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At least 73 records · Page 4

Embolism resistance explains mortality and recovery of five subtropical evergreen broadleaf trees to persistent drought

Subtropical evergreen broadleaf forest (SEBF) is experiencing and expected to suffer more frequent and severe drought events. However, how the hydraulic traits directly link to the mortality and recovery of SEBF trees remains unclear. In this study, we conducted a drought-rewatering experiment on tree seedlings of five dominant species to investigate how the hydraulic traits were related to tree mortality and the resistance and recovery of photosynthesis (A) and transpiration (E) under different drought severities. Species with greater embolism resistance (P 50 ) survived longer than those with the weaker P 50 . However, there was no general hydraulic threshold associated with tree mortality, with the lethal hydraulic failure varying from 64% to 93% loss of conductance. Further, the photosynthesis and transpiration of tree species with greater P 50 were more resistant to and recovered faster from drought than those with lower P 50 . Other plant traits could not explain the interspecific variation in tree mortality and drought resistance and recovery. These results highlight the unique importance of embolism resistance in driving carbon and water process under persistent drought across different trees in SEBF. The absence of multiple efficient drought strategies in SEBF seedlings implies the difficulty of natural seedling regeneration under future droughts, which often occurs after destructive disturbances (e.g., extreme drought events and typhoon), suggesting that this biome may be highly vulnerable to co-occurring climate extremes.

54 ENVIRONMENTAL SCIENCES↗

Severe declines in hydraulic capacity and associated carbon starvation drive mortality in seawater exposed Sitka-spruce (Picea sitchensis) trees

Abstract Sea-level rise is causing widespread tree mortality of coastal forests, with large consequences on the Earth system as a result of these forests’ importance in carbon and nutrient export. The mechanisms of mortality under these conditions are, however, poorly tested. We used wood anatomy traits, wood δ 13 C, and tree radial growth to retrospectively assess the physiological process of seawater effects on whole tree xylem hydraulic capacity, gas exchange, and radial growth. During the latter stages of mortality (2018–2019), we directly measured metrics of water use and carbon metabolism across trees having crowns ranging from fully foliated to completely defoliated to investigate mortality processes at the sub-annual scale. Upon seawater exposure, soil salinity increased and allocation to hydraulic function declined, resulting in a dramatic reduction in water supply to the crown, increased crown-level water stress, and subsequent crown foliage loss. Simultaneously, leaf-level photosynthetic capacity declined steeply with increasing salinity. The combined loss of crown foliage area and photosynthetic rates per unit leaf area promoted carbon starvation, while no evidence of hydraulic failure was observed. These results elucidate mechanisms of coastal forest death under seawater exposure, enabling more accurate modeling in the future.

54 ENVIRONMENTAL SCIENCES↗

Climate Change Risks to Global Forest Health: Emergence of Unexpected Events of Elevated Tree Mortality Worldwide

Recent observations of elevated tree mortality following climate extremes, like heat and drought, raise concerns about climate change risks to global forest health. We currently lack both sufficient data and understanding to identify whether these observations represent a global trend toward increasing tree mortality. In this work, we document events of sudden and unexpected elevated tree mortality following heat and drought events in ecosystems that previously were considered tolerant or not at risk of exposure. These events underscore the fact that climate change may affect forests with unexpected force in the future. We use the events as examples to highlight current difficulties and challenges for realistically predicting such tree mortality events and the uncertainties about future forest condition. Advances in remote sensing technology and greater availably of high-resolution data, from both field assessments and satellites, are needed to improve both understanding and prediction of forest responses to future climate change.

