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PubMed2002

Depression and cancer risk: a register-based study of patients hospitalized with affective disorders, Denmark, 1969-1993.

The authors investigated the cancer risk of patients hospitalized for depression in a nationwide Danish cohort study. All 89,491 adults in Denmark who had been admitted to a hospital with depression, as defined in the International Classification of Diseases, Eighth Revision, between 1969 and 1993 were identified. There were 1,117,006 person-years of follow-up. Incidence rates of all cancers and of site-specific cancers were compared with national incidence rates for first primary cancers, with data being adjusted for sex, age, and calendar time. A total of 9,922 cases of cancer were diagnosed in the cohort, with 9,434.6 having been expected; this yielded a standardized incidence ratio of 1.05 (95% confidence interval (CI): 1.03, 1.07). The risk of cancer was increased for the first year after hospital admission, with brain cancer especially occurring more frequently than expected. When the first year of follow-up was excluded, the increase was attributable mainly to an increased risk of tobacco-related cancers: Standardized incidence ratios for non-tobacco-related cancers were 1.00 (95% CI: 0.97, 1.03) after 1-9 years of follow-up and 0.99 (95% CI: 0.95, 1.02) after 10 or more years of follow-up. These data provide no support for the hypothesis that depression independently increases risk of cancer, but they emphasize the deleterious effect that depression can have on lifestyle factors.

Adult↗

PubMed2002

Fracture risk in patients with celiac Disease, Crohn's disease, and ulcerative colitis: a nationwide follow-up study of 16,416 patients in Denmark.

The authors studied fracture risk among 16,416 Danish patients with bowel disease. All patients diagnosed with celiac disease (n = 1,021), Crohn's disease (n = 7,072), or ulcerative colitis (n = 8,323) in Denmark between January 1, 1983, and December 31, 1996, were included. Each patient was compared with three age- and gender-matched controls randomly drawn from the background population. No increase in fracture risk could be demonstrated for celiac disease before or after diagnosis. In patients with Crohn's disease, overall fracture risk was increased both before diagnosis (incidence rate ratio = 1.15, 95% confidence interval (CI): 1.00, 1.32) and after diagnosis (incidence rate ratio = 1.19, 95% CI: 1.06, 1.33). Bowel surgery was associated with a decreased risk of sustaining a fracture before diagnosis (odds ratio = 0.70, 95% CI: 0.54, 0.90) and after diagnosis (hazard ratio = 0.81, 95% CI: 0.67, 0.99). Overall fracture risk was not increased in patients with ulcerative colitis, except for a small increase around the time of diagnosis. Increasing age and having a fracture before diagnosis increased the risk of sustaining a new fracture after diagnosis. Crohn's disease was associated with a minor increase in overall fracture risk in contrast to ulcerative colitis and celiac disease. The severity of the inflammatory process and the amount of corticosteroids given may explain the difference in fracture risk.

Adult↗

PubMed2005

Spatial distribution and registry-based case-control analysis of Campylobacter infections in Denmark, 1991-2001.

Using data from an 11-year period (1991-2001), the authors analyzed available information on location of residence for all registered, laboratory-confirmed, domestically acquired cases of campylobacteriosis in Denmark. Patient data were merged with data from a national register on housing and addresses, and a population density index was constructed using the Danish population register. The study was performed as a register-based case-control study; 15 age-matched controls for each case were selected from the national population register. A total of 22,066 cases were compared with 318,958 controls in logistic regression analysis. Living in types of housing found in rural areas and living in areas with a low population density were both associated with an increased risk of infection. This relation concerned children in particular and explained one third of cases among children in the countryside. Furthermore, in some counties there was an association between infection and type of drinking-water company serving the home. This study indicated that contact with animals or the environment is the source of a substantial proportion of sporadic Campylobacter infections in the Danish countryside, particularly among children.

Adolescent↗

PubMed2006

Sibship characteristics and risk of multiple sclerosis: a nationwide cohort study in Denmark.

It has been hypothesized that age at infection with a common microbial agent may be associated with the risk of multiple sclerosis (MS). The authors addressed this hypothesis by using number of older siblings and other sibship characteristics as an approximation of age at exposure to common infections. Data on family characteristics and vital status from the Danish Civil Registration System were used to establish a cohort of all Danes whose mothers had been born in Denmark since 1935. Persons diagnosed with MS during the period 1968-1998 were identified through linkage with the Danish Multiple Sclerosis Register. The cohort of 1.9 million Danes was followed for 28.1 million person-years; during that time, 1,036 persons developed MS. Overall, there was no association between number of older siblings, number of younger siblings, total number of siblings, age distance from the nearest younger sibling, or exposure to younger siblings under 2 years of age and risk of MS later in life. There was no association of MS risk with multiple birth (vs. singleton birth) or with the age of the mother or father at birth. These results do not lend support to the hypothesis that number of older siblings or any of the other sibship characteristics studied is associated with risk of MS.

