[Show abstract][Hide abstract] ABSTRACT: SUMMARY: The WHO MONICA Project is designed to measure the trends in mortality and morbidity from coronary heart disease (CHD) and stroke, and to assess the extent to which they are related to changes in known risk factors in different populations in 27 countries. Risk-factor data are collected from population samples examined in at least two population surveys (one at the beginning of the study and the other at the end). The results of the baseline population surveys are presented. In populations studied, the proportion of smokers varied between 34-62% among men and 3-52% among women. The population median of systolic blood pressure varied between 121-146 mmHg in men. In women the figures were 118 mmHg and 141 mmHg respectively. In diastolic blood pressure, the variation of median was from 74 mmHg to over 91 mmHg among men and from 72-89 mmHg among women. The third major risk factor considered was total cholesterol, with the population median ranging between 4.1-6.4 mmol/l among men and 4.2-6.3 mmol/l among women. Caution is required when making cross-sectional comparisons between the risk-factor levels as the MONICA Project was not designed for this purpose. Nevertheless, these data demonstrate clearly the large variety of baseline risk-factor patterns in populations studied in the MONICA Project.
MeSH Terms: Adult; Australia; Blood Pressure; Body Weight; China; Cholesterol/blood; Coronary Disease/etiology*; Data Interpretation, Statistical; Europe; Female; Humans; Male; Middle Aged; Population Surveillance*; Quality Control; Risk Factors; Smoking/statistics & numerical data; USSR; World Health Organization;
[Show abstract][Hide abstract] ABSTRACT: The incidence of type 2 diabetes is increasing among Finnish young adults. A slightly increased risk in men was found in the north-east and western part of the country. The higher risk areas in women were found in the western coastal area and in eastern Finland. The present register-based study aimed to evaluate the regional association of the incidence of type 2 diabetes among young adults with the concentration of magnesium in local ground water. The association was evaluated using Bayesian modeling of geo-referenced data aggregated into a regular 10 km × 10 km grid cells. No marked association was found, although suggestive findings were detected for magnesium in well water and diabetes in young adult women. The results of this register-based study did not completely rule out the association of well water magnesium with the geographical variation of type 2 diabetes. The incidence of type 2 diabetes was much higher among individuals aged 40 or over. These suggestive findings indicate that the association between magnesium and type 2 diabetes would also be worth examining among individuals over 40 years of age.
Environmental Research 11/2011; 112:126-8. · 3.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our aim was to study the recurrence risk of type 1 diabetes in the offspring of parents with adult-onset (15-39 years) type 1 diabetes and to evaluate the transmission of diabetes within a continuum of parental age at onset of diabetes from childhood to adulthood.
Diabetes status of all offspring (n = 9,636) in two Finnish cohorts of parents with type 1 diabetes was defined until the end of year 2007. Cumulative incidences of type 1 diabetes among the offspring were estimated, and several factors contributing to the risk were assessed.
During 137,455 person-years, a total of 413 offspring were diagnosed with type 1 diabetes. The cumulative incidence by 20 years was 4.0% (95% CI 3.1-4.8) for the offspring of parents with adult-onset diabetes. The risk was equal according to the sex of the parents. The cumulative incidence decreased in parallel with the increase in age at onset of diabetes in the fathers. In the offspring of diabetic mothers, the risk was equal regardless of the age at onset of diabetes. However, the reduced risk in the maternal offspring was most pronounced in the daughters of the mothers with a diagnosis age <10 years.
Type 1 diabetes transmission ratio distortion is strongly related to the sex and age at onset of diabetes in the diabetic parents.
[Show abstract][Hide abstract] ABSTRACT: To determine if there is a worldwide seasonal pattern in the clinical onset of Type 1 diabetes.
Analysis of the seasonality in diagnosis of Type 1 diabetes was based on the incidence data in 0- to 14-year-old children collected by the World Health Organization Diabetes Mondiale (WHO DiaMond) Project over the period 1990-1999. One hundred and five centres from 53 countries worldwide provided enough data for the seasonality analysis. The incidence seasonality patterns were also determined for age- and sex-specific groups.
