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ABSTRACT: OBJECTIVE: To examine the risk of thoracic aortic disease (TAD) when one or more first-degree relatives are affected, and to relate the risk of family history to the risk of other cardiopulmonary comorbidity. DESIGN: Population-based, matched, case-control study. SETTING: Registry-based investigation. PATIENTS: All cases, nationwide, of TAD diagnosed 2001-2005 in individuals born 1932 or later (n=2436) were identified, and a random control-group (n=12 152) matched for age, sex and geography was generated. First-degree relatives were identified in the Multigeneration Registry. Family history of TAD was assessed by cross-linking nationwide health registries. INTERVENTIONS: None. RESULTS: Family history was present in 108 cases (4.4%), compared with 93 (0.77%) controls (p<0.0001). The risk of TAD increased with number of affected relatives: OR 5.8 (95% CI 4.3 to 7.7) vs OR 20 (2.2 to 179) with one versus two or more affected relatives. The relative risk of TAD was highest in the youngest (≤49 years) age group and slightly more pronounced in women than in men (OR 7.2 (4.2 to 12) vs OR 5.5 (3.9 to 7.7)). Among cardiopulmonary comorbidities, heart failure conferred the highest relative risk, OR 6.3 (4.1 to 9.8). CONCLUSIONS: Family history confers a significantly increased (sixfold to 20-fold) relative risk of TAD. The effect is more pronounced in women and in younger subjects, and is not conveyed by cardiopulmonary comorbidity. Knowledge of family history is important to counselling, treatment indications, surveillance and screening protocols.
Heart (British Cardiac Society) 04/2013; · 4.22 Impact Factor
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ABSTRACT: Celiac disease (CD) is associated with both lymphoproliferative malignancy (LPM) and increased death from LPM. Research suggests that co-existing autoimmune disease may influence survival in LPM. Through Cox regression we examined overall and cause-specific mortality in 316 individuals with CD+LPM versus 689 individuals with LPM only. CD was defined as having villous atrophy according to biopsy reports at any of Sweden's 28 pathology departments, and LPM as having a relevant disease code in the Swedish Cancer Register. During follow-up, there were 551 deaths (CD: n = 200; non-CD: n = 351). Individuals with CD+LPM were at an increased risk of death compared with LPM-only individuals [adjusted hazard ratio (aHR) = 1.23; 95 % confidence interval (CI) = 1.02-1.48]. However, this excess risk was only seen in the first year after LPM diagnosis (aHR = 1.76), with HRs decreasing to 1.09 in years 2-5 after LPM diagnosis and to 0.90 thereafter. Individuals with CD and non-Hodgkin lymphoma (NHL) were at a higher risk of any death as compared with NHL-only individuals (aHR = 1.23; 95 % CI = 0.97-1.56). This excess risk was due to a higher proportion of T cell lymphoma in CD patients. Stratifying for T- and B cell status, the HR for death in individuals with CD+NHL was 0.77 (95 % CI = 0.46-1.31). In conclusion, we found no evidence that co-existing CD influences survival in individuals with LPM. The increased mortality in the first year after LPM diagnosis is related to the predominance of T-NHL in CD individuals. Individuals with CD+LPM should be informed that their prognosis is similar to that of individuals with LPM only. However, this study had low statistical power to rule our excess mortality in patients with CD and certain LPM subtypes.
European Journal of Epidemiology 03/2013; · 4.71 Impact Factor
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ABSTRACT: Month of birth - an indicator for a variety of prenatal and early postnatal exposures - has been associated with life expectancy in adulthood. On the northern hemisphere, people born in the autumn live longer than those born during the spring. Only one study has followed a population longitudinally and no study has investigated the relation between month of birth and mortality risk below 50 years.