59 BASIC BIOLOGICAL SCIENCES↗

The association between neighborhood obesogenic factors and prostate cancer risk and mortality: the Southern Community Cohort Study

Background: Prostate cancer is one of the leading causes of cancer-related mortality among men in the United States. We examined the role of neighborhood obesogenic attributes on prostate cancer risk and mortality in the Southern Community Cohort Study (SCCS). Methods: From the total of 34,166 SCCS male participants, 28,356 were included in the analysis. We assessed the relationship between neighborhood obesogenic factors [neighborhood socioeconomic status (nSES) and neighborhood obesogenic environment indices including the restaurant environment index, the retail food environment index, parks, recreational facilities, and businesses] and prostate cancer risk and mortality by controlling for individual-level factors using a multivariable Cox proportional hazards model. We further stratified prostate cancer risk analysis by race and body mass index (BMI). Results: Median follow-up time was 133 months [interquartile range (IQR): 103, 152], and the mean age was 51.62 (SD: ± 8.42) years. There were 1,524 (5.37%) prostate cancer diagnoses and 98 (6.43%) prostate cancer deaths during follow-up. Compared to participants residing in the wealthiest quintile, those residing in the poorest quintile had a higher risk of prostate cancer (aHR = 1.32, 95% CI 1.12–1.57, p = 0.001), particularly among non-obese men with a BMI < 30 (aHR = 1.46, 95% CI 1.07–1.98, p = 0.016). The restaurant environment index was associated with a higher prostate cancer risk in overweight (BMI ≥ 25) White men (aHR = 3.37, 95% CI 1.04–10.94, p = 0.043, quintile 1 vs. None). Obese Black individuals without any neighborhood recreational facilities had a 42% higher risk (aHR = 1.42, 95% CI 1.04–1.94, p = 0.026) compared to those with any access. Compared to residents in the wealthiest quintile and most walkable area, those residing within the poorest quintile (aHR = 3.43, 95% CI 1.54–7.64, p = 0.003) or the least walkable area (aHR = 3.45, 95% CI 1.22–9.78, p = 0.020) had a higher risk of prostate cancer death. Conclusion: Living in a lower-nSES area was associated with a higher prostate cancer risk, particularly among Black men. Restaurant and retail food environment indices were also associated with a higher prostate cancer risk, with stronger associations within overweight White individuals. Finally, residing in a low-SES neighborhood or the least walkable areas were associated with a higher risk of prostate cancer mortality.

60 APPLIED LIFE SCIENCES↗

Hypothesis-Agnostic Network-Based Analysis of Real-World Data Suggests Ondansetron is Associated with Lower COVID-19 Any Cause Mortality

Background: The COVID-19 pandemic generated a massive amount of clinical data, which potentially hold yet undiscovered answers related to COVID-19 morbidity, mortality, long-term effects, and therapeutic solutions.Objectives: The objectives of this study were (1) to identify novel predictors of COVID-19 any cause mortality by employing artificial intelligence analytics on real-world data through a hypothesis-agnostic approach and (2) to determine if these effects are maintained after adjusting for potential confounders and to what degree they are moderated by other variables.Methods: A Bayesian statistics-based artificial intelligence data analytics tool (bAIcis®) within the Interrogative Biology® platform was used for Bayesian network learning and hypothesis generation to analyze 16,277 PCR+ patients from a database of 279,281 inpatients and outpatients tested for SARS-CoV-2 infection by antigen, antibody, or PCR methods during the first pandemic year in Central Florida. This approach generated Bayesian networks that enabled unbiased identification of significant predictors of any cause mortality for specific COVID-19 patient populations. These findings were further analyzed by logistic regression, regression by least absolute shrinkage and selection operator, and bootstrapping.Results: We found that in the COVID-19 PCR+ patient cohort, early use of the antiemetic agent ondansetron was associated with decreased any cause mortality 30 days post-PCR+ testing in mechanically ventilated patients.Conclusions: The results demonstrate how a real-world COVID-19-focused data analysis using artificial intelligence can generate unexpected yet valid insights that could possibly support clinical decision making and minimize the future loss of lives and resources.

