Associations between only pro-inflammatory components of AIDI and bladder cancer risk, overall and by disease stage (1998–2020).

Supplementary Table 4 summarises baseline characteristics of Swedish men and women by quartiles of the Anti-Inflammatory Diet Index (AIDI; maximum score 13), including participant numbers, follow-up time (person-years), age, education, smoking pack-years, BMI, employment status, history of hypertension and diabetes, family history of cancer, and total energy intake. It also presents mean (±SD) consumption of the AIDI food components (anti-inflammatory and pro-inflammatory items) by quartile, together with p-values for overall differences across quartiles; civil status is reported for men only because it was not available in the women’s cohort.

Supplementary Table 8 reports stratified associations between the Anti-Inflammatory Diet Index (AIDI) and bladder cancer risk by baseline smoking status (never vs ever smokers). Hazard ratios (HRs) and 95% confidence intervals are presented for AIDI quartiles (Q2–Q4 vs Q1) for baseline AIDI (1998) and for AIDI modelled as a repeated measure (1998 and 2009; cumulative-average method), including p-values for trend within each smoking stratum. Fully adjusted Model 3 covariates are specified, and p-values for interaction between AIDI trend and smoking group are provided for both exposure specifications.

There is evidence that persistent dysregulation of the immune system caused by SARS-CoV-2 infection may increase susceptibility to other infections. Here, we assessed whether it is associated with subsequent diagnoses of infectious mononucleosis due to Epstein-Barr virus (EBV-IM). Residents of Sweden aged 3-100 years without a prior diagnosis of EBV-IM were followed between January 1, 2020, and November 30, 2022, comprising a total of 9 978 860 participants. Individuals were categorized into those without a COVID-19 diagnosis, those with a positive SARS-CoV-2 polymerase chain reaction (PCR) test only - less severe exposure, and those admitted to hospital with COVID-19 - more severe exposure. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for the association between the exposure, modeled as a time-varying covariate, and EBV-IM occurrence. EBV-IM rates per 100 000 person-years and 95% CIs were 4.6 (4.4-4.9) for individuals not diagnosed with COVID-19, 7.8 (6.9-8.9) for those with a positive SARS-CoV-2 test only, and 10.5 (6.2-17.6) for patients admitted to hospital with COVID-19. HR and 95% CI were 1.61 (1.39-1.88) for people with a positive PCR test only and 5.71 (3.33-9.79) for those admitted to hospital with COVID-19 compared with people without a COVID-19 diagnosis, after adjustment for birth year, sex, Swedish healthcare region, region of birth, and Charlson comorbidity index. SARS-CoV-2 infection was associated with a subsequent raised risk of EBV-IM, including among those with less severe acute infection, signaling immune perturbation and the possibility of further delayed sequelae linked with EBV-IM.

Associations between only anti-inflammatory components of AIDI and bladder cancer risk, overall and by disease stage (1998–2020).

Supplementary Table 7 shows lagged sensitivity analyses evaluating the association between the Anti-Inflammatory Diet Index (AIDI) and bladder cancer risk after excluding cases diagnosed early in follow-up (no lag, 2-year lag, and 3-year lag). For each lag period, the table reports the number of excluded cases, remaining cases and person-years, hazard ratios (HRs) with 95% confidence intervals for AIDI quartiles (Q2–Q4 vs Q1), and p-values for trend, using fully adjusted Model 3 for baseline AIDI (1998) and for AIDI modelled as a repeated measure (1998 and 2009; cumulative-average method).

Descriptive baseline characteristics of Swedish men and women by quartiles of the AIDI (maximum score = 13).