In this nation-wide Swedish study, we included 6,194,745 subjects, using data from population-based health and administrative registries. The relation between month of birth (January - December) and mortality risk was assessed by fitting Cox proportional hazard regression models using attained age as the underlying time scale. Analyses were made for ages >30, >30 to 50, >50 to 80 and >80 years. Month of birth was a significant predictor of mortality in the age-spans >30, >50 to 80, and >80 years. In models adjusted for gender and education for ages >30 and >50 to 80 years, the lowest mortality was seen for people born in November and the highest mortality in those born in the spring/summer, peaking in May for mortality >30 years (25‰ excess hazard ratio compared to November, [95% confidence interval = 16-34 ]) and in April for mortality >50 to 80 years (42‰ excess hazard ratio compared to November, [95% confidence interval = 30-55]). In the ages >80 years the pattern was similar but the differences in mortality between birth months were smaller. For mortality within the age-span >30 to 50 years, results were inconclusive.
Month of birth is associated to risk of mortality in ages above 50 years in Sweden. Further studies should aim at clarifying the mechanisms behind this association.
PLoS ONE 01/2013; 8(2):e56425. · 4.09 Impact Factor
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ABSTRACT: Abstract Objective. This study compared survival after diagnosis of prostate cancer (PC) in men previously treated with finasteride, in men previously treated with α-adrenoceptor antagonists, in men treated with both, and in men who had received neither type of medication. Material and methods. In total, 3791 men diagnosed with PC in northern Denmark were identified. The region's prescription database was used to identify all men prescribed finasteride and α-adrenoceptor antagonists and those who had received neither medication during the period 1989-2001. Among men with a diagnosis of PC, overall survival and disease-specific survival were assessed after diagnosis using Cox proportional hazards regression. The risk of being diagnosed with non-localized PC was estimated using conditional logistic regression. Results. The adjusted hazard ratio (HR) for PC death and overall death after treatment with finasteride was 0.93 [95% confidence interval (CI) 0.76-1.14] and 0.92 (95% CI 0.77-1.10), respectively. Treatment with α-adrenoceptor antagonists was associated with a reduced risk of PC death and overall death (HR 0.78, 95% CI 0.67-0.90, and 0.82, 95% CI 0.73-0.93, respectively. The risk of being diagnosed with non-localized PC was increased for men taking finasteride (odds ratio 1.14, 95% CI 1.01-1.29) per 100 defined daily doses. Conclusions. Treatment with finasteride prior to a diagnosis of PC did not affect PC-specific survival, but increased the risk of being diagnosed with non-localized disease. Treatment with α-adrenoceptor antagonists was associated with better cause-specific survival and lower risk of non-localized disease.
Scandinavian Journal of Urology and Nephrology 11/2012; · 0.99 Impact Factor
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ABSTRACT: The purpose of this study was to compare the risk of surgically treated stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in relation to mode of delivery and age at first childbirth.
This was a cohort study. Data from the Swedish Medical Birth Register on women with only cesarean delivery (n = 30,880 women) or only vaginal delivery (n = 59,585 women) were compared with the Swedish Patient Register to calculate incidence rates and hazard ratios (95% confidence interval [CI]) for SUI and POP surgery.
In analyses that were stratified by age, vaginal delivery consistently increased the risks of SUI and POP surgery. Among vaginally delivered women who were ≥30 years old, incidence rates of POP surgery were 13.8 (95% CI, 12.7-15.1), and for younger women were 6.4 (95% CI, 6.0-6.8) per 10,000 person-years. Exclusion of instrumental vaginal delivery did not alter the conclusions.
Increasing age at first delivery increased the risk of subsequent SUI and POP surgery after both vaginal and cesarean delivery.
American journal of obstetrics and gynecology 10/2012; 207(4):303.e1-7. · 3.28 Impact Factor
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ABSTRACT: Little is known about complications from ulcerative colitis (UC) or Crohn's disease (CD) during pregnancy and delivery. We assessed complications by using data from a large, population-based cohort.