60 APPLIED LIFE SCIENCES↗

Source Contributions to Fine Particulate Matter and Attributable Mortality in India and the Surrounding Region

Fine particulate matter (PM 2.5 ) is a leading mortality risk factor in India and the surrounding region of South Asia. This study evaluates the contribution of emission sectors and fuels to PM 2.5 mass for 29 states in India and 6 surrounding countries (Pakistan, Bangladesh, Nepal, Bhutan, Sri Lanka, and Myanmar) by combining source-specific emission estimates, stretched grid simulations from a chemical transport model, high resolution hybrid PM 2.5 , and disease-specific mortality estimates. We find that 1.02 (95% Confidence Interval (CI): 0.78-1.26) million deaths in South Asia attributable to ambient PM 2.5 in 2019 were primarily from three leading sectors: residential combustion (28%), industry (15%), and power generation (12%). Solid biofuel is the leading combustible fuel contributing to the PM 2.5 -attributable mortality (31%), followed by coal (17%), and oil and gas (14%). State-level analyses reveal higher residential combustion contributions (35%-39%) in states (Delhi, Uttar-Pradesh, Haryana) with high ambient PM 2.5 (>95 µg/m 3 ). The combined mortality burden associated with residential combustion (ambient) and household air pollution (HAP) in India is 0.72 million (95% CI:0.54-0.89) (68% attributable to HAP, 32% attributable to residential combustion). Our results illustrate the potential to reduce PM 2.5 mass and improve population health by reducing emissions from traditional energy sources across multiple sources in South Asia.

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTAN↗

Mechanisms of woody-plant mortality under rising drought, CO 2 and vapour pressure deficit

Drought-associated woody plant mortality may have increased over the past several decades, and is projected to increase in the future, impacting terrestrial climate forcing, biodiversity, and resource availability. The mechanisms underlying such mortality, however, are debated owing to interactions between multiple drivers and mechanisms. In this work, we synthesize knowledge of drought-related tree mortality under a warming and drying atmosphere with rising atmospheric CO 2 . Drought-associated mortality results from the depletion of pools of water and carbon within a plant and declines in their fluxes relative to demand by living tissues. These pools and fluxes are interdependent and underlay plant defenses against biotic agents. Death via failure to maintain a positive water balance is particularly dependent on soil-to-root conductance, capacitance, vulnerability to hydraulic failure, cuticular water losses, and dehydration tolerance, all of which could be exacerbated by reduced carbon supply rates to support cellular survival e.g. the carbon starvation process. The depletion of plant water and carbon pools accelerates under rising vapor pressure deficit; however, increasing CO 2 can mitigate these impacts. Advancing knowledge and reducing predictive uncertainties requires studies that integrate carbon, water, and defensive processes, and utilize a range of experimental and modeling approaches.

54 ENVIRONMENTAL SCIENCES↗

Mortality among workers at the Rocky Flats Plant, 1951–2017

The Rocky Flats (RFs) Plant operated from 1951–1989 as part of the U.S. Department of Energy (DOE) nuclear complex. Its primary mission was weapons component fabrication, whereby workers were potentially exposed to radioactive and non-radioactive hazards. RF worker mortality was compared to the general population, and dose-response relationships between mortality and radiation organ doses were examined. RF workers first employed between 1951 and 1979 for ⩾30 d were identified (n = 9397). Vital status was determined using national and state death records up to 2017. Organ doses from external photons and neutrons irritation and internalised plutonium (Pu), americium (Am), and uranium (U) were modelled as cumulative lagged total doses per year. Beryllium exposure was evaluated as an effect modifier using data from the DOE Nationwide Beryllium Medical Program. Statistical analyses included standardised mortality ratios (SMRs), Cox proportional hazard models, and excess relative risk (ERR) models. Approximately 53.2% of workers were deceased by the end of the study. Nearly 90% were monitored for radiation exposure, with a mean weighted absorbed dose of 59.0 mGy for the lungs. Nearly 45% of workers had intakes of alpha-particle emitting radionuclides, and 46.7% were monitored for neutrons. Leading causes of death included ischemic heart disease (n = 999) and lung cancer (n = 361). The highest SMRs were observed for berylliosis (SMR: 176.9; 95% CI: 76.2, 348.7; n < 10) and asbestosis (SMR: 4.65; 95% CI: 2.23, 8.55; n = 10). Dose-response analyses showed no statistical increase in risk from low-dose radiation including lung cancer (ERR per 100 mGy: −0.02; 95% CI: −0.11, 0.08; n = 361) and Parkinson’s disease (ERR per 100 mGy: 0.13; 95% CI: −0.26, 0.31; n = 57). Approximately 45% of workers were monitored for beryllium, with a weak non-significant indication of effect modification for lung cancer risk. The RF cohort showed no evidence of a statistically significant increase in mortality from occupational radiation exposure. However, this study was limited by low statistical power, which inhibits the ability to detect effects. Future pooling of Million Person Study (MPS) cohorts will provide further insights, particularly regarding Pu as a carcinogen.

