The role of selected prior medical conditions in the etiology of hematopoietic malignancies was examined in a case-control study of members of two regional branches of the Kaiser Permanente Medical Care Program (USA). Past history of chronic infectious, autoimmune, allergic, and musculoskeletal disorders was abstracted from medical records for leukemia (n = 299), non-Hodgkin's lymphoma (NHL, n = 100), and multiple myeloma (n = 175) cases and matched controls (n = 787). Little difference was found between cases and controls for most of the chronic conditions evaluated, including sinusitis, carbuncles, urinary tract infections, pelvic infections, herpes zoster, asthma, rheumatoid arthritis, psoriasis, bursitis, and gout. Only three statistically significant elevated risks were found, i.e., with combined disc disease myeloma among patients with prior eczema and disk and other musculoskeletal conditions, and NHL following tuberculosis. Only two of these associations showed consistent patterns by sex and geographic region (myeloma with eczema and with musculoskeletal conditions). While prior history of eczema and musculoskeletal conditions may slightly increase risk of myeloma, this study provided little if any support for an association of chronic infectious, autoimmune, allergic, and musculoskeletal conditions with subsequent occurrence of the leukemias or NHL. Additionally, these data did not support a role for chronic antigenic stimulation, as defined in previous epidemiologic studies, in the etiology of hematopoietic malignancies.

    View details for Web of Science ID A1992JL16900007

    View details for PubMedID 1525326

  • FORCED EXPIRATORY VOLUME (1-SECOND) AND LUNG-CANCER INCIDENCE AND MORTALITY EPIDEMIOLOGY VANDENEEDEN, S. K., Friedman, G. D. 1992; 3 (3): 253-257

    Abstract

    We evaluated the relation between forced expiratory volume in 1 second (FEV1) and lung cancer incidence and mortality among members of the Kaiser Permanente Medical Care Program who took a multiphasic health checkup. FEV1 was inversely related to risk of lung cancer among former and current smokers, but not related among never-smokers. We observed a decreased risk of lung cancer mortality only in the higher quintiles of FEV1 in current smokers among men, but not in women. FEV1 appears to be associated with lung cancer as a physiologic marker for smoking-induced pulmonary damage.

    View details for Web of Science ID A1992HT91200011

    View details for PubMedID 1591325

  • A CASE CONTROL STUDY OF SCREENING SIGMOIDOSCOPY AND MORTALITY FROM COLORECTAL-CANCER NEW ENGLAND JOURNAL OF MEDICINE Selby, J. V., Friedman, G. D., Quesenberry, C. P., Weiss, N. S. 1992; 326 (10): 653-657

    Abstract

    The efficacy of sigmoidoscopic screening in reducing mortality from colorectal cancer remains uncertain. A randomized trial would be ideal for clarifying this issue but is very difficult to conduct. Case-control studies provide an alternative method of estimating the efficacy of screening sigmoidoscopy.Using data on the 261 members of the Kaiser Permanente Medical Care Program who died of cancer of the rectum or distal colon from 1971 to 1988, we examined the use of screening by rigid sigmoidoscopy during the 10 years before the diagnosis and compared it with the use of screening in 868 control subjects matched with the case subjects for age and sex.Only 8.8 percent of the case subjects had undergone screening by sigmoidoscopy, as compared with 24.2 percent of the controls (matched odds ratio, 0.30; 95 percent confidence interval, 0.19 to 0.48). Adjustment for potential confounding factors increased the odds ratio to 0.41 (95 percent confidence interval, 0.25 to 0.69). The negative association was as strong when the most recent sigmoidoscopy was 9 to 10 years before diagnosis as it was when examinations were more recent. By contrast, for 268 subjects with fatal colon cancer above the reach of the sigmoidoscope and for 268 controls, the adjusted odds ratio was 0.96 (95 percent confidence interval, 0.61 to 1.50). The specificity of the negative association for cancer within the reach of the sigmoidoscope is consistent with a true efficacy of screening rather than a confounding by unmeasured selection factors.Screening by sigmoidoscopy can reduce mortality from cancer of the rectum and distal colon. A screening once every 10 years may be nearly as efficacious as more frequent screening.

    View details for Web of Science ID A1992HG11700001

    View details for PubMedID 1736103

  • MISCLASSIFICATION OF SMOKING STATUS IN THE CARDIA STUDY - A COMPARISON OF SELF-REPORT WITH SERUM COTININE LEVELS AMERICAN JOURNAL OF PUBLIC HEALTH Wagenknecht, L. E., Burke, G. L., Perkins, L. L., Haley, N. J., Friedman, G. D. 1992; 82 (1): 33-36

    Abstract

    Although widely used in epidemiological studies, self-report has been shown to underestimate the prevalence of cigarette smoking in some populations.In the CARDIA study, self-report of cigarette smoking was validated against a biochemical marker of nicotine uptake, serum cotinine.The prevalence of smoking was slightly lower when defined by self-report (30.9%) than when defined by cotinine levels equal to or greater than 14 ng/mL (32.2%, P less than .05). The misclassification rate (proportion of reported nonsmokers with cotinine levels of at least 14 ng/mL) was 4.2% and was significantly higher among subjects who were Black, had a high school education or less, or were reported former smokers. Possible reasons for misclassification include reporting error, environmental tobacco smoke, and an inappropriate cutoff point for delineation of smoking status. Using self-report as the gold standard, the cotinine cutoff points that maximized sensitivity and specificity were 14, 9, and 15 ng/mL for all, White, and Black subjects, respectively. The misclassification rate remained significantly higher in Black than in White subjects using these race-specific criteria.Misclassification of cigarette smoking by self-report was low in these young adults; however, within certain race/education groups, self-report may underestimate smoking prevalence by up to 4%.

    View details for Web of Science ID A1992HL39900007

    View details for PubMedID 1536331

  • SCREENING FOR PROSTATIC-CANCER LANCET Friedman, G. D., Hiatt, R. A., Quesenberry, C. P., Selby, J. V. 1991; 338 (8777): 1271-1272

    View details for Web of Science ID A1991GQ16600038

    View details for PubMedID 1682665

  • HELICOBACTER-PYLORI INFECTION AND THE RISK OF GASTRIC-CARCINOMA NEW ENGLAND JOURNAL OF MEDICINE Parsonnet, J., Friedman, G. D., Vandersteen, D. P., Chang, Y., Vogelman, J. H., Orentreich, N., Sibley, R. K. 1991; 325 (16): 1127-1131

    Abstract

    Infection with Helicobacter pylori has been linked with chronic atrophic gastritis, an inflammatory precursor of gastric adenocarcinoma. In a nested case-control study, we explored whether H. pylori infection increases the risk of gastric carcinoma.From a cohort of 128,992 persons followed since the mid-1960s at a health maintenance organization, 186 patients with gastric carcinoma were selected as case patients and were matched according to age, sex, and race with 186 control subjects without gastric carcinoma. Stored serum samples collected during the 1960s were tested for IgG antibodies to H. pylori by enzyme-linked immunosorbent assay. Data on cigarette use, blood group, ulcer disease, and gastric surgery were obtained from questionnaires administered at enrollment. Tissue sections and pathology reports were reviewed to confirm the histologic results.The mean time between serum collection and the diagnosis of gastric carcinoma was 14.2 years. Of the 109 patients with confirmed gastric adenocarcinoma (excluding tumors of the gastroesophageal junction), 84 percent had been infected previously with H. pylori, as compared with 61 percent of the matched control subjects (odds ratio, 3.6; 95 percent confidence interval, 1.8 to 7.3). Tumors of the gastroesophageal junction were not linked to H. pylori infection, nor were tumors in the gastric cardia. H. pylori was a particularly strong risk factor for stomach cancer in women (odds ratio, 18) and blacks (odds ratio, 9). A history of gastric surgery was independently associated with the development of cancer (odds ratio, 17; P = 0.03), but a history of peptic ulcer disease was negatively associated with subsequent gastric carcinoma (odds ratio, 0.2; P = 0.02). Neither blood group nor smoking history affected risk.Infection with H. pylori is associated with an increased risk of gastric adenocarcinoma and may be a cofactor in the pathogenesis of this malignant condition.

    View details for Web of Science ID A1991GK53800003

    View details for PubMedID 1891020

  • CASE-CONTROL STUDY OF SCREENING FOR PROSTATIC-CANCER BY DIGITAL RECTAL EXAMINATIONS LANCET Friedman, G. D., Hiatt, R. A., Quesenberry, C. P., Selby, J. V. 1991; 337 (8756): 1526-1529

    Abstract

    Although commonly thought to be an effective method of screening for prostatic cancer, digital rectal examinations have yet to be shown by controlled study to help prevent advanced forms of this disease. 139 men with metastatic (stage D) prostatic cancer (cases) were compared with an equal number of matched men free of this condition (controls), with respect to rectal examinations recorded in the medical records up to, on average, 23 years before the cases' initial diagnosis of prostatic cancer. Cases and controls were members of a large health maintenance organisation in northern California. In the 10 years before initial diagnosis (excluding the last three months) the average number of examinations for routine screening (2.45 vs 2.52) or to evaluate intestinal or rectal symptoms (0.44 in both) were similar in cases and controls, respectively. After adjustment for racial differences, the relative risk of metastatic prostatic cancer for men with one or more screening rectal examinations compared with men with none was 0.9 with a 95% confidence interval of 0.5-1.7. Screening by routine digital rectal examination appears to have little if any effect in preventing metastatic prostatic cancer. If there is a small benefit, it will be difficult to demonstrate by conventional epidemiological study.

    View details for Web of Science ID A1991FT11600014

    View details for PubMedID 1675379

  • ALCOHOL DRINKING AND CIGARETTE-SMOKING - AN EXPLORATION OF THE ASSOCIATION IN MIDDLE-AGED MEN AND WOMEN DRUG AND ALCOHOL DEPENDENCE Friedman, G. D., Tekawa, I., Klatsky, A. L., Sidney, S., Armstrong, M. A. 1991; 27 (3): 283-290

    Abstract

    The association of alcohol and cigarette consumption was explored among 13,673 black or white persons aged 40-49 years, who received check-ups from mid-1979 to 1985. Alcohol use was strongly associated with number of cigarettes smoked per day, but not with tar-yield, mentholation and presence of filters. Duration of cigarette use, frequency and depth of inhalation, proportion of cigarette smoked and greater time from arising to first cigarette were significantly related to alcohol use in some but not all race-sex groups. Among smokers who consumed alcohol, liquor drinkers smoked the most cigarettes per day and wine drinkers the least. Thus, the association between alcohol drinking and cigarette smoking is strong in middle-aged persons but there are race- and sex-related disparities when specific aspects of smoking behaviour are considered.

    View details for Web of Science ID A1991FU56900011

    View details for PubMedID 1884670

  • DIAGNOSTIC-X-RAY PROCEDURES AND RISK OF LEUKEMIA, LYMPHOMA, AND MULTIPLE-MYELOMA JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Boice, J. D., Morin, M. M., Glass, A. G., Friedman, G. D., Stovall, M., HOOVER, R. N., Fraumeni, J. F. 1991; 265 (10): 1290-1294

    Abstract

    Exposure to diagnostic x-rays and the risk of leukemia, non-Hodgkin's lymphoma (NHL), and multiple myeloma were studied within two prepaid health plans. Adult patients with leukemia (n = 565), NHL (n = 318), and multiple myeloma (n = 208) were matched to controls (n = 1390), and over 25,000 x-ray procedures were abstracted from medical records. Dose response was evaluated by assigning each x-ray procedure a score based on estimated bone marrow dose. X-ray exposure was not associated with chronic lymphocytic leukemia, one of the few malignant conditions never linked to radiation (relative risk [RR], 0.66). For all other forms of leukemia combined (n = 358), there was a slight elevation in risk (RR, 1.17) but no evidence of a dose-response relationship when x-ray procedures near the time of diagnosis were excluded. Similarly, patients with NHL were exposed to diagnostic x-ray procedures more often than controls (RR, 1.32), but the RR fell to 0.99 when the exposure to diagnostic x-ray procedures within 2 years of diagnosis was ignored. For multiple myeloma, overall risk was not significantly high (RR, 1.14), but there was consistent evidence of increasing risk with increasing numbers of diagnostic x-ray procedures. These data suggest that persons with leukemia and NHL undergo x-ray procedures frequently just prior to diagnosis for conditions related to the development or natural history of their disease. There was little evidence that diagnostic x-ray procedures were causally associated with leukemia or NHL. The risk for multiple myeloma, however, was increased among those patients who were frequently exposed to x-rays.

    View details for Web of Science ID A1991FA51100025

    View details for PubMedID 2053936

  • RACIAL-DIFFERENCES IN CEREBROVASCULAR-DISEASE HOSPITALIZATIONS STROKE Klatsky, A. L., Armstrong, M. A., Friedman, G. D. 1991; 22 (3): 299-304

    Abstract

    We studied the relationship of race to incidence of hospitalization for cerebrovascular disease among 74,096 white and 33,041 black persons who took health examinations in a prepaid health care program. Analyses were controlled for age, sex, body mass index, coffee use, smoking, alcohol use, systolic blood pressure, and baseline disease. Blacks were at higher hospitalization risk than whites for hemorrhagic cerebrovascular disease (relative risk = 2.4, 95% confidence interval = 1.3-5.8), cerebral thrombosis (relative risk = 1.9, 95% confidence interval = 1.2-2.9), and nonspecific cerebrovascular disease (relative risk = 1.6, 95% confidence interval = 1.2-2.2) but at lower hospitalization risk for extracranial occlusive disease (relative risk = 0.4, 95% confidence interval = 0.2-0.7). Blood pressure had a similar relation to all types of cerebrovascular disease in both races, but there were disparities in the relations of other atherosclerosis risk factors to different types of cerebrovascular disease. Educational attainment had little relation to hospitalization for extracranial occlusive disease, a finding that reduces the likelihood that selection bias explains the racial disparity. These data show unexplained racial differences in the type and location of cerebrovascular disease. The differences are important in understanding the pathogenesis of cerebrovascular disease and have practical clinical implications.

    View details for Web of Science ID A1991FB98900001

    View details for PubMedID 2003299

  • THE LEUKOCYTE COUNT AND CANCER MORTALITY AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Fireman, B. H. 1991; 133 (4): 376-380

    Abstract

    A previous report that the leukocyte count was related to mortality from cancer was evaluated in two large groups of multiphasic health examinees in the San Francisco Bay area, California--a cohort of about 25,000 persons followed up for mortality and a cohort of about 160,000 persons followed up for cancer incidence between 1964 and 1980. The leukocyte count was related to mortality from all cancers, smoking-related cancers, and cancers that were not smoking-related, but it was not related to cancer mortality in nonsmokers. The leukocyte count showed an association with the incidence of smoking-related cancers that was only partially removed by analytical control for smoking. It was only slightly, if at all, related to the incidence of not-smoking-related cancers and to the incidence of all cancers among nonsmokers. The relation of the leukocyte count to cancer mortality appears to be due to its close association with cigarette smoking, which raises the incidence of certain cancers and can hasten death attributed to cancer.

    View details for Web of Science ID A1991EZ15700008

    View details for PubMedID 1994701

  • Cardiovascular risk factors in young adults. The CARDIA baseline monograph. Controlled clinical trials Cutter, G. R., Burke, G. L., Dyer, A. R., Friedman, G. D., Hilner, J. E., HUGHES, G. H., Hulley, S. B., Jacobs, D. R., Liu, K., Manolio, T. A. 1991; 12 (1): 1S-77S

    View details for PubMedID 1851696

  • THE PREDICTIVE VALUE OF SERUM BETA-CAROTENE FOR SUBSEQUENT DEVELOPMENT OF LUNG-CANCER NUTRITION AND CANCER-AN INTERNATIONAL JOURNAL Orentreich, N., Matias, J. R., Vogelman, J. H., SALKELD, R. M., Bhagavan, H., Friedman, G. D. 1991; 16 (3-4): 167-169

    View details for Web of Science ID A1991GW53600001

    View details for PubMedID 1775382

  • THE LEUKOCYTE COUNT - CORRELATES AND RELATIONSHIP TO CORONARY RISK-FACTORS - THE CARDIA STUDY INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Tekawa, I., Grimm, R. H., Manolio, T., Shannon, S. G., Sidney, S. 1990; 19 (4): 889-893

    Abstract

    Correlates of the leucocyte count (WBC) and its relationships to other coronary heart disease (CHD) risk factors were assessed in 4981 black and white young adults. Mean WBC was higher in women than men, higher in whites than blacks, and higher in those aged 18-24 than aged 25-30 years. It also varied by season with the highest levels in the autumn. Other characteristics with persistent statistically significant direct associations with the WBC after multivariate adjustments were cigarette smoking, marijuana use, geographical location (possibly an inter-laboratory artifact), use of birth control pills, body mass index, pulse rate, and systolic blood pressure; height, physical fitness and high density lipoprotein cholesterol (HDL-C) level were inversely associated with the WBC. The negative association of WBC with HDL-C was too small to explain the association of WBC with CHD found elsewhere. The WBC is a commonly performed clinical test; yet much remains to be learned about its variation in the general population and its value as a predictor rather than merely an indicator of disease.

    View details for Web of Science ID A1990ET59500017

    View details for PubMedID 2084017

  • APPENDECTOMY, APPENDICITIS, AND LARGE-BOWEL CANCER CANCER RESEARCH Friedman, G. D., Fireman, B. H. 1990; 50 (23): 7549-7551

    Abstract

    A cohort of 167,561 persons who received multiphasic health checkups were followed up for cancer development. A history of appendectomy showed slightly negative nonsignificant associations with the development of cancer of the colon, rectum, and all sites combined. By inference, the relation of appendicitis with these cancers was also inverse. Upper 95% confidence limits were compatible only with small positive associations of appendectomy and appendicitis with these cancers. These data do not support the view that removing the appendix increases cancer risk by diminishing immunocompetency. A link between appendicitis and large bowel cancer has been noted in intersociety correlations and has been hypothesized to be due to prevention of both by a high-fiber diet. However, appendicitis does not appear to be a useful predictor of large bowel cancer within a developed society.