Background:Dietary patterns with anti-inflammatory properties have been linked to lower risks of several chronic diseases and some cancers, but their impact on survival after cancer is less well understood. Objective:We assessed whether a higher prediagnostic Anti-Inflammatory Diet Index (AIDI) score was associated with all-cause mortality after urologic cancer diagnosis, with urologic cancer-specific mortality evaluated as a secondary end point. Design setting and participants:In the Cohort of Swedish Men and the Swedish Mammography Cohort, incident urologic cancers and deaths were identified through Swedish registers. AIDI was derived from food-frequency questionnaires (1997; 2009 in a subset) and defined as the assessment at least 2 yr before diagnosis, preferentially 2009 when available. Follow-up ran from diagnosis to death, emigration, or December 31, 2020. Outcome measurements and statistical analysis:Cox models estimated hazard ratios (HRs) per 1 standard deviation (SD) higher AIDI, adjusting for demographic factors, lifestyle, comorbidities, and total energy intake. Fine-Gray models assessed urologic cancer-specific mortality while accounting for death from other causes as a competing event. Results and limitations:Among 7686 patients with valid AIDI, 6609 had complete covariate data, including 4990 patients with prostate cancer. During follow-up, 3281 deaths occurred, including 1435 urologic cancer deaths. Each 1-SD higher AIDI was associated with lower all-cause mortality (HR = 0.91, 95% confidence interval [CI] = 0.88-0.95). Evidence for an association with urologic cancer-specific mortality was weak and borderline in cause-specific Cox models (HR = 0.95, 95% CI = 0.90-1.00) and was attenuated in competing-risk analysis (subdistribution HR = 0.97, 95% CI = 0.92-1.02). Conclusions:Higher prediagnostic AIDI was associated with lower all-cause mortality after urologic cancer diagnosis. Whether this reflects a causal effect of diet or residual confounding, healthy-lifestyle clustering, health care engagement bias, or differences in competing noncancer mortality requires further study.

Supplementary Table 6 presents sensitivity analyses examining whether additional adjustment for alcohol intake and/or leisure-time physical activity influences the association between the Anti-Inflammatory Diet Index (AIDI) and bladder cancer risk. Hazard ratios (HRs) and 95% confidence intervals are shown for quartiles of AIDI (Q2–Q4 vs Q1) and p-values for trend, using Model 3 for baseline AIDI (1998) and for AIDI modelled as a repeated measure (1998 and 2009; cumulative-average method). Results are reported for the full sample and for complete-case subsets for alcohol, physical activity, and both combined, with models additionally adjusted for total alcohol intake (g/day) and/or leisure-time exercise (hours/week category) as indicated.

ABSTRACT Background and Aims Informal caregiving has increased over recent decades. Caregivers may face an increased risk of accidental falls because of care tasks or their consequences, such as fatigue. However, this association has not been investigated. Therefore, we aimed to examine whether giving personal care to someone at home increases fall risk. Methods Using longitudinal repeated measures for adults aged over 50 years in 17 European countries, with biennial data collection in 2004–2017 (N = 51,132), we compared periods of caregiving to non‐caregiving for falls (outcome) using fixed‐effects logistic models, estimating odds ratios (OR) with 95% confidence intervals (95% CI) while controlling for measured time‐varying variables as well as unmeasured time‐invariant confounders. To shed light on mechanisms, we tested effect modification by sociodemographic characteristics, and examined whether fatigue, sleep problems, lower concentration, and changes in behaviour mediate the association. Results Compared with the period of not giving care, the period of providing care was associated with higher fall risk (OR 1.19 [95% CI 1.05–1.35]). This association differed by baseline household income (below or above median). In higher‐income households, there was no statistically significant difference in fall risk between the period giving and not giving care (OR 1.07 [95% CI 0.90, 1.26]). In contrast, in lower‐income households, the caregiving period was associated with higher fall risk (OR 1.36 [95% CI 1.14–1.63]), which was equivalent to 29% (95% CI 12–46) increased probability of falls in caregiving periods. Fatigue, sleep problems, lower concentration, and behavioural changes jointly mediated 12% of the effect; thus, most of the effect of caregiving on falls is a direct effect. Conclusion There was an increased fall risk among caregivers who provide personal care at home in lower‐income households. Fatigue and other consequences of caregiving mediated only small effects. Other factors, such as lack of equipment and living space, may relate to mechanisms.

