Avoidance of sun exposure is a risk factor for all-cause mortality: results from the Melanoma in Southern Sweden cohort
Version of Record online: 23 APR 2014
© 2014 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 276, Issue 1, pages 77–86, July 2014
How to Cite
Avoidance of sun exposure is a risk factor for all-cause mortality: results from the MISS cohort. J Intern Med 2014; 276: 77–86., , , , , , (Clintec, Karolinska University Hospital, Stockholm; Karolinska University Hospital, Stockholm; Lund University Hospital, Lund; Lund University Hospital, Lund; Lund University, Lund; Karolinska Institutet, Stockholm; Lund University Hospital, Lund).
- Issue online: 18 JUN 2014
- Version of Record online: 23 APR 2014
- Accepted manuscript online: 4 APR 2014 01:40AM EST
- Karolinska Institutet
- Faculty of Medicine
- Lund University
- Region Skåne (ALF)
- Swedish Cancer Society
- Swedish Medical Research Council
- Lund University Hospital
- Gustav V Jubilee
- Gunnar Nilsson Foundation
- Kamprad Foundation
- European Research Council. Grant Number: ERC-2011-294576
- population attributable risk;
- UV radiation;
- vitamin D
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.