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PubMed2000

Do clinical databases render population-based cancer registers obsolete? The example of breast cancer in Denmark.

OBJECTIVE: Clinical databases have been invented to monitor treatment outcomes, therapies or diseases, often in great detail. The traditional population-based cancer registry has been invented to collect a minimum of information about all incident cancers. Do clinical databases render population-based cancer registers obsolete as sources of cancer cases for epidemiological study? METHODS: We compared the study base of first incident breast cancer cases in Denmark in 1978-1994 known from the national cancer register and from the national clinical database on breast cancer patients. The clinical database is used for monitoring protocoled treatment. RESULTS: Combining the two data sources we found 48,522 first primary breast cancers in Denmark 1978-1994. Of these, 37,640 were included in both data sources, 2151 were included only in the clinical database, and 8731 were included only in the cancer register. A major part of the difference between the two data sources was due to treatment-focused data collection in the clinical database, and a minor part due to differences in the registration of second primaries, date of diagnosis and invasiveness. CONCLUSIONS: Cancer incidence data are sensitive to registration procedures and definitions. Clinical cancer databases cannot generally replace the traditional cancer register as a reliable data source for incident cancer cases in a national population.

Adult↗

PubMed2001

Impact of a 10-year nation-wide alcohol campaign on knowledge of sensible drinking limits in Denmark.

In Great Britain and in Denmark, strong efforts have been made to influence knowledge on upper threshold for hazardous drinking. In Denmark, a campaign has been repeated every week 40 from 1990 to 2000 with information on the sensible drinking limits of 21 drinks per week for men and 14 drinks per week for women. The aim of this study was to examine the effect of this ongoing campaign on the level of knowledge of sensible drinking limits for men and women. Random representative samples of 1030 adult Danes were telephone interviewed each year during 1994-1999. Our main finding was that the level of knowledge of sensible drinking limits for own sex increased in all subsets of the population throughout the period. However, at the end of the study period (1999) a total of 80% of highly educated young (18-25 years) men knew sensible drinking limits for own sex, while only 35% of uneducated older (more than 65 years) men had knowledge on sensible drinking limits. The proportions were similar among women. Subjects admitting an intake higher than sensible for own sex, i.e. 21 and 14 drinks per week, respectively, had the highest knowledge of these drinking limits. We conclude that public health campaigns, such as the sensible drinking limit campaign, certainly has an impact on level of awareness in the general population. Furthermore, those drinking more than 21 and 14 drinks per week, respectively, are reached by these campaigns.

Adult↗

PubMed2000

Results from 8 yrs of susceptibility testing of clinical Mycobacterium tuberculosis isolates in Denmark.

Increased rates of multidrug-resistant (MDR) tuberculosis (TB) has been reported from countries close to Denmark. This study evaluated the incidence of drug resistance in Denmark in order to determine the magnitude of the problem. Susceptibility testing was performed in isolates from 85.4% of all notified patients during 1991-1998. Epidemiological information was retrieved from the mandatory notification forms. Total drug resistance remained largely constant, although a minor increase was observed in 1997-1998. Monoresistance was observed in 7.3%, of the isolates. Among 3.6% polyresistant isolates, resistance to isoniazid and streptomycin accounted for 2.8%, whereas MDR accounted for 0.5%. The MDR strains displayed different restriction fragment length polymorphism (RFLP) patterns, and no matches were identified in the international MDR database. Drug resistance in untreated Danes and foreigners were 5.9% and 14.6%, respectively. Among Danes and foreigners with previous TB, 6.2% and 22.7% had drug resistance, respectively. Increased drug-resistance was found among untreated Danes aged 25-54 yrs mainly due to a single isoniazid and streptomycin-resistant RFLP-cluster. Among all patients with isoniazid and streptomycin-resistance, 77.0% had clustered strains. In conclusion, although drug resistance among untreated Danes was close to the rate estimated in good national programmes, close monitoring is needed in future years, as active transmission of isoniazid- and streptomycin-resistant Mycobacterium tuberculosis was demonstrated.

Adolescent↗

PubMed1998

Current trends in cataract surgery in Denmark--1997 survey.

A survey of the preferred techniques and choices in cataract surgery of the members of the Danish Ophthalmological Society with address in Denmark was performed in January 1998. Only ophthalmologists performing cataract surgery were asked to return the questionnaire. Ninety-one responses were received by the cut-off day, representing 28872 cataract operations per year. The data were compared to data from previous surveys in Denmark, and similar data from the US and Japan.

