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PubMed2007

Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: a population-based study from Copenhagen, Denmark.

BACKGROUND: It remains uncertain whether the increasing incidence of inflammatory bowel disease (IBD) during the last decades has been accompanied by an alteration in the presentation, course, and prognosis of the disease. To answer this question, 3 consecutive population-based IBD cohorts from Copenhagen, Denmark (1962-2005), were assessed and evaluated. METHODS: Phenotype, initial disease course, use of medications, cumulative surgery rate, standardized incidence ratio of colorectal cancer (CRC), and standardized mortality ratio (SMR) were compared in the 3 cohorts, which had a total of 641 patients with Crohn's disease (CD) and 1575 patients with ulcerative colitis (UC). RESULTS: From 1962 to 2005, the proportion of IBD patients suffering from CD increased (P < 0.001), time from onset of symptoms to diagnosis of CD decreased (P = 0.001), and median age at diagnosis of UC increased (P < 0.01). The prevalence of upper gastrointestinal involvement and pure colonic CD varied significantly between cohorts. UC patients diagnosed in the 1990s had a higher prevalence of proctitis, received more medications, and had a milder initial disease course than did previous patients. The surgery rate decreased significantly in CD but not in UC. The risk of CRC in IBD was close to expected over the entire period, whereas the mortality of patients with CD increased (overall SMR, 1.31; 95% CI, 1.07-1.60). CONCLUSIONS: Despite variations in the presentation and initial course of IBD during the last 5 decades, its long-term prognosis remained fairly stable. Treatment of IBD changed recently, and future studies should address the effect of these changes on long-term prognosis.

Adolescent↗

PubMed2004

Fertility pattern does not explain social gradient in breast cancer in denmark.

The present study was undertaken to assess the impact of reproductive behavior on the social class gradient in breast cancer occurrence in Denmark. Objectives were to study whether the gradient across socioeconomic groups could be explained by fertility differences, whether the gradient across educational groups could be explained by fertility differences and whether the effect of socioeconomic group on breast cancer incidence and mortality could be explained by education and vice versa. We studied 674,084 women aged 20-39 at the census on 9 November 1970 for whom we had complete data on fertility history. The cohort was followed up for breast cancer incidence and mortality until 8 November 1998. Fertility history varied considerably across socioeconomic group, where 38% of the academics were childless at the age of 30, in contrast to only 8% of women in agriculture. The academics had the highest risk of breast cancer and women in agriculture had the lowest risk. For incidence, the gradient in the relative risks was 1.74, which changed to 1.49 when fertility history was incorporated and to 1.29 when school education was also taken into account. For school education, women with > or = 12 years of schooling had the highest risk and women with < or = 7 years of schooling had the lowest risk. For incidence, the gradient in the relative risk was 1.38, which changed to 1.26 when fertility history was incorporated and to 1.22 when socioeconomic group was also taken into account.

Adult↗

PubMed2005

Incidence of intracranial meningiomas in Denmark, Finland, Norway and Sweden, 1968-1997.

It has been reported that the incidence of meningioma increased in several industrialized countries in the late 1970s and early 1980s. The aim of this study was to evaluate the time trends in incidence of meningiomas in Denmark, Finland, Norway and Sweden, with emphasis on the age distribution and sex ratio. Information about cases of meningiomas in people aged 15-84 years was obtained from the cancer registries of these Nordic countries for the years 1968-1997, and estimates of person-years at risk were calculated from information provided by the national population registries. Age-specific incidence rates per 100,000 and incidence rate ratios were calculated for 3-year periods. The female:male ratios were also evaluated. The combined incidence among men increased from 1.4 to 1.9 per 100,000 during the follow-up period, the corresponding rates for women were 2.6 and 4.5. The female:male ratio increased over time for several age groups and was as high as 3.5:1 in the group aged 40-44 years in the latest follow-up period (1993-1997). In summary, our results provide some support for the idea that the introduction of computed tomography in the late 1970s has had an impact on the detection of cases in people aged 60 and over. The decrease in the rate or detection postmortem has affected the incidence time trend, but it also coincides with widespread use of new imaging technologies. The increasing trend shown for the female:male ratio in the group aged 35-59 years is consistent with the possibility that increasing use of hormones may affect the incidence of meningiomas in women.