We analyzed data from 1209 women with UC, 787 women with CD, and 10,773 women without these diseases (the comparison group) by using the Medical Birth, Patient, and Prescribed Drug Registers of all residents in Sweden. All the women included in the analysis gave birth to a single infant between October 2006 and December 2009. We used data on medical treatment, surgery, and hospital admissions to assess disease activity. Risks of pregnancy and delivery complications were determined from adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
The risk of venous thromboembolism was increased among women with UC (aOR, 3.78; 95% CI, 1.52-9.38), particularly for those with flaring disease. Women with CD had a higher risk of antepartum hemorrhage (aOR, 1.66; 95% CI, 1.12-2.45), with the highest risks among those with no disease activity. Risks of elective cesarean delivery were more than doubled among women with UC (aOR, 2.44; 95% CI, 2.06-2.88) or CD (aOR, 2.31; 95% CI, 1.89-2.83). Women with UC (aOR, 1.39; 95% CI, 1.13-1.70) or CD (aOR, 1.50; 95% CI, 1.17-1.92) had increased risk for emergency cesarean delivery. Women with an inactive UC or flaring CD had the highest risks of cesarean delivery.
Women with UC or CD have more complications during pregnancy and delivery than women without these diseases. Disease activity affects mode of delivery, and thrombophilic events present differently in women with UC vs CD.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 08/2012; 10(11):1246-52. · 5.64 Impact Factor
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ABSTRACT: Obesity is a risk factor for gestational diabetes, whereas the role of the mother's birth weight is more uncertain. We aimed to investigate the combined effect of mothers' birth-weight-for-gestational-age and early pregnancy Body Mass Index (BMI) in relation to risk of gestational diabetes. Between 1973 and 2006, we identified a cohort of 323,083 women included in the Swedish Medical Birth Register both as infants and as mothers. Main exposures were mothers' birth-weight-for-gestational-age (categorized into five groups according to deviation from national mean birth weight) and early pregnancy BMI (classified according to WHO). Rates of gestational diabetes increased with adult BMI, independently of birth-weight-for-gestational-age. However, compared to women with appropriate birth-weight-for-gestational-age [appropriate-for-gestational age (AGA); -1 to +1 SD] and BMI (<25.0), women with obesity class II-III (BMI ≥ 35.0) had an adjusted odds ratio (OR) of 28.7 (95 % confidence interval, CI 17.0-48.6) for gestational diabetes if they were born small-for-gestational-age [small for gestational age (SGA); <-2SD], OR = 20.3 (95 % CI 11.8-34.7) if born large-for-gestational-age [large-for-gestational-age (LGA); >2SD], and OR = 10.4 (95 % CI 8.4-13.0) if born AGA. Risk of gestational diabetes is not only increased among obese women, but also among women born SGA and LGA. Severely obese women born with a low or a high birth-weight-for-gestational-age seem more vulnerable to the development of gestational diabetes compared to normal weight women. Normal pre-pregnancy BMI diminishes the increased risk birth size may confer in terms of gestational diabetes. Therefore, the importance of keeping a healthy weight cannot be overemphasized.
European Journal of Epidemiology 08/2012; · 4.71 Impact Factor
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation of the airways. In the majority of cases,
the inflammation is triggered by tobacco smoke. Smoking also affects the pathogenesis of inflammatory bowel disease (IBD),
protecting against ulcerative colitis (UC) and promoting development of Crohn’s disease (CD). The present study was undertaken
to investigate occurrence of IBD among COPD patients, indicating common inflammatory pathways and shared vulnerability on
a genetic basis. The study was designed as a population-based cohort study. All individuals discharged with a diagnosis of
COPD from 1987 to 2002 were identified in the Swedish Inpatient Register (n=180,239). Controls and first-degree relatives of both cases and controls were identified using the Multi-Generation Register.
Finally, all individuals (n=1,174,557) were compared with the Inpatient Register, identifying discharges with a diagnosis of UC or CD. Hazard ratios
(HR) for IBD were determined by Cox proportional hazards regression analysis. COPD patients had a significantly higher risk
of both UC (HR 1.83; 95% CI 1.61-2.09) and CD (HR 2.72; 95% CI 2.33-3.18). Among first-degree relatives of COPD patients,
there was also an overall increased risk of CD (HR 1.25; 95% CI 1.09–1.43) but not of UC (HR 1.09; 95% CI 0.96-1.23). The
kinship of first-degree relatives displayed an increased risk of both UC and CD among siblings (HR 1.49; 95% CI 1.15-1.91
and HR 1.46; 95% CI 1.12-1.89, respectively). The results suggest that COPD and IBD may have inflammatory pathways in common,
including genetic variants of genes predisposing for disease.