Adolescent↗

PubMed1992

The clinical and epidemiological profile of Lyme neuroborreliosis in Denmark 1985-1990. A prospective study of 187 patients with Borrelia burgdorferi specific intrathecal antibody production.

This prospective study reports the clinical and epidemiological features of 187 consecutive patients with neuroborreliosis recognized in Denmark over the 6-yr period, 1985-1990. Only patients with intrathecal Borrelia burgdorferi specific antibody synthesis were included. In 1990 regional incidences varied between 5.7 and 24.1 per million. Ninety-four percent of the patients had early (second stage) neuroborreliosis. The most common manifestation was a painful lymphocytic meningoradiculitis (Bannwarth's syndrome) either with paresis (61%) or as a radicular pain syndrome only (25%). Central nervous system (CNS) involvement in early neuroborreliosis was rare; 4% had signs of myelitis and only one patient had acute encephalitis. Children showed a different course of the disease. Six percent of the patients suffered a chronic course with a disease duration between 6 mths and 6 yrs either as chronic lymphocytic meningitis (1.6%) or as third stage chronic encephalomyelitis (4.3%). Meningeal signs were rare despite pronounced inflammatory cerebrospinal fluid (CSF) changes (median cell count 160/microliters; median protein concentration 1.13 g/l). High dose i.v. penicillin G was administered to 91% of the patients. Based on the clinical outcome and normalization of CSF no treatment failures were recognized. The final morbidity after a median follow-up of 33 mths was low; disabling sequelae were reported in nine patients, mainly those with previous CNS involvement. We conclude that neuroborreliosis is a common and characteristic neurological disorder. The diagnosis should be based on the demonstration of inflammatory CSF changes and B. burgdorferi specific intrathecal antibody production.

Aged↗

PubMedDate not supplied

Changing pattern of bone and joint infections due to Staphylococcus aureus: study of cases of bacteremia in Denmark, 1959-1988.

Of the 15,170 cases of bacteremia due to Staphylococcus aureus that occurred in Denmark between 1959 and 1988, we review 525 cases of acute hematogenous osteomyelitis and 185 cases of septic arthritis that developed subsequent to the bacteremia and 134 cases of contiguous osteomyelitis in which the bacteremia developed secondarily. The pattern of acute infections of bones and joints has changed over the three decades studied. The frequency of secondary bone or joint infections due to S. aureus bacteremia has changed, as have the phage-type pattern and antibiotic resistance of the infective strains. The prevalence of hospital-acquired cases has increased and the age distribution of patients has changed, as is reflected in an increasing number of older patients. The localization of hematogenous osteomyelitis has shifted, and the vertebral column is now the most common site of infection. The rate of chronic cases of osteomyelitis that occur following acute hematogenous osteomyelitis has been reduced from 34% to 6%. The mortality associated with S. aureus bacteremic infections of bones or joints is low compared to that associated with other cases of S. aureus bacteremia.

Acute Disease↗

PubMed1996

Capnocytophaga canimorsus septicemia in Denmark, 1982-1995: review of 39 cases.

Thirty-nine Danish cases of Capnocytophaga canimorsus septicemia were reviewed to determine the clinical course of this infection. The cases of septicemia were related to recent dog bites or other close contact with dogs. The period from the bite to the onset of symptoms ranged from 1 to 8 days. The mean age of the patients was 59.1 years (range, 28-83 years). Underlying conditions included previous splenectomy and alcoholism. Thirteen patients had previously been in good health. Common initial symptoms were fever, malaise, myalgia, vomiting, diarrhea, abdominal pain, dyspnea, confusion, headache and skin manifestations. Disseminated intravascular coagulation developed in 14 patients, meningitis in 5, and endocarditis in 1. Twelve of the patients died. All patients except two were treated with penicillin or ampicillin. Five patients had received antibiotics prior to admission. Attention should be drawn to C. canimorsus septicemia in cases of febrile illness following dog bites or contact with dogs, as well as those involving previously healthy persons. The incidence of this condition in Denmark is estimated to be 0.5 case per 1 million people per year.

Adult↗

PubMedDate not supplied

Vaccination with inactivated poliovirus vaccine and oral poliovirus vaccine in Denmark.