    View details for Web of Science ID A1990EK64200022

    View details for PubMedID 2253203

  • RISK OF CARDIOVASCULAR MORTALITY IN ALCOHOL DRINKERS, EX-DRINKERS AND NONDRINKERS AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Armstrong, M. A., Friedman, G. D. 1990; 66 (17): 1237-1242

    Abstract

    Lower cardiovascular mortality rates in lighter drinkers (versus abstainers or heavier drinkers) in population studies have been substantially due to lower coronary artery disease (CAD) mortality. Controversy about this U-shaped curve focuses on whether alcohol protects against CAD or, because of other traits, whether abstainers are at increased risk. Inclusion of ex-drinkers among abstainers in some studies has led to speculation that this might be the trait increasing the risk of abstainers. This new prospective study among 123,840 persons with 1,002 cardiovascular (600 CAD) deaths showed that ex-drinkers had higher cardiovascular and CAD mortality risks than lifelong abstainers in unadjusted analyses, but not in analyses adjusted for age, gender, race, body mass index, marital status and education. Use of alcohol was associated with higher risk of mortality from hypertension, hemorrhagic stroke and cardiomyopathy, but with lower risk from CAD, occlusive stroke and nonspecific cardiovascular syndromes. Subsets free of baseline cardiovascular or CAD risk had U-shaped alcohol-CAD curves similar to subsets with baseline risk. Among ex-drinkers, maximal past intake and reasons for quitting (medical versus non-medical) were unrelated to cardiovascular or CAD mortality. These data show that: (1) alcohol has disparate relations to cardiovascular conditions; (2) higher cardiovascular mortality rates among ex-drinkers are due to confounding traits related to past alcohol use; and (3) the U-shaped alcohol-CAD relation is not due to selective abstinence by persons at higher risk. The findings indirectly support a protective effect of lighter drinking against CAD.

    View details for Web of Science ID A1990EH71100018

    View details for PubMedID 2239729

  • EYE COLOR AND HYPERTENSION MEDICAL HYPOTHESES Friedman, G. D., Selby, J. V., Quesenberry, C. P., Newman, B., KING, M. C. 1990; 33 (3): 201-206

    Abstract

    We searched for predictors of essential hypertension in 1,031 persons aged 30-49 who were observed to progress from normotension to hypertension, as compared to an equal number of matched subjects who remained normotensive. Blood pressure status was well documented in both multiphasic screenings and clinical records. Compared to persons with each lighter eye color, those with brown eyes were more prone to develop hypertension, with relative risk of 1.5 (95% confidence interval 1.18-1.96) compared to all persons with nonbrown eyes. The association persisted after control for race, sex, body mass index, alcohol use, educational level, parental history of hypertension, and among whites, for ethnic origin as crudely estimated by last name. Partial confirmation was obtained in three largely independent study groups: 1) 25 pairs of eye-color-discordant dizygotic twins; 2) 894 pairs of incident hypertensives and controls selected only with multiphasic screening blood pressure measurements; and 3) cross-sectional analysis of 152,018 multiphasic screenees. The weak association of eye color with hypertension clearly requires further confirmation. Although it has little potential for use in screening or clinical care, it may have implications regarding etiology. Areas for further exploration include the close metabolic relation of melanins to catecholamines, both derived from the amino acid tyrosine, and the possibility that dark-eyed persons react more quickly and strongly to stimuli than light-eyed persons.

    View details for Web of Science ID A1990EJ08500014

    View details for PubMedID 2292985

  • DEPRESSION, WORRY, AND THE INCIDENCE OF CANCER AMERICAN JOURNAL OF PUBLIC HEALTH Friedman, G. D. 1990; 80 (11): 1396-1397

    View details for Web of Science ID A1990EF80100033

    View details for PubMedID 2240321

  • BE KIND TO YOUR READER AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D. 1990; 132 (4): 591-593

    View details for Web of Science ID A1990EB31400001

    View details for PubMedID 2403103

  • Colorectal cancer: have we identified an effective screening strategy? Journal of general internal medicine Friedman, G. D., Selby, J. V. 1990; 5 (5): S23-7

    Abstract

    Three currently used screening methods are aimed at detecting colorectal cancer when it is asymptomatic and curable, and at detecting polyps so that they can be removed before they can progress to cancer. Digital rectal examinations are relatively cheap and easy but can detect only a small fraction of large-bowel cancers. Sigmoidoscopy is more sensitive, but its low acceptability to patients has been only partially mitigated by the introduction of the 35-cm flexible instrument. Fecal occult blood testing has limited sensitivity because blood from cancers and polyps is neither continuously shed nor uniformly distributed in feces; specificity and positive predictive value are also low because of other sources of blood in the stool. Prudent judgment suggests that all of these screening tests may prevent death from colorectal cancer in some patients. However, none has been proven effective in general use by well-controlled studies. Case-control studies can provide timely and valuable new evidence in this regard; the authors' investigations in progress are described. The current lack of strong evidence in support of these screening tests should not be interpreted as evidence against their use.

    View details for PubMedID 2231060

  • COFFEE USE PRIOR TO MYOCARDIAL-INFARCTION RESTUDIED - HEAVIER INTAKE MAY INCREASE THE RISK AMERICAN JOURNAL OF EPIDEMIOLOGY Klatsky, A. L., Friedman, G. D., Armstrong, M. A. 1990; 132 (3): 479-488

    Abstract

    Because of conflicting evidence about the relation of coffee use to coronary artery disease, the authors conducted a new cohort study of hospitalizations among 101,774 white persons and black persons admitted to Kaiser Permanente hospitals in northern California in 1978-1986. In analyses controlled for eight covariates, use of coffee was associated with higher risk of myocardial infarction (p = 0.0002). Compared with nondrinkers of coffee, the following relative risks (RRs) were found: at 1-3 cups/day, RR = 1.14 (95% confidence interval (CI) 0.91-1.42); at 4-6 cups/day, RR = 1.42 (CI 1.10-1.84), p = 0.007; and at greater than 6 cups/day, RR = 1.41 (CI 1.00-1.99), p = 0.05. The relation remained significant when also controlled for blood cholesterol, blood glucose, blood pressure, and adiposity, singly or combined. Tea use was unrelated to myocardial infarction; neither coffee nor tea was related to other coronary diagnoses. Although causality remains unestablished and uncertainty remains, the authors conclude that 1) these data suggest a weak independent relation of coffee use to acute myocardial infarction, not mediated by an effect on blood cholesterol; and 2) persons at risk of myocardial infarction should consider limitation of coffee intake to less than 4 cups/day.

    View details for Web of Science ID A1990DW64200012

    View details for PubMedID 2389752

  • HOW OFTEN DOES METRONIDAZOLE INDUCE PANCREATITIS GASTROENTEROLOGY Friedman, G. D., Selby, J. V. 1990; 98 (6): 1702-1703

    Abstract

    Two case reports of metronidazole-induced pancreatitis raised the question of how often this reaction occurs. Of 6485 patients who received 7704 computer-recorded prescriptions for metronidazole from a health maintenance organization, none were hospitalized for pancreatitis while taking the drug or within the following month. Accordingly, the upper 95% confidence limit for the occurrence rate of metronidazole-induced pancreatitis requiring hospitalization is 3.9/10,000 prescriptions and 4.6/10,000 recipients; the true rates are probably lower. Severe pancreatitis appears to be a rare adverse reaction to metronidazole.

    View details for Web of Science ID A1990DD18000044

    View details for PubMedID 2338202

  • PRECURSORS OF ESSENTIAL-HYPERTENSION - PULMONARY-FUNCTION, HEART-RATE, URIC-ACID, SERUM-CHOLESTEROL, AND OTHER SERUM CHEMISTRIES AMERICAN JOURNAL OF EPIDEMIOLOGY Selby, J. V., Friedman, G. D., Quesenberry, C. P. 1990; 131 (6): 1017-1027

    Abstract

    Exploratory analyses were conducted in a nested case-control study of 1,031 incident cases of essential hypertension and 1,031 persistently normotensive controls from the Kaiser Permanente Multiphasic Health Checkup cohort in Northern California. Previous analyses have confirmed hypotheses that baseline weight, subsequent weight gain, alcohol consumption, parental history of hypertension, excessive use of salt, and centralized body fat distribution are predictive of developing hypertension. In the present study, pulmonary function tests, several serum chemistries, and heart rate were strongly predictive in univariate analyses. Adjusting for the risk factors mentioned above, forced vital capacity (p less than 0.001), serum uric acid (p = 0.003), serum cholesterol (p = 0.012), and heart rate (p = 0.014) remained independently predictive. Further adjustment for baseline blood pressure completely explained the association of heart rate with hypertension, and reduced the association with serum cholesterol to borderline significance. Forced vital capacity remained a strong, inverse predictor (odds ratio, fifth vs. first quintile = 0.22, 95% confidence interval (Cl) 0.11-0.46). Uric acid remained positively related to risk (odds ratio, fifth vs. first quintile = 2.19, 95% Cl 1.20-3.98). Although neither association is presently understood, both forced vital capacity and serum uric acid are closely linked to development of hypertension and may be markers of susceptibility or intermediate steps in pathways leading to hypertension.

    View details for Web of Science ID A1990DG76200009

    View details for PubMedID 2343854

  • NONGENETIC INFLUENCES OF OBESITY ON OTHER CARDIOVASCULAR-DISEASE RISK-FACTORS - AN ANALYSIS OF IDENTICAL-TWINS AMERICAN JOURNAL OF PUBLIC HEALTH Newman, B., Selby, J. V., Quesenberry, C. P., KING, M. C., Friedman, G. D., Fabsitz, R. R. 1990; 80 (6): 675-678

    Abstract

    The importance of genetic influences on obesity has been emphasized recently. We conducted matched co-twin analyses of 250 pairs of White, male, monozygotic twins from the National Heart, Lung, and Blood Institute (NHLBI) Twin Study. Entirely in the absence of genetic influences, obesity was significantly associated with systolic and diastolic blood pressures; one-hour, post-load glucose; total, LDL-, and HDL-cholesterol; and triglycerides among these 42-55 year old men. Similar results were obtained in longitudinal analyses of weight change during adulthood (from mean age of 20 to mean age of 48 years) and risk factor status at middle-age. These results indicate that behaviors and environmental exposures that occur later in life are responsible, at least in part, for the associations between adult obesity and cardiovascular disease risk, supporting the appropriateness of weight reduction efforts during adulthood.

    View details for Web of Science ID A1990DE73300008

    View details for PubMedID 2343948

  • AUTOMATED RECORD LINKAGE CLINICAL PHARMACOLOGY & THERAPEUTICS Friedman, G. D. 1990; 47 (4): 547-548

    View details for Web of Science ID A1990DB20000019

    View details for PubMedID 2328563

  • SCREENING SIGMOIDOSCOPY AND COLORECTAL-CANCER MORTALITY JOURNAL OF GENERAL INTERNAL MEDICINE Selby, J. V., Friedman, G. D. 1990; 5 (2): 181-181

    View details for Web of Science ID A1990CU89200017

    View details for PubMedID 2313411

  • CIGARETTE-SMOKING BEHAVIOR IS STRONGLY RELATED TO EDUCATIONAL STATUS - THE CARDIA STUDY PREVENTIVE MEDICINE Wagenknecht, L. E., Perkins, L. L., Cutter, G. R., Sidney, S., Burke, G. L., Manolio, T. A., Jacobs, D. R., Liu, K. A., Friedman, G. D., HUGHES, G. H., Hulley, S. B. 1990; 19 (2): 158-169

    Abstract

    The prevalence and correlates of cigarette smoking were examined in 5,116 men and women ages 18-30 years including both blacks and whites of varied educational levels. Prevalence of smoking was approximately 30% in each race by gender subgroup after adjusting for age and education. The prevalence decreased with increasing education, from 54% among participants with less than a high school education to 12% among those with graduate degrees (P less than 0.001). Cessation rates followed a similar pattern, with former smokers twice as common among those with more education. Differences in smoking prevalence across occupational groups were largely explained by differences in educational achievement. More educated individuals smoked fewer cigarettes per day and chose brands with lower nicotine yield. Race and gender were not strongly related to smoking prevalence. However, among smokers, whites reported smoking 50% more cigarettes per day than blacks but the average nicotine and tar content of the cigarette was nearly three times higher among blacks than whites. The strong inverse relationship between education and cigarette smoking patterns has important implications for public health efforts directed at the prevention of cigarette smoking.

    View details for Web of Science ID A1990DK49400004

    View details for PubMedID 2193307

  • ALCOHOL INTAKE AND BLOOD-PRESSURE IN YOUNG-ADULTS - THE CARDIA STUDY JOURNAL OF CLINICAL EPIDEMIOLOGY Dyer, A. R., Cutter, G. R., Liu, K., Armstrong, M. A., Friedman, G. D., HUGHES, G. H., DOLCE, J. J., Raczynski, J., BURKE, G., Manolio, T. 1990; 43 (1): 1-13

    Abstract

    Associations between self-reported average daily alcohol intake and blood pressure were assessed in 5031 black and white men and women ages 18-30 from the Coronary Artery Risk Development in Young Adults Study (CARDIA). In general, intake was positively but weakly related to both systolic and diastolic blood pressure. Associations with systolic pressure were generally stronger than those with diastolic pressure. With average daily alcohol intake categorized as none, 0.1-9.9 ml, 10.0-19.9 ml, 20.0-29.9 ml, and 30.0+ ml, mean systolic pressure, adjusted for age, body mass index, education, smoking, and physical activity, increased progressively with increasing intake in black and white men and in white women. Mean diastolic pressure increased progressively with increasing intake only in white men and women, but was highest for those averaging 30.0+ ml per day in black women as well as white men and women. Mean pressures were also compared for those averaging 75.0+ ml per day (men) or 50.0+ ml per day (women) vs those reporting no intake. Differences in adjusted mean pressures for white men were 3.2 mmHg (95% confidence limits (CL) -0.3, 6.8) for systolic pressure and 1.7 mmHg (-1.6, 5.0) for diastolic pressure. In black men differences were 4.4 mmHg (1.4, 7.4) and 3.4 mmHg (0.6, 6.3), respectively. Differences in white women were 1.4 mmHg (-2.5, 5.3) for systolic pressure and 0.9 mmHg (-2.7, 4.5) for diastolic pressure and for black women, -0.2 mmHg (-4.3, 3.8) and 1.9 mmHg (-1.9, 5.8). Separate analyses in smokers and nonsmokers of the associations between alcohol intake and blood pressure suggested that associations may differ by smoking status in some sex-race groups.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1990CJ19800001

    View details for PubMedID 1969463

  • THE LEUKOCYTE COUNT - A PREDICTOR OF HYPERTENSION JOURNAL OF CLINICAL EPIDEMIOLOGY Friedman, G. D., Selby, J. V., Quesenberry, C. P. 1990; 43 (9): 907-911

    Abstract

    In an exploratory study of 1031 persons observed to progress from normotension to essential hypertension and 1031 matched subjects who remained normotensive, the initial leukocyte count (WBC) was found to be related to the development of hypertension, with risk increased 40% (95% confidence interval 12-82%) in persons in the highest as compared to the lowest quartile of WBC. This relationship proved to be largely independent of body mass index, body fat distribution, alcohol and tobacco consumption, and parental history of hypertension. An increased WBC may reflect greater sympathetic tone or may directly increase peripheral vascular resistance by impeding circulation through small blood vessels. If confirmed, this study adds another condition to the growing list for which the WBC is predictive. This simple, cheap test should be considered for inclusion in prospective epidemiological studies of many different diseases.

    View details for Web of Science ID A1990EC89200008

    View details for PubMedID 2213079

  • CIGARETTE-SMOKING, COTININE, AND BLOOD-PRESSURE CIRCULATION Friedman, G. D. 1989; 80 (5): 1493-1494

    View details for Web of Science ID A1989AZ60200043

    View details for PubMedID 2805282

  • SCREENING PRESCRIPTION DRUGS FOR POSSIBLE CARCINOGENICITY - 11 TO 15 YEARS OF FOLLOW-UP CANCER RESEARCH Selby, J. V., Friedman, G. D., Fireman, B. H. 1989; 49 (20): 5736-5747

    Abstract

    Using computerized pharmacy records from 1969 to 1973 for a cohort of 143,574 members of the Kaiser Permanente Medical Care Program, we have been testing associations of 215 drugs or drug groups with subsequent incidence of cancer at 56 sites. This paper presents findings with follow-up through 1984. There were 227 statistically significant (P less than 0.05, two-tailed) associations: 170 positive, 57 negative. Some were undoubtedly chance findings; others were likely due to confounding by unmeasured covariables. However, several associations suggested hypotheses for further studies and/or the need for continued observation. Most notable among findings not previously reported were associations of several antibiotics, both oral and topical, with lung cancer. These associations could not be explained by indications for drug use or by differences in smoking habits between users and nonusers, and suggest a possible link between the occurrence of bacterial infections and risk for cancer. In general, our results continue to suggest that most medications used during that period did not affect cancer incidence substantially. However, for less frequently prescribed medications, our power to detect moderate increases in cancer risk was quite low.

    View details for Web of Science ID A1989AU13800043

    View details for PubMedID 2571410

  • MENTHOLATED CIGARETTE USE AMONG MULTIPHASIC EXAMINEES, 1979-86 AMERICAN JOURNAL OF PUBLIC HEALTH Sidney, S., Tekawa, I., Friedman, G. D. 1989; 79 (10): 1415-1416

    Abstract

    Mentholated cigarette use was studied in relation to age and race in 29,037 current smokers who were Kaiser Permanente Medical Care Program members. The percentages of mentholated cigarette users were much higher in Blacks and Asians than in Whites, especially in the younger age groups. A marked inverse relationship between mentholated cigarette use and age was present in Blacks and Asians; mentholated cigarette use showed little difference with age in Whites.

    View details for Web of Science ID A1989AR32500020

    View details for PubMedID 2782516

  • DIETARY-INTAKE OF CAROTENE IN NONSMOKERS WITH AND WITHOUT PASSIVE SMOKING AT HOME AMERICAN JOURNAL OF EPIDEMIOLOGY Sidney, S., Caan, B. J., Friedman, G. D. 1989; 129 (6): 1305-1309

    View details for Web of Science ID A1989U852400020

    View details for PubMedID 2786331

  • ALCOHOL-USE AND SUBSEQUENT CEREBROVASCULAR-DISEASE HOSPITALIZATIONS STROKE Klatsky, A. L., Armstrong, M. A., Friedman, G. D. 1989; 20 (6): 741-746

    Abstract

    We studied the relations between reported alcohol use and the incidence of hospitalization for several types of cerebrovascular disease. Daily consumption of three or more drinks, but not lighter drinking, was related to higher hospitalization rates for hemorrhagic cerebrovascular disease, especially intracerebral hemorrhage. Age, blood pressure, and black race were other independent predictors of hemorrhagic events; higher blood pressure appeared to be a partial mediator of the relation between alcohol use and hemorrhagic events. Alcohol use was associated with lower hospitalization rates for occlusive cerebrovascular disease; an inverse relation was present in both sexes, whites and blacks, and for extracranial and intracerebral occlusive lesions. Other predictors of hospitalization for occlusive disease included age, blood pressure, smoking, blood glucose and total cholesterol concentrations, and baseline disease. Our data suggest that heavier drinking increases the risk of hemorrhagic cerebrovascular events, but that alcohol use may lessen the risk of occlusive lesions.