Beiträge zur Klinik der Tuberkulose 04/2012; 186(3):167-172. · 1.90 Impact Factor
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ABSTRACT: ObjectiveAcute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent haemodialysis (IHD). Whether
this choice affects renal recovery has been debated, since it has implications on quality of life and costs. Our objective
was to determine the impact of CRRT and IHD on renal recovery.
DesignNationwide retrospective cohort study between the years 1995 and 2004. Follow-up ranged between 3 months and 10 years.
SettingThirty-two Swedish intensive care units.
Patients and participantsEligible subjects were adults treated in Swedish general intensive care units with RRT. Atotal of 2,642 patients from 32
ICUs were included. We then excluded patients with end-stage renal disease (252) and patients lacking adiagnosis in the in-patient
register (188). Thus, 2,202 patients were studied. Follow-up was complete.
InterventionsNone.
Measurements and resultsThe primary outcome was renal recovery. Secondarily we studied the mortality of the cohort. There were no differences between
IHD and CRRT patients regarding baseline characteristics, such as age, sex and comorbidities. Of the 1,102 patients surviving
90 days after inclusion in the cohort, 944 (85.7%) were treated with CRRT and 158 (14.3%) were treated with IHD. Seventy-eight
patients (8.3%; confidence interval, CI, 6.6–10.2), never recovered their renal function in the CRRT group. The proportion
was significantly higher among IHD patients, where 26 subjects or 16.5% (CI 11.0–23.2) developed need for chronic dialysis.
ConclusionsThe use of CRRT is associated with better renal recovery than IHD, but mortality does not differ between the groups.
Intensive Care Medicine 04/2012; 33(5):773-780. · 5.40 Impact Factor
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ABSTRACT: Maternal smoking during pregnancy may increase the risk of nicotine dependence, especially in girls, but data are conflicting and confounding by other familial factors cannot be ruled out.
To clarify the relationship between prenatal tobacco exposure and adolescent tobacco uptake and dependence in boys and girls respectively, while taking confounding factors into close consideration.
We conducted a prospective longitudinal study, comprising 3020 Swedish youths followed from 11 to 18 years of age. Exposure and outcome information was elicited via self-administered parental and repeated youth questionnaires. Hazard ratios (HRs), odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated as measures of associations.
Girls prenatally exposed to maternal tobacco use had a two- to threefold increased odds of experiencing a high number of withdrawal symptoms (OR = 2.83, 95% CI 1.68-4.87), craving for tobacco (OR = 2.04, 95% CI 1.28-3.32) and heavy tobacco use (five or more cigarettes or snus dips per day) (OR = 1.93, 95% CI 1.30-2.86). These associations were weaker among boys, and did not reach formal statistical significance. Associations between prenatal tobacco exposure and onset of regular tobacco use in both genders appeared to be mostly explained by parents' social position and postnatal smoking behaviour.
Prenatal exposure to tobacco is linked to an increased risk of nicotine dependence among adolescent girls.
The British journal of psychiatry: the journal of mental science 03/2012; 200(3):202-9. · 6.62 Impact Factor
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ABSTRACT: The study aimed to investigate relevant clinical risk factors for re-exploration due to bleeding after primary coronary artery bypass graft (CABG) surgery, and to evaluate the influence of antiplatelet and antifibrinolytic drugs.
Three retrospective analyses were performed on patients who underwent CABG: (1) Logistic regression was used to identify clinical risk factors for re-exploration (n = 3000). (2) A case-control study (n = 228) was used to obtain information on exposure of antithrombotic and hemostatic therapy. (3) Based on exposure to antiplatelet and antifibrinolytic therapy, and odds ratios (ORs) in multivariate logistic models, the proportion of re-explorations attributed to these drugs was calculated.
