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Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan

OBJECTIVE: To clarify the causes of deaths among patients with Itai-itai disease and severe cadmium (Cd) poisoning. DESIGN: Nested case–control analysis of a population-based cohort study. SETTING: Database of patients with Itai-itai disease and residents of Cd-polluted areas, maintained by the Mini...

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Autores principales: Nishijo, Muneko, Nakagawa, Hideaki, Suwazono, Yasushi, Nogawa, Kazuhiro, Kido, Teruhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734474/
https://www.ncbi.nlm.nih.gov/pubmed/28710217
http://dx.doi.org/10.1136/bmjopen-2016-015694
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author Nishijo, Muneko
Nakagawa, Hideaki
Suwazono, Yasushi
Nogawa, Kazuhiro
Kido, Teruhiko
author_facet Nishijo, Muneko
Nakagawa, Hideaki
Suwazono, Yasushi
Nogawa, Kazuhiro
Kido, Teruhiko
author_sort Nishijo, Muneko
collection PubMed
description OBJECTIVE: To clarify the causes of deaths among patients with Itai-itai disease and severe cadmium (Cd) poisoning. DESIGN: Nested case–control analysis of a population-based cohort study. SETTING: Database of patients with Itai-itai disease and residents of Cd-polluted areas, maintained by the Ministry of Environment, Japan. PARTICIPANTS: Subjects included 142 women with Itai-itai disease, 111 women with Cd-induced renal tubular dysfunction and 253 controls matched for sex, age and occupation. All subjects participated in a health impact survey between 1979 and 1984 and were followed until 30 November 2005. MAIN OUTCOMES AND MEASURES: Adjusted HRs with 95% CIs for cause of death in women with Itai-itai disease and screened female cases with tubular dysfunction were compared with matched pair controls, using Cox’s proportional hazard model. Vital statistics data were used to determine cause of death. Direct causes of death from autopsy records were used in 29 patients who died from Cd poisoning. RESULTS: The most common cause of death among patients with Itai-itai disease was pneumonia, with a significantly increased adjusted HR of 4.54 (95% CI 2.65 to 7.76). Renal diseases were the most common cause of death in renal tubular dysfunction cases, with an increased HR of 12.0 (95% CI 3.92 to 36.8). The adjusted HR for renal diseases was also significantly increased in patients with Itai-itai disease (19.49 (95% CI 6.43 to 59.09)), with a greater impact on mortality of patients with Itai-itai disease than screened cases. The HR for gastrointestinal (GI) diseases was significantly increased (13.79 (95% CI 3.87 to 49.10)) in patients, especially in the first 10 years (37.1 (4.81 to 286.0)). CONCLUSIONS: Among patients with Itai-itai disease, pneumonia and GI diseases contributed to increased mortality risk. Renal disease is also a significant mortality risk in patients with Itai-itai disease and women with renal tubular dysfunction.
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spelling pubmed-57344742017-12-20 Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan Nishijo, Muneko Nakagawa, Hideaki Suwazono, Yasushi Nogawa, Kazuhiro Kido, Teruhiko BMJ Open Epidemiology OBJECTIVE: To clarify the causes of deaths among patients with Itai-itai disease and severe cadmium (Cd) poisoning. DESIGN: Nested case–control analysis of a population-based cohort study. SETTING: Database of patients with Itai-itai disease and residents of Cd-polluted areas, maintained by the Ministry of Environment, Japan. PARTICIPANTS: Subjects included 142 women with Itai-itai disease, 111 women with Cd-induced renal tubular dysfunction and 253 controls matched for sex, age and occupation. All subjects participated in a health impact survey between 1979 and 1984 and were followed until 30 November 2005. MAIN OUTCOMES AND MEASURES: Adjusted HRs with 95% CIs for cause of death in women with Itai-itai disease and screened female cases with tubular dysfunction were compared with matched pair controls, using Cox’s proportional hazard model. Vital statistics data were used to determine cause of death. Direct causes of death from autopsy records were used in 29 patients who died from Cd poisoning. RESULTS: The most common cause of death among patients with Itai-itai disease was pneumonia, with a significantly increased adjusted HR of 4.54 (95% CI 2.65 to 7.76). Renal diseases were the most common cause of death in renal tubular dysfunction cases, with an increased HR of 12.0 (95% CI 3.92 to 36.8). The adjusted HR for renal diseases was also significantly increased in patients with Itai-itai disease (19.49 (95% CI 6.43 to 59.09)), with a greater impact on mortality of patients with Itai-itai disease than screened cases. The HR for gastrointestinal (GI) diseases was significantly increased (13.79 (95% CI 3.87 to 49.10)) in patients, especially in the first 10 years (37.1 (4.81 to 286.0)). CONCLUSIONS: Among patients with Itai-itai disease, pneumonia and GI diseases contributed to increased mortality risk. Renal disease is also a significant mortality risk in patients with Itai-itai disease and women with renal tubular dysfunction. BMJ Publishing Group 2017-07-13 /pmc/articles/PMC5734474/ /pubmed/28710217 http://dx.doi.org/10.1136/bmjopen-2016-015694 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Epidemiology
Nishijo, Muneko
Nakagawa, Hideaki
Suwazono, Yasushi
Nogawa, Kazuhiro
Kido, Teruhiko
Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan
title Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan
title_full Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan
title_fullStr Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan
title_full_unstemmed Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan
title_short Causes of death in patients with Itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in Japan
title_sort causes of death in patients with itai-itai disease suffering from severe chronic cadmium poisoning: a nested case–control analysis of a follow-up study in japan
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734474/
https://www.ncbi.nlm.nih.gov/pubmed/28710217
http://dx.doi.org/10.1136/bmjopen-2016-015694
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