Adolescent↗

PubMed2006

Cancer incidence in the age range 0-34 years: historical and actual status in Denmark.

On the basis of 55 years of continuous cancer registration in Denmark, we present cancer incidence rates, time trends and birth cohort analyses for persons aged 0-34 years. The group of 40,750 cancer patients showed a substantial over-representation of males aged 1-24 years. The cancer pattern among young (15-34 years) men was dominated by testicular cancer (35%), lymphomas (14%) and tumors of the brain (13%), while the pattern among young women was governed by invasive cervical cancer (19%), malignant melanoma (15%) and cancer of the breast (12%). In this age range, a positive time trend was seen after 1970, equivalent to average annual percentage increases of 1.9% for men and 1.8% for women, due mainly to markedly increasing trends for testicular cancer, malignant melanoma, brain tumors, thyroid cancer, skin carcinomas and skin sarcoma among men, and for brain tumors, non-Hodgkin lymphoma, malignant melanoma, skin carcinomas and thyroid cancer among women. We saw no clear time trend for breast cancer among women. The cancer pattern among children (0-14 years) was similar to that reported for other white populations.

Adolescent↗

PubMed2006

Performance of clinical mammography: a nationwide study from Denmark.

Clinical mammography is the key tool for breast cancer diagnosis, but little is known about the impact of the organisational set-up on the performance. We evaluated whether organisational factors influence the performance of clinical mammography. Clinical mammography data from all clinics in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine sensitivity, specificity and accuracy, the latter using a receiver-operating characteristics (ROC) analysis. In 96,534 clinical mammography examinations, sensitivity was 75% and specificity 99%. The presence of at least one high volume-reading radiologist in the clinic increased accuracy (AUC = 0.91 for <1,000 examinations/year and 0.92 for >2,000 examinations/year, p = 0.017). The examination volume per clinic showed no clear effect on performance, as accuracy was significantly higher in clinics with a medium number of examinations (AUC = 0.93 for 2,000-4,000 examinations/year and 0.90 for >6,000 examinations/year, p = 0.003). Accuracy was significantly lower in regions with high annual utilisation rate of clinical mammography, which means the proportion of examined women in a region (AUC = 0.90 for 3.0-5.0% annual utilisation rate and AUC = 0.93 for 2.0-2.5% annual utilisation rate, and p = 0.001), indicating that clinical mammography worked best in patient populations of purely symptomatic women. Our data indicate that to increase the accuracy of clinical mammography at the community level, the presence of an experienced radiologist should be prioritized ahead of raising the clinic size.

Adult↗

PubMed1980

Malignant melanoma in Connecticut and Denmark.

The rising incidence of malignant melanoma of the skin was reviewed using data from the Connecticut Tumor Registry (1935-1974) (Eisenberg et al., 1967) and the Danish Cancer Registry (1942-1972) (Clemmesen, 1965, 1974, 1977). A total of 7,530 cases were analyzed according to age, sex and anatomic site. The total age-adjusted incidence rates were similar for these two countries, despite geographic and demographic differences. HOwever, the most rapid changes in melanoma incidence were observed in females from Denmark and males from Connecticut. In addition, the largest increases occurred for lower-extremity lesions in Danish middle-aged women and trunk-neck melanomas in Connecticut middle-aged men. Melanoma of the face was resistant to changing incidence and occurred in an older age group than melanoma of other skin sites. In general, birth cohort analysis confirmed that changing incidence began for persons born around 1900, but the rising incidence for lower-extremity melanomas in women and trunk-neck melanomas in males began earlier. In comparing incidence for anatomic sites by correcting for surface area and melanocyte density, higher than expected rates were seen for melanoma of the face in both sexes and trunk-neck melanoma in the males. The data presented support the concept that a cumulative exposure to solar radiation may be important in the etiology of melanoma of the face, but short-, intense sun exposure is probably related to melanoma in other sun-exposed areas, and that melanoma in areas other than the face is responsible for the rising incidence of this disease.

Adult↗

PubMed1988

Trends in breast cancer incidence and mortality in Denmark, 1943-1982.