61 RADIATION PROTECTION AND DOSIMETRY↗

Growth–Mortality Coordination Differs Among Xerophytic Versus Mesophytic Tree Species During Severe Drought

ABSTRACT Forest composition is changing, yet the consequences for terrestrial carbon cycling are unclear. In the eastern United States, water‐demanding “mesophytic” tree species are replacing “xerophytic” oaks (Quercusspp.) and hickories (Caryaspp.), raising concerns that forest productivity will become increasingly sensitive to more frequent and severe drought conditions predicted for the region. However, we have a limited understanding of the extent to which the mortality risk of xerophytes versus mesophytes is coordinated with their growth sensitivity during drought. Here, we evaluated growth and mortality dynamics for 20 abundant eastern United States tree species following a severe drought in the summer of 2012. We synthesized data from ~4500 forest inventory plots and used an approach that quantified relative drought responses between co‐located trees to minimize impacts from environmental heterogeneity. We found that mesophytes were just as likely to perish as co‐occurring xerophytes but were more sensitive to drought in terms of diminished growth. These findings suggest that xerophytic decline is likely to lead to reduced carbon uptake during drought and that management efforts to conserve oak‐hickory stands will be decisive to sustain the carbon mitigation potential of these forests. However, we also found that growth‐mortality relationships differed between functional groups. Among xerophytes, growth and survival during drought were decoupled. Among mesophytes, there was a high degree of coordination, where species that experienced greater mortality also experienced greater growth reductions. Therefore, mesophytes with high growth sensitivity to water deficits are likely to be the most vulnerable to drought‐driven die‐off events moving forward.

Biodiversity & Conservation↗

Mortality attributable to PM 2.5 from wildland fires in California from 2008 to 2018

In California, wildfire risk and severity have grown substantially in the last several decades. Research has characterized extensive adverse health impacts from exposure to wildfire-attributable fine particulate matter (PM 2.5 ), but few studies have quantified long-term outcomes, and none have used a wildfire-specific chronic dose-response mortality coefficient. Here, we quantified the mortality burden for PM 2.5 exposure from California fires from 2008 to 2018 using Community Multiscale Air Quality modeling system wildland fire PM 2.5 estimates. We used a concentration-response function for PM 2.5 , applying ZIP code–level mortality data and an estimated wildfire-specific dose-response coefficient accounting for the likely toxicity of wildfire smoke. We estimate a total of 52,480 to 55,710 premature deaths are attributable to wildland fire PM 2.5 over the 11-year period with respect to two exposure scenarios, equating to an economic impact of $\$432$ to $\$456$ billion. These findings extend evidence on climate-related health impacts, suggesting that wildfires account for a greater mortality and economic burden than indicated by earlier studies.

