Department of Obstetrics and Gynecology, Clintec, Karolinska University Hospital, Stockholm, Sweden.
J Intern Med. 2014 Jul;276(1):77-86. doi: 10.1111/joim.12251. Epub 2014 Apr 23.
Sunlight exposure and fair skin are major determinants of human vitamin D production, but they are also risk factors for cutaneous malignant melanoma (MM). There is epidemiological evidence that all-cause mortality is related to low vitamin D levels.
We assessed the avoidance of sun exposure as a risk factor for all-cause mortality for 29 518 Swedish women in a prospective 20-year follow-up of the Melanoma in Southern Sweden (MISS) cohort. Women were recruited from 1990 to 1992 and were aged 25 to 64 years at the start of the study. We obtained detailed information at baseline on their sun exposure habits and potential confounders. Multivariable flexible parametric survival analysis was applied to the data.
There were 2545 deaths amongst the 29 518 women who responded to the initial questionnaire. We found that all-cause mortality was inversely related to sun exposure habits. The mortality rate amongst avoiders of sun exposure was approximately twofold higher compared with the highest sun exposure group, resulting in excess mortality with a population attributable risk of 3%.
The results of this study provide observational evidence that avoiding sun exposure is a risk factor for all-cause mortality. Following sun exposure advice that is very restrictive in countries with low solar intensity might in fact be harmful to women's health.
阳光照射和白皙的皮肤是人体维生素 D 生产的主要决定因素，但它们也是皮肤恶性黑色素瘤 (MM)的风险因素。有流行病学证据表明，全因死亡率与低维生素 D 水平有关。
我们评估了避免阳光照射作为 29518 名瑞典女性全因死亡率的风险因素，这些女性参与了瑞典南部黑色素瘤 (MISS)队列的前瞻性 20 年随访。女性于 1990 年至 1992 年招募，研究开始时年龄在 25 至 64 岁之间。我们在基线时获得了有关其阳光暴露习惯和潜在混杂因素的详细信息。多变量灵活参数生存分析应用于数据。
在对初始问卷做出回应的 29518 名女性中，有 2545 人死亡。我们发现，全因死亡率与阳光暴露习惯呈负相关。避免阳光照射的女性死亡率比最高阳光暴露组高约两倍，导致死亡率增加，人群归因风险为 3%。
这项研究的结果提供了观察性证据，表明避免阳光照射是全因死亡率的一个风险因素。在阳光强度低的国家遵循非常严格的阳光暴露建议实际上可能对女性健康有害。