    View details for Web of Science ID A1989AB31000006

    View details for PubMedID 2728039

  • METRONIDAZOLE AND CANCER JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Friedman, G. D., Selby, J. V. 1989; 261 (6): 866-866

    View details for Web of Science ID A1989T074500025

    View details for PubMedID 2913382

  • US Preventive Services Task Force. Sigmoidoscopy in the periodic health examination of asymptomatic adults. JAMA : the journal of the American Medical Association Selby, J. V., Friedman, G. D. 1989; 261 (4): 594-601

    View details for PubMedID 2642564

  • SIGMOIDOSCOPY IN THE PERIODIC HEALTH EXAMINATION OF ASYMPTOMATIC ADULTS JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Selby, J. V., Friedman, G. D. 1989; 261 (4): 595-601
  • PRECURSORS OF ESSENTIAL-HYPERTENSION - THE ROLE OF BODY-FAT DISTRIBUTION PATTERN AMERICAN JOURNAL OF EPIDEMIOLOGY Selby, J. V., Friedman, G. D., Quesenberry, C. P. 1989; 129 (1): 43-53

    Abstract

    Progression from normotension between 1964 and 1972 to essential hypertension by age 55 years was documented in 1,031 adult members of the Kaiser Permanente Medical Care Program (Northern California region) from computerized multiphasic health checkup records and medical record review. Each case was matched to a persistently normotensive control on age, sex, race, number, and dates of multiphasics. In 609 pairs with baseline measurements of subscapular and triceps skinfolds, mean interval from baseline to the case's first hypertensive multiphasic was 5.7 years, and mean age at onset of hypertension was 47 years. Baseline measures of body mass index, subscapular skinfold, and triceps skinfold were each predictive of development of hypertension (odds ratios 3.85, 3.75, and 2.29 respectively, comparing highest with lowest quintiles, p less than 0.0001 for each). When both skinfolds were included in the same model, subscapular skinfold was highly predictive and triceps skinfold was no longer related to risk. When the authors controlled for overall obesity (body mass index), subscapular skinfold remained highly predictive (p less than 0.0001). In 330 pairs who also had skinfold measurements at the hypertensive multiphasic, weight gain was a strong predictor of hypertension. Increase in subscapular skinfold conferred a small increase in risk in women only. The authors conclude that centrally deposited body fat increases risk for developing essential hypertension independent of the overall level of obesity, while peripherally deposited fat does not.

    View details for Web of Science ID A1989R639600006

    View details for PubMedID 2910071

  • PROGNOSIS OF GALLSTONES WITH MILD OR NO SYMPTOMS - 25 YEARS OF FOLLOW-UP IN A HEALTH MAINTENANCE ORGANIZATION JOURNAL OF CLINICAL EPIDEMIOLOGY Friedman, G. D., Raviola, C. A., Fireman, B. 1989; 42 (2): 127-136

    Abstract

    Two-hundred ninety-eight patients with gallstones accompanied by mild or nonspecific symptoms, 123 with asymptomatic gallstones, and 46 with nonfunction on cholecystogram and mild or nonspecific symptoms were followed in the setting of a health maintenance organization for up to 25 years after diagnosis. In a life-table analysis, complications (severe events) developed in about 1% per year of patients with visualized gallstones and in about 2% per year of patients with nonfunction. During each of the first 5 years after diagnosis, all events, both severe and non-severe (including surgery for continuing mild symptoms) occurred in about 6% of the patients with mild symptoms accompanying either gallstones or nonfunction, and in about 4% of patients with asymptomatic gallstones. The annual probabilities for all events tended to decrease as length of follow-up increased. Among patients with stones and mild symptoms, women were more apt to develop any event than men (p = 0.02) and more obese patients were more likely to develop severe events than those who were thinner (p = 0.05). The patients in this study are probably more representative of outpatients with gallstones seen by most primary care physicians than are most groups investigated previously for prognosis. Their event rates are sufficiently similar to those used in published decision analyses, that they should not alter previous conclusions that early elective cholecystectomy will have little positive or negative effect on average life expectancy of patients with gallstones.

    View details for Web of Science ID A1989T431400006

    View details for PubMedID 2918322

  • GYNECOLOGIC CONSEQUENCES OF LONG-TERM, UNOPPOSED ESTROGEN REPLACEMENT THERAPY MATURITAS Ettinger, B., Golditch, I. M., Friedman, G. 1988; 10 (4): 271-282

    Abstract

    We evaluated the gynecologic risks of unopposed, long-term estrogen use in postmenopausal women. Our medical record review showed that unopposed estrogen users (mean dose, 0.9 mg of conjugated estrogens) had a significantly higher (P less than 0.001) incidence of abnormal vaginal bleeding, curettage, hysterectomy, and endometrial cancer. The ratios of occurrence of these events among users compared with non-users were 7.8, 4.9, 6.6 and 7.7. The prevalence of hysterectomy reached 28.2% of users compared with 5.3% of non-users, and endometrial carcinoma developed in 9.9% of users compared with 1.4% of non-users.

    View details for Web of Science ID A1988R919800003

    View details for PubMedID 3226337

  • THE RELATIONS OF ALCOHOLIC BEVERAGE USE TO COLON AND RECTAL-CANCER AMERICAN JOURNAL OF EPIDEMIOLOGY Klatsky, A. L., Armstrong, M. A., Friedman, G. D., Hiatt, R. A. 1988; 128 (5): 1007-1015

    Abstract

    The authors prospectively studied the incidence of cancers of the colon and rectum in 106,203 men and women, both white and black, who supplied data at northern California Kaiser Permanente facilities about use of alcoholic beverages in 1978-1984. Analysis controlling for age, sex, race, body mass index, coffee use, total serum cholesterol, and education showed a positive association of alcohol use to both types of cancer, which was stronger for rectal cancer (trend test, p = 0.03) than for colon cancer (trend test, p = 0.11). When persons with a daily intake of three or more drinks were compared with abstainers, relative risk for rectal cancer was 3.17 (95% confidence interval (CI): 1.05-9.57) and relative risk for colon cancer was 1.71 (95% CI: 0.92-3.19). Women with a daily intake of three or more drinks had a relative risk for colon cancer of 2.56 (95% CI: 1.03-6.40) compared with 1.16 (95% CI: 0.46-2.90) for men. Among drinkers, preference for wine, beer, or hard liquor had no significant independent relation to either type of cancer; those who preferred beer were at slightly greater risk of rectal cancer, but those who preferred wine were more likely to develop colon cancer. These data suggest that total alcohol use, but no one specific beverage type, is associated with increased risk of rectal cancer.

    View details for Web of Science ID A1988Q806700006

    View details for PubMedID 3189277

  • CATARACT-EXTRACTION - RISK-FACTORS IN A HEALTH MAINTENANCE ORGANIZATION POPULATION UNDER 60 YEARS OF AGE ARCHIVES OF OPHTHALMOLOGY Schwab, I. R., Armstrong, M. A., Friedman, G. D., Wong, I. G., CARPENTIERI, A. C., Dawson, C. R. 1988; 106 (8): 1062-1065

    Abstract

    Risk factors for cataract extraction in a young (less than 60 years of age) urban health maintenance organization population were evaluated in a case-control study. The subjects (72 case-control pairs) subscribed to the Kaiser Permanente Medical Care Program in the San Francisco Bay area and had cataract extraction between 1976 and 1980. All patients had visual acuity of at least 20/40 OU, documented before development of cataracts. Thirty-six (50%) of the 72 cataract extraction patients had at least one known risk factor for cataract formation, including trauma, intraocular inflammation, diabetes mellitus, syphilis, oral or topical steroid use, or previous eye surgery. Male patients were found to be a mean of 4.3 years younger than female patients, and diabetics were found to be a mean of 3.5 years older than nondiabetics. Variables found to be related to cataract extraction in univariate analysis included diagnosis of diabetes mellitus, a family history of cataracts, pulse rate, white blood cell count, and syphilis.

    View details for Web of Science ID A1988P575900021

    View details for PubMedID 3261164

  • PRECURSORS OF ESSENTIAL-HYPERTENSION - BODY-WEIGHT, ALCOHOL AND SALT USE, AND PARENTAL HISTORY OF HYPERTENSION PREVENTIVE MEDICINE Friedman, G. D., Selby, J. V., Quesenberry, C. P., Armstrong, M. A., Klatsky, A. L. 1988; 17 (4): 387-402

    Abstract

    Body mass index, alcohol and salt consumption, and parental history of hypertension were examined as possible predictors of the development of essential hypertension in 1,031 persons, ages 30-49 years at entry, with documented normotension followed by documented hypertension after a mean interval of 6 years. In a comparison with 1,031 matched persistently normotensive persons initial body mass index and percentage increase in body mass index were each predictive of hypertension. Consumption of three or more alcoholic drinks a day at baseline was also predictive, more so if this level of intake persisted than if it diminished. Heavy salt intake as crudely estimated at baseline by one question was also associated with the development of hypertension. Parental history of hypertension was also predictive, more so for hypertension in the mother than for hypertension in the father, and the association was apparent only in female subjects. These characteristics at baseline showed independent associations with subsequent hypertension in multivariate analysis. When follow-up data were included in the multivariate analysis, alcohol consumption at the hypertensive examination was much more strongly related than at the baseline examination, suggesting a short-term effect, and heavy salt consumption was no longer predictive, possibly because of a marked loss of subjects due to missing follow-up data. This large study confirms longitudinally the importance of obesity, weight gain during adulthood, alcohol, family history, and, to some extent, salt as predictive and possibly causal factors for essential hypertension.

    View details for Web of Science ID A1988P807600001

    View details for PubMedID 3217372

  • EPIDEMIOLOGIC EVIDENCE OF AN ASSOCIATION BETWEEN BODY IRON STORES AND RISK OF CANCER INTERNATIONAL JOURNAL OF CANCER Selby, J. V., Friedman, G. D. 1988; 41 (5): 677-682

    Abstract

    Biologic evidence suggests that high body iron stores could promote development of cancer. Because a previous study had shown an association between prescribed iron medication and lung cancer risk in men, we examined recent iron use as well as 2 additional indirect measures of body iron stores, anemia and the total iron-binding capacity (TIBC) of plasma, in relation to subsequent risk of cancer in a larger cohort of 174,507 persons. Women, but not men, who reported recent iron use had a lower risk of lung cancer than those who did not [RR = 0.60, 95% confidence limits (CL) 0.37, 0.97] after adjustment for age and cigarette smoking. Women who had used iron appeared to remain relatively iron-depleted. Risk for other cancers was slightly, but not significantly, lower in women who used iron. Anemia (hemoglobin less than 12 g) was also associated with lower risk of lung cancer in women (RR = 0.61, 95% CL 0.61, 0.98), but not in men. TIBC, which is inversely related to body iron stores, was inversely related to risk of lung cancer in women in a graded fashion (RR = 0.41, 95% CL 0.23, 0.73 comparing highest with lowest quartile). In men, a protective effect of higher TIBC against lung cancer was suggested, but did not reach statistical significance. These indirect measures of body iron stores appeared to reflect iron stores better in women than in men, probably because variability in iron stores is greater in women and iron deficiency more prevalent. A possible alternative explanation for our findings is incomplete adjustment for the confounding effects of cigarette smoking. This could apply to iron use and hemoglobin level which were related to smoking, but not to TIBC, which was not. These data, which indicate lower risk of cancer in iron-depleted women, lend epidemiologic support to the hypothesis that high iron stores may increase cancer risk, at least for lung cancer.

    View details for Web of Science ID A1988N448100006

    View details for PubMedID 3366489

  • SIGMOIDOSCOPY AND MORTALITY FROM COLORECTAL-CANCER - THE KAISER PERMANENT MULTIPHASIC EVALUATION STUDY JOURNAL OF CLINICAL EPIDEMIOLOGY Selby, J. V., Friedman, G. D., Collen, M. F. 1988; 41 (5): 427-434

    Abstract

    The Kaiser Permanente Multiphasic Evaluation Study is often cited as evidence from a randomized trial that screening sigmoidoscopy reduces mortality from colorectal cancer. To examine the role of sigmoidoscopy in this reduction, we reviewed the 110 incident cases of colorectal cancer occurring among the 10,713 subjects from randomization in 1964 through 1982. Tumor stage at diagnosis, location, mode of discovery, and current mortality status were determined for each. We also reanalyzed chart review data for the years 1965 through 1974 to assess the difference in exposure to sigmoidoscopy between groups. Study group subjects, who were urged to have annual multiphasic health checkups (MHC), had both a lower cumulative incidence (4.3 vs 6.7 cases per 1000 persons) and a better stage distribution (86 vs 54% Stage B or better) than nonurged control subjects for colorectal cancers arising within reach of the sigmoidoscope. The lowered incidence accounted for two-thirds of the total difference in mortality. No appreciable difference in removal of colorectal polyps was seen between groups. Only a slight excess in exposure to sigmoidoscopy was seen in the study group (30 vs 25% of subjects examined at least once between 1965 and 1974), which was unlikely to account for more than a small fraction of the study group's decrease in mortality. Although the Multiphasic Evaluation Study did find a significantly lower mortality from colorectal cancer in the study group, it did not achieve a substantial difference in exposure to sigmoidoscopy. Its results are therefore inconclusive with respect to sigmoidoscopy and should not be used as evidence either for or against sigmoidoscopic screening.

    View details for Web of Science ID A1988N334600002

    View details for PubMedID 3367172

  • CANCER OF THE LARGE BOWEL AFTER CHOLECYSTECTOMY BIOMEDICINE & PHARMACOTHERAPY Friedman, G. D. 1988; 42 (6): 369-372

    Abstract

    The possibility that cholecystectomy may increase the risk of developing cancer of the large bowel has been a matter of concern for several years. The association has biological plausibility because of the effects of cholecystectomy on the formation of secondary bile acids. Recent evidence, however, suggests that the association is absent or weak. This underlines the recommendation that biological explanations should not be relied upon too heavily when considering epidemiological associations.

    View details for Web of Science ID A1988R103700001

    View details for PubMedID 3064820

  • US Preventive Services Task Force. Automobile injury--selected risk factors and prevention in the health care setting. JAMA : the journal of the American Medical Association Polen, M. R., Friedman, G. D. 1988; 259 (1): 76-80

    Abstract

    Every year, highway crashes cause tens of thousands of deaths and millions of nonfatal injuries, many of which can be prevented. Following a mandate from the US Preventive Services Task Force, in this article we describe the magnitude of the automobile injury problem, identify injury risk factors that might be reduced by clinically based preventive programs, and review reports of interventions by health professionals to promote the use of child restraint devices, the only area in which we found published evaluations. We conclude that despite the lack of experimental evidence of the long-term effectiveness of clinically based efforts to promote occupant restraint use, such efforts may be warranted because of the enormous social and economic costs of automobile injury. In addition, physicians and other health professionals are urged to consider promoting nonclinical automobile injury prevention measures.

    View details for PubMedID 3334776

  • CARDIA - STUDY DESIGN, RECRUITMENT, AND SOME CHARACTERISTICS OF THE EXAMINED SUBJECTS JOURNAL OF CLINICAL EPIDEMIOLOGY Friedman, G. D., Cutter, G. R., Donahue, R. P., HUGHES, G. H., Hulley, S. B., Jacobs, D. R., Liu, K., Savage, P. J. 1988; 41 (11): 1105-1116

    Abstract

    In 1984, a prospective cohort study, Coronary Artery Risk Development in Young Adults (CARDIA) was initiated to investigate life-style and other factors that influence, favorably and unfavorably, the evolution of coronary heart disease risk factors during young adulthood. After a year of planning and protocol development, 5,116 black and white women and men, age 18-30 years, were recruited and examined in four urban areas: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California. The initial examination included carefully standardized measurements of major risk factors as well as assessments of psychosocial, dietary, and exercise-related characteristics that might influence them, or that might be independent risk factors. This report presents the recruitment and examination methods as well as the mean levels of blood pressure, total plasma cholesterol, height, weight and body mass index, and the prevalence of cigarette smoking by age, sex, race and educational level. Compared to recent national samples, smoking is less prevalent in CARDIA participants, and weight tends to be greater. Cholesterol levels are representative and somewhat lower blood pressures in CARDIA are probably, at least in part, due to differences in measurement methods. Especially noteworthy among several differences in risk factor levels by demographic subgroup, were a higher body mass index among black than white women and much higher prevalence of cigarette smoking among persons with no more than a high school education than among those with more education.

    View details for Web of Science ID A1988R520300009

    View details for PubMedID 3204420

  • Recruitment in the Coronary Artery Disease Risk Development in Young Adults (Cardia) Study. Controlled clinical trials HUGHES, G. H., Cutter, G., Donahue, R., Friedman, G. D., Hulley, S., Hunkeler, E., Jacobs, D. R., Liu, K., ORDEN, S., Pirie, P. 1987; 8 (4): 68S-73S

    Abstract

    Coronary Artery Disease Risk Development in Young Adults (CARDIA) is a longitudinal study designed to trace the development of risk factors for coronary heart disease in 5100 individuals 18-30 years old. The study will compare, by cross-sectional and longitudinal analyses, trends and processes involved in risk factor development by sex, race, age, and other sociodemographic characteristics. Participants for the approximately 4 1/2-hour baseline examination were randomly selected and recruited by telephone from census tracts in Minneapolis and Chicago, by telephone exchanges within the Birmingham city limit, and from lists of the Kaiser-Permanente Health Plan membership in Oakland and Berkeley. A major issue was the desirability of sampling approximately equal numbers by age, race, sex, and education as compared with sampling numbers representative of the population base. The recruitment goal of 5100 was achieved on schedule.

    View details for PubMedID 3440391

  • RECRUITMENT IN THE CORONARY-ARTERY DISEASE RISK DEVELOPMENT IN YOUNG-ADULTS (CARDIA) STUDY CONTROLLED CLINICAL TRIALS HUGHES, G. H., Cutter, G., Donahue, R., Friedman, G. D., Hulley, S., Hunkeler, E., Jacobs, D. R., Liu, K., ORDEN, S., Pirie, P., Tucker, B., Wagenknecht, L. 1987; 8 (4): S68-S73
  • CONCORDANCE FOR TYPE-2 (NON-INSULIN-DEPENDENT) DIABETES-MELLITUS IN MALE TWINS DIABETOLOGIA Newman, B., Selby, J. V., KING, M. C., Slemenda, C., Fabsitz, R., Friedman, G. D. 1987; 30 (10): 763-768

    Abstract

    Concordance for Type 2 (non-insulin-dependent) diabetes was determined in 250 monozygotic and 264 dizygotic white male twin pairs who participated in the National Heart, Lung, and Blood Institute Twin Study. These twins were born between 1917 and 1927 and were identified from military records without regard to disease status. We examined surviving members of the cohort twice--at mean ages of 47 and 57 years--and obtained 1-h post-load glucose tests and medication histories. Diagnostic criteria for Type 2 diabetes included a glucose value greater than or equal to 13.9 mmol/l or current use of antidiabetic medication; possible Type 1 (insulin-dependent) diabetic twins were excluded. A strong genetic predisposition to Type 2 diabetes was suggested by 3 lines of evidence from the second examination: (1) 58% of monozygotic co-twins of diabetic twins were themselves diabetic compared with an expected prevalence of 10%; (2) only 1 of 15 originally disease-discordant, monozygotic twin pairs remained discordant for diabetes; and (3) 65% of non-diabetic monozygotic co-twins of diabetic twins had elevated glucose values. Because concordance for diabetes was less than 100% for twins aged 52-65 years and because twins varied in age at onset of disease, non-genetic factors may also influence diabetes development. Among the 19 monozygotic twins pairs discordant for diabetes, diabetic twins did not differ from their non-diabetic co-twins in obesity, diet, alcohol consumption, or education. However, compared with unrelated non-diabetic twins of the same ages, non-diabetic co-twins of diabetic twins gained more weight as adults (p less than 0.02) and had higher glucose levels (p less than 0.03).