60 APPLIED LIFE SCIENCES↗

Regional differences in tobacco smoking and lung cancer in Portugal in 2018: a population-based analysis using nationwide incidence and mortality data

Objectives: This study aims to estimate the proportion of lung cancer cases and deaths attributable to tobacco smoking in Portugal in 2018, complemented by trends in incidence and mortality, by sex and region. Design: Cancer cases for 1998–2011 and cancer deaths for 1991–2018 were obtained from population-based registries and Statistics Portugal, respectively. We projected cases for 2018 and used reported deaths for the same year to estimate, using Peto’s method, the number and proportion of lung cancer cases and deaths caused by tobacco smoking in 2018. We calculated the age-adjusted incidence and mortality rates in each year of diagnosis and death. We fitted a joinpoint regression to the observed data to estimate the annual percentage change (APC) in the rates. Setting: Portugal. Results: In 2018, an estimated 3859 cases and 3192 deaths from lung cancer were attributable to tobacco smoking in Portugal, with men presenting a population attributable fraction (PAF) of 82.6% (n=3064) for incidence and 84.1% (n=2749) for mortality, while in women those values were 51.0% (n=795) and 42.7% (n=443), respectively. In both sexes and metrics, the Azores were the region with the highest PAF and the Centre with the lowest. During 1998–2011, the APC for incidence ranged from 0.6% to 3.0% in men and 3.6% to 7.9% in women, depending on region, with mortality presenting a similar pattern between sexes. Conclusion: Exposure to tobacco smoking has accounted for most of the lung cancer cases and deaths estimated in Portugal in 2018. Differential patterns of tobacco consumption across the country, varying implementation of primary prevention programmes and differences in personal cancer awareness may have contributed to the disparities observed. Primary prevention of lung cancer remains a public health priority, particularly among women.

60 APPLIED LIFE SCIENCES↗

Familial Associations of Prevalence and Cause-Specific Mortality for Thoracic Aortic Disease and Bicuspid Aortic Valve in a Large-Population Database

Thoracic aortic disease and bicuspid aortic valve (BAV) likely have a heritable component, but large population-based studies are lacking. This study characterizes familial associations of thoracic aortic disease and BAV, as well as cardiovascular and aortic-specific mortality, among relatives of these individuals in a large-population database. In this observational case-control study of the Utah Population Database, we identified probands with a diagnosis of BAV, thoracic aortic aneurysm, or thoracic aortic dissection. Age- and sex-matched controls (10:1 ratio) were identified for each proband. First-degree relatives, second-degree relatives, and first cousins of probands and controls were identified through linked genealogical information. Cox proportional hazard models were used to quantify the familial associations for each diagnosis. We used a competing-risk model to determine the risk of cardiovascular-specific and aortic-specific mortality for relatives of probands. The study population included 3,812,588 unique individuals. Familial hazard risk of a concordant diagnosis was elevated in the following populations compared with controls: first-degree relatives of patients with BAV (hazard ratio [HR], 6.88 [95% CI, 5.62–8.43]); first-degree relatives of patients with thoracic aortic aneurysm (HR, 5.09 [95% CI, 3.80–6.82]); and first-degree relatives of patients with thoracic aortic dissection (HR, 4.15 [95% CI, 3.25–5.31]). In addition, the risk of aortic dissection was higher in first-degree relatives of patients with BAV (HR, 3.63 [95% CI, 2.68–4.91]) and in first-degree relatives of patients with thoracic aneurysm (HR, 3.89 [95% CI, 2.93–5.18]) compared with controls. Dissection risk was highest in first-degree relatives of patients who carried a diagnosis of both BAV and aneurysm (HR, 6.13 [95% CI, 2.82–13.33]). First-degree relatives of patients with BAV, thoracic aneurysm, or aortic dissection had a higher risk of aortic-specific mortality (HR, 2.83 [95% CI, 2.44–3.29]) compared with controls. Our results indicate that BAV and thoracic aortic disease carry a significant familial association for concordant disease and aortic dissection. The pattern of familiality is consistent with a genetic cause of disease. Furthermore, we observed higher risk of aortic-specific mortality in relatives of individuals with these diagnoses. In conclusion, this study provides supportive evidence for screening in relatives of patients with BAV, thoracic aneurysm, or dissection.