Adult↗

PubMed1999

Current trends in cataract surgery in Denmark--1998 survey.

A survey of the preferred techniques and choices in cataract surgery of the members of the Danish Ophthalmological Society with address in Denmark was performed in January 1999. Only ophthalmologists performing cataract surgery were asked to return the questionnaire. Ninety-three responses were received by the cut-off day, representing 32,832 cataract operations per year. The data were compared to data from previous surveys in Denmark, and similar data from the US and Japan.

Adult↗

PubMed2000

Orbital space-occupying lesions in Denmark 1974-1997.

PURPOSE: To determine the frequency, distribution according to diagnosis and the recurrence frequency of orbital space-occupying lesions in Denmark, to determine sex and age of the patients and to establish a national orbital data register. METHODS: All biopsied/surgically removed orbital lesions collected by Danish pathological departments during the period 1974-1997 were identified by SNOMED codes. In addition, in each case gender and age of the patients and number of recurrences were registered. RESULTS: 965 orbital lesions from 841 patients were identified during the 24-year period. The incidence of orbital lesions increased significantly over the study period and at present about 80 cases/year are registered. The ratio benign/malignant lesion per year remained constant during the observation period. Lesions in children constituted a total of 152 (16%), the percentage of lesions in children being constant during the period. Malignant tumors comprised a total of 364 (45%) in adults and 34 (22%) in children. Malignant tumors were in adults distributed with 43% primary, 48% secondary invading and 9% metastatic tumors, and in children with 65% primary, 29% secondary invading and 6% metastatic tumors. Normal tissue was only found in 6% of the cases recorded. CONCLUSION: A registration of all histologically evaluated orbital space-occupying lesions in Denmark during a period of 24 years was performed and a national orbital database established. Orbital lesions are rare and primarily benign.

Adolescent↗

PubMed2003

Prevalence of mental disorders among 15-17-year-old male adolescent remand prisoners in Denmark.

OBJECTIVE: To determine the past year prevalence of mental disorders of 15-17-year-old adolescent remand prisoners in east Denmark. METHOD: One hundred 15-17-year-old boys from east Denmark consecutively remanded during 1 year were interviewed with diagnostic instruments to obtain ICD-10 diagnoses. All were screened in The Danish Psychiatric Case Register and The Danish Criminal Register. RESULTS: Past year prevalence of 'any mental disorder' was 69%, substance use disorders 41%. Two per cent had schizophrenia and 2% schizotypal disorder. Thirty-six per cent had 'probable personality disorder'. Conduct disorder was found in 31% and 1% had a hyperkinetic disorder. Ten per cent had previous registered psychiatric contact. CONCLUSION: The prevalence of mental disorders was found substantially higher compared with literature of population-based samples. With an association between mental disorders and violence, early detection and treatment of mental disorders in adolescent delinquents is of importance in the prevention of violence.

Adolescent↗

PubMed2002

Monitoring and analysis of bovine spongiform encephalopathy (BSE) testing in Denmark using statistical models.

The evolution of monitoring and surveillance for bovine spongiform encephalopathy (BSE) from the phase of passive surveillance that began in the United Kingdom in 1988 until the present is described. Currently, surveillance for BSE in Europe consists of mass testing of cattle slaughtered for human consumption and cattle from certain groups considered to be at higher risk of having clinical or detectable BSE. The results of the ongoing BSE testing in Denmark have been analyzed using two statistical approaches: the "classical" frequentist and the Bayesian that is widely used in quantitative risk analysis. The analyses were intended to provide information for decision-makers, the media and the public as well as to provide inputs for future BSE surveillance models. The results to date suggest that the total number of BSE cases that will be found in Denmark in 2001 will not exceed 16.

Age Distribution↗

PubMed1973

Male breast cancer. 5. Clinical manifestations in 257 cases in Denmark.