Forty-two out of 105 centres exhibited significant seasonality in the incidence of Type 1 diabetes (P < 0.05). The existence of significant seasonal patterns correlated with higher level of incidence and of the average yearly counts. The correlation disappeared after adjustment for latitude. Twenty-eight of those centres had peaks in October to January and 33 had troughs in June to August. Two out of the four centres with significant seasonality in the southern hemisphere demonstrated a different pattern with a peak in July to September and a trough in January to March.
The seasonality of the incidence of Type 1 diabetes mellitus in children under 15 years of age is a real phenomenon, as was reported previously and as is now demonstrated by this large standardized study. The seasonality pattern appears to be dependent on the geographical position, at least as far as the northern/southern hemisphere dichotomy is concerned. However, more data are needed on the populations living below the 30th parallel north in order to complete the picture.
Diabetic Medicine 08/2009; 26(7):673-8. · 3.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The regional pattern of insulin-dependent diabetes mellitus (IDDM) incidence among children in Finland was analysed applying several methods attempting to describe the geographical variation in occurrence of IDDM. From 1987 to 1991 the number of newly diagnosed cases aged 14 years or less at diagnosis was 1728. The incidence, the incidence rate ratio and the Bayes relative risk (RR) for IDDM were calculated by municipality, by functional area (an urban centre with a subordinated surrounding area) and by area with a population of equal size at risk employing the Geographical Information Systems. The association of IDDM incidence with the degree of urbanization was assessed using the population density as a criterion for the degree of urbanization. The overall mean of the IDDM incidence was 35 per 100000 persons per year. Between municipalities the incidence varied from 4 to 245 per 100000 persons per year, whereas a clear regional pattern was seen among the functional areas and the incidence varied from 26 to 43 per 100000 persons per year. The RR for IDDM among the municipalities ranged from 0.82 to 1.34 and from 0.73 to 1.27 among the functional areas. The incidence determined in four zones with the same size of population was the highest in the middle part of the country. There was a strong inverse correlation between population density and the incidence of IDDM and this also applied to the relationship between child population density and incidence.
[Show abstract][Hide abstract] ABSTRACT: To examine the effects of the size of the mother and the newborn, including placental weight and gestational age at delivery, on the risk for young adult-onset type 1 diabetes (T1DM) and type 2 diabetes (T2DM).
Subjects with T1DM and T2DM aged 15-39 at diagnosis between the years 1992 and 1996. The number of case-control pairs was 858 for T1DM and 355 for T2DM.
Diabetic subjects were identified from the Finnish national healthcare registers and reports from diabetes nurses. Control subjects were obtained from the population register. Data on perinatal factors were obtained from the original healthcare records. The odds ratios (ORs) for both types of diabetes were estimated using conditional logistic regression.
The risk for early-onset T2DM decreased with increasing birthweight until 4.2 kg (OR 0.49 (95% confidence interval 0.37-0.66) per 1 kg), but with birthweight above 4.2 kg the risk increased (OR 4.8 (1.3-17.6) per 1 kg). The risk for T2DM decreased also with increasing birth length (OR 0.88 (0.81-0.95) per 1 cm), body mass index at birth (OR 0.81 (0.73-0.90) per 1 kg/m2), and placental weight (OR 0.77 (0.61-0.98) per 100 g). The latter was not significant when adjusted for birthweight. The examined perinatal factors did not affect the risk for T1DM in young adults.
Birth size significantly affects the risk for T2DM diagnosed in young adulthood but no evidence was found of an association between late-onset T1DM and perinatal factors.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine the effects of childhood BMI growth dynamics on the risk of developing young adult-onset type 1 and type 2 diabetes.
Finnish national healthcare registers were used to identify individuals with diabetes diagnosed between 1992 and 1996 at 15-39 years of age. Non-diabetic control participants were chosen from the National Population Registry. Anthropometric measurements were obtained from the original child welfare clinic records. Only the case-control pairs with sufficient growth data recorded were included in the analyses (218/1,388 for type 1 diabetes [16%] and 64/1,121 for type 2 diabetes [6%]). Two developmental stages in BMI growth (the points of infancy maximum BMI and the BMI rebound) were examined, and conditional logistic regression was applied to the variables of interest.