    View details for Web of Science ID A1987L026700002

    View details for PubMedID 3428496

  • FAMILY HISTORY OF CORONARY HEART-DISEASE AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Klatsky, A. L. 1987; 126 (1): 159-159

    View details for Web of Science ID A1987H764300027

    View details for PubMedID 3591784

  • ENVIRONMENTAL AND BEHAVIORAL DETERMINANTS OF FASTING PLASMA-GLUCOSE IN WOMEN - A MATCHED COTWIN ANALYSIS AMERICAN JOURNAL OF EPIDEMIOLOGY Selby, J. V., Newman, B., KING, M. C., Friedman, G. D. 1987; 125 (6): 979-988

    Abstract

    Comparing results of an unmatched analysis in a sample of unrelated persons created by randomly selecting one twin from each pair with results of a matched monozygotic co-twin analysis provides a means of distinguishing environmental influences from genetic influences on a dependent variable of interest. Determinants of the fasting plasma glucose level were investigated in a large sample of adult female nondiabetic twins from the Kaiser Permanente Twin Registry. In the subsample of unrelated persons, fasting plasma glucose was significantly and positively associated with age, body mass index, uric acid level, and alcohol intake and was significantly inversely related to leisure time physical activity. When monozygotic twins were treated as matched pairs, only the effects of body mass index and alcohol consumption remained significant, whereas the association with leisure time physical activity was greatly reduced and no longer statistically significant. These results suggest that behavioral and therefore alterable aspects of obesity and alcohol consumption influence the fasting plasma glucose level; alcohol consumption may be a risk factor for non-insulin-dependent diabetes mellitus; and common underlying genetic factor(s) may be responsible for the negative association between physical activity and fasting plasma glucose.

    View details for Web of Science ID A1987H376300006

    View details for PubMedID 3578256

  • CHOLECYSTECTOMY AND LARGE BOWEL-CANCER LANCET Friedman, G. D., Goldhaber, M. K., Quesenberry, C. P. 1987; 1 (8538): 906-908

    Abstract

    The records of 5898 patients with colorectal cancer and 27,687 controls were examined for previous cholecystectomy. The estimated relative risks (and 95% confidence intervals) of development of any cancer of the large bowel and cancer of the right colon after cholecystectomy were 1.0 (0.8-1.2) and 1.1 (0.8-1.5) in women and 1.1 (0.9-1.5) and 1.2 (0.8-1.9) in men, respectively. Although these data do not rule out a small increase in risk, it is proposed that the association found in some other studies is, at least in part, an artifact. Intense diagnostic effort and treatment aimed at mild abdominal symptoms, encouraged by some patients and some medical care settings, could increase the detection and removal of gallstones and the early detection of colorectal cancer.

    View details for Web of Science ID A1987G898500014

    View details for PubMedID 2882301

  • THINNESS AND MORTALITY AMERICAN JOURNAL OF PUBLIC HEALTH Sidney, S., Friedman, G. D., SIEGELAUB, A. B. 1987; 77 (3): 317-322

    Abstract

    The relationship of thinness to mortality was examined in White adult members of the Kaiser Permanente Medical Care Program who had at least three multiphasic health checkups between 1964 and 1972, with mortality follow-up through 1980. A detailed comparison was performed of the mortality patterns of "thin" (decile 1 of Quetelet's index) and "average" weight (deciles 4 and 5) cohort members who were age 40-79 years and free of illness at the beginning of follow-up. Thin male (relative risk 1.6, 95 per cent confidence limits 1.0, 2.6) and female (R.R. 2.1, 95 per cent C.L. 1.1, 3.9) current cigarette smokers were at increased risk of mortality compared with average weight smokers. Unmeasured differences between thin and average weight smokers with respect to quantity of cigarettes smoked may have contributed to the apparent association of thinness with mortality in smokers. Thinness was not associated with increased mortality in never smokers and ex-smokers (R.R. 1.0 in men and women). As association of long-term weight loss with mortality was present in thin and average weight men and in thin women.

    View details for Web of Science ID A1987G091400011

    View details for PubMedID 3812838

  • RISK-FACTORS FOR CORONARY HEART-DISEASE IN ADULT FEMALE TWINS - GENETIC HERITABILITY AND SHARED ENVIRONMENTAL-INFLUENCES AMERICAN JOURNAL OF EPIDEMIOLOGY Austin, M. A., KING, M. C., BAWOL, R. D., Hulley, S. B., Friedman, G. D. 1987; 125 (2): 308-318

    Abstract

    The contributions of shared genes and shared environments to familial aggregation of coronary heart disease risk factors were investigated by genetic and epidemiologic analysis of 434 adult female twin pairs from the Kaiser-Permanente Twin Registry in Oakland, California, during 1978 and 1979. Initial estimates of genetic heritability were statistically significant for serum levels of high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and Quetelet index, but were only marginally significant for systolic and diastolic blood pressures. These estimates were biased, however, because sisters in the same identical twin pair were more similar than sisters in the same fraternal twin pair not only with respect to shared genes but also with respect to shared environmental and behavioral influences. Heritability was estimated again after adjusting for shared environmental and behavioral effects by multiple regression analysis. Genetic heritability remained significant for HDL cholesterol (0.66), LDL cholesterol (0.88), triglycerides (0.53), and relative weight (0.55) but not for systolic (0.42) and diastolic (0.25) blood pressures. The strong genetic components of the levels of LDL cholesterol, HDL cholesterol, and relative weight may in part explain why some women have high levels of these coronary disease risk factors despite following recommended health behaviors.

    View details for Web of Science ID A1987F823500016

    View details for PubMedID 3812436

  • SMOKING-HABITS AMONG MULTIPHASIC EXAMINEES, 1979 TO 1984 WESTERN JOURNAL OF MEDICINE Friedman, G. D., Sidney, S., Polen, M. R. 1986; 145 (5): 651-656

    Abstract

    In tabulating the smoking habits of 95,744 residents of the San Francisco Bay Area, as reported between July 1979 and June 1984 at multiphasic health checkups, the prevalence of current smoking was found to be higher in men than in women aged 30 years and above, but in those younger than 30 the reverse was true. In every age group, compared with male smokers, female smokers tended to smoke fewer cigarettes per day, to inhale less and to smoke cigarettes with lower tar and nicotine yield. Blacks showed the highest percentage of smokers, whites were second highest and Asians were lowest, with Asian women being substantially lower than other race-sex groups. On average, white smokers smoked more cigarettes per day and inhaled more than did black smokers, but whites were more apt to smoke low-yield cigarettes. Compared with a 1964 to 1968 study in the same setting, there has been a decrease in the prevalence of cigarette smokers but, among smokers, a higher proportion in 1979 to 1984 smoked at least 20 cigarettes per day. During the 1979 to 1984 period, there were small downward trends in the prevalence of cigarette smoking in men and white women and in the prevalence of heavy smoking among male smokers, but there was no apparent increase in the use of lower-yield cigarettes by smokers. Although this study group contained relatively fewer smokers, most of the age, sex and racial differences and long-term trends parallel what has been observed nationally.

    View details for Web of Science ID A1986E740600003

    View details for PubMedID 3798914

  • RELATIONS OF ALCOHOLIC BEVERAGE USE TO SUBSEQUENT CORONARY-ARTERY DISEASE HOSPITALIZATION AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Armstrong, M. A., Friedman, G. D. 1986; 58 (9): 710-714

    Abstract

    Unresolved questions about the inverse relation between alcohol consumption and coronary artery disease (CAD) include; Dose past drinking have a role in the apparently higher CAD risk of abstainers? Is the lower CAD risk found only among lighter drinkers? Does type of alcoholic beverage matter? Are abstainers at higher risk of CAD because symptoms or illness cause many to quit drinking? In a prospective study among 85,001 health examinees giving an alcohol history at a health examination from 1978 through 1982, 756 persons were later hospitalized for CAD in the same years. Using lifelong abstainers as the reference group and controlling for age, sex, race, smoking, coffee drinking and education, analysis showed that past drinkers and very infrequent drinkers had CAD risk similar to that of lifelong abstainers. A significantly and progressively lower CAD risk was found at higher drinking levels. Preference for wine, liquor or beer had no major independent effect. A subset of persons apparently free of CAD and other recent major illnesses showed a similar alcohol-CAD relation. Thus, this study suggests a negative answer to the 4 questions above and supports the view that alcohol protects against CAD. As most of the apparent protection was present at a daily intake of 1 to 2 drinks/day, an amount generally regarded as safe for most persons, the findings should not be used to justify heavier drinking.

    View details for Web of Science ID A1986E235900009

    View details for PubMedID 3766412

  • MULTIPLE-MYELOMA - RELATION TO PROPOXYPHENE AND OTHER DRUGS, RADIATION AND OCCUPATION INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Friedman, G. D. 1986; 15 (3): 424-426

    Abstract

    A case-control study involving 327 cases of multiple myeloma (MM) did not confirm that propoxyphene use is a predisposing factor. The evidence that any drugs are involved in the aetiology of MM is very weak. There was some suggestive evidence that x-ray therapy and certain occupations were predictors of MM.

    View details for Web of Science ID A1986E110500024

    View details for PubMedID 3771083

  • SERUM-CHOLESTEROL AND LARGE BOWEL-CANCER - A CASE-CONTROL STUDY AMERICAN JOURNAL OF EPIDEMIOLOGY Sidney, S., Friedman, G. D., Hiatt, R. A. 1986; 124 (1): 33-38

    Abstract

    A case-control study of the relationship of serum cholesterol to large bowel cancer incidence was performed for 245 members of the Kaiser Permanente Medical Care Program in northern California. Five controls were obtained for each case, matched for age, sex, race, and time of examination. The mean serum cholesterol levels of cases were not significantly different from those of controls for all colorectal cancers, right-sided colon cancers, and left-sided colon cancers. Analysis by quartiles of serum cholesterol level suggested neither a direct nor an inverse relationship between serum cholesterol and large bowel cancer, and there was no evidence of a threshold value below which the risk of cancer increased. The study did not support the findings from other studies of an inverse relationship between serum cholesterol and large bowel cancer.

    View details for Web of Science ID A1986C817300004

    View details for PubMedID 3717139

  • SERUM RETINOL AND RETINOL-BINDING PROTEIN-LEVELS DO NOT PREDICT SUBSEQUENT LUNG-CANCER AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Blaner, W. S., GOODMAN, D. S., Vogelman, J. H., Brind, J. L., Hoover, R., Fireman, B. H., Orentreich, N. 1986; 123 (5): 781-789

    Abstract

    Retinol and retinol-binding protein levels were measured in sera previously obtained, and stored in the frozen state, at multiphasic health checkups from 151 persons subsequently found to have lung cancer (cases) and 302 persons who remained free of cancer (controls). Two controls were matched to each case for sex, skin color, age, date of multiphasic health checkup, and aspects of the smoking habit. Mean levels in cases and controls were, respectively, retinol: 82.17 and 82.37 micrograms/dl (p = 0.93), and retinol-binding protein: 6.04 and 6.00 mg/dl (p = 0.81). Mean differences between cases and controls were, retinol: 0.195 micrograms/dl with 95% confidence limits, -3.91 and 4.30 micrograms/dl; retinol-binding protein: -0.033 mg/dl with 95% confidence limits, -0.31 and 0.24 mg/dl. No significant trend in relative risk of lung cancer was observed when the retinol or retinol-binding protein distribution was divided into quintiles. No significant associations were observed in subgroups based on age, sex, histologic type of cancer, cigarette consumption, or interval between blood drawing and cancer diagnosis. In this large study, retinol and retinol-binding protein levels were not useful in predicting the subsequent development of lung cancer.

    View details for Web of Science ID A1986A934800004

    View details for PubMedID 3962962

  • THE RELATIONSHIPS BETWEEN ALCOHOLIC BEVERAGE USE AND OTHER TRAITS TO BLOOD-PRESSURE - A NEW KAISER PERMANENT STUDY CIRCULATION Klatsky, A. L., Friedman, G. D., Armstrong, M. A. 1986; 73 (4): 628-636

    Abstract

    In a new study controlled for many factors, we reconfirmed the relationship of higher blood pressure to alcohol use. This relationship was slightly stronger in men, whites, and persons 55 years of age or older. A slight increase in blood pressure appeared in men who drank one to two drinks daily, and a continuous increase occurred at all higher drinking levels among white men who had constant drinking habits. Among women, an increase occurred only at three or more drinks daily. The data suggest complete regression, beginning within days, of alcohol-associated hypertension upon abstinence. Blood pressure showed minor differences with beverage preference: those who preferred liquor had higher adjusted mean blood pressure than those preferring wine or beer. The results of this study contribute to the likelihood that the alcohol-blood pressure association is causal. Smoking, coffee use, and tea use showed no association with higher blood pressure. Systolic pressure showed a positive relationship to total serum calcium and an inverse relationship to serum potassium, but diastolic pressure showed little relationship to these blood constituents; the explanations include a possible direct effect on regulation of blood pressure.

    View details for Web of Science ID A1986A581900004

    View details for PubMedID 3948365

  • MULTIPHASIC HEALTH CHECK-UP EVALUATION - A 16-YEAR FOLLOW-UP JOURNAL OF CHRONIC DISEASES Friedman, G. D., Collen, M. F., Fireman, B. H. 1986; 39 (6): 453-463

    Abstract

    The Multiphasic Health Checkup Evaluation Study, a long-term clinical trial, has been completed. A study group of 5156 men and women age 35-54 at entry was urged to have annual multiphasic health checkups (MHCs) for 16 years. A control group of 5557 comparable subjects was not so urged but was followed up in a comparable fashion. The mean and median number of MHCs per person were 6.8 and 6, respectively, in the study group and 2.8 and 1, respectively, in the control group. During 16 years the study group experienced a 30% reduction (p less than 0.05) in deaths from pre-specified "potentially postponable" causes, largely associated with lower death rates from colorectal cancer and hypertension. This reduction was most pronounced in the early years of the study. The two groups did not differ to a statistically significant degree in mortality from all other causes (84% of total mortality) or in total mortality. There was no difference in self-reported disability in the overall groups. In the setting of our prepaid health care plan where MHCs were already available on a voluntary basis, a program of urging middle-aged persons to undergo regular MHCs brought about a substantial reduction in mortality from preselected diseases.

    View details for Web of Science ID A1986C966800006

    View details for PubMedID 3711252

  • CARDIOVASCULAR AND OTHER DISEASES IN SMOKERS OF LOW YIELD CIGARETTES JOURNAL OF CHRONIC DISEASES Petitti, D. B., Friedman, G. D. 1985; 38 (7): 581-588

    Abstract

    The association of smoking low yield cigarettes with the risk of cancer, cardiovascular disease, and other disease associated previously with smoking is controversial. In 1979 we began a prospective epidemiologic study of this subject. We here report on the first 4 years of follow-up in the 16,270 current, regular cigarette smokers and the 42,113 subjects who never used any form of tobacco enrolled in the study. In multivariate analyses that included age, sex, race, number of cigarettes smoked per day and other factors related to cardiovascular disease, the risk of cardiovascular diseases was consistently higher in smokers of higher than in smokers of lower yield cigarettes, although the magnitude of the difference in risk was very small. The risks of cancer of the trachea, bronchus and lung, of all smoking-related cancers as a group, of diseases of the respiratory system, and of peptic ulcer diseases were not significantly associated with yield in smokers. The incidence rates of cardiovascular diseases considered as a group, cancer of the trachea, bronchus, and lung and all smoking-related cancers were higher in smokers of low yield cigarettes than in never users of any form of tobacco. We conclude that the smoking of low yield cigarettes is not without associated hazard. On the other hand, the results suggest that smokers who cannot quit might best use the least number of the lowest yield cigarette.

    View details for Web of Science ID A1985AME3600010

    View details for PubMedID 4008601

  • COFFEE, TEA AND CHOLESTEROL AMERICAN JOURNAL OF CARDIOLOGY Klatsky, A. L., Petitti, D. B., Armstrong, M. A., Friedman, G. D. 1985; 55 (5): 577-578

    View details for Web of Science ID A1985ACK2400015

    View details for PubMedID 3969902

  • RESPIRATORY MORBIDITY IN SMOKERS OF LOW-YIELD AND HIGH-YIELD CIGARETTES PREVENTIVE MEDICINE Petitti, D. B., Friedman, G. D. 1985; 14 (2): 217-225

    Abstract

    To study the association between smoking cigarettes with a low yield of tar and nicotine (tar less than 15.0 mg per cigarette and nicotine less than 1.0 mg) and respiratory disease, we reviewed the medical records of 4,610 current, regular cigarette smokers and 2,035 persons who had never used any form of tobacco and who were enrolled in a smoking study. In the year after recruitment to the study, the percentage of subjects with pneumonia or influenza was lower in female but not in male smokers of low-yield cigarettes. The percentage of subjects with any disease of the respiratory tract was lower in both male and female smokers of low-yield cigarettes. In multiple logistic regression analyses in which tar was included as a continuous variable and in which we also controlled for age, sex, race, and number of cigarettes smoked per day, smoking lower tar cigarettes was associated with lower risk for pneumonia or influenza, but not with the risk for other acute respiratory infections, other diseases of the upper respiratory tract, chronic obstructive pulmonary disease and allied conditions, or all respiratory diseases considered as a group. In other multiple logistic regression analyses, in which we controlled for age, race, and sex, smokers of low-yield cigarettes had a higher risk for pneumonia or influenza and chronic obstructive pulmonary disease when compared with subjects who had never used tobacco. We conclude that, with regard to pneumonia and influenza seen in an outpatient setting, smoking low-yield cigarettes is probably less hazardous than smoking high-yield cigarettes, but it still represents a considerable hazard compared with not smoking cigarettes at all.

    View details for Web of Science ID A1985APR8000008

    View details for PubMedID 4048084

  • THE ROLE OF ALCOHOL IN THE EPIDEMIOLOGY OF HYPERTENSION - IS ALCOHOL ASSOCIATED HYPERTENSION A COMMON PREVENTABLE DISEASE ANNALS OF CLINICAL RESEARCH Klatsky, A. L., Friedman, G. D. 1984; 16: 89-96

    Abstract

    It has become evident from a series of epidemiologic studies that an association exists between regular use of large amounts of alcoholic beverages and hypertension. In most studies, regular intake of smaller amounts of alcohol is not associated with hypertension but a possible threshold cannot be precisely defined at present. The relationship between alcohol and blood pressure is not attributable to demographic characteristics, obesity, reported salt use, smoking, or coffee use nor can it be explained by underreporting of alcohol consumption. If the relationship is causal then the pathogenesis is not yet firmly established. Multiple mechanisms, including direct effects of alcohol or of withdrawal from alcohol, are possible explanations. Alcohol shows a positive association with some sequelae of hypertension, but not to others. The most important exception is CHD, which is negatively associated with alcohol intake. Health professionals should not ignore the role of alcohol intake as a possible factor raising blood pressure in a certain proportion of hypertensive persons.

