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PubMed2005

Health expectancy in Denmark, 1987-2000.

BACKGROUND: While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states. METHODS: Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan's method. RESULTS: In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased. CONCLUSION: The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen. KEY POINTS: Health expectancy expresses average lifetime in various states of health. The study examines changes in expected lifetime in selfrated good health, lifetime without longstanding illness and lifetime without longterm disability. Among 65-year-olds the percentage of disabilityfree life expectancy increased from 63.4% to 74.9% for men and from 55.6% to 61.0% for women between 1987 and 2000. Health status among elderly Danes has apparently improved, but secular trends in health expectancy depend on the choice of health indicator.

Adult↗

PubMed2005

The social patterning of relative body weight and obesity in Denmark and Finland.

BACKGROUND: Relative body weight is typically inversely associated with social status in affluent societies but studies comparing the social patterning of relative body weight and obesity in different countries have only seldom been conducted. The aim of this study was to analyse and compare the social patterning of relative weight and obesity by occupational status, educational attainment and marital status between Danish and Finnish women and men. METHODS: Data from the Finnish Survey on Living Conditions and the Danish Health and Morbidity Survey, both collected in 1994, were compared. Relative weight was studied by using body mass index (BMI), and those with BMI > or =30 kg/m(2) were regarded as obese. Logistic regression analysis was used to examine the social patterning of obesity in the pooled dataset. Two-variable interaction effects were tested separately. RESULTS: Compared with their Danish counterparts, Finnish women and men had higher average relative weight and they were more often obese. There were no country differences in the socio-economic patterning of obesity by educational attainment, but a stronger patterning of obesity by occupational status was found among Danish women. Moreover, non-married women in Denmark were more likely to be obese than their married counterparts. CONCLUSIONS: Finns have higher relative weight and they are more often obese than Danes. The social patterning of obesity was similar in both studied countries but stronger in Denmark.

Adult↗

PubMed2001

Home- and community-based long-term care: lessons from Denmark.

PURPOSE: Denmark is cited as a model in the development of home- and community-based systems for the frail elderly population. We examined the results of this natural experiment and considered implications for U.S. policy. DESIGN AND METHODS: We used international comparative policy analysis, including site visits and semistructured interviews with Danish leadership in conjunction with a review of published literature, reports, and administrative data from Denmark and the United States. RESULTS: After 12 years of implementing integrated systems for home- and community-based services in 275 municipalities, growth in Danish long-term care expenditures has leveled off; expenditures appear to be decreasing for the over-80 population and have dropped as a percentage of the gross domestic product. Access to and quality of long-term care services appear to remain generally satisfactory. During this period, comparable expenditures in the United States have increased, and deficits in access and quality persist. IMPLICATIONS: These findings should be of interest to state and federal policy makers considering strategies to reduce the rate of growth in Medicaid and Medicare expenditures for elders and to expand home- and community-based services.

Aged↗

PubMed1982

Prevalence and socioeconomic correlates of subfecundity and spontaneous abortion in Denmark.

This paper provides an estimate of the prevalence of subfecundity and spontaneous abortion in Denmark, and examines social factors associated with these problems of reproduction. The data of this study were collected by interviewing a stratified random sample of 1.4 women per thousand in Denmark between the ages 25 and 45. The interview generated detailed information on reproductive history and sociodemographic data for 709 women. The survey results indicate that reduced fecundity is a relatively common health problem. The proportion of women that either could not achieve a wanted conception or experienced a delay of one or more years before achieving conception was 0.16 in a first pregnancy and 0.17 in a second or subsequent pregnancy attempt. Four per cent of the women interviewed never produced a desired first child and an additional four per cent reported failure to produce a second or subsequent desired child. Social factors relating to subfecundity and spontaneous abortion were studied using logistic regression. No significant associations were found between the occurrence of subfecundity and family net income, employment status of the 'head of the household', area of residence, type of housing or age at time of interview. Women without a college education were more likely to exhibit primary subfecundity than college-educated women (p less than .05). The rate of spontaneous abortion was not found to be associated with socioeconomic class. A significantly higher rate of abortion was found among women with a history of subfecundity than among women with no such history.

Abortion, Incomplete↗

PubMed1984

Suicide and self-poisoning in three countries--a study from Ireland, England and Wales, and Denmark.