In Denmark a polio vaccination program including both inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine ( OPV ) has been in use since 1968. Three injections of IPV are given when the children are five, six, and 15 months of age. Subsequently, three vaccinations with trivalent OPV are administered at the age of three, four, and five years. The acceptance rate is high-93%-98%-and greater than 95% of the population has antibodies to poliovirus. The geometric mean titer of serum antibodies is much greater than 10 IU for all three types. The epidemiology of poliomyelitis and the background for the development of the present vaccination schedule are reviewed.

Antibodies, Viral↗

PubMed2004

Changes in hospitalization rate and mortality after acute myocardial infarction in Denmark after diagnostic criteria and methods changed.

AIMS: To analyse the effect of the change in diagnostic criteria for acute myocardial infarction (AMI) and the use of troponin as a diagnostic marker on the hospitalization rate and mortality of hospitalized AMI patients from 1994 to 2001. METHODS AND RESULTS: Patients (> or =30 years) admitted for their first AMI were identified using the National Patient Registry in Denmark. We registered when each hospital introduced troponin as a diagnostic marker. The reported hospitalization rate decreased until 1998 and then increased substantially from 1999 to 2001 from 3472 to 4163 per million inhabitants (19.9%) for men and from 1648 to 2020 per million inhabitants (22.6%) for women. Troponin use was associated with a significant 14% increase in hospitalization rate in this period [rate ratio 1.14, 95% confidence interval (CI) 1.11-1.18]. The effect of troponin was greatest among patients 70 years and older (rate ratio 1.19, 95% CI 1.14-1.23). The 28 day mortality decreased steadily from 25.9% in 1994 to 17.5% in 2002 (32.4%) and was not affected by troponin use. CONCLUSION: The reported hospitalization rate for AMI increased significantly after the new diagnostic criteria for AMI were introduced. The measurement of cardiac troponins further increased the hospitalization rate. The mortality among hospitalized patients with AMI declined steadily and was not affected by the use of troponins.

Adult↗

PubMed1999

Regional differences in waiting time to pregnancy: pregnancy-based surveys from Denmark, France, Germany, Italy and Sweden. The European Infertility and Subfecundity Study Group.

The objective of this study was examine geographical variation in couple fecundity in Europe. The study was based upon all recently pregnant (or still pregnant) women within well-defined geographical areas in Europe (Denmark, Germany, Italy, Sweden and France) at a given time period in 1992. Altogether, 4035 women responded to a highly structured questionnaire. Highest fecundity was found in Southern Italy and Northern Sweden; lowest fecundity was seen in data from the East German centre. Approximately 16% of the study population had a waiting time of more than 12 months to become pregnant. Most of the pregnancies were planned (64%) and approximately 14% were the result of contraceptive failures. The study shows that smoking, body mass index, age and parity did not explain the differences in fecundity found between the centres. Regional differences in fecundity exist and the causes may be genetic or due to variations in behavioural and environmental exposures.

Adult↗

PubMed1983

Demographic factors and cancer mortality. A mathematical model for cancer mortality in Denmark 1943-78.

Deaths from cancer in Denmark from 1943-1978 were extracted from the Danish National Death Register at the Danish Institute for Clinical Epidemiology. This paper illustrates the relationship between demographic factors and mortality from a large group of cancers, which increases progressively from young adult life into old age. One-year age-specific mortality rates between 30 and 79 years of age were computed for 14 different cancer sites among both males and females, in five ten-year birth cohorts and for the capital and provinces. The number of deaths at a particular age were found to follow a Poisson distribution and the mortality rate could be expressed by the function lx = bxk, where lx is the mortality rate at age x, and b and k are parameters to be estimated. With this model a straight line is obtained, when mortality and age are plotted on a double logarithmic scale. The maximum likelihood estimates of b and k were found iteratively for each of the 280 combinations of sex--cancer site--residence--cohort. For fixed sex and cancer site the relationship between age, residence and cohort was examined. It appeared that k was independent of residence. For 10 of the male cancers and 12 of the female cancers, k was found to be independent of cohort and in the last 6 cases k was found to be a linear function of cohort. For 12 out of 14 cancer sites among males the ratio of mortality in the capital to mortality in the provinces was significantly greater than one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Leukaemia after cervical cancer irradiation in Denmark.

