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Biomedical subjects

Måns Rosén

Publications and source records attributed to Måns Rosén.

At least 19 recordsLinked to original sources
PubMed2007

The new Swedish Prescribed Drug Register--opportunities for pharmacoepidemiological research and experience from the first six months.

PURPOSE: To describe the content and potentials of the new Swedish national register on prescribed and dispensed medicines. METHODS: The Swedish Prescribed Drug Register contains information about age, sex and unique identifier of the patient as well as the prescriber's profession and practice. Information regarding drug utilization and expenditures for prescribed drugs in the entire Swedish population was extracted from the first six months July-December 2005 and compared with total drug sales in the country including OTC and hospital use. RESULTS: The total quantity of drugs sold in Sweden was 2666 million DDDs, corresponding to 1608 DDD/1000 inhabitants daily. The total expenditures were 1.6 billion Euro. The prescribed drugs, included in the register, accounted for 84% of the total utilization and 77% of the total expenditures. About half of all men and two-thirds of all women in the country purchased drugs. The proportion increased by age. The most common drugs for chronic treatment were diuretics among women (8.8% of the population) and antithrombotic agents among men (7.6%). Psychotropic drugs, corticosteroids and analgesics were more common among women, while men used antithrombotic agents, antidiabetic drugs, lipid lowering agents and ACE inhibitors to a greater extent. CONCLUSIONS: The new register provides valuable data on exposure to drugs and is useful to study patterns of drug utilization. The possibilities for record linkage to other health registers gives from an international perspective good opportunities to explore drug and disease associations and the risks, benefits, effectiveness and health economical effects of drug use.

Adolescent↗
PubMed2006

Optimising health care within given budgets: primary prevention of cardiovascular disease in different regions of Sweden.

This study investigated the consequences of applying strict health maximisation to the choice between three different interventions with a defined budget. We analysed three interventions of preventing cardiovascular diseases, through doctor's advice on smoking secession, through blood-pressure-lowering drugs, and through lipid-lowering drugs. A state transition model has been used to estimate the cost-utility ratios for entire population in three different county councils in Sweden, where the populations were stratified into mutually excluding risk groups. The incremental cost-utility ratios are being presented in a league table and combined with the local resources and the local epidemiological data as a proxy for need for treatment. All interventions with an incremental cost-utility ratio exceeding the threshold ratios are excluded from being funded. The threshold varied between 1687 Euro and 6192 Euro. The general reallocation of resources between the three interventions was a 60% reduction of blood-pressure-lowering drugs with redistribution of resources to advice on smoking secession and to lipid-lowering drugs. One advantage of this method is that the results are very concrete. Recommendations can thereby be more precise which hopefully will create a public debate between decision-makers, practising physicians and patient groups.

Adult↗
PubMed2006

Trends in alcohol-related mortality in Sweden 1969-2002: an age-period-cohort analysis.

AIM: To study the effects of age, period and cohorts on alcohol-related mortality trends in Sweden. DESIGN: The study comprises an age-period-cohort analysis. SETTING AND PARTICIPANTS: The analysis was based on all deaths in the Swedish population between 1969 and 2002. MEASUREMENTS: Data on alcohol-related deaths in Sweden from 1969 to 2002 excluding accidental injury and homicide were used. The analysis covered 43 021 deaths. FINDINGS: Time period and birth cohort both influenced alcohol-related mortality. Male cohorts born in the 1930-40s exhibited the highest alcohol-related mortality, while for females those born in the 1940-50s had the highest alcohol-related mortality. For both men and women, those born in the 1960-70s had the lowest age-adjusted alcohol-related mortality. High-risk cohorts were young or in early adulthood during the periods that alcohol became more available in Sweden. The low-risk cohorts of the 1960-70s were brought up during a period when society was concerned with increasing alcohol problems and more emphasis was placed on issuing alcohol awareness information in schools. CONCLUSIONS: Cohort effects were found suggesting that the link between alcohol consumption and non-accident alcohol-related mortality at the population level is dependent on other factors that may change over time. One such factor may be that restrictive alcohol policies have a greater effect on drinking in those who are younger at the time they are put into effect.

Adolescent↗
PubMed2005

Are cancer patients at higher suicide risk than the general population?