Supplementary Table 5 quantifies the reduction in analytic sample size when restricting to complete cases for alcohol intake and/or physical activity, reporting the remaining number of participants, bladder cancer cases, and person-years, as well as the numbers and percentages excluded due to missing data. Estimates are shown for the overall bladder cancer dataset and for the non-muscle invasive (NMIBC) and muscle invasive (MIBC) stage-specific datasets.

Supplementary Table 1 lists the food frequency questionnaire (FFQ)-derived components of the Anti-Inflammatory Diet Index (AIDI), indicates whether each component is classified as anti-inflammatory or pro-inflammatory, specifies the intake cut-offs used to assign a score of 1, and defines the binary scoring rule (1 if the criterion is met; otherwise 0).

Associations between AIDI and bladder cancer risk by stage (1998–2020).

Supplementary Table 2 reports hazard ratios (HRs) and 95% confidence intervals for bladder cancer risk across quartiles of the Anti-Inflammatory Diet Index (AIDI) among Swedish women (1998–2020), overall and stratified by tumour stage (non-muscle invasive and muscle invasive). Results are shown for baseline AIDI (1998) and for AIDI modelled as a repeated measure (1998 and 2009; cumulative-average method), with tests for linear trend. Estimates are presented from three progressively adjusted Cox models: Model 1 (age and sex), Model 2 (additionally smoking pack-years, BMI, education, employment status, and mean-centred energy intake), and Model 3 (additionally diabetes, hypertension, and family history of cancer). Case counts and person-years are provided for each AIDI category, and stage-specific analyses include cases diagnosed from 2004 onwards.

BACKGROUND:Dietary patterns influencing systemic levels of inflammation have been proposed and investigated as possible determinants of cancer risk. We evaluated the association between the anti-inflammatory potential of diet and the risk of bladder cancer. METHODS:The anti-inflammatory diet index (AIDI), composed of 16 food groups (11 anti- and 5 pro-inflammatory), was used to score dietary patterns in N = 79,292 individuals derived from the Cohort of Swedish Men (established in 1997) and the Swedish Mammography Cohort (established in 1987). Dietary information was collected in 1997 and 2009; repeated-measures analyses used a cumulative-average AIDI. Incident bladder cancer cases were identified from the Swedish Cancer Register using International Classification of Diseases, 10th Revision code C67, and a baseline study questionnaire was used to assess covariates. We estimated multivariable hazard ratios (HR) across AIDI quartiles using Cox models. RESULTS:After a 22-year follow-up, 1,165 individuals were diagnosed with bladder cancer, of whom 249 had non-muscle invasive bladder cancer (NMIBC), 201 had muscle-invasive bladder cancer (MIBC), and 715 had unknown stage. In repeated-measures analyses, the highest anti-inflammatory quartile (Q4) was associated with lower bladder cancer risk compared with the lowest quartile [Q1; HR, 0.74; 95% confidence interval (CI), 0.61-0.89]. Stratifying for tumor stage, there was a clear association between AIDI score and MIBC (HR, 0.35; 95% CI, 0.22-0.57) but not for NMIBC (HR, 0.86; 95% CI, 0.57-1.28). CONCLUSIONS:An anti-inflammatory dietary pattern was associated with lower bladder cancer risk, with the clearest association for MIBC. IMPACT:These findings support the role of dietary inflammation in bladder cancer etiology and suggest that promoting anti-inflammatory dietary patterns could contribute to cancer prevention strategies.