    View details for Web of Science ID A1984AGG7200014

    View details for PubMedID 6398987

  • TWIN STUDIES OF DISEASE HERITABILITY BASED ON MEDICAL RECORDS - APPLICATION TO ACNE-VULGARIS ACTA GENETICAE MEDICAE ET GEMELLOLOGIAE Friedman, G. D. 1984; 33 (3): 487-495

    Abstract

    Establishment of the Kaiser-Permanente Twin Registry permitted the study of disease heritability in twins based on review of the twins' medical records. The records of 930 pairs of twins were reviewed. Based on previous questionnaires, 342 pairs were MZ, 345 were DZ and 243 were of unknown zygosity. Because of the age distribution of these twins and the time period in which they received care, conditions of youth, such as acne vulgaris were most reliably studied. Heritability of acne was assessed in three ways; all indicated a substantial genetic influence. Certain problems with twin studies using medical records became apparent: 1) Zygosity information is often lacking; 2) Differing times and durations of observation of the two twins in each pair must be accounted for; 3) Categorization by diagnosis is difficult and strict criteria for diagnosis may be impractical; 4) Patients' behavior that affects assessment of disease concordance must be considered; 5) The order in which records are reviewed may influence apparent concordance.

    View details for Web of Science ID A1984AAQ6600016

    View details for PubMedID 6241419

  • DIGITALIS AND BREAST-CANCER LANCET Friedman, G. D. 1984; 2 (8407): 875-875

    View details for Web of Science ID A1984TM39300050

    View details for PubMedID 6148608

  • RISK-FACTORS FOR BENIGN BREAST DISEASE - A CASE-CONTROL STUDY OF DISCORDANT TWINS AMERICAN JOURNAL OF EPIDEMIOLOGY Odenheimer, D. J., Zunzunegui, M. V., KING, M. C., SHIPLER, C. P., Friedman, G. D. 1984; 120 (4): 565-571

    Abstract

    The influences of potential risk factors for benign breast disease were assessed using women twins in a matched pair design. Two groups of cases from the Kaiser-Permanente Twin Registry were considered: 1) 90 pairs of female twins in which one twin reported a history of benign breast disease confirmed by biopsy and her twin reported no history of benign breast disease, and 2) 48 pairs of female twins in which the case had clinically diagnosed fibrocystic benign breast disease and her twin was free of disease at examination and reported no history of the disease. Results were similar in these two samples. A significant positive association was found between benign breast disease and coffee consumption. Oral contraceptive use and greater body mass were inversely associated with benign breast disease after controlling for possible confounding variables by matched-pairs multiple logistic analysis. All associations were stronger for monozygotic than for dizygotic pairs. Twin pairs discordant for disease provide an excellent sample in which to assess the importance of potential risk factors while controlling for early environmental and genetic backgrounds.

    View details for Web of Science ID A1984TK71100008

    View details for PubMedID 6540984

  • EXOGENOUS ESTROGEN AND BREAST-CANCER AFTER BILATERAL OOPHORECTOMY CANCER Hiatt, R. A., BAWOL, R., Friedman, G. D., Hoover, R. 1984; 54 (1): 139-144

    Abstract

    Estrogen use in 119 women in whom breast cancer developed after surgically induced menopause was compared to use among an equal number of controls matched for age, date of bilateral oophorectomy, and duration of follow-up. No increased risk for estrogen use versus no use was evident (relative risk = 0.7). When the authors examined three measures of estrogen dose--number of chart notations of estrogen use, time since first use, and duration between first and last use--only those with greater than or equal to 5 notations had any significantly elevated risk (relative risk = 2.1; confidence limits 1.2-3.6), and there was a significant trend toward increasing risk with more notations (P = 0.03). Use specifically of conjugated estrogens was also associated with an increasing risk with more notation of estrogen use (P = 0.07). However, the other two measures of dose did not confirm this trend. Matched multiple logistic analysis suggested that number of notations of estrogen use conferred increased breast cancer risk (relative risk = 1.7), in dose-response relationships, but this result could have occurred by chance. Because of a lack of consistency, the generally low and statistically nonsignificant relative risks, and the lack of consistent effect modification in high-risk groups, the authors were unable to demonstrate a clear increased risk of breast cancer associated with replacement estrogen use.

    View details for Web of Science ID A1984SW28800027

    View details for PubMedID 6722739

  • SOME OBSTACLES TO THE EVALUATION AND EFFECTIVE PERFORMANCE OF HEALTH APPRAISALS WESTERN JOURNAL OF MEDICINE Friedman, G. D. 1984; 141 (6): 782-785

    Abstract

    Certain obstacles exist in evaluating screening tests and health examinations. When a voluntarily screened group is compared with an unscreened group and when the survival of cases detected in these two groups is compared, self-selection bias, lead-time bias, length bias and overdiagnosis confuse the evaluation and usually make an examination seem better than it really is. A randomized controlled trial overcomes these biases; one group is offered screening, the other is not and the outcomes in both entire groups are observed. Unavoidable crossovers between the groups tend to obscure any benefit of the examination, however. Evaluations of screening tests have tended to emphasize the value of positive results and have neglected the value of negative results. In obtaining maximum benefit from health appraisals, attention needs to be directed at self-selection, nonmedical threats to life and health, risk factors in addition to early disease and tailoring an examination to the needs of individual patients.

    View details for Web of Science ID A1984TY01500005

    View details for PubMedID 6523859

  • RACIAL PATTERNS OF ALCOHOLIC BEVERAGE USE ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Klatsky, A. L., SIEGELAUB, A. B., Landy, C., Friedman, G. D. 1983; 7 (4): 372-377

    Abstract

    Among 59,766 persons who had routine health examinations in the years 1978 through 1980, the proportions reporting drinking among self-classified racial groups were: white, 89.5%; Latin, 84.8%; Japanese, 81.9%; black, 79.8%; Chinese, 68.1%; Filipino, 63.9%. Reported use of 3 or more drinks daily was similar in whites, Latins, and blacks but was much lower in the Asian groups. Men of all races reported more drinking than women. A large proportion of drinkers in all race-sex subgroups reported use of small amounts of alcohol, and most nondrinkers reported lifelong abstinence. Wine drinking (2+ days/week) was favored over spirits or beer by whites of both sexes and women of most races; beer use was favored by men of all races except white. All race-sex groups reported a strong alcohol-cigarette smoking association. Comparison with data collected 15 years earlier showed a substantial decline in reported proportions of abstainers and heavier (3+) drinkers as well as apparent narrowing of race-sex differences.

    View details for Web of Science ID A1983RR08400005

    View details for PubMedID 6362460

  • PSYCHOLOGICAL QUESTIONNAIRE SCORE, CIGARETTE-SMOKING, AND MYOCARDIAL-INFARCTION - A CONTINUING ENIGMA PREVENTIVE MEDICINE Friedman, G. D., Fireman, B. H., Petitti, D. B., SIEGELAUB, A. B., URY, H. K., Klatsky, A. L. 1983; 12 (4): 533-540

    Abstract

    The ability of a group of 94 psychological questions to discriminate between men in whom cigarette smoking was associated with increased risk of myocardial infarction and men in whom smoking was not so associated remains puzzling. Further analyses, controlling for reported alcohol consumption and for a questionnaire item that might reflect physical activity, failed to alter this finding. This interaction of the questionnaire responses with smoking was not found with two other major coronary risk factors, serum cholesterol and systolic blood pressure. Believing that these observations may provide (a) a clue to how cigarette smoking affects risk of myocardial infarction, or (b) some means of identifying greater or lesser susceptibility to the effects of smoking, we invite other investigators to join in the pursuit of this matter. A list of ten selected yes-or-no questions with strong interaction with smoking is provided to assist others in studying this phenomenon; these are similar to ten items on the Minnesota Multiphasic Personality Inventory.

    View details for Web of Science ID A1983RE52900005

    View details for PubMedID 6622437

  • EVIDENCE FOR COMPENSATION IN SMOKERS OF LOW YIELD CIGARETTES INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Petitti, D. B., Friedman, G. D. 1983; 12 (4): 487-489

    Abstract

    To determine the relation of smoking low yield cigarettes (tar yield less than 15.0 mg and nicotine yield less than 1.0 mg per cigarette) to the number of cigarettes smoked per day, we analysed information provided on self-administered questionnaires by 7706 current, regular cigarette smokers. The mean age at starting to smoke and the mean number of years of smoking were not consistently different in smokers of low yield compared with smokers of high yield cigarettes. In contrast, at all ages in both men and women, smokers of low yield cigarettes smoked significantly more cigarettes per day than smokers of high yield cigarettes. The differences in the number of cigarettes smoked per day between smokers of low and high yield cigarettes were small--about 3 cigarettes per day in men and about 1 1/2 cigarettes per day in women. However, these small differences might translate to the smoking of as many as one billion more packs of cigarettes per year in the United States alone. The potential beneficial effect of the smoking of cigarettes whose yield per cigarette is lower must be weighed against a possible adverse effect of the smoking of more cigarettes if the relation between smoking low yield cigarettes and smoking more cigarettes is causal.

    View details for Web of Science ID A1983RU14600017

    View details for PubMedID 6654569

  • BARBITURATES, BENZODIAZEPINES AND LUNG-CANCER INTERNATIONAL JOURNAL OF EPIDEMIOLOGY Friedman, G. D. 1983; 12 (3): 375-376

    View details for Web of Science ID A1983RF16900020

    View details for PubMedID 6629629

  • ALCOHOL INTAKE AND HYPERTENSION ANNALS OF INTERNAL MEDICINE Friedman, G. D., Klatsky, A. L., SIEGELAUB, A. B. 1983; 98 (5): 846-849

    Abstract

    In several studies, persons drinking relatively large amounts of alcohol were found to have higher average blood pressures. The association between alcohol and blood pressure is not explained by adiposity; reported use of salt, coffee, or cigarettes; or by under-reporting of alcohol intake. We examined 12-year follow-up data on two matched groups of 850 hypertensive patients each; one group reported an intake of at least three alcoholic drinks per person per day, and the other group, fewer than three per day or none. Except for a lower rate of hospitalization for coronary disease, for which alcohol may be protective, cardiovascular complications leading to hospitalization or death had similar frequency in the two groups. These preliminary findings suggest that presumed alcohol-induced hypertension is as harmful as other forms of hypertension. A method for distinguishing alcohol-induced from non-alcohol-induced hypertension in drinkers is needed.

    View details for Web of Science ID A1983QP38400030

    View details for PubMedID 6847023

  • VASECTOMY AND THE INCIDENCE OF HOSPITALIZED ILLNESS JOURNAL OF UROLOGY Petitti, D. B., Klein, R., Kipp, H., Friedman, G. D. 1983; 129 (4): 760-762

    Abstract

    To determine the long-term effects of vasectomy on health we studied the incidence of hospitalized illness in 4,385 vasectomized and 13,155 age and race-matched nonvasectomized men. In none of the 16 disease groupings we examined was the incidence of hospitalized illness in the vasectomized men significantly different from that in the nonvasectomized men, considering men with all durations of vasectomy. Neither the incidence of acute myocardial infarction, other ischemic heart disease nor that of all atherosclerotic diseases considered as a group was significantly different between the vasectomized and nonvasectomized men, even in those whose duration of vasectomy was 10 years or more. These data are reassuring, providing no evidence for an adverse health effect of vasectomy in men.

    View details for Web of Science ID A1983QN33400017

    View details for PubMedID 6842696

  • THE RARITY OF CRYPTOCOCCOSIS IN NORTHERN-CALIFORNIA - THE 10-YEAR EXPERIENCE OF A LARGE DEFINED POPULATION AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D. 1983; 117 (2): 230-234

    Abstract

    The incidence of clinically manifest cryptococcosis was determined among over one million subscribers to the Kaiser-Permanente Medical Care Program in Northern California during the 10-year period 1971-1980. A total of 10 persons developed the disease, of whom two had no underlying immunosuppressive disease or therapy. The overall incidence was 0.8 per million persons per year; for nonimmunosuppressed individuals the incidence was estimated to be 0.2 per million per year. Incidence increased with age into the seventh decade of life and was greater in men than in women. The overall case fatality rate was 40 per cent. The data are not consistent with the view that cryptococcosis usually occurs in persons without obvious predisposing factors.

    View details for Web of Science ID A1983QB70000013

    View details for PubMedID 6829552

  • PREVALENCE AND CORRELATES OF PASSIVE SMOKING AMERICAN JOURNAL OF PUBLIC HEALTH Friedman, G. D., Petitti, D. B., BAWOL, R. D. 1983; 73 (4): 401-405

    Abstract

    The duration per week of exposure to others' tobacco smoke in different locations was tabulated from the questionnaire responses of 37,881 non-smokers and ex-smokers who received multiphasic health checkups in 1979 and 1980. Altogether 63.3 per cent of subjects reported some exposure, 34.5 per cent were exposed at least 10 hours per week, and 15.9 per cent at least 40 hours per week. Duration of exposure per week was weakly correlated with serum thiocyanate level in a small test group. Exposure was strongly related to age with a peak of 78.2 per cent in the twenties decade and an accelerating decline thereafter to 13.9 per cent in those age 80 and over. Sex and race were related to passive smoking only to a relatively small degree. Persons reporting longer exposures were more apt to report greater use of alcohol and marijuana, exposure to occupational hazards, and being currently not married. Lack of college education was most frequent among those denying exposure but was directly related to exposure duration among those reporting some passive smoking. Studies of the health effects of passive smoking should take into account these associated factors. Although the reported passive smoking of married persons was strongly related to their spouses' habits, categorization by spouses' smoking resulted in considerable misclassification.

    View details for Web of Science ID A1983QG54700008

    View details for PubMedID 6829823

  • SCREENING FOR POSSIBLE DRUG CARCINOGENICITY - 2ND REPORT OF FINDINGS JOURNAL OF THE NATIONAL CANCER INSTITUTE Friedman, G. D., URY, H. K. 1983; 71 (6): 1165-1175

    Abstract

    Cancer development was followed up through 1978 in 143,574 outpatients who were identified on the basis of computer-stored drug-dispensing data as users of various medicinal drugs during the 4-year period starting in July 1969. Screening analyses were repeated for the 95 most commonly used drugs and drug groups, which were reported previously after a shorter follow-up, and it was found that several drug-cancer associations had either gained or lost statistical significance since the report. Screening of 120 additional less commonly used drugs revealed one negative and 43 positive drug-cancer associations. A few of these associations suggested interesting new hypotheses about possible drug effects, but further study is required before conclusions on causality can be drawn. The absence of association with cancer for many drugs provides some provisional assurance for the absence of carcinogenicity, but further follow-up is needed to rule out later effects.

    View details for Web of Science ID A1983RZ74100010

    View details for PubMedID 6581357

  • RAUWOLFIA AND BREAST-CANCER - NO RELATION FOUND IN LONG-TERM USERS AGE 50 AND OVER JOURNAL OF CHRONIC DISEASES Friedman, G. D. 1983; 36 (5): 367-370

    Abstract

    It has been suggested that conflicting findings regarding rauwolfia drugs as predisposing factors for breast cancer can be explained by the hypothesis that use for a long duration predisposes to breast cancer occurring after age 50. In a follow-up study of 2077 women who received prescriptions for rauwolfia drugs there was no excess risk for breast cancer diagnosed at age 50 or greater (morbidity ratio = 0.9 compared to 1.0 expected). In comparing 35 patients in this age group with 168 women who received rauwolfia but remained free of breast cancer, there was no excess risk for long (greater than or equal to 5 yr) duration of use (relative risk = 0.9). Thus, the hypothesis could not be confirmed in this study group. It is likely that the excess risk among long-duration rauwolfia users, if present at all, is less than 2-fold.

    View details for Web of Science ID A1983QS10700002

    View details for PubMedID 6853662

  • Alcohol, tobacco, and hypertension. Hypertension Friedman, G. D., Klatsky, A. L., SIEGELAUB, A. B. 1982; 4 (5): III143-50

    Abstract

    In many studies of diverse populations it has been found that persons drinking relatively large amounts of alcohol tend to have higher blood pressures. In the Kaiser-Permanente study of about 87,000 persons, this alcohol-blood pressure association was not attributable to demographic characteristics, adiposity, reported salt use, smoking, or coffee consumption, nor could it be explained by underreporting of alcohol consumption. If the relationship is a causal one, the pathogenesis is not yet established; direct mechanisms or the effects of withdrawal from alcohol are possible explanations. The Kaiser-Permanente data suggest that about 5% of hypertension in the general population may be due to the consumption of three or more alcoholic drinks per day. Alcohol use shows a positive relation to some sequelae of hypertension but not others; the outstanding exception is coronary heart disease which is negatively related to alcohol intake, probably through different mechanisms. In most studies, cigarette smokers have shown similar or slightly lower blood pressures than non smokers. The degree to which this is due to the thinner body build of smokers, on the average, is not well established; nor is the degree to which a stronger negative relation of smoking to blood pressure might be masked by concomitant alcohol use.

    View details for PubMedID 7049929

  • Elimination of 'lead time' bias in assessing the effect of early breast cancer diagnosis. American journal of epidemiology Friedman, G. D. 1982; 115 (5): 801-802

    View details for PubMedID 7081210

  • BREAST-CANCER AND SERUM-CHOLESTEROL JOURNAL OF THE NATIONAL CANCER INSTITUTE Hiatt, R. A., Friedman, G. D., BAWOL, R. D., URY, H. K. 1982; 68 (6): 885-889

    Abstract

    Recent studies have suggested a role for dietary fat in the etiology of breast cancer. The relation of serum cholesterol and other serum lipid measures to breast cancer incidence was investigated in a cohort of 95, 179 women who had multiphasic health checkups from 1964 through 1972. Through 1977, 1,035 new breast cancer cases occurred in over 752,000 person-years of follow-up. Age-adjusted incidence rates were 1.45, 1.37, 1.31, and 1.40/1,000 person-years from the lowest to the highest quartile of serum cholesterol level, respectively. Similarly, no statistically significant relation was detected between beta-lipoprotein or total lipids and breast cancer. The sample size was sufficiently large to have detected a relative risk of 1.4 or larger with a probability of 99.9% at the 0.05 level of significance. The expected relation od breast cancer to established risk factors was confirmed by univariate analysis, and serum cholesterol and breast cancer were not associated after simultaneous consideration of nine other risk factors by multivariate analysis. These data suggest that the postulated causal relation between dietary fat and breast cancer does not act via an effect on circulating lipid levels.

