Research Article See commentary, p. 582 Ultraviolet Exposure and Mortality among Women in Sweden

Background: Ecological studies have reported possible effects of sunlight on the risk of several diseases. Little evidence is available on the association between mortality and solar and artificial UV exposure by individual level from prospective studies. Methods: The SwedishWomen’s Lifestyle and Health cohort study included women aged 30 to 49 years in 1991–1992. Participants completed a questionnaire and were followed-up through linkages to national registries until the end of 2006. Cox models were used to estimate adjusted HRs and 95 % CIs for all-cause mortality and for cancer and cardiovascular disease (CVD) mortality. Results: During 15 years of follow-up, among the 38,472 women included in the present study, 754 deaths occurred: 457 due to cancer and 100 due to CVD. When combining the information on sun exposure from age 10 to 39 years, womenwho got sunburned twice or more per year during adolescence had a reduced all-cause mortality, comparedwithwomenwho had been sunburned once or less. A reduced risk for all-cause andCVD mortality was observed in women who went on sunbathing vacations more than once a year over three decades. Solarium use once or more per month for at least one decade increased the risk of all-cause mortality, when compared with women who never used a solarium. Conclusions: Solar UV exposurewas associatedwith reduced overall and CVDmortality, whereas artificial UV exposure was associated with increased overall and cancer mortality among Swedish women. Impact: Moderate sun exposure may protect against cause-specific mortality. Cancer Epidemiol Biomarkers Prev; 20(4); 683–90. 2011 AACR