The risk for type 1 diabetes increased 1.19-fold per 1 kg/m(2) rise in the infancy maximum BMI (p = 0.02). In addition, there was a 1.77-fold increase in the risk for type 2 diabetes per 1 kg/m(2) rise in the level of BMI at the BMI rebound (p = 0.04). Higher values of BMI at these points corresponded to a larger BMI gain from birth to that developmental stage. Age at the infancy maximum BMI or age at the BMI rebound did not affect the risk for either type of diabetes.
The BMI gain in infancy among individuals who subsequently developed young adult-onset type 1 diabetes was faster than that of those who remained healthy. The excess BMI gain in individuals who developed young adult-onset type 2 diabetes could already be seen during early childhood.
[Show abstract][Hide abstract] ABSTRACT: Previous studies have suggested that seasonal variation and weather conditions have an influence on the incidence and mortality of acute myocardial infarction (AMI). The influence of these factors on AMI: case fatality is less studied. Aims. The aim of this study was to examine the temporal variation of AMI case fatality and the effect of daily weather conditions on it.
We analysed death registry and hospital discharge data from all men and women (n=7328) with their first AMI occurrence in the seven largest cities in Finland in the years 1983, 1988, and 1993, aged 25 to 74 years.
The mean annual 28-day case fatality was 44%. We found significant weekly and monthly variation of case fatality (P<0.001). The December holiday season had the highest case fatality throughout the year in women and men aged 65-74 years (P<0.05). The highest weekly case fatality was on Sundays; it differed significantly from the rest of the weekdays only for the oldest age-group (64-74) (P<0.01).
There is significant weekly and monthly variation in case fatality of AMI. The highest case fatality risk for AMI is during the Christmas season and on Sundays. Weather conditions were not found to have an effect on the case fatality.
Annals of Medicine 10/2008; 41(1):73-80. · 4.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The protective role of water hardness and Mg in cardiovascular illness has been suggested in several epidemiological studies. In the present ecological study, the association of Ca, Mg, Al, Cu, F, Fe, Zn and NO3 in local ground water and spatial variation of acute myocardial infarction (AMI) incidence among men and women 35–74 years of age in rural Finland in 1991–2003 were examined. Data on AMI cases, 67,755 men and 25,450 women, were obtained from the Finnish Cardiovascular Disease Register. The statistical analysis was carried out using Bayesian modeling. 10 × 10 km grid cells were used instead of administrative boundaries to partition the study area. On average, 1 mg/L increment in Mg level in local ground water was associated with 2% (95% HDR −0.0391, −0.0028) decrease in incidence of AMI in the rural population. In conclusion, high AMI incidence in eastern Finland is associated with soft ground water, low in Mg.
[Show abstract][Hide abstract] ABSTRACT: To examine geographic variation in the incidence of ischemic stroke (IS) and acute myocardial infarction (AMI) in Finland during 1991-2003.
Data included all cases of first IS (n = 115,383) and AMI (n = 205,213) in persons aged 35-84 years. We used full Bayesian spatial shared component disease models for mapping the geographic risk patterns.
The risk component shared by IS and AMI explained 73% (95% credible interval [CI]; 59%, 87%) of the geographic variation in IS risk and 68% (41%, 91%) in AMI risk. The spatial variation was similar in men and women. In the northeastern part of Finland, annual age-adjusted IS incidence was 356.4/100,000 (95% CI; 350.3, 362.6) in men and 231.2 (226.9, 235.4) in women. Annual AMI incidence was 855.6 (846.1, 865.2) in men and 351.4 (346.2, 356.5) in women. In the southwestern part of the country, annual IS incidence was 334.7 (331.6, 337.8) in men and 210.6 (208.5, 212.6) in women. Annual AMI incidence was 707.3 (702.8, 711.8) in men and 278.3 (276.0, 280.7) in women.
A marked part of the spatial variation in IS and AMI incidence was disease specific, even though these diseases share a similar atherosclerotic background. Further studies are warranted for understanding the reasons for the different geographic variation.
