Publications (30)161.87 Total impact
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Article: Marriage, cohabitation and mortality in Denmark: national cohort study of 6.5 million persons followed for up to three decades (1982-2011).
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ABSTRACT: BACKGROUND: Living arrangements have changed markedly in recent decades, so we wanted to provide an up-to-date assessment of mortality as a function of marital status and cohabitation status in a complete population. METHODS: We studied mortality in a national cohort of 6.5 million Danes followed for 122.5 million person-years during 1982-2011, using continuously updated individual-level information on living arrangements, socio-demographic covariates and causes of deaths. Hazard ratios (HRs) estimated relative mortality in categories of marital status, cohabitation status and combinations thereof. RESULTS: HRs for overall mortality changed markedly over time, most notably for persons in same-sex marriage. In 2000-2011, opposite-sex married persons (reference, HR = 1) had consistently lower mortality than persons in other marital status categories in women (HRs 1.37-1.89) and men (HRs 1.37-1.66). Mortality was particularly high for same-sex married women (HR = 1.89), notably from suicide (HR = 6.40) and cancer (HR = 1.62), whereas rates for same-sex married men (HR = 1.38) were equal to or lower than those for unmarried, divorced and widowed men. Prior marriages (whether opposite-sex or same-sex) were associated with increased mortality in both women and men (HR = 1.16-1.45 per additional prior marriage). CONCLUSION: Our study provides a detailed account of living arrangements and their associations with mortality over three decades, thus yielding accurate and statistically powerful analyses of public health relevance to countries with marriage and cohabitation patterns comparable to Denmark's. Of note, mortality among same-sex married men has declined markedly since the mid-1990s and is now at or below that of unmarried, divorced and widowed men, whereas same-sex married women emerge as the group of women with highest and, in recent years, even further increasing mortality.International Journal of Epidemiology 03/2013; · 6.41 Impact Factor -
Article: Marriage, cohabitation and incidence trends of invasive penile squamous cell carcinoma in Denmark 1978-2010.
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ABSTRACT: Few population-based studies have investigated the relation between living arrangements and risk of invasive penile squamous cell carcinoma (iP-SCC). Using long-term national cancer registry data in Denmark we examined incidence trends of iP-SCC. Furthermore, we examined the relation between marital status, cohabitation status and risk of iP-SCC using hazard ratios (HRs) with 95% confidence intervals (CIs) obtained in Cox proportional hazards regression analyses as our measure of relative risk. Overall, 1,292 cases of iP-SCC were identified during 65.6 million person-years of observation between 1978 and 2010. During this period, the WHO world age-standardized incidence remained relatively stable (p-trend = 0.41) with an average incidence of 1.05 cases per 100,000 person-years. When compared to married men, those who were unmarried (HR 1.37; 95% CI: 1.13-1.66), divorced (HR 1.49; 95% CI: 1.24-1.79) or widowed (HR 1.36; 95% CI: 1.13-1.63) were at increased risk of iP-SCC. Regarding cohabitation status, single-living men were at increased risk of iP-SCC compared to men in opposite-sex cohabitation (HR 1.43; 95% CI: 1.26-1.62). Risk increased with increasing numbers of prior opposite-sex (p-trend = 0.02) and same-sex (p-trend < 0.001) cohabitations. In conclusion, single-living Danish men and men who are not currently married are at increased risk of iP-SCC, and the risk increases with the number of prior cohabitations, perhaps reflecting less stable sexual relations in these subgroups.International Journal of Cancer 02/2013; · 5.44 Impact Factor -
Article: Validation of the 5-year tetanus, diphtheria, pertussis and polio booster vaccination in the Danish childhood vaccination database.