A series of 257 cases of carcinoma of the male breast in Denmark during the period from 1 January 1943 to 1 July 1972 has been reviewed, and a number of clinical symptoms have been recorded and assessed.Male breast carcinoma comprised 0·8% of all breast carcinomata in Denmark. The average age was 65·2 years, which is considerably higher than in women. The median duration of symptoms was 6 months. In only 13% was a palpable tumour the single symptom present on referral. In 27% ulceration was found on admission. However, ulceration was not, as commonly supposed, a particularly early manifestation of male breast cancer. It has been proved that ulceration is significantly related to duration of symptoms and size of tumour. According to the TNM classification, 35% of 253 cases were in stage I, 11% in stage II, 42% in stage III and 12% in stage IV. There was a significant correlation between the duration of symptoms and the clinical stage, and the histological degree of malignancy and the clinical stage. Expressed by the classification into stages, the clinical picture was definitely more favourable on referral during the period 1958-72 than during the period 1943-57.

Adult↗

PubMed1978

Incidence and long term survival of children with intracranial tumours treated in Denmark 1935-1959.

The total number of children under 15 years of age with intracranial tumours in Denmark during the years 1935-1959 was found to be 533. The average incidence was 21 new cases/10(6) children/year during the 25-year period in question, and 25/10(6) children/year during the first 17 years of Danish cancer registration. The sex ratio (290 boys to 243 girls) was not significantly different from that of the child population in Denmark. In 219 cases the tumour was located in the supratentorial and in 314 in the infratentorial space. 93% of the tumours were histologically verified, with the following order of frequency for the most usual types: astrocytomas (all grades), medulloblastomas, ependymomas, and craniopharyngiomas. Follow-up was 100%. For the 345 children who survived for more than one month after operation or diagnosis, 36% were alive after 15 years. 119 patients were alive in April 1974 and these were all observed between 15-40 years after diagnosis and operation. Of these 44 had tumours in the supratentorial and 75 in the infratentorial space. 66% of the survivors with supratentorial and 90% with infratentorial tumours led a normal life. Most of the survivors had had a cerebellar astrocytoma, a supratentorial astrocytoma, an apendymoma or oligodendroglioma, but other histological diagnoses were also represented, especially in the supratentorial group. The long-term prognosis was especially bad for children with brain-stem tumours, infratentorial ependymomas and medulloblastomas.

Adolescent↗

PubMed1985

Trend and distribution of mesothelioma in Denmark.

The time trend and the distribution of malignant mesothelioma in Denmark are described on the basis of all notifications of cancer cases to the Danish Cancer Registry during the period 1943-1980. The age and sex adjusted incidence rates of pleural as well as peritoneal mesothelioma are increasing with time and reached in the latest 3-year registration period 1978-1980 a remarkably high total incidence of 14.7 cases per million men and 7.0 cases per million women. Towards the end of the observation period, however, the rate of increase was stagnating and for the younger age-groups even a fall in incidence of this malignancy was noted, perhaps reflecting the introduction of compulsory hygienic precautions in the handling of asbestos in Denmark. The incidence and time trend of peritoneal mesothelioma was similar among males and females while pleural mesothelioma was three times more common among males compared with females and showed an increase in incidence 15 years previous to females. For pleural mesothelioma in men notified through the 10-year period 1968, 1977, a significant excess was associated with residence in areas with high degrees of urbanization and in ship building towns.

Adult↗

PubMed1994

Regional trends in breast cancer incidence and mortality in Denmark prior to mammographic screening.

To provide a basis for the evaluation of mammographic screening programmes in Denmark, a study was undertaken of the regional differences in breast cancer incidence and mortality. All 16 regions were followed for the 20 year period, 1970-89, before the start of the first population-based mammographic screening programme in the Copenhagen municipality in 1991. Multiplicative Poisson models were used for the analysis. In general, the incidence increased during this period from 55 to 70 [per 100,000 standardised world standard population (WSP)], and the analysis shows this to be most pronounced among women below age 60. The mortality was more stable, changing only from 24 to 28 (per 100,000 standardised WSP), but a significant increase occurred in the late 1980s. The study showed regional differences in both incidence and mortality of breast cancer in Denmark. Both the incidence and the mortality varied between the regions, with maximum differences of 22%. The analysis showed no variation in the time trends in the different regions, and thus indicates that the use of a regional comparison group would be a valid basis for evaluation of the Copenhagen programme. Our study, however, underlies the difficulties inherent in the evaluation of screening programmes without internal control groups.

Adolescent↗

PubMed2006

Secular change in size at birth from 1973 to 2003: national data from Denmark.