Because it has been suggested that both the frequency of deliberate self-poisoning and the characteristics of those who self-poison differ between Ireland, and England and Wales on the one hand and Denmark on the other we have examined self-poisoning rates and suicide rates in these three countries. Higher self-poisoning rates were found for England and Wales than for the other two countries below age 35. After this age self-poisoning rates decline in both England and Ireland but female rates continue to rise in Denmark up to age 45. Danish suicide rates are conspicuously higher than those of both England and Wales, and Ireland. Because combined death rates for suicide, undetermined and accidental deaths diminish but do not remove the differences between countries it is suggested that the Danish suicide death rate reflects a genuinely higher rate of suicide in that country.

Adolescent↗

PubMed1989

Thyroid cancer: incidence, mortality and histological pattern in Denmark.

In Denmark, as in many other countries, the incidence of thyroid cancer is increasing, while mortality from this disease is decreasing. The proportionate distribution of cell types is similar to that seen elsewhere. The increase in incidence in other countries has been attributed to the increased use of radiation for benign conditions of the head and neck. This cannot explain the increase in incidence in Denmark, and other factors may contribute importantly to the changing picture of thyroid cancer.

Adolescent↗

PubMed1994

Epidemiology of pertussis in Denmark: the impact of herd immunity.

BACKGROUND: An evaluation is presented of the Danish pertussis immunization programme, which consists of three injections of plain whole-cell pertussis vaccine given alone at ages 5 weeks, 9 weeks, and 10 months. DATA: The incidence of pertussis in vaccinated and unvaccinated children since the start of vaccination was obtained from the notification system for infectious diseases. Data for vaccination coverage were obtained from the National Social Security. The data for 1980-1986 were supplemented with data from culture-verified cases and hospitalized cases. RESULTS: Compared with other countries using four injections, incidence rates in Denmark are high, especially in pre-school years, leaving infants at a relatively high risk for contracting pertussis from siblings. However, compared with the era before general vaccination, the incidence of pertussis has fallen to one-sixteenth of its former levels. Today, only one in 20 vaccinated, and one in six unvaccinated children develop pertussis before the age of 15 years. This considerable fall, which has also occurred among unvaccinated children, is used to elucidate the importance of herd immunity, which, with the relatively high vaccination coverage in Denmark, was found to play a major role. CONCLUSIONS: The importance of herd immunity is stressed, and it is recommended that a fourth injection of pertussis vaccine is introduced to bring incidence rates down to the very low values found in countries with more intensive vaccination programmes.

Adolescent↗

PubMed1996

Trends in mortality, incidence and case fatality of ischaemic heart disease in Denmark, 1982-1992.

BACKGROUND: In Denmark, as in many other Western countries, a decline in mortality from ischaemic heart disease (IHD) has been observed. The present study assesses whether the decline in IHD mortality is due to a decrease in incidence and/or case-fatality, and whether parallel changes occurred in the various manifestations of IHD requiring hospitalization. METHODS: The National Patient Register of hospital discharges and the Causes-of-Death Register were linked and all cases of first admission for IHD including AMI and fatal first manifestations of IHD since 1977 in the entire Danish population were identified. Cases of AMI and IHD were considered as incident cases if no admission for these diagnoses had occurred during the preceding 5 years. Sex-specific, age-standardized annual mortality, incidence and case-fatality rates of AMI (ICD8 code 410), narrowly defined IHD (NIHD, ICD8 codes 410-4) and broadly defined IHD (BIHD, ICD8 codes 410-4, 427 and 795-6) were calculated for the period 1982-1992. RESULTS: During the entire period the age-standardized mortality of AMI, NIHD and BIHD decreased in both men and women. The incidence of AMI and NIHD decreased, while the incidence of BIHD remained constant. Case fatality of AMI decreased in both men and women, while case fatality of NIHD and BIHD decreased in men and in women aged 0-64 years only. CONCLUSION: The declining mortality from IHD in Denmark may be partly due to declining incidence as well as declining case fatality, but changes in disease manifestation or diagnostic drift may also contribute because more broadly defined diagnostic groups showed less or no decline in incidence.

Adolescent↗

PubMed1999

Increasing inequality in ischaemic heart disease morbidity among employed men in Denmark 1981-1993: the need for a new preventive policy.