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ABSTRACT: BACKGROUND: In Denmark, data from the childhood vaccination database are used to calculate vaccination coverage (VC) for childhood vaccinations. However, there may be under-reporting in this database. Accurate VC estimates are necessary for adjusting vaccination strategies and providing population-level protection. AIMS: The main purpose of this study was to validate the reporting of the tetanus, diphtheria, pertussis and polio (Tdap-IPV) booster in the childhood vaccination database, identify reasons a child was not vaccinated, for the unregistered vaccinations, identify where the vaccination was provided, and to adjust calculations of the VC accordingly. METHODS: Children registered in the Danish Civil Registry System (residing legally in Denmark) from the 2000 to 2003 birth cohorts without a recorded Tdap-IPV booster in the childhood vaccination database were randomly selected for this cross-sectional, questionnaire-based study. The adjusted VC in the population was calculated by adding the fraction of the study population registered with the Tdap-IPV booster in the childhood vaccination database to the fraction of the study population who reported being vaccinated on the questionnaire but who were not register according to the childhood vaccination database. FINDINGS: Of the 574 contacted parents, 386 (67%) completed a questionnaire; 272 (70%) reported that their child received the Tdap-IPV booster, with 121 (44%) providing the date of vaccination. Most commonly reported reasons for not receiving the booster included forgetting (37%) and not wanting the vaccination (16%). The majority (89%) of children who received the booster were vaccinated by their general practitioners (GPs); 6% abroad and <1% in a hospital. Using a conservative approach, considering only those who used a vaccination card to answer the questionnaire and who provided an exact data of vaccination, the adjusted Tdap-IPV booster VC was 85.6% (95% CI, 85.1-86.3%) compared to 82% from the childhood vaccination database. CONCLUSION: We identified substantial underreporting of the Tdap-IPV booster in the childhood vaccination database, mainly due to GPs not registering given vaccinations. Validating data used for VC calculations is needed to obtain more precise estimates.Vaccine 12/2012; · 3.77 Impact Factor -
Article: Trends in Overall and Cause-Specific Mortality Among Patients With Inflammatory Bowel Disease From 1982-2010.
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ABSTRACT: BACKGROUND & AIMS: Treatments for inflammatory bowel diseases (IBDs) such as ulcerative colitis (UC) and Crohn's disease (CD) have changed over time, with unclear effects on prognosis. We assessed overall and cause-specific mortality in a Danish cohort of patients with IBD during a 30-year time period. METHODS: We compared data from 36,080 patients with UC and 15,361 with CD, who were diagnosed in Denmark from 1982-2010, and compared them with data from 2,858,096 matched individuals from the general population (controls). Overall and cause-specific mortality were estimated by Cox regression analysis, adjusted for age, sex, disease duration, and known comorbidities before IBD diagnosis. Results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Mortality greatly increased in the first year after individuals were diagnosed with IBD; intermediate-term and long-term mortalities increased by approximately 10% among individuals with UC and 50% among those with CD, compared with the general population. Compared with the time period of 1982-1989, mortalities decreased among patients diagnosed with UC from 1990-1999 (HR, 0.96; 95% CI, 0.90-1.02) and from 2000-2010 (HR, 0.88; 95% CI, 0.82-0.95). These reductions were mainly due to decreased mortality from colorectal cancer, gastrointestinal disorders, and suicide. For individuals with CD, mortality did not change among these time periods because of long-term increases in mortality from infections, cancer, respiratory diseases, and gastrointestinal diseases. CONCLUSIONS: In a Danish cohort, mortality from UC decreased from 1982 to 2010, largely because of reduced mortalities from gastrointestinal disorders and colorectal cancer. People with CD had 50% greater mortality than the general population, and this value did not change during this time period.Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 09/2012; · 5.64 Impact Factor -
Article: Reply.
Gastroenterology 09/2012; 143(5):e20-1. · 11.68 Impact Factor -
Article: Decreasing risk of colorectal cancer in patients with inflammatory bowel disease over 30 years.
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ABSTRACT: The risk for colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) could have changed over time, with changes in treatment options. We studied CRC risk in a nationwide cohort of 47,374 Danish patients with IBD over a 30-year period. We determined relative risk (RR) values using Poisson regression-derived incidence rate ratios of CRC from 1 year after IBD diagnosis, adjusted for age, sex, and calendar time. We compared incidence of CRC among patients with IBD vs individuals without IBD. During 178 million person-years of follow-up evaluation, 268 patients with ulcerative colitis (UC) and 70 patients with Crohn's disease (CD) developed CRC. The overall risk of CRC among patients with UC was comparable with that of the general population (RR, 1.07; 95% confidence interval [CI], 0.95-1.21). However, patients diagnosed with UC in childhood or as adolescents, those with long duration of disease, and those with concomitant primary sclerosing cholangitis were at increased risk. For patients with UC, the overall RR for CRC decreased from 1.34 (95% CI, 1.13-1.58) in 1979-1988 to 0.57 (95% CI, 0.41-0.80) in 1999-2008. Among patients with CD, the overall RR for CRC was 0.85 (95% CI, 0.67-1.07), which did not change over time. A diagnosis of UC or CD no longer seems to increase patients' risk of CRC, although subgroups of patients with UC remain at increased risk. The decreasing risk for CRC from 1979 to 2008 might result from improved therapies for patients with IBD.Gastroenterology 04/2012; 143(2):375-81.e1; quiz e13-4. · 11.68 Impact Factor -
Article: Questionable evidence of increasing incidence of invasive penile cancer in Denmark.