60 APPLIED LIFE SCIENCES↗

The public health exposome and pregnancy-related mortality in the United States: a high-dimensional computational analysis

Racial inequities in maternal mortality in the U.S. continue to be stark. The 2015–2018, 4-year total population, county-level, pregnancy-related mortality ratio (PRM; deaths per 100,000 live births; National Center for Health Statistics (NCHS), restricted use mortality file) was linked with the Public Health Exposome (PHE). Using data reduction techniques, 1591 variables were extracted from over 62,000 variables for use in this analysis, providing information on the relationships between PRM and the social, health and health care, natural, and built environments. Graph theoretical algorithms and Bayesian analysis were applied to PHE/PRM linked data to identify latent networks. PHE variables most strongly correlated with total population PRM were years of potential life lost and overall life expectancy. Population-level indicators of PRM were overall poverty, smoking, lack of exercise, heat, and lack of adequate access to food. In this high-dimensional analysis, overall life expectancy, poverty indicators, and health behaviors were found to be the strongest predictors of pregnancy-related mortality. This provides strong evidence that maternal death is part of a broader constellation of both similar and unique health behaviors, social determinants and environmental exposures as other causes of death.

60 APPLIED LIFE SCIENCES↗

Understanding the impacts of elevated CO2 and vapor pressure deficit on tree mortality - CRADA 599 (Abstract)

Many studies have examined the effects of rising CO2 on gas exchange and growth of plants. However, concurrent with the rise in CO2 has been the rise in temperature and associated drying of the atmosphere, or vapor pressure deficit (VPD), which increases tree mortality. Little attention has been given to the net outcome of these antagonistic drivers of plant performance. The net balance of rising CO2 and VPD upon plant and ecosystem function is possibly the largest uncertainty in model projections of the terrestrial carbon and water cycles. The purpose of this CRADA is to improve our predictive understanding of tree mortality under our changing environment. We will collaborate with WSU to provide a mechanistic understanding of the relative impacts of CO2 and VPD on tree mortality that scales across the globe. Ultimately, we will understand the potential impacts and mechanisms underlying CO2 and VPD responses and will enable improved prediction of future tree mortality.

54 ENVIRONMENTAL SCIENCES↗

Estimating the Benefits of Sustainable Aviation Fuel Usage at Chicago O’Hare International Airport on Ultrafine Particle Exposure and Mortalities Reductions

The expanding commercial aviation sector necessitates diverse energy sources, and sustainable aviation fuels (SAFs) have emerged as a promising option. Widespread SAF adoption can help meet transportation fuel demand and offer health benefits for people residing near airports or along airport landing and takeoff (LTO) pathways, where elevated levels of aircraft-derived air pollution often exist. Blending SAF with traditional jet fuels can reduce ultrafine particle (UFP) emissions, which may improve health of near airport population. We analyzed a population of about 8 million people in 1925 census tracts around the Chicago O’Hare International Airport (ORD). We conducted a risk assessment to estimate anticipated UFP reductions for three adoption scenarios using blends of traditional jet fuels with 5, 25, and 50% SAF across all flights landing and taking off from ORD. We calculated baseline estimates of UFP emissions using ORD flight data, a dispersion model, and a calibration function derived from mobile monitoring data. We used this baseline UFP emission profile across the study area to estimate population-weighted UFP, as well as the attributable case reductions (ACRs) and attributable mortality rate reductions (AMRRs) across the demographic distribution around the airport, based on the SAF blending scenarios. We found a positive association of SAF blending with UFP reductions, particularly near the airport and along LTO flight pathways. Our study showed that the population-weighted UFP across different demographics was similar. ACRs were largely dependent on individual demographic populations, while AMRRs for all populations were relatively similar, with an estimated 0.3 (95% range: 0.2−0.3), 1.1 (0.9−1.4), and 1.8 (1.5−2.2) fewer mortalities per 100,000 people per year expected with the adoption of 5, 25, and 50% SAF blends, respectively. This study indicates that communities near ORD, across a range of demographics, may benefit similarly from SAF adoption, thus highlighting how SAF adoption may offer an opportunity to improve health outcomes like aviation UFP-related mortalities around airports.