BACKGROUND: In the mid 1980s European governments committed themselves to the WHO goal 'reduced inequality in health by year 2000' according to which inequality in health should be reduced by 25% by the year 2000. The study aim is to estimate the time trend in relative risk due to ischaemic heart disease (IHD) morbidity in employment status groups in Denmark in the period from 1981 to 1993 and to recommend a strategy to reduce inequality in health. MATERIAL AND METHODS: The study dealt with change in relative risk of IHD in main employment status AND groups as measured in three successive cohorts. The cohorts were defined as all METHODS: gainfully employed men in Denmark as of 1 January 1981, 1986 and 1991, respectively. Information on employment was retrieved for the three previous years. The cohorts were followed for first admissions with IHD as the principal cause during 5, 5, and 3 years respectively. RESULTS: Managers and white collar workers had an average or low and decreasing relative risk while male blue collar workers had a high and increasing relative risk. Thus the social inequality in IHD is rapidly increasing. Some occupational groups are known to be at high risk. Some of these high-risk groups, such as bus drivers, even have an increasing relative risk. CONCLUSIONS: The general health education has been successful in the prevention of IHD in the high-status groups but has failed to reduce the risk among blue collar workers. Preventive measures against IHD should focus on occupational groups at high, increasing risk and the measures should tailor to their 'subculture.'

Adult↗

PubMed2003

Cancer incidence in Denmark following exposure to poliovirus vaccine contaminated with simian virus 40.

BACKGROUND: Early poliovirus vaccines were accidentally contaminated with simian virus 40 (SV40). In Denmark, poliovirus vaccine was administered to most children from 1955 through 1961. SV40 DNA sequences have been detected in several human malignancies, including mesothelioma, ependymoma, choroid plexus tumors, and non-Hodgkin's lymphoma. To clarify whether SV40 infection increases risk of these cancers or of cancers arising in children, we examined cancer incidence in three Danish birth cohorts. METHODS: Population-based cancer incidence data from 1943 through 1997 were obtained from the Danish Cancer Registry. The relationship between exposure to SV40-contaminated vaccine and cancer incidence was evaluated by examining incidence in birth cohorts that differed in exposure to SV40-contaminated vaccine. In addition, cancer incidence was examined in children who were 0-4 years of age before, during, and after the period of vaccine contamination. Incidence was compared using Poisson regression, adjusting for age differences. All statistical tests were two-sided. RESULTS: After 69.5 million person-years of follow-up, individuals exposed to SV40-contaminated poliovirus vaccine as infants (i.e., born 1955-1961) or children (i.e., born 1946-1952) had lower overall cancer risk (age-adjusted relative risk [RR] = 0.86, 95% confidence interval [CI] = 0.81 to 0.91 and RR = 0.79, 95% CI = 0.75 to 0.84, respectively; P<.001 for both) than unexposed individuals (i.e., born 1964-1970, after the vaccine was cleared of SV40 contamination). Specifically, SV40 exposure was not associated with increased incidence of mesothelioma, ependymoma, choroid plexus tumor, or non-Hodgkin's lymphoma. After 19.5 million person-years of follow-up, incidence of all cancers combined, of intracranial tumors, and of leukemia among children aged 0-4 years was also not associated with SV40 exposure. Ependymoma incidence was higher during the exposed period than during the unexposed period (RR = 2.59, 95%CI = 1.36 to 4.92; P =.004 versus the period before contamination); however, incidence peaked in 1969, after the vaccine was cleared of SV40. CONCLUSION: Exposure to SV40-contaminated poliovirus vaccine in Denmark was not associated with increased cancer incidence.

Child, Preschool↗

PubMed1997

Nicotine patches in smoking cessation: a randomized trial among over-the-counter customers in Denmark.