A receiver operating characteristic curve was created for clinical risk factors. The C-index was 0.64, indicating limited ability to predict re-exploration for bleeding. Clopidogrel was the only drug influencing the risk of re-exploration (OR 3.2, 95% CI 1.7-5.9). The harmful effect of clopidogrel was confirmed in multivariate model (OR 4.7, 95% CI 2.2-9.9), and aprotinin had a protective effect of the same magnitude (OR 0.2, 95% CI 0.1-0.6).
Clopidogrel is an essential risk factor for re-exploration due to bleeding, and attributable to at least one-quarter of surveyed cases. Aside from pharmaceuticals, there are no strong clinical risk factors.
Scandinavian cardiovascular journal: SCJ 02/2012; 46(1):39-44. · 1.07 Impact Factor
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ABSTRACT: To examine associations between personality and abnormal glucose regulation.
This cross-sectional study comprised 2152 men and 3143 women (43-66 years). Oral glucose tolerance test identified 316 men and 213 women with previously unknown impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT, or type 2 diabetes. Personality traits antagonism (low agreeableness), impulsivity (low conscientiousness), hedonic capacity (high extraversion), negative affectivity (high neuroticism) and alexithymia (low openness) were measured by a self-report inventory. Based on distribution of scores, responses were divided into "low" (<1 SD), "middle" (±1 SD) and "high" (>1 SD). Middle groups were considered reference groups. Prevalence odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.
In men, OR for low antagonism was 0.3 (CI 0.2-0.6) (age- and multi-adjusted models) while in women, neither high nor low antagonism was associated to abnormal glucose regulation. Men and women with high hedonic capacity had ORs 0.5 (0.3-0.9) and 0.6 (0.4-1.0), respectively (age- and multi-adjusted models). The other scales illustrated no significant associations.
No elevated risk of abnormal glucose regulation was observed for deviating scores on personality scales. Instead, reduced risks were indicated in men with low antagonism, and in men and women with high hedonic capacity.
Diabetes research and clinical practice 01/2012; 95(1):145-52. · 2.16 Impact Factor
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ABSTRACT: To compare birth outcomes between women exposed and unexposed to the antiviral medications oseltamivir or zanamivir during pregnancy.
This was an observational cohort study including women who gave birth to singletons in Sweden 2005-2007 and their infants. We obtained information from the national health registers and evaluated risks of low Apgar score, small for gestational age (SGA), low birth weight, preterm delivery, congenital malformations, birth-related death (stillbirth and neonatal death combined), and neonatal morbidity by conditional logistic regression. The unexposed [n = 860] were matched to the exposed [n = 86] by birth year and fetal gender.
A total of 81 women filled a prescription with oseltamivir only, 2 with zanamivir, and 3 with both oseltamivir and zanamivir. Compared with the unexposed infants, the exposed ones had higher risks of late transient hypoglycemia (crude OR = 4.00, 95%CI: 1.26-12.76). There were no statistical increased risks of low Apgar score, congenital malformations, SGA, low birth weight, preterm birth, or birth-related death. Adjusting for maternal age, parity, smoking, and body mass index had minor effects on the results. None of the women exposed to oseltamivir or zanamivir had been admitted to hospital for influenza during their pregnancy.
Except for an increased risk of late transient hypoglycemia, we found no increased risks of adverse birth outcomes among infants exposed to neuraminidase inhibitors in fetal life compared with the unexposed.
Pharmacoepidemiology and Drug Safety 07/2011; 20(10):1030-4. · 2.53 Impact Factor
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ABSTRACT: Celiac disease has been associated with gastrointestinal (GI) cancers in small studies; risks have not been estimated from large populations or based on histopathology analyses.
We examined the risk of GI cancers by using data from cohorts of patients with celiac disease (villous atrophy, Marsh score of 3; n = 28,882) or inflammation (Marsh score of 1-2; n = 12,860); biopsy samples were evaluated at 28 pathology centers. A third cohort included 3705 individuals with latent celiac disease (normal mucosa, but positive serology results). Data were compared with those from an age- and sex-matched population.