Cancer Causes and Control 03/2012; 23(4):659-60; author reply 661-2. · 2.88 Impact Factor -
Article: Effectiveness of vaccine against pandemic influenza A/H1N1 among people with underlying chronic diseases: cohort study, Denmark, 2009-10.
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ABSTRACT: To determine the effectiveness of an adjuvanted monovalent vaccine against pandemic influenza A/H1N1 among people with underlying chronic diseases. Historical cohort study. Mandatory national reporting systems, 2 November 2009 to 31 January 2010, Denmark. 388,069 people under 65 years of age with a diagnosis in the past five years of at least one underlying disease expected to increase the risk of severe illness after influenza. Laboratory confirmed H1N1 infection and influenza related hospital admission with laboratory confirmed H1N1 infection. Estimates of vaccine effectiveness were adjusted for age and underlying disease. The effectiveness of pandemic vaccine against confirmed H1N1 infection 14 days after one dose of vaccine was 49% (95% confidence interval 10% to 71%). The effectiveness of vaccine against admission to hospital for confirmed H1N1 infection was 44% (-19% to 73%). The adjuvanted monovalent vaccine against pandemic influenza A/H1N1 was offered late in the 2009-10 influenza season. Among chronically ill people, this vaccine offered protection against laboratory confirmed H1N1 infection but only offered non-significant protection against influenza related hospital admissions confirmed as H1N1 infection. This finding is of public health relevance because the population of chronically ill people is a major target group for pandemic vaccinations and because of the delayed availability of pandemic vaccines in a forthcoming pandemic.BMJ (Clinical research ed.). 01/2012; 344:d7901. -
Article: Uptake of the human papillomavirus-vaccination within the free-of-charge childhood vaccination programme in Denmark.
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ABSTRACT: Persistent infection with human papillomavirus (HPV) is a prerequisite for cervical cancer, which causes 175 yearly deaths and substantial morbidity in Denmark. In January 2009, HPV-vaccination for 12 year-old girls was introduced into the free-of-charge childhood vaccination programme. Due to concerns about potential poor compliance we determined the uptake and identified determinants for vaccination after the first year of the programme. All vaccinations given within the vaccination programme are reported to a central register, which we linked to demographic information found in the Danish civil register. We calculated vaccination uptake and used Cox regression survival analysis to compare the uptake rates between demographic subgroups in the population, e.g. by number of siblings, age of mother (at the daughter's birth) and place of origin. The uptake among the 33,838 eligible girls was 80%, 75% and 62% respectively for the three HPV-doses. All subgroups had uptake above 68% for the first HPV-vaccination. Girls with mothers younger or older than the reference group of 25-34 years had a lower uptake rate (adjHR 0.94, 95% CI 0.91-0.97 and adjHR 0.91, 95% CI 0.88-0.94 respectively). Girls with 5 or more siblings had lower uptake rate than girls without siblings (adjHR 0.79, 95% CI 0.71-0.87). Girls born in other EU/EFTA-countries had lower uptake rate than Danish-born girls with Danish-born parents (adjHR 0.74, 95% CI 0.67-0.82). The introduction of routine HPV-vaccination in Denmark resulted in a relatively high uptake, indicating little reason for major concern about barriers towards the vaccination in Denmark. Population groups with reduced uptake were identified, but as they were small in number their effect on the overall vaccination coverage was marginal. Nonetheless, these groups should be targeted in future acceptance studies and vaccination awareness campaigns.Vaccine 12/2011; 29(52):9663-7. · 3.77 Impact Factor -
Article: Antimicrobial use: a risk factor or a protective factor for acquiring campylobacteriosis?
