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DOI: 10.1093/aje/kwi147
ORIGINAL CONTRIBUTIONS
Acne in Adolescence and Cause-specic Mortality: Lower Coronary Heart
Disease but Higher Prostate Cancer Mortality
The Glasgow Alumni Cohort Study
Received for publication August 16, 2004; accepted for publication January 27, 2005.
Androgen level or androgen activity is implicated in several health outcomes, but its independent role remains
controversial. This study investigated the association between history of acne in young adulthood, a marker of
hormone activity, and cause-specic mortality in the Glasgow Alumni Cohort Study. Male students who attended
Glasgow University between 1948 and 1968 and participated in voluntary health checks reported history of acne
(n 11,232). Vital status has been traced, and risk factors in adulthood are known for about 50% of the
participants. Those with a history of acne were more often nonsmokers while university students and tended
to be from a lower socioeconomic position. The two groups did not differ in other adolescent (height, body mass
index, blood pressure, and number of siblings) or in most adult risk factors. Students who reported a history of
acne had a lower risk of all-cause (hazard ratio 0.89, 95% condence interval (CI): 0.76, 1.04) and coronary
heart disease (hazard ratio 0.67, 95% CI: 0.48, 0.94) mortality but had some evidence of a higher risk of
prostate cancer mortality (hazard ratio 1.67, 95% CI: 0.79, 3.55). This study shows that androgen activity
during adolescence may protect against coronary heart disease but confer a higher risk of prostate cancer
mortality.
acne vulgaris; androgens; coronary disease; hormones; mortality; prostatic neoplasms
Abbreviations: CI, condence interval; HR, hazard ratio; ICD-9, International Classication of Diseases, Ninth Revision; ICD-10,
International Classication of Diseases, Tenth Revision.
Testosterone has been implicated in prostate cancer development and, although once thought to explain the higher risk
of coronary heart disease in men, its role in health outcomes
is controversial (1). A recent review concluded that circulating androgens have a neutral or protective effect on coronary
Correspondence to Dr. Bruna Galobardes, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8
2PR, United Kingdom (e-mail: bruna.galobardes@bristol.ac.uk).
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Am J Epidemiol 2005;161:10941101
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No history of acne
(mean (SD))
p value
20.0 (2.40)
20.7 (2.81)
174.96 (6.37)
174.78 (6.35)
0.255
21.57 (2.23)
21.60 (2.23)
0.549
131.06 (13.01)
130.58 (12.97)
0.135
<0.001
77.02 (8.52)
77.36 (8.49)
0.114
1.71 (1.56)
1.72 (1.56)
0.723
No.
No.
1,948
53.25
8,882
56.86
0.004
No smoking (n 10,703)
1,943
68.20
8,760
65.59
0.022
1,798
55.30
7,786
54.31
0.446
RESULTS
stolic blood pressure, and number of siblings at the university were similar among those with and those without a
history of acne (table 1). Students with a history of acne
were more often nonsmokers at the university (68.20 percent vs. 65.59 percent; p 0.022) and from a lower socioeconomic background. In adulthood, those with a history of
acne were more likely to have never smoked (47.74 percent
vs. 43.34 percent; p 0.027) (table 2). There were no differences in adult social class, marital status, height, body mass
index, physical activity, alcohol consumption, fat consumption, or hypertension.
History of acne
(mean (SD*))
No history of acne
(mean (SD))
p value
176.41 (6.52)
176.47 (6.50)
0.809
25.52 (3.13)
0.883
25.50 (3.14)
No.
No.
770
90.56
3,274
88.32
0.061
578
51.28
2,393
52.48
0.606
774
47.74
3,284
43.34
0.027
No physical activity
(n 4,044)
774
33.82
3,270
34.33
0.786
Hypertension (n 4,010)
765
30.54
3,245
31.00
0.801
Alcohol consumption on
12 days/week or less
(n 4,018)
763
38.92
3,255
36.96
0.319
Am J Epidemiol 2005;161:10941101
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TABLE 3. Hazard ratio and 95% condence interval of all-cause and cause-specic mortality among men with a history of acne
compared with those who did not have acne, Glasgow Alumni Cohort Study, 19482004
No. of
deaths
Hazard
ratio
95% condence
interval
1,315
0.89
0.76, 1.03
Cardiovascular disease
527
0.74
369
0.67
Stroke
88
Lung cancer
No. of
deaths
Hazard
ratio
95% condence
interval
1,286
0.87
0.74, 1.01
0.57, 0.95
518
0.72
0.49, 0.93
362
0.65
1.27
0.75, 2.15
88
87
1.25
0.73, 2.13
Prostate cancer
43
1.58
Colon cancer
47
1.03
External causes
79
1.05
All causes
Model 3z
Model 2y
Model 1*
Causes of death
No. of
deaths
Hazard
ratio
95% condence
interval
1,213
0.89
0.76, 1.04
0.55, 0.94
482
0.74
0.56, 0.96
0.47, 0.90
336
0.67
0.48, 0.94
1.26
0.74, 2.14
81
1.24
0.71, 2.17
83
1.22
0.71, 2.11
80
1.27
0.72, 2.24
0.78, 3.20
41
1.48
0.71, 3.12
37
1.67
0.79, 3.55
0.48, 2.21
47
1.02
0.48, 2.19
43
1.01
0.45, 2.27
0.60, 1.85
76
1.02
0.57, 1.82
72
1.08
0.60, 1.94
DISCUSSION
Androgen activity
Although we adjusted for available risk factors, confounding may still remain an issue in observational studies
(50). Adjustment for more detailed categorizations of
Am J Epidemiol 2005;161:10941101
Am J Epidemiol 2005;161:10941101
Conclusion
ACKNOWLEDGMENTS
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