10 SYNTHETIC FUELS↗

Recent California tree mortality portends future increase in drought-driven forest die-off

Vegetation tolerance to drought depends on an array of site-specific environmental and plant physiological factors. This tolerance is poorly understood for many forest types despite its importance for predicting and managing vegetation stress. We analyzed the relationships between precipitation variability and forest die-off in California's Sierra Nevada and introduce a new measure of drought tolerance that emphasizes plant access to subsurface moisture buffers. We applied this metric to California's severe 2012-2015 drought, and show that it predicted the patterns of tree mortality. We then examined future climate scenarios, and found that the probability of droughts that lead to widespread die-off increases threefold by the end of the 21st century. Our analysis shows that tree mortality in the Sierra Nevada will likely accelerate in the coming decades and that forests in the Central and Northern Sierra Nevada that largely escaped mortality in 2012-2015 are vulnerable to die-off.

54 ENVIRONMENTAL SCIENCES↗

Within and Among Fish Species Differences in Simulated Turbine Blade Strike Mortality: Limits on the Use of Surrogacy for Untested Species

Use of surrogacy remains a useful method for prioritizing research on representatives of at-risk groups of fishes, yet quantifiable evidence in support of its use is generally not available. Blade strike impact represents one of the most traumatic stressors experienced by fish during non-volitional movements through hydropower turbines. Here, we use data generated from laboratory trials on blade strike impact experiments to directly test use of surrogacy for salmonid and clupeid fishes. Results of logistic regression indicated that a -taxonomic (genus) variable was not a significant predictor of mortality among large rainbow trout and brook trout. Similar results were found for young-of-the-year shad species, but genus-level taxonomy was a significant predictor of mortality while species was not. Multivariate analysis of morphometric data showed that shad clustered together based on similarities in fish shape which was also closely associated with genus. Logistic regression including size as a major covariate suggested total fish length was not a significant predictor of mortality, yet dose–response data suggest differential susceptibility to lower strike velocities. We suggest that use of surrogacy among species is justifiable but should be avoided within a species since the effects of size remain unclear.

59 BASIC BIOLOGICAL SCIENCES↗

Obesity is associated with biliary tract cancer mortality and incidence: A pooled analysis of 21 cohort studies in the Asia Cohort Consortium

Abstract Body fatness is considered a probable risk factor for biliary tract cancer (BTC), whereas cholelithiasis is an established factor. Nevertheless, although obesity is an established risk factor for cholelithiasis, previous studies of the association of body mass index (BMI) and BTC did not take the effect of cholelithiasis fully into account. To better understand the effect of BMI on BTC, we conducted a pooled analysis using population‐based cohort studies in Asians. In total, 905 530 subjects from 21 cohort studies participating in the Asia Cohort Consortium were included. BMI was categorized into four groups: underweight (<18.5 kg/m 2 ); normal (18.5‐22.9 kg/m 2 ); overweight (23‐24.9 kg/m 2 ); and obese (25+ kg/m 2 ). The association between BMI and BTC incidence and mortality was assessed using hazard ratios (HR) and 95% confidence intervals (CIs) by Cox regression models with shared frailty. Mediation analysis was used to decompose the association into a direct and an indirect (mediated) effect. Compared to normal BMI, high BMI was associated with BTC mortality (HR 1.19 [CI 1.02‐1.38] for males, HR 1.30 [1.14‐1.49] for females). Cholelithiasis had significant interaction with BMI on BTC risk. BMI was associated with BTC risk directly and through cholelithiasis in females, whereas the association was unclear in males. When cholelithiasis was present, BMI was not associated with BTC death in either males or females. BMI was associated with BTC death among females without cholelithiasis. This study suggests BMI is associated with BTC mortality in Asians. Cholelithiasis appears to contribute to the association; and moreover, obesity appears to increase BTC risk without cholelithiasis.

Oze, Isao↗