Of patients with celiac disease, 372 developed incident GI cancers; 347 patients with inflammation and 38 with latent celiac disease developed GI cancers. In the first year after diagnosis and initial biopsy, celiac disease was associated with 5.95-fold increase in risk of incident GI cancer (95% confidence interval [CI], 4.64-7.64); the hazard ratio [HR] for inflammation was 9.13 (95% CI, 7.19-11.6) and for latent celiac disease was 8.10 (95% CI, 4.69-14.0). After the first year, patients were at no significant increase in risk for GI cancers; the HR for celiac disease was 1.07 (95% CI, 0.93-1.23), for inflammation it was 1.16 (95% CI, 0.98-1.37), and for latent celiac disease it was 0.96 (95% CI, 0.56-1.66). The absolute risk for any GI cancer in patients with celiac disease was 101/100,000 person-years, with an excess risk of 2/100,000 person-years.
Although celiac disease, inflammation, and latent disease all increase risk for GI cancers in the first year after diagnosis, there is no increase in risk thereafter.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 06/2011; 10(1):30-6. · 5.64 Impact Factor
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Magnus Björkholm,
Asa R Derolf,
Malin Hultcrantz,
Sigurdur Y Kristinsson,
Charlotta Ekstrand,
Lynn R Goldin,
Björn Andreasson,
Gunnar Birgegård,
Olle Linder,
Claes Malm,
Berit Markevärn,
Lars Nilsson,
Jan Samuelsson, Fredrik Granath,
Ola Landgren
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ABSTRACT: Patients with myeloproliferative neoplasms (MPNs), including polycythemia vera, essential thrombocythemia, and primary myelofibrosis, have a propensity to develop acute myeloid leukemia (AML) and myelodysplastic syndromes (MDSs). Using population-based data from Sweden, we assessed the role of MPN treatment and subsequent AML/MDS risk with special focus on the leukemogenic potential of hydroxyurea (HU).
On the basis of a nationwide MPN cohort (N = 11,039), we conducted a nested case-control study, including 162 patients (153 and nine with subsequent AML and MDS diagnosis, respectively) and 242 matched controls. We obtained clinical and MPN treatment data for all patients. Using logistic regression, we calculated odds ratios (ORs) as measures of AML/MDS risk.
Forty-one (25%) of 162 patients with MPNs with AML/MDS development were never exposed to alkylating agents, radioactive phosphorous (P(32)), or HU. Compared with patients with who were not exposed to HU, the ORs for 1 to 499 g, 500 to 999 g, more than 1,000 g of HU were 1.5 (95% CI, 0.6 to 2.4), 1.4 (95% CI, 0.6 to 3.4), and 1.3 (95% CI, 0.5 to 3.3), respectively, for AML/MDS development (not significant). Patients with MPNs who received P(32) greater than 1,000 MBq and alkylators greater than 1 g had a 4.6-fold (95% CI, 2.1 to 9.8; P = .002) and 3.4-fold (95% CI, 1.1 to 10.6; P = .015) increased risk of AML/MDS, respectively. Patients receiving two or more cytoreductive treatments had a 2.9-fold (95% CI, 1.4 to 5.9) increased risk of transformation.
The risk of AML/MDS development after MPN diagnosis was significantly associated with high exposures of P(32) and alkylators but not with HU treatment. Twenty-five percent of patients with MPNs who developed AML/MDS were not exposed to cytotoxic therapy, supporting a major role for nontreatment-related factors.
Journal of Clinical Oncology 06/2011; 29(17):2410-5. · 18.37 Impact Factor
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ABSTRACT: Experimental evidence indicates that prolactin might play a role in tumorigenesis of several human cancers, but data on cancer risk in hyperprolactinemia patients are sparse. The aim of this study was to investigate cancer risk in hyperprolactinemia patients. Design A population-based matched cohort study in Sweden.
The hyperprolactinemia cohort consisted of patients hospitalized for hyperprolactinemia from 1987 to 1995 identified in the National Patient Register (n=585) and a hospital cohort of prolactinoma patients at Karolinska University Hospital (n=384). For each patient, ten matched individuals were identified via the Register of Population. Cancer occurrence was ascertained via the Swedish Cancer Registry. Hazard ratios (HRs) were estimated by Cox proportional hazards regression.
