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Mortality in a cohort of men expressing the glucose-6-phosphate dehydrogenase deficiency
Insights
Men with glucose-6-phosphate dehydrogenase (G6PD) deficiency showed lower mortality from cardiovascular diseases and liver cirrhosis. However, cancer mortality, particularly non-Hodgkin's lymphoma, was higher than expected in this G6PD deficiency study.
Area of Science:
- Epidemiology
- Human Genetics
- Medical Research
Background:
- Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common genetic disorder.
- Previous studies suggested a potential link between G6PD deficiency and altered mortality risks.
- This study investigates mortality patterns in a Sardinian cohort with G6PD deficiency.
Purpose of the Study:
- To test the hypothesis of reduced cancer and cardiovascular disease mortality in G6PD-deficient men.
- To analyze cause-specific mortality ratios in a defined cohort.
- To explore potential protective or detrimental effects of G6PD deficiency on specific diseases.
Main Methods:
- A mortality study was conducted using death certificates from 1982-1992.
- A cohort of 1,756 G6PD-deficient men, identified in 1981, was analyzed.
- Cause-specific standardized mortality ratios (SMRs) were calculated against the general Sardinian male population.
Main Results:
- Significantly lower mortality was observed for ischemic heart disease (SMR 28), cerebrovascular disease (SMR 22), and liver cirrhosis (SMR 12).
- These conditions accounted for 95.6% of the total mortality deficit.
- Cancer mortality was near expected, but non-Hodgkin's lymphoma showed a significantly increased SMR (545).
Conclusions:
- The findings support a decreased risk of cardiovascular disease and liver cirrhosis mortality in G6PD-deficient men, though selection bias is a possible factor.
- The study refutes the hypothesis of decreased cancer risk, with an observed increase in non-Hodgkin's lymphoma mortality.
- Further research is needed to confirm cardiovascular protection and understand the non-Hodgkin's lymphoma association.
Abstract:
The objective of this study was to test the hypothesis of a lower mortality from cancer and cardiovascular diseases among men expressing glucose-6-phosphate dehydrogenase (G6PD) deficiency. We designed a mortality study based on death certificates from January 1, 1982 through December 31, 1992 in a cohort of G6PD-deficient men. Cohort members were 1,756 men, identified as expressing the G6PD-deficient phenotype during a 1981 population screening of the G6PD polymorphism. The setting was the island of Sardinia, Italy. Outcome measures were cause-specific standardized mortality ratios (SMRs), which were computed as 100 times the observed/expected ratio, with the general Sardinian male population as the reference. Deaths from all causes were significantly less than expected due to decreased SMRs for ischemic heart disease (SMR, 28; 95% confidence interval [CI], 10 to 62), cerebrovascular disease (SMR, 22; 95% CI, 6 to 55), and liver cirrhosis (SMR, 12; 95% CI, 0 to 66), which explained 95.6% of the deficit in total mortality. All cancer mortality was close to the expectation, with a significant increase in the SMR for non-Hodgkin's lymphoma (SMR, 545; 95% CI, 147 to 1,395). A decrease in mortality from cardiovascular diseases was one of the study hypotheses, based on an earlier human report and experimental evidence. However, selection bias is also a likely explanation. Further analytic studies are warranted to confirm whether subjects expressing the G6PD-deficient phenotype are protected against ischemic heart disease and cerebrovascular disease. This cohort study is consistent with more recent case-control studies in rejecting the hypothesis of a decreased cancer risk among G6PD-deficient subjects. The observed increase in mortality from non-Hodgkin's lymphoma and decrease in mortality from liver cirrhosis were not previously reported.