Annals of Epidemiology 04/2008; 18(3):206-13. · 2.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine the effects of birth order and parental age on the risk of type 1 and type 2 diabetes among Finnish individuals aged 15-39 years.
Data on all cases of type 1 diabetes (n = 1,345) and type 2 diabetes (n = 1,072), diagnosed between 1992 and 1996, were collected from four sources: standardised national reports from diabetes nurses, the National Hospital Discharge Register, the Drug Prescription Register and the Drug Reimbursement Register. Information on matched controls and the family members of all study subjects were obtained from the National Population Registry. The odds ratios (ORs) for both types of diabetes were estimated using a conditional logistic regression model.
There was a U-shaped relationship between maternal age and the risk of type 2 diabetes in the offspring: the risk was higher in children born to young and old mothers compared with children born to mothers aged around 30 years. The children born second (OR 0.76, 95% CI 0.62-0.94), third (OR 0.73, 95% CI 0.55-0.95), or fourth (OR 0.66, 95% CI 0.47-0.94) had a lower risk of type 2 diabetes than the first-born children. Maternal age, paternal age, and birth order did not have an effect on the risk of type 1 diabetes in the individuals aged 15-39 years at the time of diagnosis.
Maternal age and birth order are both associated with the risk of early-onset type 2 diabetes. However, part of these associations may be due to low birthweight. In this study neither parental age nor birth order showed a significant association with the risk of type 1 diabetes diagnosed after 15 years of age.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine the incidence and trends of type 1 and type 2 diabetes in the 15-39 year-old population between 1992 and 1996 in Finland.
Data on the nationwide incidence of diabetes were obtained from four data sources: standardised reports from diabetes nurses, the Finnish National Hospital Discharge Register, the Drug Reimbursement Register and the Drug Prescription Register. The inclusion criterion was consistency in the diagnosis of diabetes across at least two data sources. The sex- and age-specific incidence was calculated for 5-year age groups, both for type 1 and type 2 diabetes. The effects of age, sex and year of diagnosis were assessed by fitting the linear regression model to the incidence data.
Between 1992 and 1996 the age-adjusted incidence of type 1 diabetes among 15-39 year olds was 15.9 per 100,000/year. The incidence was highest among the 15-19 year olds and decreased with age. Conversely, the incidence of type 2 diabetes was very low among 15-19 year olds and increased with age. The total age-adjusted incidence of type 2 diabetes among 15-39 year olds was 11.8 per 100,000/year. The average annual increase in the incidence of type 2 diabetes was 7.9% (95% CI 3.7-12.2%).
The age at which the Finnish population is at risk of type 1 diabetes extends into young adulthood. The rapid increase in the incidence of type 2 diabetes in the young adult population is a current public health problem.
[Show abstract][Hide abstract] ABSTRACT: Several epidemiologic studies have shown an association between calcium and magnesium and coronary heart disease mortality and morbidity. In this small-area study, we examined the relationship between acute myocardial infarction (AMI) risk and content of Ca, Mg, and chromium in local groundwater in Finnish rural areas using Bayesian modeling and geospatial data aggregated into 10 km times symbol 10 km grid cells. Data on 14,495 men 35-74 years of age with their first AMI in the years 1983, 1988, or 1993 were pooled. Geochemical data consisted of 4,300 measurements of each element in local groundwater. The median concentrations of Mg, Ca, and Cr and the Ca:Mg ratio in well water were 2.61 mg/L, 12.23 mg/L, 0.27 microg/L, and 5.39, respectively. Each 1 mg/L increment in Mg level decreased the AMI risk by 4.9%, whereas a one unit increment in the Ca:Mg ratio increased the risk by 3.1%. Ca and Cr did not show any statistically significant effect on the incidence and spatial variation of AMI. Results of this study with specific Bayesian statistical analysis support earlier findings of a protective role of Mg and low Ca:Mg ratio against coronary heart disease but do not support the earlier hypothesis of a protective role of Ca.