The authors examined the effect of 24-hour nicotine patches in smoking cessation among over-the-counter customers in Denmark, based on a randomized double-blind placebo-controlled trial. Participants were consecutive customers to whom nicotine patches were offered as the only treatment. Forty-two pharmacies in the areas of Aarhus and Copenhagen in Denmark participated in the trial, and 522 customers who smoked 10 or more cigarettes per day were randomized to either nicotine patches or placebo from January to March 1994. Customers with chronic diseases and pregnant or breastfeeding women were excluded from the trial. Twenty-four-hour patches were offered free of charge during a 3-month period. Those smoking 20 or more cigarettes per day started on a dose of 21-mg/day patches. Customers who smoked less started on patches of 14 mg/day; and for all of the participants, the dose was gradually reduced to 7-mg/day patches during the study period. Smoking behavior and compliance were recorded by means of self-administered questionnaires and telephone interviews. Smoking status was recorded in intervals of 4 weeks, which was fixed to be a treatment period, and 26 weeks after inclusion. There was a significant increase in smoking cessation rates after 8 weeks of follow-up but only among smokers who started on 21-mg/day patches. There was a marked placebo effect at each time of contact during the trial, especially in those smoking fewer than 20 cigarettes per day. Although the noncompliance rate was high overall due to discontinuation in the use of patches by relapsed smokers, noncompliance among successful quitters was low. More side effects were seen in the nicotine group than in the placebo group, but none of the reported side effects were serious. It appears that regular healthy smokers who were customers of nonprescribed nicotine patches and who received 21-mg/day nicotine patches benefited from the active treatment (44.1% stopped smoking after 4 weeks), but almost as many stopped smoking in the placebo group (37.3% after 4 weeks). No significant differences in smoking cessation rates were seen among smokers who started with the low-dose nicotine or placebo patches.

Administration, Cutaneous↗

PubMed1999

Effects of pesticide exposure on time to pregnancy: results of a multicenter study in France and Denmark. ASCLEPIOS Study Group.

The aim of this study was to determine whether there was a relation between male exposure to pesticides and the amount of time needed to conceive (time to pregnancy) for farmers and agricultural workers in France and Denmark. The authors used retrospective studies to compare the time to pregnancy of couples in which the man was exposed to pesticides during the year before the birth of their youngest child with that of couples in which the man was not exposed. In 1995 and 1996, the authors studied 362 French rural workers (142 exposed to pesticides and 220 not exposed), 449 Danish farmers (326 conventional farmers exposed to pesticides and 123 nonexposed organic farmers), and 121 Danish greenhouse workers exposed to pesticides. The fecundability ratio for exposure to pesticides (Cox model, before and after adjustment for confounding factors) did not differ from 1 in any of the three populations. In France, the adjusted fecundability ratio was 1.17 (95% confidence interval (CI) 0.89-1.55) for exposed and nonexposed agricultural workers. In Denmark, it was 1.09 (95% CI 0.82-1.43) for exposed and nonexposed farmers and 0.83 (95% CI 0.69-1.18) for greenhouse workers and nonexposed farmers. Thus, this study found no relation between fertility (time to pregnancy) and male exposure to pesticides.

Adult↗

PubMed1996

Patterns and trends in clinically recognized HIV seroconversions among all newly diagnosed HIV-infected homo-/bisexual men in Denmark, 1991-1994.

OBJECTIVE: To analyse patterns and trends in recently acquired HIV infections among newly diagnosed homo-/bisexual men. DESIGN AND METHODS: All newly diagnosed HIV-positive homo-/bisexual men reported to the mandatory national HIV reporting system in Denmark in 1991-1994. RESULTS: A total of 495 homo-/bisexual men were diagnosed with HIV infection for the first time; 45% had previously been tested HIV-negative, among whom 68% were known to have seroconverted 4 years or less prior to the positive diagnosis. Both proportions increased significantly from 1991 to 1994. Among men previously tested negative, the median interval between last negative and first positive HIV test was 902 days (range, 14-4459 days); 21.3% had seroconverted within 1 year and 55.1% within 3 years. Men previously tested negative were significantly younger than men never tested. Sex with a known HIV-positive partner was associated with having had a previous negative test and with being young. Half of the men had HIV-associated symptoms when diagnosed with HIV. Using a logistic regression model the following variables were associated with being a clinically recognized recent seroconverter: young age, no HIV-associated symptoms when diagnosed as HIV-infected, and ever having sex with an HIV-infected man. CONCLUSION: An increasing proportion of homo-/bisexual men diagnosed with HIV in Denmark in the early 1990s had had a negative HIV test 4 years or less before being diagnosed as HIV-positive. These men were younger and had HIV-associated symptoms less often than men not previously tested. The national HIV reporting system provides valuable information for planning primary HIV prevention programmes.

AIDS Serodiagnosis↗

PubMed1980

Normalization and rehabilitation as objects of socio-political measures concerning the mentally retarded in Denmark and the Federal Republic of Germany: an intercultural comparative study.