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ABSTRACT: It is well acknowledged that the use of antimicrobial drugs in food animals leads to antimicrobial drug resistance in foodborne bacteria such as Campylobacter; however, the role of human antimicrobial usage is much less investigated. The aim of this study was to quantify the odds of campylobacteriosis conferred by human consumption of fluoroquinolones and macrolides. We conducted a registry-based retrospective case-control study on 31 669 laboratory-confirmed cases of campylobacteriosis between 1999 and 2005 in Denmark. Data were obtained from several Danish databases: the National Registry of Enteric Pathogens, the Danish Civil Registration System, the Danish National Prescription Database, and the Integrated Database on Labor Market Research. Odds ratios (OR) for campylobacteriosis were calculated by conditional logistic regression. The risk of campylobacteriosis was reduced 1 month after exposure to macrolides (OR, 0.72; 95% confidence interval [CI], 0.56-0.92). Macrolide exposure 1 month to 2 years before infection was associated with an increased risk of a Campylobacter diagnosis (OR, 1.5; 95% CI, 1.4-1.6). A history of fluoroquinolone use was also associated with increased risk (OR, 2.5; 95% CI, 1.8-3.5). This risk was higher for resistant isolates than for susceptible ones. Treatment with macrolides may protect against Campylobacter infection for a limited period of time, possibly due to the antibacterial effects of the drug or its metabolites. Fluoroquinolone treatment confers increased risk, probably due to a combination of competitive and selective effects, similar to what has been observed for nontyphoid Salmonella infection.Clinical Infectious Diseases 10/2011; 53(7):644-50. · 9.15 Impact Factor -
Article: Cesarean section and offspring's risk of inflammatory bowel disease: a national cohort study.
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ABSTRACT: Intestinal bacteria have been implicated in the etiology of the common inflammatory bowel diseases (IBD) ulcerative colitis and Crohn's disease. Because delivery by cesarean section disturbs the normal bacterial colonization of the newborn's intestine, we determined the risk of IBD according to mode of delivery. A register-based national cohort study of 2.1 million Danes born 1973-2008. The effect of mode of delivery on IBD incidence in the age-span 0-35 years was estimated by means of confounder-adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) obtained in Poisson regression analysis. Information on mode of delivery was obtained from the Danish Medical Birth Registry and cases of IBD were identified in the Danish National Patient Registry 1977-2008. During 32.6 million person-years of follow-up, a total of 8142 persons were diagnosed with IBD before age 36 years. Cesarean section was associated with moderately, yet significantly, increased risk of IBD at age 0-14 years (IRR 1.29, 95% CI 1.11-1.49), regardless of parental disposition to IBD. Assuming causality, an estimated 3.2% of IBD cases before age 15 years were attributable to cesarean section. Rates of IBD with onset in childhood are moderately increased after birth by cesarean section but underlying mechanisms remain unclear. Even if the association is causal, the possible impact of increasing cesarean section practices on the overall burden of IBD in childhood is small.Inflammatory Bowel Diseases 07/2011; 18(5):857-62. · 4.86 Impact Factor -
Article: Stressful life events in childhood and risk of infectious disease hospitalization.
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ABSTRACT: Individuals exposed to high levels of stress might have an increased risk of infectious diseases. However, most of the previous studies have been conducted among adults. To examine the effect of childhood stress, we conducted a nationwide cohort study including all Danish children born from 1977 to 2004. Stressful life events (SFLE) included parental death, death of sibling or parental divorce. Outcome was defined as hospitalizations due to less severe (LSID) or severe infectious diseases (SID). Children were followed until the age of 15 years. The association between SFLE and risk of infections was evaluated through rate ratios (RR) comparing infectious disease incidence ratios in children with and without a history of SFLE. Overall, children exposed to SFLE were at 13% increased risk of LSID (RR = 1.13 (1.10-1.15)), but at no increased risk of SID hospitalization (RR = 1.05 (0.97-1.14)). Looking at the specific type of SFLE, parental divorce increased the risk of LSID (RR = 1.11 (1.09-1.14)) and SID hospitalization (1.11 (1.02-1.21)) by 11%, whereas no increased risk of LSID and SID hospitalization was observed following parental death. Finally, a 34% increased risk of LSID hospitalization (RR = 1.34 (1.23-1.45)) was observed following death of sibling, in contrast to no increased risk of SID hospitalization. CONCLUSION: Childhood exposure to SFLE, especially parental divorce seems to increase the risk of infectious disease hospitalization. Although we cannot determine whether our observations are the result of a biological effect of stress, adoption of unhealthy behaviours or increased likelihood of hospitalization, our findings do have public health relevance as a considerable proportion of the children today will be exposed to SFLE, the majority to parental divorce.European Journal of Pediatrics 06/2011; 171(1):173-9. · 1.88 Impact Factor -
Article: Prenatal stress and risk of infectious diseases in offspring.