    View details for Web of Science ID A1982NV23200003

    View details for PubMedID 6953271

  • PHYSIOLOGIC MEASURES IN MEN WITH AND WITHOUT VASECTOMIES FERTILITY AND STERILITY Petitti, D. B., Klein, R., Kipp, H., Kahn, W., SIEGELAUB, A. B., Friedman, G. D. 1982; 37 (3): 438-440

    View details for Web of Science ID A1982NG04900022

    View details for PubMedID 7060793

  • ALCOHOL, TOBACCO, AND HYPERTENSION HYPERTENSION Friedman, G. D., Klatsky, A. L., SIEGELAUB, A. B. 1982; 4 (5): 143-150
  • CHARACTERISTICS OF PATIENTS REFERRED FOR TREATMENT OF END-STAGE RENAL-DISEASE IN A DEFINED POPULATION AMERICAN JOURNAL OF PUBLIC HEALTH Hiatt, R. A., Friedman, G. D. 1982; 72 (8): 829-833

    Abstract

    We studied the incidence of referral for treatment of end-stage renal disease (ESRD) in the Kaiser Foundation Health Plan (KFHP) in northern California from 1972 through 1977. In this population of over 1 million persons, we found an age-adjusted annual incidence of 44.9 per million after 1973, when the Federal ESRD Program went into effect. Age-specific incidence was highest in in men greater than 70 years of age and in women in the 50- to 59-year age group; the male/female ratio was 1.4:1. The most common diagnoses of patients referred with ESRD were glomerulonephritis (11.4 per million per year), diabetic nephropathy (5.0 per million per year), primary hypertensive disease (3.1 per million per year), and polycystic kidney disease (2.4 per million per year). Estimated rates of referral for ESRD were highest for Blacks, lowest for Whites, and intermediate for Asians. Incidence varied by geographic area within the health plan service area and was highest where the percentage of the Black population was highest.

    View details for Web of Science ID A1982NY23300010

    View details for PubMedID 7091479

  • PEPTIC-ULCER DISEASE AND THE TAR AND NICOTINE YIELD OF CURRENTLY SMOKED CIGARETTES JOURNAL OF CHRONIC DISEASES Petitti, D. B., Friedman, G. D., Kahn, W. 1982; 35 (7): 503-507

    Abstract

    In order to examine the association of smoking cigarettes with a lower tar and nicotine yield to peptic ulcer disease, a common disease associated in past studies with cigarette smoking. We used questionnaire information provided by 9009 current regular cigarette smokers. The percentage who ever had peptic ulcer disease in smokers whose current cigarette yielded 0.00-0.81, 0.81-0.99, 1.00-1.27 and 1.28 + milligrams of nicotine per cigarette were 8.5, 9.2, 9.2 and 9.5, respectively . The percentages who ever has peptic ulcer in smokers whose current cigarette yielded 0.0-11.9, 12.0-15.9, 16.0-18.9 and 19.0+ milligrams of tar per cigarette were 8.6, 9.1, 8.9 and 10.8 per 100, respectively. In contrast, the percentages who ever had peptic ulcer disease increased with the smoking of a greater number of cigarettes, being 5.9, 8.8, 9.0, 11.8 and 10.5 in smokers of less than 10, 10-19, 20-29, 30-39 and 40+ cigarettes, respectively. In multiple logistic regression analyses, peptic ulcer disease was significantly (p = 0.002) associated with number of cigarettes (RR = 1.12 per 10 cigarettes; 95% CI 1.08, 1.16), age and sex. There was no significant association (both p's less than 0.10) either with the current cigarette's tar yield (RR = 1.09 per 10 milligrams; 95% CI 0.96, 1.25) or with its nicotine yield (RR = 1.15 per milligram; 95% CI 0.94, 1.42).

    View details for Web of Science ID A1982NV56800003

    View details for PubMedID 7085843

  • FREQUENCY OF UROLITHIASIS IN A PREPAID MEDICAL-CARE PROGRAM AMERICAN JOURNAL OF EPIDEMIOLOGY Hiatt, R. A., Dales, L. G., Friedman, G. D., Hunkeler, E. M. 1982; 115 (2): 255-265

    Abstract

    The rate of occurrence of stones of the urinary tract was assessed in a large population served by the Northern California Kaiser Foundation Health Plan. The study involved three separate groups. First, data were obtained by questionnaire from approximately 175,000 adults who took a multiphasic health checkup in the period 1964-1972; of these generally well adult members, 26.2/1000 persons (32.0/1000 men and 21.0/1000 women) reported having ever been told by a physician that they had a urinary tract stone. Second, data were obtained from 139,000 persons served by the San Francisco outpatient facility in 1970-1972; 1.22/1000 per year (1.81/1000 men and 0.59/1000 women) had an initial diagnosis of a "new or recurrent" stone of the upper urinary tract. The third set of data was procured from the entire Northern California region in 1971-1975; 0.36/1000 (0.52/1000 men and 0.19/1000 women) were discharged from a hospital each year with a diagnosis of upper urinary tract stone. All rates were age-adjusted to the 1960 US Census population. Of these three rates, the rate derived from the outpatient visit record most closely estimates incidence, since nearly all persons who are hospitalized are first seen as outpatients. Rates of kidney stone diagnosis were three times more common in men and, although rare before 20 years of age, the frequency increased rapidly and peaked in the age group 40 to 59 years. Rates were approximately twice as high in whites as in blacks and Orientals; the frequency of stones was inversely related to socioeconomic status as measured by level of education. Over 90% of stones occurred in the upper urinary tract, and the majority contained calcium oxalate. Population-based rates of occurrence of kidney stones are not generally available in the United States. Comparisons with the few available studies indicate that rates in the Kaiser Foundation Health Plan population may be high.

    View details for Web of Science ID A1982NC07300013

    View details for PubMedID 7058784

  • PHENYLBUTAZONE, MUSCULOSKELETAL DISEASE, AND LEUKEMIA JOURNAL OF CHRONIC DISEASES Friedman, G. D. 1982; 35 (4): 233-243

    Abstract

    Four hundred and nine patients age 30 and over with leukemia or lymphoma and a subset of 127 patients with myelocytic leukemia were compared with equal numbers of matched hospitalized control subjects and matched subscribers to the Kaiser-Permanente Medical Care Program (member controls). Prior use of phenylbutazone was somewhat more frequent in cases than in member controls only, but the difference was not statistically significant and the association appeared to be explained by an underlying relation of musculoskeletal disease to these lymphohematopoietic cancers. The association of musculoskeletal disease with myelocytic leukemia was present even when attention was restricted to the period at least two or five years before leukemia diagnosis. There was no clear association of amount and duration of phenylbutazone therapy with risk of leukemia. Several other drugs used for musculoskeletal conditions showed positive or negative relations to subsequent leukemia.

    View details for Web of Science ID A1982NJ79200001

    View details for PubMedID 7037810

  • THE FREQUENCY OF KIDNEY AND URINARY-TRACT DISEASES IN A DEFINED POPULATION KIDNEY INTERNATIONAL Hiatt, R. A., Friedman, G. D. 1982; 22 (1): 63-68

    Abstract

    The frequencies of kidney and urinary tract diseases (KUTD) in a defined population are presented. Rates of first hospitalizations with KUTD in the 5-year period, 1971 through 1975, were determined among over 1 million members of the Kaiser Foundation Health Plan (KFHP) of Northern California. Cases were identified from computer-stored ICDA-coded final discharge diagnoses for hospitalizations. Kidney and other urinary tract diseases were final diagnoses in 35.7 first hospitalizations per 10,000 members per year in the period 1971 through 1975. Disease-specific rates were highest for urinary tract infections, benign prostatic hypertrophy, and renal and ureteral calculi. The frequency of KUTD in this population is compared to available rates from other sources.

    View details for Web of Science ID A1982NX04000010

    View details for PubMedID 6181284

  • A SURVEY OF PERSONAL HABITS, SYMPTOMS OF ILLNESS, AND HISTORIES OF DISEASE IN MEN WITH AND WITHOUT VASECTOMIES AMERICAN JOURNAL OF PUBLIC HEALTH Petitti, D. B., Klein, R., Kipp, H., Kahn, W., SIEGELAUB, A. B., Friedman, G. D. 1982; 72 (5): 476-480

    Abstract

    Using questionnaire information provided by 4.385 vasectomized and 13,155 matched, non-vasectomized men, we found no significant differences between them for a large number of symptoms and diseases, including those of the cardiovascular system. After taking into account differences in their martial status, past smoking habits, and physical activity at work, significant statistical associations of vasectomy with joint pain or swelling, back trouble, and a history of kidney or bladder infection persisted. Our data are inconsistent with the occurrence of large increases in the risks of many important diseases in vasectomized humans.

    View details for Web of Science ID A1982NL34900010

    View details for PubMedID 7065336

  • Alcohol use and cardiovascular disease: the Kaiser-Permanente experience. Circulation Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B. 1981; 64 (3): III 32-41

    Abstract

    Earlier studies of Kaiser-Permanente data have indicated that regular use of alcohol is associated with a reduced risk of major coronary events and that regular use of three or more drinks is associated with an increased prevalence of hypertension. A new study of hospitalizations in relation to alcohol use confirms this disparity in relations between alcohol use and cardiovascular disease and suggests that alcoholic cardiomyopathy has a relatively low incidence. An inverse relation between alcohol use and hospitalizations for cholelithiasis raises the possibility of a common pathogenic mechanism linking alcohol to coronary events and cholelithiasis. Overall risk of cardiovascular disease seems lower among users of two or fewer drinks daily than among either nondrinkers or heavier drinkers.

    View details for PubMedID 7020982

  • MORTALITY IN CIGARETTE SMOKERS AND QUITTERS - EFFECT OF BASE-LINE DIFFERENCES NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D., Petitti, D. B., BAWOL, R. D., SIEGELAUB, A. B. 1981; 304 (23): 1407-1410

    View details for Web of Science ID A1981LR62000008

    View details for PubMedID 7231464

  • ALCOHOL AND MORTALITY - A 10-YEAR KAISER-PERMANENTE EXPERIENCE ANNALS OF INTERNAL MEDICINE Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B. 1981; 95 (2): 139-145

    Abstract

    We studied 10-year mortality in relation to baseline alcohol use habits among four groups of 2015 persons, well matched for age, sex, race, and cigarette smoking. Persons reporting daily use of two drinks or fewer fared best; the heaviest drinkers (six or more drinks) had a doubled mortality rate, and users of three to five drinks had a mortality rate, and users of three to five drinks had a mortality rate approximately 50% higher. The nondrinkers had a mortality rate similar to that of users of three to five drinks per day. Cancer, cirrhosis, accidents, and nonmalignant respiratory conditions contributed significantly to the excess mortality of the heavier drinkers; coronary disease mortality was significantly higher among nondrinkers. Smoking intensity was a possible factor in the increased mortality of heavier drinkers, but the data were also compatible with the hypothesis that smoking and drinking are synergistic in the production of certain cancers and nonmalignant chronic respiratory illness. Other traits associated with alcohol use or abstinence are possible contributors to the excess mortality of both heavy drinkers and nondrinkers.

    View details for Web of Science ID A1981MB92800002

    View details for PubMedID 7258861

  • ACCURACY OF INFORMATION ON SMOKING-HABITS PROVIDED ON SELF-ADMINISTERED RESEARCH QUESTIONNAIRES AMERICAN JOURNAL OF PUBLIC HEALTH Petitti, D. B., Friedman, G. D., Kahn, W. 1981; 71 (3): 308-311

    Abstract

    In the setting of a prepaid medical care plan, self-administered questionnaires were an accurate source of information on smoking habits and the standard against which the physiologic measures of smoking, serum thiocyanate, and expired carbon monoxide, must be judged. Questionnaire responses were internally consistent and highly reproducible. In contrast, the physiologic measures had low overall sensitivity as tests of current tobacco exposure (0.72). Their sensitivity was improved by utilizing the self-reported information.

    View details for Web of Science ID A1981LE22900018

    View details for PubMedID 7468869

  • ALCOHOL-USE AND CARDIOVASCULAR-DISEASE - THE KAISER-PERMANENTE EXPERIENCE CIRCULATION Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B. 1981; 64 (3): 32-41
  • BARBITURATES AND LUNG-CANCER IN HUMANS JOURNAL OF THE NATIONAL CANCER INSTITUTE Friedman, G. D. 1981; 67 (2): 291-295

    Abstract

    In a hypothesis-generating study looking for possible carcinogenic effects of drugs in humans, each of three barbiturates (pentobarbital sodium, phenobarbital, and secobarbital sodium) showed a statistically significant association with the subsequent development of lung cancer, with relative risks ranging from 1.5 to 2.8. Further analysis showed that the association was not explained by the increased prescription of barbiturate drugs shortly before the diagnosis of lung cancer or by an association of barbiturate use with cigarette smoking. Much of the data did not support a causal relationship. Neither a relation of lung cancer to duration or intensity of use not one between barbiturate use and a specific histologic type could be demonstrated.

    View details for Web of Science ID A1981MD41500008

    View details for PubMedID 6943368

  • Characteristics of smoking- discordant monozygotic twins. Progress in clinical and biological research Friedman, G. D., KING, M. C., Klatsky, A. L., Hulley, S. B. 1981; 69: 17-22

    View details for PubMedID 7198240

  • ASSOCIATION OF A HISTORY OF GALLBLADDER-DISEASE WITH A REDUCED CONCENTRATION OF HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL NEW ENGLAND JOURNAL OF MEDICINE Petitti, D. B., Friedman, G. D., Klatsky, A. L. 1981; 304 (23): 1396-1398

    View details for Web of Science ID A1981LR62000005

    View details for PubMedID 7231462

  • CHANGES AFTER QUITTING CIGARETTE-SMOKING CIRCULATION Friedman, G. D., SIEGELAUB, A. B. 1980; 61 (4): 716-723

    Abstract

    Changes in cardiorespiratory symptoms and coronary disease risk indicators over an average 1 1/2-year period were assessed in 9392 persistent cigarette smokers and 3825 persons who quit smoking between two multiphasic checkups. The prevalence of questionnaire-reported chronic cough fell markedly in subjects who quit a one-or-more-pack/day habit (e.g., from 11.2% to 1.8% in white men, p less than 0.001). However, chest pain, shortness of breath and exertional leg pain showed no consistent improvement in quitters compared with persistent smokers. Weight gain was about 2-3 lbs greater in quitters, but changes in blood pressure were small and not consistent across race-sex groups, nor were there consistent differences between persistent smokers and quitters in trends in trends in vital capacity, cholesterol or prevalence of ECG abnormality. Quitting was associated with increase in serum uric acid levels of about 0.2-0.5 mg/dl and relative falls in hemoglobin, leukocyte count and serum glucose levels, all consistent with smoker-nonsmoker differences previously found in cross-sectional studies. Except for the small increases in weight and uric acid levels, quitting smoking did not appear to increase risk of coronary heart disease by other mechanisms.

    View details for Web of Science ID A1980JL68900008

    View details for PubMedID 7357713

  • DIAGNOSIS OF TWIN ZYGOSITY BY SELF-ASSESSMENT AND BY GENETIC-ANALYSIS ACTA GENETICAE MEDICAE ET GEMELLOLOGIAE KING, M. C., Friedman, G. D., LATTANZIO, D., Rodgers, G., Lewis, A. M., DUPUY, M. E., Williams, H. 1980; 29 (2): 121-126

    Abstract

    For 173 pairs of like-sex adult twins, self-assessment of zygosity was verified by laboratory diagnosis. Seventeen percent of twins who were very likely monozygous (MZ) believed themselves dizygous (DZ), frequently citing two placentas at their delivery as "evidence." We suggest that twins be asked what leads them to their assessment of their own zygosity. For 93% of Caucasian and 89% of American Black like-sex twins in our sample, DZ twins could be differentiated based on six polymorphic markers retrievable from frozen sera. MZ twins who believe themselves DZ can be considered "environmentally DZ, genetically MZ" twins, and might be used to study genetic and environmental influences on the treatment of twins and on twins' choices of social characteristics.

    View details for Web of Science ID A1980LD88500004

    View details for PubMedID 6942630

  • INITIAL SCREENING FOR CARCINOGENICITY OF COMMONLY USED DRUGS JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE Friedman, G. D., URY, H. K. 1980; 65 (4): 723-733

    Abstract

    Computer-stored drug-dispensing data for 143,574 outpatients were used to identify users of various medicinal drugs during the 4-year period beginning in July 1969. These patients were followed through 1976 for the development of cancer. This report presents the results of screening analyses for 95 commonly used drugs and drug groups in relation to 56 primary cancer sites and combinations of sites. Statistically significant positive or negative associations with at least one site were found for 53 drugs. Some of these associations were undoubtedly due to chance sampling variation; some confirmed previous reports; some suggested interesting new hypotheses concerning possible drug effects or other etiologic or preventive factors. Further study is required before conclusions as to causality can be reached. Although the duration of follow-up in this study is relatively short so far, the absence of associations for many of the drugs studied provides some provisional assurance of their lack of carcinogenic effects.

    View details for Web of Science ID A1980KJ52600014

    View details for PubMedID 6932525

  • CANCER AFTER METRONIDAZOLE NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D. 1980; 302 (9): 519-519

    View details for Web of Science ID A1980JF79900011

    View details for PubMedID 7351980

  • CIGARETTE-SMOKING AND CORONARY HEART-DISEASE - NEW EVIDENCE AND OLD REACTIONS AMERICAN HEART JOURNAL Friedman, G. D. 1980; 99 (3): 398-399

    View details for Web of Science ID A1980JH23600017

    View details for PubMedID 7355701

  • EVALUATING PERIODIC MULTIPHASIC HEALTH CHECKUPS - CONTROLLED TRIAL JOURNAL OF CHRONIC DISEASES Dales, L. G., Friedman, G. D., Collen, M. F. 1979; 32 (5): 385-404

    View details for Web of Science ID A1979GZ33200006

    View details for PubMedID 109452

  • MORTALITY IN MIDDLE-AGED SMOKERS AND NON-SMOKERS NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D., Dales, L. G., URY, H. K. 1979; 300 (5): 213-217

    Abstract

    We assessed the relation of cigarette smoking to mortality in an 11-year follow-up study of 4004 men and women, 35 to 54 years of age, who responded to urging to have multiphasic health checkups. Accounting for 48 other characteristics, both individually and in combination, failed to eliminate the association of smoking with mortality from all causes or with mortality from coronary heart disease. The smoker-to-nonsmoker mortality ratios, crude and adjusted respectively, were 2.6 and 2.1 for all causes and 4.7 and 3.6 for coronary heart disease. This analysis did not support the counterhypothesis that the association of cigarette smoking with mortality is secondary to some underlying characteristic.