The trend in breast cancer incidence and mortality was examined using data from the Danish Cancer Registry and the national mortality statistics respectively. The study population comprised 65,870 incident cases and 33,817 deaths from breast cancer in Denmark between 1943 and 1982. The incidence rate remained almost constant up to around 1960, whereafter it rose steadily. Comparatively little change was observed in mortality. Possible explanations for the differing trends in incidence and mortality include under-reporting of breast cancer from death certificates and improvement in survival. A multivariate statistical analysis showed that the increase in incidence was due mostly to a cohort effect, though calendar time may have had a slight effect as well.

Adult↗

PubMed1988

Influence of non-contraceptive exogenous and endogenous sex hormones on breast cancer risk in Denmark.

In order to evaluate the influence of sex hormones on breast cancer risk, a population-based case-control study was conducted in Denmark, including 1,486 cases diagnosed over a one-year period. These were identified from the files of the nation-wide clinical trial of the Danish Breast Cancer Cooperative Group and the Danish Cancer Registry. The control group was an age-stratified random sample of 1,336 women from the general population. Data on risk factors were collected by self-administered (mailed) questionnaires. The major findings included a trend (p = 0.001) toward decreasing risk with increasing age at menarche in pre-menopausal women, trends toward increasing risk with continued menstrual cycles after the age of 50 in pre- and post-menopausal women (p-values of 0.01 and 0.002 respectively), and a trend (p = 0.002) toward increasing risk with increasing duration of non-contraceptive sex hormone usage in post-menopausal women. Information on brand names made it possible to examine types of hormones used, which showed an RR of 1.36 (95% CI 0.98-1.87) for sequential therapy with oestrogen and progestagen and RR = 2.31 (95% CI 1.37-3.88) for combined oestrogen-androgen treatment. These results should be interpreted with caution, however, needing verification from other studies. No significant association was observed between breast cancer and self-reported height and weight.

Body Weight↗

PubMed1990

Dietary factors and breast-cancer risk in Denmark.

The influence of dietary factors, in particular the intake of fat and beta-carotene, on breast-cancer risk was evaluated in a case-control study including 1,486 breast cancer cases diagnosed over a 1 year period in Denmark. The control group was an age-stratified random sample of 1,336 women from the general population. Data on usual diet prior to the breast cancer diagnosis were collected by self-administered questionnaires of the semi-quantitative food frequency type. A highly significant trend (p less than 0.001) of increasing risk was observed with increasing fat intake, the RR for the highest quartile being 1.45 (95% Cl 1.17-1.80) compared with the lowest. However, information was not available to allow adjustment for the possible confounding effect of energy intake. The risk of breast cancer was not associated with consumption of vegetables rich in beta-carotene, multi-vitamin tablets or other dietary supplements, coffee, tea, sugar or artificial sweeteners.

Adult↗

PubMed1993

Cancer among teenagers in Denmark, 1943-1987.

A population-based study was carried out on 3,988 tumours in teenagers (aged 10-19 years) diagnosed during the period 1943-87 in Denmark and abstracted from the files of the National Cancer Registry. In that Registry, codes for tumours were based solely on topography until the end of 1977. In order to obtain a uniform data set, coded by the system of the International Classification of Diseases for Oncology (ICD-O) now used at the Cancer Registry, all cases of teenage cancer diagnosed prior to 1978 were re-evaluated, and an ICD-O code was applied. Tumours were further aggregated into diagnostic groups using an internationally agreed scheme. The average incidence rates for all histological types combined were 136 per million for boys and 108 per million for girls, which are close to those reported in Connecticut, USA. Central nervous system tumours, leukaemia and malignant lymphomas accounted for 60% of all cancers among teenagers. An overall excess of cancers among boys was mainly due to more frequent occurrence of leukaemias, malignant lymphomas, sarcomas and germ-cell tumours. Increasing trends with time were seen for malignant lymphomas in both boys and girls and for subtypes of non-seminoma germ-cell tumour among boys aged 15-19. For other diagnostic groups, including the main group of leukaemias, the rates have remained largely unchanged, suggesting that environmental factors associated with modern society play a minor role in the aetiology of cancer among teenagers.

Adolescent↗

PubMed1994

Risk factors for renal-cell carcinoma in Denmark. III. Role of weight, physical activity and reproductive factors.