OBJECTIVE: To explore whether birth weight (BW) has been increasing in Denmark at the same level as in other countries and whether this increase is paralleled by an increase in birth length (BL) or whether body proportionality, expressed as ponderal index (PI), has changed. RESEARCH METHODS AND PROCEDURES: This study used data analysis of information from The Danish Medical Birth Registry including all single live births in Denmark from 1973 to 2003 (n = 1,863,456). BW, BL, gestational age, maternal age, and smoking status (only from 1991 on) were measured. RESULTS: Mean BW increased steadily during the period (160 grams; equivalent to approximately 5 g/yr) at a rate higher than that reported from other countries. BL showed only a minor increase (2.4 mm), leading to an increase in PI (0.8 kg/m3) during the period. Controlling for the effect of increasing maternal age and decreasing gestational age and maternal smoking prevalence (only data after 1991), there was still an increase in BW of approximately 4 g/yr. DISCUSSION: During the last 30 years, neonates have become bigger, with a larger relative increase in BW than BL, leading to an increase in PI. The increasing BW and PI, which may be caused by increased maternal weight, could further promote the obesity epidemic.

Adult↗

PubMed1990

Epidemiology of spinal cord lesions in Denmark.

Denmark has a population of about 5.2 million. The rehabilitation of spinal cord injured (SCI) takes place in two specialised rehabilitation hospitals. The incidence of new traumatic SCI admitted to these hospitals in the period 1975-1984 was 9.2 per million per year. During this period 92 Danes with non-traumatic and 268 with newly sustained traumatic spinal cord lesions were admitted to the rehabilitation hospital in Hornboek, which uptake area corresponded to South and East Denmark and Greenland and the Faroe Islands. Among the traumatic SCI 47% were due to traffic accidents, 23% to falls to a level below, 8% to attempted suicides, 6% to shallow water diving, and 6% to sporting accidents. The number of SCI caused by traffic accidents was found to decrease coincidently with the introduction of general speed limits and compulsory seat belt wearing. The male/female ratio was for the traumatic SCI 3.3, which was significantly lower than in the preceding 10-year period. 40% of all traumatic SCI were sustained at 15-24 years of age, and 51% had tetraplegia. Traffic accidents gave rise to more cervical, and falls to more caudal lesions. 41% of the traumatic SCI had an improvement in their neurological status after their admission to the neurosurgical department until the discharge from the rehabilitation hospital. Those with incomplete lesions showed greater improvement than those with complete lesions regardless of the level. Complete cervical lesions had significant better remissions than complete thoracic/lumbar lesions.

Accidents, Traffic↗

PubMed2003

Breast cancer incidence after the start of mammography screening in Denmark.

Mammography screening may lead to overdiagnosis of asymptomatic breast cancers, that would otherwise not have given rise to clinical symptoms. This aspect was studied in three regional screening programmes in Denmark, which started in Copenhagen municipality, Fyn county, and Frederiksberg municipality in 1991, 1993, and 1994, respectively. In these regions, we compared time trends in incidence of invasive breast cancer with the rest of Denmark. Since the number of clinical mammograms was relatively low, it was reasonable to assume that the breast cancer incidence outside the three screening regions represented the incidence of a population with low-intensity opportunistic screening. In Copenhagen and Fyn, a prevalence peak in incidence was seen during the first invitation round. During the subsequent invitation rounds, the incidence dropped to a level in line with the incidence expected without screening. The pattern was different in the small municipality of Frederiksberg, where the sensitivity was low during the first invitation round. Inclusion of screen-detected ductal carcinoma in situ cases did not change these results. The experiences from Copenhagen and Fyn show that organised mammography screening can operate without overdiagnosis of breast cancer.

Aged↗

PubMed2006

Stabilized incidence of diabetic patients referred for renal replacement therapy in Denmark.