Environmental Health Perspectives 06/2006; 114(5):730-4. · 7.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Childhood diabetes is one of the major non-communicable diseases in children under 15 years of age. It requires a life-long insulin treatment and may lead to serious complications. Along with the worldwide increase in the incidence several countries have recently reported a decreasing trend in the age of onset of the disease. The aim of this study is to analyse long-term data on the incidence of the childhood diabetes in Finland from the birth cohorts perspective. The annual incidence data were available for the period 1965--1996 which translates into 1951--1996 birth cohorts. Hence the data consist of completely and partially observed cohorts. Bayesian modelling was employed in the analysis. Several different priors and cohort combinations were tried in order to determine the sensitivity of the results. The cumulative birth cohort incidence of diabetes was determined to have an increasing average annual trend of 2.5 per cent. Although the average birth cohort-specific age of onset was estimated to have decreased slightly over the years of observation, the trend could be a result of random variation.
Statistics in Medicine 11/2005; 24(19):2989-3004. · 2.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Type 1 diabetes mellitus (T1DM) results from environmental factors acting on genetically susceptible individuals. Microbial infections and their immunological consequences are suspected to take part in the pathogenesis of T1DM. Congenital rubella infection has been strongly associated with increased disease susceptibility. In addition, infections with different strains of enteroviruses, human cytomegalovirus, and rotavirus have been suggested to be diabetogenic in susceptible individuals. A newly emerged hypothesis states that a bacterial toxin, bafilomycin A1 produced by Streptomyces spp, could be the cause of pancreatic beta-cell damage. In some instances, microbial infections may even protect the individual from T1DM. There are several proposed mechanisms of beta-cell damage caused by microbes. T1DM can result from direct cytolysis of beta-cells. Other suggested mechanisms are cross-reactivity between microbial proteins and self antigens (molecular mimicry), bystander activation of lymphocytes, and alterations in cytokine concentrations affecting T-helper cell balance in the vicinity of pancreatic beta-cells. Proving a causal role between microbial infections and T1DM appears difficult. Despite intensive research, a final conclusion concerning the causal role of microbes in the pathogenesis of T1DM has not been made.
Medical science monitor: international medical journal of experimental and clinical research 04/2005; 11(3):RA63-9. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In Finland, the risk of childhood Type 1 diabetes varies geographically. Therefore we investigated the association between spatial variation of Type 1 diabetes and its putative environmental risk factors, zinc and nitrates.
The association was evaluated using Bayesian modelling and the geo-referenced data on diabetes cases and population.
Neither zinc nor nitrate nor the urban/rural status of the area had a significant effect on the variation in incidence of childhood Type 1 diabetes.
The results showed that although there was no significant difference in incidence between rural and urban areas, there was a tendency to increasing risk of Type 1 diabetes with the increasing concentration of NO3 in drinking water. The fact that no significant effect was found may stem from the aggregated data being too crude to detect it.
Diabetic Medicine 04/2004; 21(3):256-61. · 3.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the association of spatial variation in acute myocardial infarction (AMI) incidence and its putative environmental determinants in ground water such as total water hardness, the concentration of calcium, magnesium, fluoride, iron, copper, zinc, nitrate, and aluminium.
Small area study using Bayesian modelling and the geo-referenced data aggregated into 10 km x 10 km cells.
The population data were obtained from Statistics Finland, AMI case data from the National Death Register and the Hospital Discharge Register, and the geochemical data from hydrogeochemical database of Geological Survey of Finland.
A total of 18 946 men aged 35-74 years with the first AMI attack in the years 1983, 1988, and 1993.
One unit (in German degree degrees dH) increment in water hardness decreased the risk of AMI by 1%. Geochemical elements in ground water included in this study did not show a statistically significant effect on the incidence and spatial variation of AMI, even though suggestive findings were detected for fluoride (protective), iron and copper (increasing).
The results of this study with more specific Bayesian statistical analysis confirm findings from earlier observations of the inverse relation between water hardness and coronary heart disease. The role of environmental geochemistry in the geographical variation of the AMI incidence should be studied further in more detail incorporating the individual intake of both food borne and water borne nutrients. Geochemical-spatial analysis provides a basis for the selection of areas suitable for such research.
Journal of Epidemiology & Community Health 03/2004; 58(2):136-9. · 3.39 Impact Factor