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ABSTRACT: Animal studies have suggested that prenatal stress could affect the immune system of the offspring. In a nation-wide cohort of all Danish children born from 1977 to 2004, the authors examined the association between prenatal stress, defined as maternal exposure to a stressful life event during pregnancy or in the 3-year period before conception, and the risk of severe or less severe infectious disease hospitalization in childhood. Log-linear Poisson regression models provided estimates of rate ratios. Compared with nonexposed children, children exposed prenatally to stress had a 25% (rate ratio (RR) = 1.25, 95% confidence interval (CI): 1.06, 1.47) and a 31% (RR = 1.31, 95% CI: 1.27, 1.35) increased risk of being hospitalized with a severe or a less severe infectious disease, respectively. Children born to mothers exposed to a stressful life event during pregnancy, during the 11 months before, or during the 12-35 months before conception were at 71% (RR = 1.71, 95% CI: 1.20, 2.45), 42% (RR = 1.42, 95% CI: 1.13, 1.78), and no increased (RR = 0.86, 95% CI: 0.63, 1.18) risk of severe infectious disease hospitalization. No obvious association between risk of less severe infectious disease hospitalization and timing of maternal exposure was observed. Although the authors could not determine whether this is a biologic effect of prenatal stress or an effect of other factors related indirectly to a stressful life event, their results add new information about the consequences of prenatal stress.American journal of epidemiology 03/2011; 173(9):990-7. · 5.59 Impact Factor -
Article: Enteric Salmonella or Campylobacter infections and the risk of inflammatory bowel disease.
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ABSTRACT: Enteric pathogens have been implicated in the aetiology of inflammatory bowel disease (IBD), but increased rates of stool testing of patients with unclear gastrointestinal symptoms might cause detection bias. Hence, the objective of this study was to analyse incidence rates of Crohn's disease and ulcerative colitis among patients with Salmonella- or Campylobacter-positive and negative stool tests and to study the incidence of positive and negative stool tests among patients already diagnosed with IBD. The Danish population was followed for 94.3 million person-years during 1992-2008 using national registers to identify persons with positive and negative stool tests and patients with IBD. Using Poisson regression, incidence rate ratios (IRRs) for IBD after positive or negative stool tests and, conversely, IRRs for positive and negative stool tests following IBD, were calculated. IRRs for IBD were significantly high in the first year after Salmonella- or Campylobacter-positive stool tests (IRRs 5.4-9.8), and they remained moderately increased 1-10 years later (IRRs 1.6-2.2), and less so >10 years later (IRRs 0.8-1.8). However, IRRs for IBD <1 year after a negative stool test were several-fold higher (IRRs 53.2-57.5), and a decreasing incidence pattern over time was parallel to that following positive test results. Among patients with IBD, IRRs for subsequent positive and-most notably-negative stool test results were also significantly high. Similarities in temporal risk patterns for IBD following positive or negative stool tests indicate that the increased occurrence of Salmonella- or Campylobacter-positive results around the time of first IBD hospitalisation results from detection bias.Gut 03/2011; 60(3):318-24. · 10.11 Impact Factor -
Article: The interaction between prior antimicrobial drug exposure and resistance in human Salmonella infections.