Despite an improvement in diabetes care during the last 20 years, the number of diabetic patients starting renal replacement therapy (RRT) has continued to increase in the Western world. The aim was to study the incidence of patients starting RRT in Denmark from 1990 to 2004. Data were obtained from The Danish National Registry; Report on Dialysis and Transplantation, where all patients actively treated for end-stage renal disease have been registered since 1990. The incidence of end-stage renal disease increased until 2001. Thereafter the incidence stabilized on 130 per million people (pmp). The number of diabetic patients starting RRT increased steadily from: 52 (number of patients) in 1990, 113 in 1995, 150 in 2000, 168 in 2001, and 183 in 2002. However, during the years 2003 and 2004 this number was significantly reduced by 15% to 156 and 155, respectively. This was mainly due to a 22% reduction in the number of non-insulin- treated (type II) diabetic patients (number of patients): 98, 82, and 76 in 2002, 2003, and 2004, respectively. The mean age in the background population, the mean age in diabetic patients starting RRT and the incidence of type I and type II diabetes increased during the study period. The encouraging stabilization in the incidence of diabetic patients referred for RRT observed in Denmark could be the result of implementation of a multifactorial and more intensive renoprotective intervention in patients with diabetes and chronic progressive renal disease.

Adult↗

PubMed2001

Use of lipid-lowering drugs during 1991-98 in Northern Jutland, Denmark.

AIMS: To examine a) the use of lipid-lowering drugs in North Jutland County in Denmark from 1991 to 1998 and b) the pattern of usage according to sex and age. METHODS AND RESULTS: We used the Pharmaco-Epidemiological Prescription Database in the county to identify all reimbursed prescriptions for lipid-lowering therapy from 1991 to 1998. One-year incidence rates (IR) and prevalence (P) of the use of lipid-lowering drugs were calculated. Both IR and P of patients in lipid-lowering therapy were stable until 1994, with the IR below 100 per 100 000 for both sexes. The IR then increased from 59.9 to 236.5 per 100 000 person-years in 1998 for women, and from 88.6 to 322.8 per 100 000 person-years for men. The utilization patterns were identical between the sexes. Thus, in both women and men the highest prevalence and incidence rates of lipid-lowering drug therapy were seen in the 60-69-year-olds. Furthermore, the marked increase in both prevalence and incidence of persons on lipid-lowering drug therapy between 1994 and 1998 was the result of an increased number of prescriptions in the 50-59, 60-69 and 70 + years olds, in both women and men. There was a remarkable 4-5 fold increase in the numbers of new patients who received statins during the same period. CONCLUSIONS: The overall use of lipid-lowering drugs has increased markedly over the last few years in Northern Jutland, Denmark. The increase began following publication of the first major trial documenting the benefit of therapy with statins.

Adult↗

PubMed2000

Lack of adherence to lipid-lowering drug treatment. A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy.

AIMS: The objective was to explore differences in lipid-lowering drug (LLD) prescribing in Italy and Denmark. METHODS: We used two geographical areas with computerized drug prescription records in defined populations, one in Funen, Denmark with 500 000 inhabitants, the other in Bologna, Italy with 400 000 inhabitants. Prescriptions for patients who had purchased a LLD from 1994 until 1996 were retrieved as well as coprescriptions of antidiabetic and cardiovascular drugs as markers for diabetes and cardiovascular disease. Only patients surviving and remaining in the area were included. Compliance was defined as percentage of DDDs purchased divided by the number of days within the time window. The limit between good and poor compliance was set at 82%. RESULTS: In Bologna, LLD consumption measured in DDD increased by 41% and in Funen by 129%. Annual prevalence increased from 36.9 to 46.3 users/1000 inhabitants from 1994 to 1996 and from 3.2 to 6.6 users/1000 inhabitants in Bologna and Funen, respectively. From 1995 to 1996, the incidence of use decreased slightly in Bologna from 19.3 to 18. 8/1000 inhabitants/year, whereas in Funen the incidence increased from 1.8 to 2.3/1000 inhabitants/year. In Bologna 48% and in Funen 91% of users persisted with treatment for 2 years or longer. In Bologna, 7% and in Funen 45% were good compliers. In Bologna, 61% and in Funen, 72% received other drugs indicating cardiovascular or diabetic comorbidity. CONCLUSIONS: Patterns of use differed substantially between the two areas. In contrast with Funen, where long-term use was common, Bologna LLD use was sporadic. Based on a higher rate of coprescription, LLDs seemed to be used for secondary prevention to a higher extent in Funen than in Bologna. In Funen it appeared that the correct patients, but an insufficient number of them, were being treated adequately according to guidelines. The higher discontinuation rate of lipid lowering drugs in the Bologna area indicates that a large proportion of patients use these drugs for too short a period of time to benefit from treatment. Since society's health care resources are limited it is difficult to justify public funding of these medications without at the same time giving appropriate attention to these problems.

Adult↗