A population-based case-control study of risk factors for renal-cell carcinoma was conducted in Denmark from 1989 to 1992. A total of 368 histologically verified cases and 396 controls were included. Information on weight, height, physical activity and reproductive factors were collected in a structured interview, along with information on other suspected risk factors. A significant increase in risk was seen for obese women but not obese men. Although there was no clear gradient, the risk was highest among women with a relative weight in the upper 5% (OR 6.1; 95% CI, 2.3 to 16.1). The increased risk was most evident for high relative weight in ages 30 to 50. No association was observed for height or physical activity. Use of amphetamines was associated with increased risk but, because of the close link with obesity, we were unable to provide evidence that amphetamines are an independent risk factor. We found some evidence for an association with reproductive variables, including decreased risk for women with late menarche and first pregnancy and birth. We observed no association with number of pregnancies or age at menopause, or use of estrogen-containing medication.

Adult↗

PubMed1994

Incidence of female breast cancer in relation to prevalence of risk factors in Denmark.

The extent to which changes in prevalence of risk determinants for female breast cancer could explain the temporal variation in incidence was examined using incidence figures from Denmark for the years 1943-1989. Significant increases in incidence were observed for more recent time periods and birth cohorts. Using deviance statistics from Poisson regression measures of variability explained, only a small proportion of the increase in incidence could be accounted for by fertility rates, average age at menarche and exposure to exogenous hormones. Dietary factors, on the other hand, accounted for the greater proportion of the variation observed by time period or birth cohort. In particular, there was a strong positive association of incidence with alcohol consumption and a negative association with carbohydrate intake.

Adult↗

PubMed1994

Age-period-cohort modelling of large-bowel-cancer incidence by anatomic sub-site and sex in Denmark.

In a previous investigation, statistical modelling was used to examine the relationship between large-bowel-cancer incidence and age, time period and birth cohort by anatomic sub-site and sex, using data from the Connecticut Tumor Registry (CTR) for the period 1950 to 1984. This analysis revealed differences in age-period-cohort patterns that suggested etiologic distinctions among sub-site groupings and between the sexes. To test the generalizability of the Connecticut findings, we have conducted a similar age-period-cohort analysis using data from the Danish Cancer Registry (DCR) for the period 1953 to 1987. Cancers of the large bowel were classified into 6 anatomic sub-sites: cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum. Data were fitted to log-linear age-period-cohort models. If we interpret differences in age-period-cohort patterns as reflecting etiologic distinctions, the Denmark analysis, in conjunction with the Connecticut findings, was consistent with there being etiologic distinctions between cancers of the colon vs. the rectum in both males and females, between cancers of the cecum and the ascending colon vs. the remainder of the colon in females and between males vs. females for cancers of the sigmoid colon and rectum. Cancers of the cecum and the ascending colon were the most similar between males and females. Due to the ambiguities of age-period-cohort modelling, these should be considered only tentative conclusions that can be tested by analytical epidemiologic studies.

Adult↗

PubMed1995

Risks of second primary malignancy in patients with cutaneous and ocular melanoma in Denmark, 1943-1989.

Risks of 2nd primary cancer were assessed in all patients with cutaneous melanoma (12,460) and all patients with ocular melanoma (2,018) incident in Denmark from 1943 to 1989 and followed for totals of 88,667 person-years and 16,045 person-years, respectively. After cutaneous melanoma, 972 2nd cancers occurred. The risk of non-melanoma skin cancer was significantly raised in each sex. Risk of all non-skin cancers was not raised for all ages but was significantly increased for patients with the primary melanoma incident at ages under 50 years (standardised incidence ratio [SIR], i.e., ratio of observed to expected cancer incidence, multiplied by 100 = 117; 95% confidence interval [CI] 101-134). There were significantly increased risks of chronic lymphocytic leukaemia in males and both sexes combined, brain and nervous system cancers in females and both sexes combined and oropharyngeal cancer in both sexes combined. Risk of pancreatic cancer was not raised, suggesting that cutaneous melanoma patients generally do not share the diathesis for this malignancy which has been observed in certain families with atypical naevi and melanoma. There was no relation of 2nd primary cancer risks to duration since the first primary and no indication of any appreciable treatment-related risk. After ocular melanoma, 216 2nd cancers occurred. There was a significantly increased risk of 2nd cancer overall in males but not females and a significantly increased risk of liver cancer in each sex. Risk of non-melanoma skin cancer (NMSC) was not raised, which suggests that the aetiology of ocular melanoma is not mainly dependent on UV exposure, at least of the type causing NMSC.