A matched case-control study among cervical cancer patients in Denmark was conducted to evaluate the possible influence of radiation therapy on leukaemia risk. Among 25718 women treated between 1943-1977, 27 cases of leukaemia occurred one or more years after diagnosis. Four controls were matched to each case on age, calendar year of diagnosis and survival without developing a second cancer. Detailed medical records were abstracted, and individual radiation doses to active bone marrow were determined by medical physicists. All leukaemia diagnoses were classified by one haematopathologist. A 2.5-fold risk of radiogenic leukaemia was found, although the excess was not statistically significant (95% Cl = 0.5-12.1). The pattern of risk by dose was somewhat compatible with animal experiments, ie, the risk rose, peaked, and then decreased to near normal levels at the highest dose categories. The average dose to the total bone marrow was 783 rads, and thus a much greater risk of leukaemia was predicted on the basis of estimates from other exposed populations. Assuming that the pelvic bone marrow is essentially destroyed by high-dose radiotherapy and should, perhaps, be disregarded for the purpose of risk estimation, risk coefficients consistent with other studies can be computed. Nonetheless, the very low risk of radiogenic leukaemia found among cervical cancer patients suggests that the induction of leukaemia by radiation is a complex function of dose, and that very high doses may result in a decreased risk, possibly associated with cellular sterilization or other mechanisms.

Acute Disease↗

PubMed1988

Completeness of cancer registration in Denmark 1943-1966 and efficacy of record linkage procedures.

The completeness of registration in the national, population based cancer registry in Denmark was evaluated for the first 23 years (1943-1966) of operation. The registry was linked to a complementary data file on 5674 Danish invasive cervical cancer patients enrolled in an international, clinical follow-up study on the basis of identifying information including name, month and year of birth and date of cervical cancer diagnosis. The cancer register had a deficit of 2.2% (95% confidence interval, 1.8-2.6) cervical cancer patients; this figure is low compared to those of other cancer registers. Some 80% of the identified cases were retrieved by computerized matching alone, and an additional 15% were identified by combining computerized and visual matching procedures. Scrutiny of non-retrieved case records revealed that major errors in the identifiers of the cohort used for linkage were responsible for inability to identify an additional 1.7%. The presents study underlines the importance of meticulously recorded, high quality key identifiers in registers, and linkage of cohorts to establish the presence or absence of disease.

Denmark↗

PubMed1989

Incidence of childhood cancer in Denmark 1943-1984.

A population-based study was carried out on 5790 tumours in children (aged 0-14 years) diagnosed in the period 1943-1984 in Denmark. Cases were identified from the files of the high-quality National Cancer Registry in which codes for tumours were based solely on topography until the end of 1977. To achieve a uniform data set following the outlines of the International Classification of Diseases for Oncology (ICD-O) coding system used by the Cancer Registry today, all cases of childhood cancer diagnosed prior to 1978 were re-evaluated, and an ICD-O code was applied. Tumours were aggregated into diagnostic groups suitable for analysis and presentation using an internationally agreed scheme, which was designed by the Manchester Children's Tumour Registry and modified recently by the International Agency for Research on Cancer. The average incidence rates for all histological types of childhood cancer combined were 137 per million boys and 111 per million girls, which are close to those reported from the USA but higher than most of the overall figures reported from Europe. The proportions of specific tumours were similar to those observed in other industrialized countries. The well known excess of cancer cases among boys compared to girls was due mainly to the occurrence of 90% more lymphomas, 30% more leukaemias and 15% more tumours of the central nervous system (CNS) among boys. Although significant increases were seen in the subgroups of CNS neoplasms and neuroblastomas (both sexes) and of lymphomas (boys only), no overall increase in childhood cancer was observed during the 42-year period of registration. While the increase in the incidence of CNS tumours was explained at least partly by better cancer surveillance, no interpretation can be offered for the increases seen for neuroblastomas and lymphomas. Our descriptive data suggest that environmental exposures do not play any significant role in the aetiology of the majority of childhood cancers.

Adolescent↗

PubMed1991

Development of a semiquantitative food frequency questionnaire to assess food, energy and nutrient intake in Denmark.