Seventy-three malignant tumors were identified in the hyperprolactinemia patients and 660 tumors in the comparison group (HR 1.31; 95% confidence interval (CI): 1.02-1.68), mainly attributed to an increased risk of upper gastrointestinal cancer in both males and females (HR 3.69; 95% CI: 1.70-8.03) and hematopoietic cancer in females (HR 3.51; 95% CI: 1.06-11.6). Twelve breast cancers occurred in the female patients, corresponding to an HR of 1.09 (95% CI: 0.60-1.99). Prostate cancer risk in hyperprolactinemia men was reduced (HR 0.40; 95% CI: 0.16-0.99).
An increased overall cancer risk was found in hyperprolactinemia patients, but no increased risk of breast cancer in women and a reduced risk of prostate cancer in men. These findings warrant further investigations and to be confirmed in larger studies but may indicate the importance of an active treatment strategy and follow-up of hyperprolactinemia patients.
European Journal of Endocrinology 05/2011; 165(2):209-15. · 3.42 Impact Factor
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ABSTRACT: To compare valve-related morbidity among patients aged < 70 and ≥ 70 years, receiving either a mechanical or a biological prosthesis in a population-based setting.
In total, 3279 patients (21 644 patient-years) were followed up through the Swedish National In-Patients Register, which registers all hospital admissions. Death, thromboembolism, bleeding, endocarditis, valve thrombosis and reoperations were all captured.
Survival was lower among patients aged <70 years with a bioprosthesis compared to a mechanical prosthesis (p < 0.0001), but equal among older patients. A mechanical prosthesis indicated a lower risk (p < 0.001) of thromboembolism (1.5% per patient year, ppy), than bioprosthesis (2.6% ppy), irrespective of age. Bleeding was increased (p = 0.002) with a mechanical prosthesis (1.7% ppy) compared to a bioprosthesis (1.1% ppy); the risk of bleeding increased early (<5 years) whereas thromboembolism increased late (>5 years). Event-free survival was higher in younger patients with a mechanical prosthesis compared to bioprosthesis recipients (p < 0.001), but equal among older patients.
Survival was comparable in older patients irrespective of prosthesis type. Bleeding was increased with a mechanical prosthesis, especially in the elderly. The risk of thromboembolism was higher in patients with a bioprosthesis.
Scandinavian cardiovascular journal: SCJ 04/2011; 45(4):223-8. · 1.07 Impact Factor
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ABSTRACT: Studies of women with ulcerative colitis (UC) during pregnancy have reported increased risks of preterm delivery, growth restriction, and congenital malformation. However, the results are inconsistent due to inadequate study design and limitations in sample size.
We performed a population-based prevalence study on 2637 primiparous women with a UC hospital diagnosis prior to delivery and 868,942 primiparous women with no UC diagnosis in Denmark and Sweden, 1994-2006. Logistic regression analysis was used to estimate relative risks for moderately (32-36 weeks) and very (before 32 weeks) preterm birth, 5-minute Apgar score <7, small-for-gestational-age (SGA) birth, stillbirth, neonatal death, and congenital abnormalities.
Maternal UC was associated with increased risk of moderately preterm birth (prevalence odds ratio [POR] 1.77, 95% confidence interval [CI]: 1.54-2.05), very preterm birth (POR 1.41, 95% CI: 1.02-1.96), cesarean section (POR 2.01, 95% CI: 1.84-2.19), and neonatal death (POR 1.93, 95% CI: 1.04-3.60). The strongest associations were observed for prelabor cesarean section (POR = 2.78, 95% CI: 2.38-3.25) and induced preterm delivery (POR 2.55, 95% CI: 1.95-3.33). There was a slightly increased risk of SGA birth (POR 1.27, 95% CI: 1.05-1.54). We found no association between UC and overall risk of congenital abnormalities (POR 1.05, 95% CI: 0.84-1.31) or specific congenital abnormalities. Risks for adverse birth outcomes were higher in women with previous UC-related surgery and hospital admissions.