Adult↗

PubMed2004

Clinical characteristics of Parkinson's disease among Inuit in Greenland and inhabitants of the Faroe Islands and Als (Denmark).

In earlier studies, we found high age-adjusted prevalences of Parkinson's disease (PD) in the Faroe Islands (209 per 100,000 inhabitants) and in Greenland (187.5 per 100,000 inhabitants) compared to the age-adjusted prevalence on the island of Als in the southern part of Denmark (98.3 per 100,000 inhabitants). We thoroughly examined patients with suspected parkinsonism using internationally accepted diagnostic criteria. In the present study, we found no significant clinical differences between patients with PD in the three areas, despite this high difference in prevalence. However, comparing the age at examination and age at treatment, the patients were younger in Greenland, a higher proportion of patients had cognitive decline, and they had a higher mean Hoehn and Yahr rating score, although they received a lower levodopa dose. A higher proportion of the patients in Greenland were newly diagnosed than in the other two areas.

Aged↗

PubMed1994

Testicular germ cell tumours of childhood in Denmark, 1943-1989: incidence and evaluation of histology using immunohistochemical techniques.

In the Danish Cancer Registry, 72 testicular tumours in boys younger than 15 years of age were recorded during the period 1943-1989 and material from 34 of these was retrieved from Danish departments of pathology. The histological types were evaluated and the role of immunohistochemical staining was analysed. The survival of the patients was correlated with the histological diagnoses, and changes in the incidence of testicular cancers in childhood were analysed. Twenty-nine of the 34 patients had germ cell tumours, which fell into two groups (infantile and pubertal) with distinct differences. The tumours of infancy usually presented before the age of 3 years and were either pure yolk sac tumours or teratomas. The tumours of puberty showed no morphological or immunohistochemical differences from adult germ cell tumours. In the infantile group, immunohistochemical staining confirmed the morphological evaluation but was not necessary for diagnosis. Patients in the infantile group seemed to have a better prognosis than adult patients, only one patient dying from his disease, whereas the pubertal patients seemed to have a prognosis similar to that of adult patients. The incidence of infantile testicular cancer in Denmark appears to have increased at almost the same rate as that observed in adult men, but due to the small numbers in infancy, this cannot be statistically substantiated. We conclude that the testicular germ cell tumours of infancy and puberty may arise from different precursor cells, but both groups seem to arise prenatally.

Adolescent↗

PubMed2005

Income related inequality in prescription drugs in Denmark.

PURPOSE: To examine income-related inequity in utilisation of prescription drugs in Funen County, Denmark after a new reimbursement system was implemented. METHODS: An individual level prescription database was merged with a health survey of 2927 respondents interviewed in 2000 and 2001 about their health status and socio-economic and socio-demographic characteristics. An index of horizontal inequity was used to estimate the degree of inequity in drug utilisation across income groups, using the indirect method of standardisation to control for age, gender and health status as a proxy for need. The results were compared to estimates from a traditional regression analysis. RESULTS: The least advantaged with respect to income consume a bigger share of the prescription drugs than the most advantaged. After standardisation for age, gender and health status the least advantaged have a lower share of the drug consumption than expected. However, traditional regression analysis showed no signs of an income effect on the level of consumption of prescription drugs. CONCLUSIONS: The index of horizontal inequity suggests that some horizontal inequity favouring the better off is present. However, the results deviate from what can be found by traditional regression analysis.

Adolescent↗

PubMed2001

Conducting pharmacoepidemiologic research in Denmark.

Denmark has one of the worlds most comprehensive registration of its citizens' use of medical and social services. Most databases are population-based and of very high quality. Virtually all employ a mutual person identifier, which renders it technically possible to link any of them with others. There are two prescription registries of interest for research, the OPED and the NJPD, each covering 0.5 million persons. The content of these are described in brief. The most recent Danish data protection act can be viewed as a liberalization of prevailing registry practice. Our most important obstacles for performing record-linkage studies are costs, academic resources and a lack of generally accepted guidelines on the ethics of observational research.

Access to Information↗