Foods to be included in a Danish self-administered semiquantitative food frequency questionnaire were identified from food tables developed, together with data collected, for the survey 'Dietary habits in Denmark, 1985'. The questionnaire was to be used in a prospective study on diet, cancer and health, and the aim was to rank individuals with regard to intake of 19 different nutrients considered of prime importance in human carcinogenesis. The questionnaire for the dietary survey included 247 foods and recipes. From stepwise multiple regression analyses with the intake of each of the 19 nutrients as the dependent variable and the intake of the 247 foods and recipes as independent variables, the foods in the models explaining 90% of the between-person variability were considered for the final questionnaire. All relevant analyses were performed for the study group as a whole, for men and women separately, and in each gender for subgroups of energy intake. Taken together, the models explaining 90% of the between-person variability identified a total of 74 foods or recipes, which were important predictors of the intake of one or more of the nutrients considered. A few foods were excluded and a few foods were added to the final questionnaire based on common biological background information, and on information on foods providing important amounts of given nutrients, but which failed to contribute to regression analyses. The 92 foods and recipes, which were included in the final questionnaire provided altogether 81% of the average total supply of the nutrients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Smoking habits in Denmark from 1953 to 1991: a comparative analysis of results from three nationwide health surveys among adult Danes in 1953-1954, 1986-1987 and 1990-1991.

Changes in smoking habits in Denmark from 1953 to 1991 are described on the basis of data from three nationwide population surveys on health and morbidity. The data on smoking habits were collected at personal interviews with 34,018, 4753 and 4818 subjects aged more than 15 years in 1953-1954, 1986-1987 and 1990-1991, respectively. Among men, the proportion of smokers has fallen from 78% to 47%, but among women it has remained constant at around 40%. The greatest decrease occurred among younger men. The proportion of heavy smokers (> or = 15 g tobacco a day) has remained constant at around 25% in men, but in women it has increased from 3% to 14%. There is a correlation between occupational status and smoking; the proportion of smokers being highest among the unemployed, early retirement pensioners and unskilled workers, and lowest among upper-level salaried employees. Today, more smokers started smoking before the age of 15 years. Possible explanations of the changes include public debate, campaigns concerning the health risks of tobacco, and a change in the roles of the sexes. Since today's smokers are characterized by smoking onset before age 15 years it is proposed that future initiatives to reduce smoking must focus on the psychosocial factors related to early onset of smoking.

Adolescent↗

PubMed1997

Change in incidence of Crohn's disease and ulcerative colitis in Denmark. A study based on the National Registry of Patients, 1981-1992.

BACKGROUND: The incidence of inflammatory bowel disease (IBD) in Denmark is considered to be among the highest in Europe. However, the diseases are relatively rare and therefore it would be useful if existing registers could replace ad hoc examination in the surveillance of IBD. METHODS: The present study used the Danish National Registry of Patients to estimate incidence rates, 1981-1992. RESULTS: A total of 2806 patients with Crohn's disease (CD) and 8125 with ulcerative colitis (UC) were identified. The mean incidence for CD was 4.6 (5.4 for women and 3.7 for men) per 100,000 per year, with a peak incidence in younger women. The incidence increased in most age groups with the highest increase in older women. The mean incidence for UC was 13.2 (13.4 for women and 13.0 for men) per 100,000 per year, with the highest incidence in older men. A decreasing tendency in the incidence was present in most age groups. CONCLUSIONS: The present study found an increasing incidence for CD and a stable incidence with a tendency to decrease for UC. Comparison with ad hoc studies indicates that it is possible to use the Danish National Registry of Patients in the surveillance of IBD, especially for CD.

Adult↗

PubMed2002

Fetal growth and hospitalization with asthma during early childhood: a follow-up study in Denmark.

BACKGROUND: Childhood asthma may have a fetal origin. In order to examine this hypothesis we examined the association between fetal growth indicators and hospitalization with asthma during early childhood. METHODS: We performed a cohort study with 10 440 children whose mothers attended the midwife centres in Odense and Aalborg, Denmark, from April 1984 to April 1987 at approximately the 36th week of gestation. Information on hospitalization with asthma was extracted from the National Hospital Discharge Registry, which allowed a complete follow-up of all members of the cohort who remained alive and residents in the county. RESULTS: The cumulative incidence rates of hospitalization with 'definite' and 'any' asthma were 3.5% and 5.0%, respectively, at 12 years of age. After adjusting for potential confounders, there were increased trends in the risk of asthma hospitalization with birthweight and ponderal index. More pronounced trends, particularly in the risk of definite asthma, were found among children of over the average birthweight (IRR = 1.62, 95% CI: 1.02-2.59 per 1000 g increase) or ponderal index (IRR = 1.06, 95% CI: 1.02-1.10 per 0.1 g/cm(3) increase). However, the increased risk in large babies was seen only in children with a ponderal index of > or =2.5 g/cm3. CONCLUSION: Birthweight and ponderal index were associated with childhood asthma indicated by hospitalization. Fetal growth itself, determinants of fetal growth, or any unadjusted factors that correlate with fetal growth, could cause the association.

Anthropometry↗