This is a report on first results of a research project which tries to develop statements concerning the transferability of the concept of normalization as a basis of the care for the mentally handicapped from the Scandinavian into the German context. The intercultural comparative study is chosen as the appropriate method. This is done on the basis of a socio-political comparison of the situation and practice of public services in both countries, as well as on the basis of a comparison of selected service regions. In this paper we do report on results on that socio-political comparison. There is a difference between the comparison of structural characteristics of social systems, the comparison of socio-political measures and the comparison of social tendencies and problems which have effects on the situation of the mentally retarded. In the centre of this statement is a nearby aspect of the structures' comparison, that is the comparison of the objects of public care for the mentally handicapped in Denmark and the FRG. These aims are defined within the specific arguments for legislative standardisations. In Denmark this aim is paraphrased by the term "normalization", which means to arrange the life of a handicapped as normal as possible. In Germany there is an alignment about the objective "rehabilitation", which is formulated most comprehensively as the integration of the handicapped into work, profession and society. An analysis of the normative contents shows a close conformity in the conceptions of the aims. In contrast to this we find practically basic organisational and structural differences in the systems of public services which in essence are connected with the different social systems of both countries and the different development of reform processes in this subject.

Cross-Cultural Comparison↗

PubMed1985

Handicap research in Denmark.

In connection with recent social developments in Denmark increasing interest has been shown in research in the area of handicaps. Three Danish Research Councils (for Medicine, the Humanities and the Social Sciences) appointed a Committee to investigate this area of research. A survey conducted in the relevant fields gave evidence of much activity in this area. Very few research projects, however, integrated educational, psychological, medical, technical and social aspects. The need for more cooperation, information and training was therefore stressed as a prerequisite for better interdisciplinary handicap research in Denmark. Research seminars and workshops held in 1982-83 supported the results of the survey, especially as regards the need for training in the methods of interdisciplinary research and understanding among professionals (nurses, teachers, social workers, therapists, etc.). A formal coordination agency is recommended in order to establish the necessary cooperation among researchers, planners and users in Danish handicap research.

Denmark↗

PubMed1992

Incidence of cancer of oesophagus, cardia and stomach in Denmark.

Subtypes of oesophageal and gastric cancer in Denmark are compared with respect to their occurrence in men and in women, and in the Danish capital, Copenhagen, versus the rest of Denmark. Three categories of tumours can be distinguished epidemiologically: oesophageal squamous carcinoma, oesophageal and cardial adenocarcinoma, and distal gastric cancer. Comparison of information reported to the Danish Cancer Registry and cause of death as indicated on death certificates suggests that considerable misclassification between subtypes of tumours occurs. The Danish experience supports the findings from other populations of increasing incidence of oesophageal and cardial adenocarcinoma, but because of possible changes in diagnoses over time and of misclassification of subtypes, the data must be interpreted with caution.

Adenocarcinoma↗

PubMed2006

Do changes in lymph node status distribution explain trends in survival of breast cancer patients in Denmark?

We studied the impact on survival of changes in breast cancer patients' distribution by lymph node status at the time of diagnosis. Our study included breast cancer patients diagnosed from 1978 to 1994 in Denmark, where the treatment schemes for breast cancer patients were fairly stable, and where mammography screening was limited. We measured lymph node status by the proportion of positive lymph nodes of all excised lymph nodes, as assessed by a pathologist. This measure was available for two-thirds of the breast cancer patients. The outcome was 5-year relative survival. Changes in lymph node status distribution explained half of the improvement in 5-year relative survival, and seem to be the single most important cause behind the improved survival of breast cancer patients in Denmark.

Aged↗

PubMed1996

Genetic population structure of the prosobranch snail Potamopyrgus antipodarum (Gray) in Denmark using PCR-RAPD fingerprints.

Parthenogenetic species are often more widely distributed geographically than their sexual relatives. This success in colonizing can be explained either by dispersal of one or a few clones of wide physiological tolerance or by the distribution of many locally adapted clones. Here we test the hypothesis that successfully invading clones of Potamopyrgus antipodarum (Gray) are composed of a few broadly adapted genotypes by using polymerase chain reaction random amplified polymorphic DNA (PCR-RAPD) fingerprinting on six different populations of P. antipodarum from Denmark and three morphotypes of P. antipodarum from Britain. We detected two genotypes of P. antipodarum in six populations examined across Denmark using four decamer primers. The two genotypes were found to be morphologically and genetically indistinguishable from British P. antipodarum. In five of the six Danish populations only one genotype was found; at the remaining site, the two genotypes occurred sympatrically. The present study suggests that P. antipodarum successfully invaded Europe by the proliferation of very few clones.

Animals↗