OBJECTIVES: The aims were to test whether suicide is more prevalent among cancer patients than among the general population, whether the association changes over time, and whether the risk depends on the severity of the cancer disease. DESIGN: A register study was carried out, where standardized suicide rates for different cancer sites were analysed by sex, time periods (1965-74, 1975-84, and 1985-94), and five-year survival rates. SETTING: The setting was the Swedish population from 1965 to 1999. SUBJECTS: The cohort studied was 1,031,919 cancer cases and 2,587,152 person-years. MAIN OUTCOME MEASURES: The main outcome measure was the standardized mortality ratio (SMR) with the world population as standard population. RESULTS: Cancer patients run a higher risk of suicide than the general population. The suicide rate ratio between male cancer patients and the general population was about 2.5 in 1965-74, which thereafter reduced to about 1.5 in 1985-94. The suicide rate among female cancer patients was in excess of 2.9 in 1965-74 and 2.3 in 1985-94. In fact, a slightly higher rate for women was observed for 1985-94 than for 1975-84. There is also a strong negative association between survival rates and suicide rates, i.e. suicide rates are higher for severe cancer sites with low survival rates. CONCLUSIONS: Our findings support the hypothesis that cancer patients run greater risks of committing suicide than the general population does. The severity of the cancer increases the suicide risk. More attention to cancer patients' psychological and care situation is called for.

Adolescent↗
PubMed2005

From healthy survivors to sick survivors--implications for the twenty-first century.

BACKGROUND: Hypotheses concerning compression of morbidity have gained support, particularly due to improved lifestyles from 1950 to date, but now the increase is largely due to improvements in healthcare. METHODS: Survey data from Sweden were used to test whether the older population aged 65-84 years during 1995-2002 had more longstanding illnesses than the older population of 1980-87 or 1988-94. RESULTS: There was an increased prevalence of many longstanding illnesses among the elderly in Sweden between 1988-94 and 1995-2002. The increase was especially pronounced among those with at least three longstanding illnesses. For diabetes, heart disease, and hypertension, the prevalence among elderly men increased by over 20%. However, those reporting these kinds of longstanding illnesses perceive improved health and are less restricted in their daily activities. CONCLUSIONS: Results from Sweden indicate that many countries approaching Sweden's life expectancy will have an increased need for care for the oldest population in the future. The compression-of-morbidity hypothesis is being challenged, probably due to improvements in healthcare.

Aged↗
PubMed2005

Is perceived nervousness and anxiety a predictor of premature mortality and severe morbidity? A longitudinal follow up of the Swedish survey of living conditions.

STUDY OBJECTIVE: To find out if people perceiving nervousness, uneasiness, and anxiety have excess risks of premature death and severe morbidity. DESIGN, SETTING, PARTICIPANTS: Random samples of the Swedish population aged 16-74 years in 1980-81, 1988-89, and 1995-96 were followed up for 5 and 10 years with regard to deaths and hospital admissions for different causes. Relative risks were estimated by Poisson regression, comparing those who reported perceived nervousness, uneasiness, and anxiety with those who did not and adjustments were made for baseline characteristics as age, education, smoking, and longstanding illness. MAIN RESULTS: Perceived nervousness, uneasiness, and anxiety was strongly related to subsequent risks of suicide attempt and psychiatric disease. Those perceiving severe complaints of anxiety had a relative risk (fully adjusted) for suicide attempt of 9.2 (95% CI 3.0 to 28.8) for men and 3.1 (1.4 to 7.1) for women. Even for less severe complaints, there was a significant, but less pronounced excess risk. These negative feelings were also associated with later risks for all cause mortality, hospital care, and ischaemic heart disease, although to a lesser extent and more strongly among men. Unchanged relative risks over time shows no trend in response attitude and perceived anxiety seems to be a better predictor of a negative health outcome than self reported longstanding illness. CONCLUSIONS: Positive responses to self report survey questions about anxiety/nervousness are associated with adverse health outcomes, particularly hospital admission for deliberate self harm. This is an alarming signal bearing in mind the rapid increase in prevalence of perceived anxiety in the Swedish society.

Adolescent↗
PubMed2004

[Great regional differences in quality of obstetrical care].