    View details for Web of Science ID A1979GG07400001

    View details for PubMedID 759867

  • CASE-CONTROL STUDY OF RELATIONSHIPS OF DIET AND OTHER TRAITS TO COLORECTAL CANCER IN AMERICAN BLACKS AMERICAN JOURNAL OF EPIDEMIOLOGY Dales, L. G., Friedman, G. D., URY, H. K., Grossman, S., Williams, S. R. 1979; 109 (2): 132-144

    Abstract

    Ninety-nine black colorectal cancer patients and 280 matched controls from hospitals and multiphasic health checkup clinics were interviewed about past dietary habits and other traits. The colon cancer cases tended to report less frequent use of foods with at least 0.5% fiber content than did their controls. This relationship, though small, showed a consistent dose-response gradient, appeared in both case-hospital control and case-multiphasic health checkup control comparisons, and could not be accounted for by the effects of other variables. Colon and rectosigmoid junction cancer patients tended to have eaten foods with at least 5% saturated fat somewhat more often than controls. When consumption of these two groups of foods was considered in combination, significantly more colon cancer patients than controls reported a high saturated fat foods-low fibrous foods eating pattern, as opposed to a low saturated fat foods-high fibrous foods diet. Statistically significant excesses of the following traits were also reported by the colorectal cancer patients: prolonged cigar smoking in men, nulliparity in women, and history of colorectal polyps.

    View details for Web of Science ID A1979GJ39200003

    View details for PubMedID 425952

  • ALCOHOL USE, MYOCARDIAL-INFARCTION, SUDDEN CARDIAC DEATH, AND HYPERTENSION ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B. 1979; 3 (1): 33-39

    Abstract

    Studying coronary risk factors, this article concludes that: regular use of alcohol may protect against major coronary events; regular use of three or more drinks daily is a probable risk factor for hypertension; the relations of alcohol use to coronary disease, hypertension, and cardiomyopathy are disparate.

    View details for Web of Science ID A1979GG50000008

    View details for PubMedID 371449

  • CHARACTERISTICS PREDICTIVE OF CORONARY HEART-DISEASE IN EX-SMOKERS BEFORE THEY STOPPED SMOKING - COMPARISON WITH PERSISTENT SMOKERS AND NON-SMOKERS JOURNAL OF CHRONIC DISEASES Friedman, G. D., SIEGELAUB, A. B., Dales, L. G., SELTZER, C. C. 1979; 32 (1-2): 175-190

    View details for Web of Science ID A1979HC23400025

    View details for PubMedID 447777

  • Alcohol and hypertension. Comprehensive therapy Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B. 1978; 4 (12): 60-68

    View details for PubMedID 738015

  • CIGARETTE-SMOKING HABITS AND URINE CHARACTERISTICS - URINALYSIS ABNORMALITIES ARE MORE COMMON IN SMOKERS, BUT REASONS ARE UNCLEAR NEPHRON Dales, L. G., Friedman, G. D., SIEGELAUB, A. B., SELTZER, C. C., URY, H. K. 1978; 20 (3): 163-170
  • Cigarette smoking habits and urine characteristics: urinalysis abnormalities are more common is smokers, but the reasons are unclear. Nephron Dales, L. G., Friedman, G. D., SIEGELAUB, A. B., SELTZER, C. C., URY, H. K. 1978; 20 (3): 167-170

    Abstract

    Voided urines of 53,000 white and 9,3000 black cigarette smokers and nonsmokers were studied. Proteinuria was found to be commoner in smokers of both races and sexes. Heavy smokers showed proteinuria more frequently than light smokers. Of eight possible explanatory variables, one, alcohol consumption history, showed some interrelationship in that the smoking status-proteinuria association disappeared among heavy drinkers. Stopping smoking was not associated with a relative decline in proteinuria prevalence. Proteinuria associated with smoking did not appear to be indicative of more serious renal disease. There was a smoker-nonsmoker difference in urine glucose response to oral glucose challenge, apparently explained by higher average 1-hour serum glucose values for smokers, of unknown mechanism but partially explained by differences in alcohol usage. Hematuria, bacteriuria, and high urine acidity tended to be more prevalent in smokers, though these relationships were not consistently significant.

    View details for PubMedID 628498

  • The Kaiser-Permanente Twin Registry. Progress in clinical and biological research Friedman, G. D., Lewis, A. M. 1978; 24: 173-177

    View details for PubMedID 569305

  • STUDY OF TIME TRENDS IN MATERNAL-FETAL X-RAY EXPOSURE AMERICAN JOURNAL OF EPIDEMIOLOGY Dales, L. G., URY, H. K., Friedman, G. D., Eads, W. 1977; 106 (5): 362-369

    View details for Web of Science ID A1977EB18200003

    View details for PubMedID 597366

  • POTENTIAL PITFALL IN STUDYING TRAIT-DISCORDANT TWINS AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D. 1977; 105 (4): 291-295

    View details for Web of Science ID A1977DC16700001

    View details for PubMedID 848478

  • ALCOHOL CONSUMPTION AND BLOOD-PRESSURE - KAISER-PERMANENTE MULTIPHASIC HEALTH EXAMINATION DATA NEW ENGLAND JOURNAL OF MEDICINE Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B., Gerard, M. J. 1977; 296 (21): 1194-1200

    Abstract

    We studied blood pressure in relation to known drinking habits of 83,947 men and women of three races (83.5 per cent white). Using health-check-up questionnaire responses, we classified persons as nondrinkers or according to usual daily number of drinks: two or fewer per day, three to five per day, or six or more per day. As compared to nondrinkers blood pressures of men taking two or fewer drinks per day were similar. Women who took two or fewer drinks per day had slightly lower pressures. Men and women who took three or more drinks per day had higher systolic pressures (P less than 10(-24) in white men, and less than 10(-12) in white women), higher diastolic pressures (P less than 10(-24) in white men, and less than 10(-6) in white women), and substantially higher prevalence of pressures greater than or equal to 160/95 mm Hg. The associations of blood pressure and drinking were independent of age, sex, race, smoking, coffee use, former "heavy" drinking, educational attainment and adiposity. The findings strongly suggest that regular use of three or more drinks of alcohol per day is a risk factor for hypertension.

    View details for Web of Science ID A1977DF96000003

    View details for PubMedID 854058

  • SERUM GLUCOSE LEVELS AND ALCOHOL-CONSUMPTION HABITS IN A LARGE POPULATION DIABETES Gerard, M. J., Klatsky, A. L., SIEGELAUB, A. B., Friedman, G. D., Feldman, R. 1977; 26 (8): 780-785

    Abstract

    Using information from approximately 100,000 multiphasic check-ups performed in these facilities, we have found an association between alcohol-drinking habits and serum glucose values one hour after an oral challenge with 75 gm. of glucose. There was a positive dose-response relation between reported alcohol intake and serum glucose level over the most common range of alcohol intake. Serum glucose levels were highest in the group who consumed six to eight alcoholic drinks per day. However, among those who said they took nine or more drinks per day, mean serum glucose levels were significantly lower than in the six-to-eight-drink group. These relations persisted when the analysis was controlled for the effects of age, sex, race, adiposity, time since last food intake, time of day, previously known diabetes, and previously known liver disease. A search of the literature failed to uncover a complete explanation for these phenomena.

    View details for Web of Science ID A1977DT15500010

    View details for PubMedID 885299

  • Oral contraceptives and hypertension. Contributions to nephrology Friedman, G. D. 1977; 8: 213-220

    Abstract

    A variety of studies have noted that the use of oral contraceptives generally leads to mild increases in blood pressure which are usually reversible when the medication is discontinued. Representative data from the Walnut Creek Contraceptive Drug Study and the Royal College of General Practitioners Study concerning the magnitude of excess risk and relation to duration of use and pull content are shown. Preliminary data from women, aged 25-34 years, taking multiphasic health checkups in Oakland and San Francisco, suggest that black as well as white women are susceptible to this side effect of oral contraceptives. A method is given for estimating the proportion of hypertensives among a population of young women that is attributable to oral contraceptive use. Although the risk of pull-induced hypertension is small for the average user, oral contraceptives appear to be an important identifiable cause of hypertension in samples of women studied.

    View details for PubMedID 302197

  • ALCOHOL CONSUMPTION AMONG WHITE, BLACK, OR ORIENTAL MEN AND WOMEN - KAISER-PERMANENTE MULTIPHASIC HEALTH EXAMINATION DATA AMERICAN JOURNAL OF EPIDEMIOLOGY Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B., Gerard, M. J. 1977; 105 (4): 311-323

    Abstract

    Alcohol consumption habits as recorded on health checkup questionnaires by 91,659 white, black, or Oriental men and women were studied. Substantial age, sex, and race differences in alcohol consumption were reported. Generally, men drank more than women, drinking was most prevalent among whites and least prevalent among Orientals, and the highest proportion of drinkers was found in the age decades 20-29 and 30-39 years. Consumption of 3+ drinks per day was most prevalent in the age decades 40-49 and 50-59. The proportion of nondrinkers diminished with increasing educational attainment. Alcohol use showed a strong positive assocaition with cigarette smoking, a weaker positive association with coffee use, and no relation to blood group within race. A complex relation was observed between alcohol use and adiposity, which differed for the various sex-race subgroups. It is concluded that age, sex, race, educational attainment, smoking, and adiposity are potentially significant confounders of studies of alcohol use and health.

    View details for Web of Science ID A1977DC16700004

    View details for PubMedID 848480

  • LUNG-FUNCTION AND OUTCOME OF MYOCARDIAL-INFARCTION NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D., Klatsky, A. L., SIEGELAUB, A. B. 1976; 295 (23): 1323-1323

    View details for Web of Science ID A1976CM59200024

    View details for PubMedID 980073

  • MEDICAL USAGE AND ABUSAGE - PREVALENCE AND INCIDENCE ANNALS OF INTERNAL MEDICINE Friedman, G. D. 1976; 84 (4): 502-504

    Abstract

    In view of the frequent misuse of the term "incidence," the concepts of incidence, prevalence, and period prevalence are defined and illustrated. The importance of restricting "incidence" to the rate of development of new events in a population or a group of patients, per unit of time, is stressed. Clearly distinguishing incidence from prevalence or simple proportion can help both in the understanding and the communication of findings in patient groups.

    View details for Web of Science ID A1976BL75900051

    View details for PubMedID 1259307

  • MEDICAL HISTORY QUESTIONS PREDICTIVE OF MYOCARDIAL-INFARCTION - RESULTS FROM KAISER-PERMANENTE EPIDEMIOLOGIC-STUDY OF MYOCARDIAL-INFARCTION JOURNAL OF CHRONIC DISEASES Klatsky, A. L., Friedman, G. D., SIEGELAUB, A. B. 1976; 29 (11): 683-696

    View details for Web of Science ID A1976CM19300002

    View details for PubMedID 1032891

  • CLINDAMYCIN AND DIARRHEA JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Friedman, G. D., Gerard, M. J., URY, H. K. 1976; 236 (22): 2498-2500

    Abstract

    Of 298 outpatients receiving clindamycin for a variety of indications, diarrhea developed in ten (3.4%); none were diagnosed as having pseudo-membranous colitis. This is well within the range of relative frequencies of diarrhea development (0% to 22.2%) reported in 45 previous studies. Reliance solely on computer-recorded instances of diarrhea yielded a substantial underestimate of diarrhea occurence, but the rate was still significantly higher (P less than .05) in clindamycin users than in nonusers.

    View details for Web of Science ID A1976CM93600019

    View details for PubMedID 136523

  • LUNG-FUNCTION AND RISK OF MYOCARDIAL-INFARCTION AND SUDDEN CARDIAC DEATH NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D., ARTHUR, M. S., KLATSKY, L., SIEGELAUB, A. B. 1976; 294 (20): 1071-1075

    Abstract

    In a serach for risk factors for myocardial infarction and sudden cardiac death, the mean total vital capacity as measured at multiphasic health checkups was lower in persons who later had a first myocardial infarction than in risk-factor-matched controls (3.17 vs. 3.29 liters, 395 pairs, P less than 0.05) and non-risk-factor-matched controls (3.16 vs. 3.41 liters, 401 pairs, P less than 0.001). Findings were little affected by age and height adjustment and were similar for sudden cardiac death. The first-second vital capacity was also inversely related to later development of these conditions, but the ratio of that measurement to total vital capacity was not. Heavy smoking, productive cough, exertional dyspnea and cardiac enlargement were associated with diminished total capacity. However, exclusion of subjects with these findings did not reduce the predictive value of total vital capacity. Diminished vital capacity deserves continued attention as a possible coronary risk factor. Its relation to subsequent coronary events is not well explained.

    View details for Web of Science ID A1976BQ72500001

    View details for PubMedID 1256523

  • Predictors of sudden cardiac death. Circulation Friedman, G. D., Klatsky, A. L., SIEGELAUB, A. B. 1975; 52 (6): III164-9

    Abstract

    A search was made for predictors of sudden cardiac death (SCD) among 197 men, age 40 to 79, who had multiphasic health checkups and experienced SCD 2 days to 5 1/2 years later (mean 18.1 months). Two age-sex-race-matched control groups, one matched and one unmatched for standard coronary risk factors, have been compared to the cases. In this ambulatory population, SCD occurred largely in persons with prior diagnosed heart disease. Standard coronary risk factors were confirmed as predictors of SCD. Predictors among other laboratory and quantitative tests include chylous serum, uric acid, hemoglobin, leukocyte count, pulse rate, diminished lung volumes, and hearing loss. Some of these had predictive value independent of standard risk factors. Pain tolerance was not related to SCD or to death in, versus out of hospital. Most of these predictors were not related to terminal symptom duration; this suggests a relationship more to the underlying atherosclerotic process than to the terminal fatal mechanism.

    View details for PubMedID 1182969

  • CIGARETTE-SMOKING AND CHEST PAIN ANNALS OF INTERNAL MEDICINE Friedman, G. D., SIEGELAUB, A. B., Dales, L. G. 1975; 83 (1): 1-7

    Abstract

    Analysis of questionnaire responses of 70208 persons undergoing multiphasic health checkups showed a greater proportion of cigarette smokers than nonsmokers (excesses averaging 1.6-fold in white men, 1.3-fold in white women) admitting to nine types of chest pain. This excess in smokers was greater in younger individuals, and applied about equally to anginalike and nonanginalike pain. The smoking/chest pain association was not explained by greater alcohol or coffee consumption, diminished pain tolerance, or less reliability among smokers; nor did it appear to be mediated chiefly by excess cough, shortness of breath, coronary disease, or musculoskeletal complaints in smokers. Although smokers averaged more complaints than nonsmokers, chest pain resembled clearly smoking-related symptoms, such as cough, when the number of each subject's complaints was considered. Although more smokers had chest pain no type of pain was unique to smokers, suggesting that the "tobacco angina" concept be discarded or reserved for rare patients with coronary heart disease in whom smoking clearly provokes angina pectoris.

    View details for Web of Science ID A1975AH46400001

    View details for PubMedID 1147421

  • CHARACTERISTICS OF HEAVY USERS OF OUTPATIENT PRESCRIPTION DRUGS CLINICAL TOXICOLOGY LECH, S. V., Friedman, G. D., URY, H. K. 1975; 8 (6): 599-610

    Abstract

    One hundred fifty-eight users of eight or more different prescription drugs in a three-month period were identified, using computerstored pharmacy data. Compared with 99 "light" users of only one or two different drugs, these heavy users were more likely to be older, female, and white and to have blue collar occupations, if male, or to be housewives, if female. Heavy drug use was associated with greater use of other medical care and was usually a persistent characteristic. Prepayment for drug prescriptions was not associated with heavy use. Among heavy users were found some severely ill individuals, and some with emotional problems that appear to contribute to symptoms and requests for drugs. In a 21-month period, adverse drug reactions were experienced by 28% of heavy users as compared with 8% of light users.

    View details for Web of Science ID A1975BT07900002

    View details for PubMedID 1227767

  • PREDICTORS OF SUDDEN CARDIAC DEATH CIRCULATION Friedman, G. D., Klatsky, A. L., SIEGELAUB, A. B. 1975; 52 (6): 164-169
  • IS INCREASED RISK OF MYOCARDIAL-INFARCTION IN CIGARETTE SMOKERS DUE TO PSYCHOLOGICAL TRAITS - ATTEMPTED EXPLORATION USING PSYCHOLOGICAL QUESTIONNAIRE RESPONSES PREVENTIVE MEDICINE Friedman, G. D., SIEGELAUB, A. B., URY, H. K., Klatsky, A. L. 1975; 4 (4): 526-532

    View details for Web of Science ID A1975BD40000013

    View details for PubMedID 1208364

  • Letter: Leukocyte count and myocardial infarction: correction. New England journal of medicine Friedman, G. D., Klatsky, A. L., SIEGELAUB, A. B. 1974; 291 (25): 1361-?