Women with UC have increased risks of preterm delivery, SGA-birth, neonatal death, and cesarean section but not congenital abnormalities. Adverse birth outcomes appeared correlated with UC disease severity.
Inflammatory Bowel Diseases 03/2011; 17(3):795-801. · 4.86 Impact Factor
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ABSTRACT: Obstetric and neonatal complications have been associated with completed and attempted suicide (suicidal acts) in young offspring. Maternal smoking is one of the most important risk factors for obstetric complications, but the association between prenatal smoking exposure and offspring risk of suicidal acts is unknown. We performed a population-based study of 1,449,333 single births born in Sweden between 1983 and 1996, derived from linked registry data. Maternal smoking and risks of suicidal acts in offspring were estimated using hazard ratios, derived from proportional-hazard models, controlling for potential confounding of parental socio-demographic factors and psychiatric care in first degree relatives. To control for unmeasured familial confounding, a matched case-control analysis of suicidal acts was performed within sibling pairs discordant for prenatal smoking exposure. In the cohort analysis, the adjusted hazard ratio for completed suicide among offspring to women smoking 1-9 cigarettes and at least 10 cigarettes per day were 1.67, 95% confidence interval (CI), 1.29-2.16, and 1.54, 95% CI, 1.12-2.10. For suicidal acts, corresponding hazard ratios were 1.28, 95% CI 1.21-1.35 and 1.48, 95% CI 1.39-1.57, respectively. However, in sibling pairs discordant for suicidal acts and prenatal smoking exposure, we found no evidence that prenatal smoking exposure increased the risk of suicidal acts. We conclude that the association between prenatal smoking exposure and offspring risk of suicidal acts is probably confounded by unmeasured familial factors.
European Journal of Epidemiology 02/2011; 26(6):485-92. · 4.71 Impact Factor
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ABSTRACT: Celiac disease is associated with an increased risk of malignant lymphomas. The risk of lymphoproliferative malignancies in patients with small intestinal inflammation without villous atrophy and in patients with latent celiac disease is unknown.
We performed a cohort study using duodenal and jejunal biopsy data that were collected from all 28 Swedish pathology departments (July 1969 to February 2008). We identified two population-based cohorts composed of 28,989 individuals with biopsy-verified celiac disease (villous atrophy, Marsh stage 3) and 13,140 individuals with small intestinal inflammation without villous atrophy (Marsh 1 + 2) and a regional cohort of 3711 individuals with latent celiac disease (positive celiac disease serology and normal mucosa). Cancer data were obtained by linkage to the National Cancer Registry. We used Cox regression to estimate hazard ratios (HRs) for lymphoproliferative malignancy and any solid cancer among the three cohorts compared with a total of 227,911 age- and sex-matched reference individuals.
Although biopsy-verified celiac disease and intestinal inflammation were associated with lymphoproliferative malignancy (for celiac disease, HR = 2.82; 95% confidence interval [CI] = 2.36 to 3.37, n = 193; for inflammation, HR = 1.81; 95% CI = 1.42 to 2.31, n = 89), latent celiac disease was not associated with lymphoproliferative malignancy (HR = 0.97; 95% CI = 0.44 to 2.14, n = 7). The absolute rates of lymphoproliferative malignancies among persons with celiac disease, small intestinal inflammation, and latent celiac disease were 70.3 per 100,000 person-years, 83.4 per 100,000 person-years, and 28.0 per 100,000 person-years, respectively. Compared with individuals with celiac disease, individuals with small intestinal inflammation or latent celiac disease were at a statistically significantly lower risk of lymphoproliferative malignancy. Risk of any solid cancer was not increased beyond the first year of follow-up in any cohort. Celiac disease was associated with Hodgkin lymphoma and both T-cell and B-cell non-Hodgkin lymphomas.
The risk of lymphoproliferative malignancy in celiac disease is dependent on small intestinal histopathology, with no increased risk in latent celiac disease.
CancerSpectrum Knowledge Environment 02/2011; 103(5):436-44. · 14.07 Impact Factor