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ABSTRACT: The use of antimicrobial drugs for food animals selects for resistant non-typhoid Salmonella strains, but human consumption of antimicrobial drugs may also increase the risk of subsequent infection. The aim of this study was to determine the risk of salmonellosis attributable to human consumption of antimicrobial drugs in a case-control study of 22 602 laboratory-confirmed Salmonella infections, diagnosed in Denmark between 1997 and 2005. A population registry-based case-control study, using several Danish databases: the National Prescription Database; the National Registry for Enteric Pathogens; the Civil Registry System; and the Integrated Database on Labour Market Research. Exposure to trimethoprim, sulphonamides, broad-spectrum penicillins, tetracyclines and fluoroquinolones, during the year prior to diagnosis, was associated with an increased risk of non-typhoid Salmonella infection. Overall, the highest risk was associated with the prior use of fluoroquinolones. This risk increased as the time window of exposure approached the infection date. Previous use of fluoroquinolones was associated with an odds ratio (OR) of 4.55 [95% confidence interval (CI): 3.78-5.47] for Salmonella serotypes other than Salmonella Typhimurium or Salmonella Enteritidis, an OR of 2.21 (95% CI: 1.70-2.86) for Salmonella Typhimurium and an OR of 2.07 (95% CI: 1.76-2.42) for Salmonella Enteritidis. In particular for fluoroquinolones, there was an interaction between the pathogen resistance pattern and a history of antibiotic drug use. The increasing use of antibiotics, particularly fluoroquinolones, is likely to result in increased incidence of foodborne infections with drug-resistant Salmonella.Journal of Antimicrobial Chemotherapy 08/2010; 65(8):1819-25. · 5.07 Impact Factor -
Article: Cesarean delivery and risk of intestinal bacterial infection.
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ABSTRACT: An individual's intestinal bacterial flora is established soon after birth. Delivery by Cesarean section (c-section) deprives the newborn of colonization with maternal vaginal bacteria. We determined whether delivery by c-section is associated with an altered risk of infection with intestinal bacterial pathogens. In a cohort of 1.7 million Danes born 1973-2005 we identified cases of laboratory-confirmed non-typhoidal Salmonella species, Campylobacter species, Yersinia enterocolitica, Shigella species, and Shiga toxin-producing Escherichia coli from 1991-2005 in the National Registry of Enteric Pathogens. Using Poisson-regression we estimated confounder-adjusted incidence rate ratios (IRRs) for infection according to mode of delivery. During 14.0 million person-years of follow-up, 22,486 individuals were diagnosed with 1 intestinal bacterial infection. C-section was associated with a small increase in risk at age 1 to <2 years (IRR, 1.09; 95% confidence interval, 1.00-1.18) and at age 2 to <5 years (IRR, 1.08; 95% confidence interval, 1.00-1.17), but after age 5 years, there was no significant association. Assuming causality only 0.62% of intestinal bacterial infections were attributable to c-section. Mode of delivery appears not to be a clinically relevant determinant of risk for intestinal bacterial infections. The possible impact of increasing frequencies of c-section on the overall burden of intestinal bacterial infections appears negligible.The Journal of Infectious Diseases 03/2010; 201(6):898-902. · 6.41 Impact Factor -
Article: Clustering of acute respiratory infection hospitalizations in childcare facilities.
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ABSTRACT: To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics. Population-based prospective cohort study of 436 434 Danish 0-5-year-old children attending childcare during 1989-2004. Information was collected from Danish registers. Main outcome measure was incidence rate ratios (IRRs) of in-patient hospitalization for ARI. During 1 777 999 person-years of follow-up 42 681 hospitalizations for ARI occurred, of which 362 (1%) occurred within 1 month after another child was hospitalized for ARI in the facility. Children attending a facility with a recent ARI hospitalization had an increased risk of 42% (95% CI 27%;60%) compared with other children. The increased risk was higher in 0-2-year-old children than in 3-5-year-old children (55% vs 17%, p = 0.02) and if the latest hospitalized child was 0-2 years rather than 3-5 years (52% vs 19%, p = 0.04). The increased risk was similar in boys and girls, but was higher if the latest hospitalized child was a boy rather than a girl (52% vs 13%, p = 0.02). Although occurring infrequently, clustering of ARI hospitalizations involve 0-2-year-olds and boys as first hospitalized child relatively more often than would be expected.Acta Paediatrica 02/2010; 99(6):877-82. · 2.07 Impact Factor -
Article: Spatio-temporal cluster analysis of the incidence of Campylobacter cases and patients with general diarrhea in a Danish county, 1995-2004.