In Sweden antenatal care is free of charge, easily available and utilized by practically all pregnant women. The obstetrical care is of high quality and perinatal mortality among the lowest in the world. However, there is a potential for improvement, as evidenced by the regional differences in quality of care shown in this study. Five quality indicators of antenatal and delivery care 1998-2002 are presented for all the counties in Sweden: still birth rate, smoking habits in early pregnancy, Apgar score at five minutes, neonatal mortality, and severe perineal tear. The results were adjusted for several maternal background factors as well as for pregnancy duration. In some counties the frequency of still birth, neonatal mortality, and low Apgar score at five minutes, were two to three times higher compared to the counties with the best outcome. Differences regarding severe perineal tear and smoking during early pregnancy were also evident.

Anal Canal↗
PubMed2004

Cancer patient survival in Sweden at the beginning of the third millennium--predictions using period analysis.

Estimates of cancer patient survival made using traditional, cohort-based, methods can be heavily influenced by the survival experience of patients diagnosed many years in the past and may not be particularly relevant to recently diagnosed patients. Period-based survival analysis has been shown to provide better predictions of survival for recently diagnosed patients and earlier detection of temporal trends in patient survival than cohort analysis. We aim to provide predictions of the long-term survival of recently diagnosed cancer patients using period analysis. The period estimates are compared with the latest available cohort-based estimates. Our results, based on period analysis for the years 2000-2002, suggest an improvement in survival for many forms of cancer during recent years. For all sites combined the 5-, 10-, 15-, and 20-year relative survival ratios were 62%, 53%, 48%, and 47% for males and 67%, 62%, 60%, and 59%, for females. These estimates were 3-14% units higher than those obtained using the latest available cohorts with the respective lengths of follow-up. The interval-specific relative survival stabilised for males at 97% after 8 years of follow-up and for females at 98% after 7 years for both period and cohort analyses.

Adolescent↗
PubMed2004

Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000.

AIMS: To investigate if improved treatment of coronary heart disease and hypertension, the major causes of chronic heart failure (CHF), in the last 20 years has had an impact on the incidence of CHF and survival. METHODS: National Swedish registers on hospital discharges and cause-specific deaths were used to calculate age- and sex-specific trends and sex ratios for heart failure admissions and deaths. The study included all men and women 45 to 84 years old hospitalized for the first time for heart failure in 19 Swedish counties between 1988 and 2000, a mean annual population 2.9 million. A total of 156?919 hospital discharges were included. RESULT: In 1988, a total of 267 men and 205 women per 100?000 inhabitants (age adjusted) were discharged for the first time with a principal diagnosis of heart failure. After 1993 a yearly decrease was observed, with 237 men and 171 women per 100?000 inhabitants discharged during 2000. The 30-day mortality decreased significantly. The decrease in 1-year mortality was more pronounced in the younger age groups, with a total reduction in mortality of 69% among men and 80% among women aged 45-54 years. The annual decrease was 9% among men and 10% among women aged 45-54 years (95% CI -7% to -12% and -6% to -14% respectively) and 4% among men and 5% among women (95% CI -4% to -5% for both) aged 75-84 years. CONCLUSION: The decrease in incidence and improved prognosis after a first hospitalization for heart failure coincides with the establishment of ACE-inhibitor therapy, the introduction of beta-blockers for treatment of heart failure, home-care programmes for heart failure, and more effective treatment and prevention of underlying diseases. Notwithstanding, despite considerable improvement, 1-year mortality after a first hospitalization for heart failure is still high.

Age Distribution↗
PubMed2004

Up-to-date long-term survival of cancer patients: an evaluation of period analysis on Swedish Cancer Registry data.

The natural development of cancers as well as the measures to fight the disease are often long processes that require decades of follow up. Available information on long-term survival will thus often appear outdated and irrelevant. A few years ago, period-survival analysis was proposed as a means to obtain more up-to-date information on long-term cancer survival. This article assesses period and conventional cohort-based survival analyses on their ability to predict future survival. Based on historical data from the nationwide Swedish Cancer Registry 5-, 10- and 15-year relative survival actually observed for patients diagnosed at one particular point in time are compared to the most recent period and cohort-based survival estimates available at that point in time. The study shows that period analysis can, in most cases, be used to provide more up-to-date long-term estimates of cancer survival. Period analysis reduces the time lag of the survival estimates by some 5-10 years for all cancers combined and especially affects the survival estimates for small intestine carcinoids, meningioma and intracranial neurinoma of the brain, non-seminoma testicular cancer, chronic lymphocytic leukaemia and Hodgkin's lymphoma.