INTRODUCTION:A diet rich in fruits, vegetables, coffee, and tea, limited red meat, and moderate alcohol intake may reduce the risk of renal cell carcinoma (RCC). The anti-inflammatory potential of diet has been proposed as a mechanism influencing cancer risk. This study assessed the association between an anti-inflammatory diet and RCC risk. METHODOLOGY:Data from two Swedish cohorts, the Swedish-Mammography-Cohort and the Cohort-of-Swedish-Men, were analysed. Dietary habits were assessed using a 96-item food frequency questionnaire. The Anti-Inflammatory Diet Index (AIDI), composed of 16 food groups (11 anti-inflammatory and 5 pro-inflammatory), was used to score dietary patterns. RCC cases were identified from the Swedish Cancer Register using ICD-10 codes, and Cox proportional hazards models were used to estimate hazard ratios based on AIDI quartiles. RESULTS:Among 71,421 participants, 431 RCC cases were identified during a 19.7-year follow-up. Higher AIDI scores were associated with a lower RCC risk (HR for Q4 vs. Q1: 0.68, CI: 0.52-0.89). In sex-stratified analyses (p-for heterogeneity = 0.006), the association was stronger in among women (HR: 0.47, CI: 0.30-0.75) but less clear in among men (HR: 0.83, CI: 0.63-1.24). CONCLUSION:These data suggest that adherence to an anti-inflammatory diet may confer a reduced risk for RCC, especially among women.

Supplementary Figure from Use of Antibiotics and Risk of Psychiatric Disorders in Newly Diagnosed Cancer Patients: A Population-Based Cohort Study in Sweden

Importance Childhood bereavement increases the risk of common psychiatric disorders later in life. However, the role of stress resilience in this association remains underexplored. Objective To assess whether stress resilience mediates the association between childhood bereavement and psychiatric disorder risk in adulthood. Design, Setting, and Participants Three matched cohort studies were performed using data recorded in the Swedish Military Conscription Register. Individuals with childhood loss of either a parent or a sibling (19 162 participants), a parent (16 247 participants), or a sibling (3023 participants) due to death from 1987 to 2020, together with 10 unexposed individuals per exposed individual, were matched on sex, birth year, and county of birth. All participants had available stress resilience measure at conscription. Data were analyzed from February to December 2024. Exposures Childhood bereavement was ascertained from the Swedish Multi-Generation and Causes of Death Registers. Main outcomes and Measures Incident diagnosis of depression, anxiety, substance use disorder, and stress-related disorder was ascertained from the Swedish Patient Register. Cox models were used to estimate the association between childhood bereavement and risk of postconscription psychiatric disorders after multivariable adjustment. Causal mediation analysis was conducted to examine if stress resilience measured at conscription mediated this association. Results Among 1 733 085 conscripted individuals (median [IQR] age at conscription 18.2 [18.0-18.5] years; 1 707 960 [98.5%] male), the median (IQR) age of individuals exposed to loss of either a parent or a sibling, parent, or sibling was 13.4 (9.6-15.8), 13.7 (10.4-15.9), and 10.7 (5.5-14.9) years, respectively. The crude incidence rate of any psychiatric disorder was 7.9, 8.1, and 6.6 per 1000 person-years among the 3 groups (5.3, 5.8, and 5.5 per 1000 person-years among the respective unexposed groups). A positive association was noted for loss of either a parent or a sibling (HRs ranged from 1.13; 95% CI, 1.06-1.20 for anxiety to 1.31; 95% CI, 1.23-1.40 for substance abuse disorder) and loss of a parent (HRs ranged from 1.10; 95% CI, 1.01-1.20 for stress-related disorders to 1.19; 95% CI, 1.12-1.27 for depression). For loss of a sibling, the statistically significant associations were for any common psychiatric disorder (HR, 1.12; 95% CI, 1.00-1.25) and stress-related disorders (1.27; 95% CI, 1.04-1.55). Stress resilience partially mediated the associations (proportions for loss of either a parent or a sibling ranged from 10.6%-19.4%, for a parent ranged from 15.6%-21.7%, and for a sibling ranged from 6.2% for stress-related disorders to 18.4% for any common psychiatric disorder). Conclusions and Relevance In this cohort study of a nationwide Swedish sample, altered stress resilience was found to be one mechanism through which childhood bereavement is associated with risk of psychiatric disorders later in life.