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ABSTRACT: Campylobacter infections are the main cause of bacterial gastroenteritis in Denmark. While primarily foodborne, Campylobacter infections are also to some degree acquired through other sources which may include contact with animals or the environment, locally contaminated drinking water and more. We analyzed Campylobacter cases for clustering in space and time for the large Danish island of Funen in the period 1995-2003, under the assumption that infections caused by 'environmental' factors may show persistent clustering while foodborne infections will occur randomly in space. Input data were geo-coded datasets of the addresses of laboratory-confirmed Campylobacter cases and of the background population of Funen County. The dataset had a spatial extent of 4.900 km2. Data were aggregated into units of analysis (so-called features) of 5 km by 5 km times 1 year, and the Campylobacter incidence calculated. We used a modified form of local Moran's I to test if features with similar incidence rates occurred next to each other in space and time, and compared the observed clusters with simulated clusters. Because clusters may be caused by a high tendency among local GPs to submit stool samples, we also analyzed a dataset of all submitted stool samples for comparison. The results showed a significant persisting clustering of Campylobacter incidence rates in the Western part of Funen. Results were visualized using the Netlogo software. The underlying causes of the observed clustering are not known and will require further examination, but may be partially explained by an increased rate of stool samples submissions by physicians in the area. We hope, by this approach, to have developed a tool which will allow for analyses of geographical clusters which may in turn form a basis for further epidemiological examinations to cast light on the sources of infection.International Journal of Health Geographics 03/2009; 8:11. · 2.62 Impact Factor -
Article: Risk of adverse birth outcome after group B meningococcal disease: results from a Danish national cohort.
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ABSTRACT: Group B meningococcal (GBM) disease induces antibodies that react in vitro with neural cell adhesion molecules in fetal brain tissue. Because IgG antibodies to GBM cross the placenta, the authors investigated whether women with a previous GBM disease had an increased risk of giving birth to preterm or to stillborn infants and whether the live-born children had an increased risk of birth defects. Data were obtained from 4 national registries in the period 1974-2005 to form 2 cohorts: (1) 1422 women with confirmed GBM disease, and (2) their 502 firstborn children. Overall, there was no increased risk of preterm or stillbirths among the first cohort. Among the children, there was no increased risk of being born small for the gestational age, having birth defects (OR: 1.00; 95% CI: 0.53-1.90), diseases of the nervous system (HR: 0.38; 95% CI: 0.08-1.74), or any diseases within the first 3 years of life (HR: 1.06; 95% CI: 0.78-1.45) compared to births from a reference population with prior group C meningococcal disease. The results do not support the proposal that GBM is associated with immunoreactive disease that may affect the health of the offspring and are consistent with previous findings that GBM disease is not associated with an increased risk of autoimmune disease.The Pediatric Infectious Disease Journal 02/2009; 28(3):199-203. · 3.58 Impact Factor -
Article: Child care is not a substantial risk factor for gastrointestinal infection hospitalization.
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ABSTRACT: The objective was to study the effect of age at first enrollment into child care and other child care-related factors on the risk for hospitalization from gastrointestinal infection. This was a population-based prospective cohort study of 1,110,973 Danish children aged 0 to 5 years in the period 1989-2004. By means of Poisson regression, risk for gastrointestinal infection hospitalization was evaluated by incidence rate ratio and 95% confidence intervals. Overall, children who were attending child care had an IRR of gastrointestinal infection hospitalization of 1.02 compared with children in home care. When compared within the group of children who attended child care, those who were enrolled after 18 months of age had a slightly increased risk compared with those who were enrolled before 1 year of age. The first 5 months of enrollment were associated with an IRR of 1.18 compared with later periods, and similar risks were observed in different types of child care facilities. The effect of child care was similar in most strata of the studied child, family, and demographic variables; however, children younger than 1 year who attended child care had an IRR of 1.44 compared with children of the same age in home care. Well established risk factors for gastrointestinal infection such as young age and male gender were reproduced; compared with 5-year-olds, children younger than 1 year had an IRR of 7.37 and boys had an IRR of 1.18 compared with girls. The results of this study suggest that child care attendance is not a substantial risk factor for gastrointestinal infection hospitalization in most Danish children. Late enrollment and the first short period of enrollment were associated with a slightly increased risk for gastrointestinal infection hospitalization.PEDIATRICS 01/2009; 122(6):e1168-73. · 4.47 Impact Factor
Top co-authors
Top Journals
- Clinical Infectious Diseases (3)
- The Journal of Infectious Diseases (2)
- PEDIATRICS (2)
- Gastroenterology (2)
- Vaccine (2)
Institutions
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2005–2013
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Statens Serum Institut
Copenhagen, Capital Region, Denmark
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2011
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European Programme for Intervention Epidemiology Training (EPIET)
Stockholm, Stockholm, Sweden
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