Cohort Studies↗
PubMed2004

Case-fatality rates for myocardial infarction declined in Denmark and Sweden during 1987-1999.

OBJECTIVE: To evaluate trends in prognosis after acute myocardial infarction (AMI) between Denmark and Sweden using routinely collected data and different case-fatality measures. STUDY DESIGN AND SETTING: We compared three case-fatality measures during 1987-1999 using national registries in Denmark and Sweden, and extended these measures with underlying deaths of ischemic heart disease and sudden deaths of unknown cause. RESULTS: Changed coding practice distorted trends of case fatality rates during the day of the event. In general, Denmark had higher case-fatality rates, but trends in hospital-based rates were very similar, except for men 35-64 years old; Denmark declined more steeply. Short- and long-term prognosis improved considerably: the odds ratios for case fatality during days 1-28 for 1999 vs. 1987 were 0.48 among men in Denmark (women 0.58) and 0.53 among men in Sweden (women 0.55) and the odds ratios for case fatality during days 29-365 for 1999 vs. 1987 were 0.56 among men in Denmark (women 0.65) and 0.66 among men in Sweden (women 0.67). CONCLUSION: Short- and long-term prognosis improved considerably during 1987-1999 in Denmark and Sweden. Case fatality during the day of the event is epidemiologically important, but less certain than case-fatality measures defined after the day of the event when comparing countries.

Adult↗
PubMed2004

Premature mortality among lone fathers and childless men.

This study focuses on male family situation and premature mortality. For a total of 682,919 men, we analysed mortality from different causes (1991-2000) among lone fathers, with and without custody of their children, and among childless men, with and without partners. Long-term cohabiting fathers with a child in their household were used as comparison group. We employed data from Swedish censuses, national health-data registers, and a Swedish register containing information about known biological relations between children and parents. We investigated the extent to which different kinds of relations were influenced by varying socioeconomic circumstances between groups, and also processes of health selection. The results suggest that lone non-custodial fathers and lone childless men face the greatest increase in risks, especially from injury and addiction, and also from all-cause mortality and ischaemic heart disease. Being a lone custodial father also entails increased risk, although generally to a much lesser extent, and not for all outcomes. The elevated risks found in all the subgroups considered diminished substantially when proxy variables to control for health-selection effects and socioeconomic circumstances were added to the initial model. Risks fell most in response to introduction of the socioeconomic variables, but health selection also played a major role, mostly in the cases of lone non-custodial fathers and lone childless men. However, even following these adjustments, significant risk increases, although greatly attenuated, remained for all the subgroups.

Adult↗
PubMed2004

Inequality in access to coronary revascularization in Sweden.

OBJECTIVES: To investigate social and gender equality in access to coronary revascularization for those treated for coronary heart disease in Sweden between 1991 and 2000. DESIGN: All Swedish residents between 25 and 74 years old with a hospital stay for coronary heart disease were eligible for the study, in total about 153,000 persons. The Swedish Hospital Discharge Register from 1988 through 2000 was used to define the study population. Poisson regression analyses were used to estimate the effect of socio-economic status on the likelihood for coronary artery bypass grafting (CABG) within 2 years. In the analysis of gender differences, the likelihood for percutaneous coronary intervention (PCI) was also included. RESULTS: Males were 1.5 times more likely to undergo revascularization procedures than females even after adjusting for confounding factors and the fact that women are less eligible for interventions. The analyses also showed significant socio-economic inequalities in access to CABG among men, but not among women. CONCLUSIONS: There are gender and socio-economic inequalities in access to cardiac procedures in Sweden.

Adult↗
PubMed2003

[Mortality after myocardial infarction has decreased in nearly all Swedish counties during the 1990's. Greatest improvement seen in those counties with the worst initial results].

In an international perspective, Sweden has a very low case fatality after acute myocardial infarction (AMI). The aim of this study was to present trends and regional differences in case fatality within 28 days of the first AMI for males and females in Sweden after adjusting for co-morbidity. Adjustments in order to remove random effects on the rank order of county councils were made. The study was based on national data on more than 500,000 cases of AMI. Between 1987 and 1999, case fatality after AMI decreased from 47% to 37% among men and from 44% to 34% among women. The case fatality in the individual counties varied from 29% to 37% for men and from 31% to 40% for women. Further analysis is needed in order to explain these variations.

Comorbidity↗