    View details for PubMedID 4427631

  • SMOKING-HABITS AND PAIN TOLERANCE ARCHIVES OF ENVIRONMENTAL HEALTH SELTZER, C. C., Friedman, G. D., SIEGELAU, A. B., Collen, M. F. 1974; 29 (3): 170-172

    View details for Web of Science ID A1974T978300011

    View details for PubMedID 4843774

  • CIGARETTES, ALCOHOL, COFFEE AND PEPTIC-ULCER NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D., SIEGELAU, A. B., SELTZER, C. C. 1974; 290 (9): 469-473

    View details for Web of Science ID A1974S185000001

    View details for PubMedID 4810814

  • HEALTH SERVICE UTILIZATION BY SMOKERS AND NONSMOKERS MEDICAL CARE OAKES, T. W., Friedman, G. D., SELTZER, C. C., SIEGELAU, A. B., Collen, M. F. 1974; 12 (11): 958-966

    View details for Web of Science ID A1974U617700007

    View details for PubMedID 4444367

  • PSYCHOLOGICAL QUESTIONNAIRE PREDICTIVE OF MYOCARDIAL-INFARCTION - RESULTS FROM KAISER-PERMANENTE EPIDEMIOLOGIC STUDY OF MYOCARDIAL-INFARCTION PSYCHOSOMATIC MEDICINE Friedman, G. D., URY, H. K., Klatsky, A. L., SIEGELAU, A. B. 1974; 36 (4): 327-343

    View details for Web of Science ID A1974T692600006

    View details for PubMedID 4153260

  • SMOKING AND DRUG CONSUMPTION IN WHITE, BLACK, AND ORIENTAL MEN AND WOMEN AMERICAN JOURNAL OF PUBLIC HEALTH SELTZER, C. C., Friedman, G. D., SIEGELAU, A. B. 1974; 64 (5): 466-473

    View details for Web of Science ID A1974S682700014

    View details for PubMedID 4150426

  • RACIAL DIFFERENCES IN SERUM AND URINE GLUCOSE AFTER GLUCOSE CHALLENGE DIABETES Dales, L. G., SIEGELAU, A. B., Feldman, R., Friedman, G. D., SELTZER, C. C., Collen, M. F. 1974; 23 (4): 327-332

    View details for Web of Science ID A1974S801900012

    View details for PubMedID 4823912

  • KAISER-PERMANENTE EPIDEMIOLOGIC STUDY OF MYOCARDIAL-INFARCTION - STUDY DESIGN AND RESULTS FOR STANDARD RISK-FACTORS AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Klatsky, A. L., SIEGELAU, A. B., McCarthy, N. 1974; 99 (2): 101-116

    View details for Web of Science ID A1974S275800004

    View details for PubMedID 4810625

  • CIGARETTE-SMOKING AND SERUM CHEMISTRY TESTS JOURNAL OF CHRONIC DISEASES Dales, L. G., Friedman, G. D., SIEGELAU, A. B., SELTZER, C. C. 1974; 27 (6): 293-307

    View details for Web of Science ID A1974T859300004

    View details for PubMedID 4430699

  • DIFFERENCES IN PULMONARY-FUNCTION RELATED TO SMOKING-HABITS AND RACE AMERICAN REVIEW OF RESPIRATORY DISEASE SELTZER, C. C., SIEGELAU, A. B., Friedman, G. D., Collen, M. F. 1974; 110 (5): 598-608

    View details for Web of Science ID A1974U657000010

    View details for PubMedID 4429256

  • HEARING-LOSS IN ADULTS - RELATION TO AGE, SEX, EXPOSURE TO LOUD NOISE, AND CIGARETTE-SMOKING ARCHIVES OF ENVIRONMENTAL HEALTH SIEGELAU, A. B., Friedman, G. D., ADOUR, K., SELTZER, C. C. 1974; 29 (2): 107-109

    View details for Web of Science ID A1974T748300009

    View details for PubMedID 4835178

  • LEUKOCYTE COUNT AS A PREDICTOR OF MYOCARDIAL-INFARCTION NEW ENGLAND JOURNAL OF MEDICINE Friedman, G. D., Klatsky, A. L., SIEGELAU, A. B. 1974; 290 (23): 1275-1278

    View details for Web of Science ID A1974T131100002

    View details for PubMedID 4827627

  • SOCIAL-CLASS AND RACIAL DIFFERENCES IN BLOOD-PRESSURE AMERICAN JOURNAL OF PUBLIC HEALTH Syme, S. L., OAKES, T. W., Friedman, G. D., Feldman, R., SIEGELAU, A. B., COLLEN, M. 1974; 64 (6): 619-620

    View details for Web of Science ID A1974T059600023

    View details for PubMedID 4829079

  • EVALUATION OF A PERIODIC MULTIPHASIC HEALTH CHECKUP METHODS OF INFORMATION IN MEDICINE Dales, L. G., Friedman, G. D., Collen, M. F. 1974; 13 (3): 140-146

    View details for Web of Science ID A1974T754800002

    View details for PubMedID 4424992

  • ALCOHOL CONSUMPTION BEFORE MYOCARDIAL-INFARCTION - RESULTS FROM KAISER-PERMANENTE EPIDEMIOLOGIC STUDY OF MYOCARDIAL-INFARCTION ANNALS OF INTERNAL MEDICINE Klatsky, A. L., Friedman, G. D., SIEGELAU, A. B. 1974; 81 (3): 294-301

    View details for Web of Science ID A1974U112500002

    View details for PubMedID 4850474

  • Multiphasic checkup evaluation study. 4. Preliminary cost benefit analysis for middle-aged men. Preventive medicine Collen, M. F., Dales, L. G., Friedman, G. D., Flagle, C. D., Feldman, R., SIEGELAUB, A. B. 1973; 2 (2): 236-246

    View details for PubMedID 4723639

  • Multiphasic checkup evaluation study. 3. Outpatient clinic utilization, hospitalization, and mortality experience after seven years. Preventive medicine Dales, L. G., Friedman, G. D., Ramcharan, S., SIEGELAUB, A. B., Campbell, B. A., Feldman, R., Collen, M. F. 1973; 2 (2): 221-235

    View details for PubMedID 4723638

  • Multiphasic checkup evaluation study. 1. Methods and population. Preventive medicine Cutler, J. L., Ramcharan, S., Feldman, R., SIEGELAUB, A. B., Campbell, B., Friedman, G. D., Dales, L. G., Collen, M. F. 1973; 2 (2): 197-206

    View details for PubMedID 4723635

  • Multiphasic checkup evaluation study. 2. Disabilty and chronic disease after seven years of multiphasic health checkups. Preventive medicine Ramcharan, S., Cutler, J. L., Feldman, R., SIEGELAUB, A. B., Campbell, B., Friedman, G. D., Dales, L. G., Collen, M. F. 1973; 2 (2): 207-220

    View details for PubMedID 4723637

  • Smoking habits and the leukocyte count. Archives of environmental health Friedman, G. D., SIEGELAUB, A. B., SELTZER, C. C., Feldman, R., Collen, M. F. 1973; 26 (3): 137-143

    View details for PubMedID 4688852

  • SOCIAL FACTORS IN NEWLY DISCOVERED ELEVATED BLOOD PRESSURE JOURNAL OF HEALTH AND SOCIAL BEHAVIOR OAKES, T. W., Syme, S. L., Feldman, R., Friedman, G. D., SIEGELAU, A. B., Collen, M. F. 1973; 14 (3): 198-204

    View details for Web of Science ID A1973R938300002

    View details for PubMedID 4754416

  • COFFEE DRINKING PRIOR TO ACUTE MYOCARDIAL-INFARCTION - RESULTS FROM KAISER-PERMANENTE EPIDEMIOLOGIC STUDY OF MYOCARDIAL-INFARCTION JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Klatsky, A. L., Friedman, G. D., SIEGELAU, A. B. 1973; 226 (5): 540-543

    View details for Web of Science ID A1973R050200002

    View details for PubMedID 4800303

  • CIGARETTE-SMOKING AND EXPOSURE TO OCCUPATIONAL HAZARDS AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D., SIEGELAU, A. B., SELTZER, C. C. 1973; 98 (3): 175-183

    View details for Web of Science ID A1973Q931800003

    View details for PubMedID 4741838

  • MAIL SURVEY RESPONSE BY HEALTH STATUS OF SMOKERS, NONSMOKERS, AND EX-SMOKERS AMERICAN JOURNAL OF EPIDEMIOLOGY OAKES, T. W., Friedman, G. D., SELTZER, C. C. 1973; 98 (1): 50-55

    View details for Web of Science ID A1973Q633400006

    View details for PubMedID 4780927

  • Survey of stroke epidemiology studies: Committee on Criteria and Methods, Council of Epidemiology, American Heart Association. Stroke; a journal of cerebral circulation Kuller, L. H., Cook, L. P., Friedman, G. D. 1972; 3 (5): 579-585

    View details for PubMedID 4652732

  • BIOCHEMICAL SCREENING-TESTS - EFFECT OF PANEL SIZE ON MEDICAL-CARE ARCHIVES OF INTERNAL MEDICINE Friedman, G. D., Goldberg, M., BASSIS, M. L., AHUJA, J. N., SIEGELAU, A. B., COLLEN, M. I. 1972; 129 (1): 91-?

    View details for Web of Science ID A1972L287100011

    View details for PubMedID 4550300

  • SCREENING CRITERIA FOR DRUG MONITORING - KAISER-PERMANENTE DRUG REACTION MONITORING SYSTEM JOURNAL OF CHRONIC DISEASES Friedman, G. D. 1972; 25 (1): 11-?

    View details for Web of Science ID A1972L822400002

    View details for PubMedID 5027328

  • PAIN TOLERANCE - DIFFERENCES ACCORDING TO AGE, SEX AN RACE PSYCHOSOMATIC MEDICINE WOODROW, K. M., Friedman, G. D., SIEGELAU, A. B., Collen, M. F. 1972; 34 (6): 548-556

    View details for Web of Science ID A1972O208200007

    View details for PubMedID 4644663

  • SMOKING AMONG WHITE, BLACK, AND YELLOW MEN AND WOMEN - KAISER-PERMANENTE MULTIPHASIC HEALTH EXAMINATION DATA, 1964-1968 AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Collen, M. F., SIEGELAU, A. B., SELTZER, C. C., Feldman, R. 1972; 96 (1): 23-?

    View details for Web of Science ID A1972N006500003

    View details for PubMedID 5039726

  • EXPERIENCE IN MONITORING DRUG REACTIONS IN OUTPATIENTS - KAISER-PERMANENTE DRUG MONITORING SYSTEM JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Friedman, G. D., Collen, M. F., Harris, L. E., VANBRUNT, E. E., Davis, L. S. 1971; 217 (5): 567-?

    View details for Web of Science ID A1971J932600001

    View details for PubMedID 5109088

  • Systolic hypertension in the elderly. An epidemiologic assessment. Circulation COLANDREA, M. A., Friedman, G. D., Nichaman, M. Z., LYND, C. N. 1970; 41 (2): 239-245

    View details for PubMedID 5412985

  • SYSTOLIC HYPERTENSION IN ELDERLY . AN EPIDEMIOLOGIC ASSESSMENT CIRCULATION COLANDRE, M. A., Friedman, G. D., Nichaman, M. Z., LYND, C. N. 1970; 41 (2): 239-?
  • TRANSIENT ISCHEMIC ATTACKS IN A COMMUNITY JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Friedman, G. D., Wilson, W. S., MOSIER, J. M., COLANDRE, M. A., Nichaman, M. Z. 1969; 210 (8): 1428-?

    View details for Web of Science ID A1969E712400002

    View details for PubMedID 4242838

  • RELATIONSHIP OF STROKE TO OTHER CARDIOVASCULAR DISEASE CIRCULATION Friedman, G. D., LOVELAND, D. B., EHRLICH, S. P. 1968; 38 (3): 533-?

    View details for Web of Science ID A1968B770100012

    View details for PubMedID 5673605

  • CIGARETTE SMOKING AND GEOGRAPHIC VARATION IN CORONARY HEART DISEASE MORTALITY IN UNITED STATES JOURNAL OF CHRONIC DISEASES Friedman, G. D. 1967; 20 (10): 769-?

    View details for Web of Science ID A1967A548500002

    View details for PubMedID 6080820

  • AN EVALUATION OF FOLLOW-UP METHODS IN FRAMINGHAM HEART STUDY AMERICAN JOURNAL OF PUBLIC HEALTH AND THE NATIONS HEALTH Friedman, G. D., Kannel, W. B., DAWBER, T. R., MCNAMARA, P. M. 1967; 57 (6): 1015-?

    View details for Web of Science ID A19679485700018

    View details for PubMedID 6067346

  • COMPARISON OF PREVALENCE CASE HISTORY AND INCIDENCE DATA IN ASSESSING POTENCY OF RISK FACTORS IN CORONARY HEART DISEASE AMERICAN JOURNAL OF EPIDEMIOLOGY Friedman, G. D., Kannel, W. B., DAWBER, T. R., MCNAMARA, P. M. 1966; 83 (2): 366-?

    View details for Web of Science ID A19667894400019

    View details for PubMedID 5933418

  • EPIDEMIOLOGY OF GALLBLADDER DISEASE - OBSERVATIONS IN FRAMINGHAM STUDY JOURNAL OF CHRONIC DISEASES Friedman, G. D., Kannel, W. B., DAWBER, T. R. 1966; 19 (3): 273-?

    View details for Web of Science ID A19667534300006

    View details for PubMedID 5910970

  • RISK FACTORS IN CORONARY HEART DISEASE - EVALUATION OF SEVERAL SERUM LIPIDS AS PREDICTORS OF CORONARY HEART DISEASE - FRAMINGHAM STUDY ANNALS OF INTERNAL MEDICINE Kannel, W. B., GLENNON, W. E., MCNAMARA, P. M., Friedman, G. D., DAWBER, T. R. 1964; 61 (5P1): 888-?

    View details for Web of Science ID A19644654A00009

    View details for PubMedID 14233810

  • THE USE OF COMPUTERS IN CARDIOVASCULAR EPIDEMIOLOGY PROGRESS IN CARDIOVASCULAR DISEASES DAWBER, T. R., Kannel, W. B., Friedman, G. D. 1963; 5 (4): 406-417

    View details for Web of Science ID A1963WS33900008

    View details for PubMedID 14025560

Conference Proceedings


  • Alcohol drinking and risk of hemorrhagic stroke Klatsky, A. L., Armstrong, M. A., Friedman, G. D., Sidney, S. KARGER. 2002: 115-122

    Abstract

    In view of conflicting prior reports, we prospectively studied associations between alcohol consumption and subsequent hospitalization for hemorrhagic stroke (HS) in 431 persons. Alcohol use was determined at examinations in 1978-1984 among 128,934 members of a prepaid health plan. Cox proportional hazards models, with 6 covariates, yielded the following multivariate relative risks (95% CI's) for HS: lifelong abstainers (ref) = 1.0, exdrinkers = 0.9 (0.5-1.5), persons drinking <1/month = 1.1 (0.8-1.4), >1/month; <1 drink/day = 0.7 (0.5-0.9), 1-2/day = 0.8 (0.6-1.1), 3-5/day = 1.0 (0.6-1.5), 6+/day = 1.9 (1.0-3.5). Relationships to alcohol were similar for subarachnoid (31% of HS) or intracerebral hemorrhage (69% of HS) and in men or women. Beverage choice (wine, beer, and liquor) was not independently related. We conclude that only heavy drinking is weakly related to increased HS risk and that light drinking need not be proscribed with respect to HS risk.

    View details for Web of Science ID 000175589100003

    View details for PubMedID 12006774

  • Exposure to environmental tobacco smoke: association with personal characteristics and self reported health conditions Iribarren, C., Friedman, G. D., Klatsky, A. L., Eisner, M. D. B M J PUBLISHING GROUP. 2001: 721-728

    Abstract

    To examine the association between exposure to environmental tobacco smoke (ETS) and demographic, lifestyle, occupational characteristics and self reported health conditions.Cross sectional study, using data from multiphasic health checkups between 1979 and 1985.Large health plan in Northern California, USA.16 524 men aged 15-89 years and 26 197 women aged 15-105 years who never smoked.Sixty eight per cent of men and 64 per cent of women reported any current ETS exposure (at home, in small spaces other than home or in large indoor areas). The exposure time from all three sources of ETS exposure correlated negatively with age. Men and women reporting high level ETS exposure were more likely to be black and never married or separated/divorced, to have no college or partial college education, to consume three alcoholic drink/day or more and to report exposure to several occupational hazards. Consistent independent relations across sexes were found between any current exposure to ETS and a positive history of hay fever/asthma (odds ratio (OR)=1.22 in men, 1.14 in women), hearing loss (OR=1.30 in men, 1.27 in women), severe headache (OR=1.22 in men, 1.17 in women), and cold/flu symptoms (OR=1.52 in men, 1.57 in women). Any current ETS exposure was also associated with chronic cough (OR=1.22) in men and with heart disease (OR=1.10) in women. Self reported stroke was inversely associated with any current ETS exposure in men (OR=0.27). No associations were noted for cancer or tumour and for migraine.ETS exposure correlated with several personal characteristics potentially associated with adverse health outcomes. Although the study design precluded causal inference, ETS exposure was associated with several self reported acute and chronic medical conditions.

    View details for Web of Science ID 000171160400008

    View details for PubMedID 11553655

  • Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men Iribarren, C., Tekawa, I. S., Sidney, S., Friedman, G. D. MASSACHUSETTS MEDICAL SOC. 1999: 1773-1780

    Abstract

    The sale of cigars in the United States has been increasing for the past six years. Cigar smoking is a known risk factor for certain cancers and for chronic obstructive pulmonary disease (COPD). However, unlike the relation between cigarette smoking and cardiovascular disease, the association between cigar smoking and cardiovascular disease has not been clearly established.We performed a cohort study among 17,774 men 30 to 85 years of age at base line (from 1964 through 1973) who were enrolled in the Kaiser Permanente health plan and who reported that they had never smoked cigarettes and did not currently smoke a pipe. Those who smoked cigars (1546 men) and those who did not (16,228) were followed from 1971 through the end of 1995 for a first hospitalization for or death from a major cardiovascular disease or COPD, and through the end of 1996 for a diagnosis of cancer.In multivariate analysis, cigar smokers, as compared with nonsmokers, were at higher risk for coronary heart disease (relative risk, 1.27; 95 percent confidence interval, 1.12 to 1.45), COPD (relative risk, 1.45; 95 percent confidence interval, 1.10 to 1.91), and cancers of the upper aerodigestive tract (relative risk, 2.02; 95 percent confidence interval, 1.01 to 4.06) and lung (relative risk, 2.14; 95 percent confidence interval, 1.12 to 4.11), with evidence of dose-response effects. There appeared to be a synergistic relation between cigar smoking and alcohol consumption with respect to the risk of oropharyngeal cancers and cancers of the upper aerodigestive tract.Independently of other risk factors, regular cigar smoking can increase the risk of coronary heart disease, COPD, and cancers of the upper aerodigestive tract and lung.

    View details for Web of Science ID 000080726800001

    View details for PubMedID 10362820

  • NATURAL-HISTORY OF ASYMPTOMATIC AND SYMPTOMATIC GALLSTONES Friedman, G. D. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 1993: 399-404

    Abstract

    Review of the sparse literature on the prognosis of asymptomatic and mildly symptomatic gallstones reveals a diversity of methods, definitions, and groups of patients studied, which makes it difficult to draw conclusions. It appears that serious symptoms and complications develop in about 1% to 2% of patients with asymptomatic gallstones annually, with fewer complications developing in later years than in years soon after gallstones are discovered. In patients with stones with mild symptoms, rates of the development of complications are perhaps a little higher, about 1% to 3% per year. In patients who are initially mildly symptomatic, cholecystectomy for severe symptoms probably is undertaken in 6% to 8% per year in the early years, decreasing with longer follow-up. Other than symptoms, no factors related to prognosis have been established. Acute cholecystitis is the most common severe complication of gallstones. Based on follow-up studies, obstructive jaundice, cholangitis, pancreatitis, and cancer of the gallbladder are infrequent complications. Risk of subsequent colon cancer should not ordinarily be a factor when cholecystectomy is considered. Analyses of cost-effectiveness have not demonstrated substantial differences in life expectancy between patients with asymptomatic gallstones who undergo immediate open cholecystectomy compared with watchful waiting.

    View details for Web of Science ID A1993KY34500003

    View details for PubMedID 8480871

  • EPIDEMIOLOGIC SCREENING FOR POTENTIALLY CARCINOGENIC DRUGS Friedman, G. D., Selby, J. V. BIRKHAUSER VERLAG. 1990: 83-96

    Abstract

    This paper describes a unique program for the systematic screening of commonly used prescription drugs for possible carcinogenic effects, by following up a large cohort of patients with computer-stored pharmacy data for incidence of cancer. Among the most interesting findings in recent analyses are an association of several antibiotics with subsequent lung cancer, and negative associations of prescribed vitamin E and diazepam with certain cancers. Analyses of additional data do not clearly indicate that these represent causal relationships to the drugs themselves. Also of interest is our continuing negative evidence regarding reserpine and metronidazole. The planned computerization of all pharmacies in our medical care program now serving over 2.2 million subscribers, should greatly increase our drug surveillance capabilities.

    View details for Web of Science ID A1990BQ12Q00006

    View details for PubMedID 2316434

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