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ABSTRACT: Inuits of the Arctic experience very high rates of chronic suppurative otitis media (CSOM), yet world-wide, very little is known about the epidemiology of CSOM. The study aims were to determine incidence, median age at debut, risk factors, and associated population attributable risks for CSOM in young children in Sisimiut, the second biggest town of Greenland (population 5400), where living conditions are relatively western and approximately 90% are Inuits.
A population-based birth cohort of 465 children aged between 0 and 4 years was followed for a 2-year period (1996 to 1998), and cases of CSOM were registered based on medical history and clinical examinations. Kaplan-Meier curves were used for estimations of cumulative risk and Cox regression analyses for hazard rates associated with risk factors.
Cumulative risk of CSOM at 4 years of age was 14%, and median age at debut was 336 days. Risk factors were attending childcare centers (hazard ratio [HR]: 3.18, 95% confidence interval [CI]: 1.53- 6.61), having smokers in the household (HR: 4.56, 95% CI: 1.07-19.4), having a mother who reported a history of purulent ear discharge (3.27, 95% CI: 1.74-6.13), having a high burden of upper respiratory tract infections (HR: 1.19, 95% CI: 1.03-1.37), and being Inuit (HR: 5.56, 95% CI: 0.78-50).
Greenlandic children have high rates of CSOM with debut early in life, but the identified risk factors and the associated population attributable risks indicate that preventive measures regarding use of childcare centers and passive smoking may reduce the high frequency of CSOM in this high-risk population.
The Pediatric Infectious Disease Journal 01/2011; 30(1):25-9. · 3.58 Impact Factor
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ABSTRACT: The aim of the study is to compare differences in cancer stage at diagnosis between migrant women and native Danish women. The stage is used as a clinical indicator of access to healthcare until the point of diagnosis. Refugees and family reunited migrants who received residence permits in Denmark from 1 January 1993 to 31 December 1999 were included and matched 1 : 4 on age and sex with a Danish-born reference population. Our final female population included 24 734 migrants and 123 670 controls. Civil registration numbers of the cohort were linked to the Danish Cancer Registry whereby cases were identified in the period 1.1.1993-31.12.2002. Only women from Eastern Europe and the Middle East were included. This amounted to 269 migrants and 1608 native Danes. Data from the Danish Cancer Registry included diagnosis, time of diagnosis and disease stage at diagnosis. Our initial analyses of migrant subgroups showed that migrant women had decreased odds ratios of being diagnosed at the local stage and increased odds of having unknown stage, although these tendencies were mainly not statistically significant. A subsequent analysis of an overall migrant effect on all cancer sites emphasized these tendencies. This analysis reached borderline significance for local versus nonlocal stage and significance for unknown versus known stage. Our results indicate that migrant women may experience barriers in access to healthcare until cancer diagnosis compared with Danish women. More research is, however, needed to confirm our results and to find out if they indicate general problems concerning migrants' access to healthcare in Denmark.
European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 07/2008; 17(3):185-90. · 2.21 Impact Factor
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ABSTRACT: Intussusception is the most common cause of intestinal obstruction in infancy and early childhood, but its etiology remains unknown. The present study analyzes whether some children with intussusception subsequently have a higher risk of tonsil disease, suggesting an enhanced tendency to lymphoid hyperplasia.
This nationwide cohort study included all Danish children younger than age 15 years, who were born in 1977-2001 and diagnosed with intussusception at a hospital (n = 2018). The cohort was followed-up for tonsil disease in the Danish National Patient Registry and the Danish Health Security System.
A total of 172 children were identified with tonsil disease following intussusception. The risk of tonsil disease was 48% higher (95% confidence interval = 27%-72%) after intussusception compared with the general population of the same age. Age, sex, age at intussusception, and time since intussusception did not modify risk of tonsil disease. The risks of acute tonsillitis, chronic disease of the tonsils, and tonsillectomy were equally increased after intussusception.
Intussusception was associated with an increased risk of tonsil disease in childhood. Children with a general tendency to lymphoid hyperplasia may be at increased risk of intussusception.
Epidemiology 02/2008; 19(1):71-4. · 5.57 Impact Factor
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ABSTRACT: Tonsillectomy is one of the most frequent operations performed on children and young adults, but little is known regarding its distribution by age, sex, and calendar period.
We designed a population-based cohort study including all Danish residents from 1980 to 2001 to describe national incidence figures for tonsillectomy. Persons undergoing tonsillectomy were identified in the Danish National Patient Registry and from the Danish Health Security System. Overall, the cohort consisted of 6.3 million persons, who were followed up for 106.9 million person-years.
During the study period 153,212 patients had tonsillectomies, comprising 84,831 females and 68,381 males. The age-specific incidence of tonsillectomy peaked at 4 years of age for both boys and girls, with 9.7 and 6.9 tonsillectomies per 1000 person-years, respectively. A second peak emerged during teenage years in both sexes, being highest among girls with 8.6 tonsillectomies per 1000 person-years at 16 years of age and 3.1 tonsillectomies per 1000 person-years among 17-year-old boys. The cumulative risk of tonsillectomy during the first 20 years of life increased from 7.9% among females and 6.0% among males in 1980 to 9.2% and 7.7%, respectively, in 2001. Over 90% of the patients less than 20 years of age registered at hospital with chronic disease of the tonsils had tonsillectomies within a year.
The incidence of tonsillectomy revealed significant gender differences. Furthermore, 2 incidence peaks emerged at age 4 years and age 16-17 years. The second peak in adolescence was particularly pronounced for females and is unexplained.
The Pediatric Infectious Disease Journal 01/2008; 26(12):1117-21. · 3.58 Impact Factor
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ABSTRACT: Smoking is not considered a risk factor for chronic lymphocytic leukemia (CLL) yet increased lung cancer risk has been reported for these patients. Little data exist on the temporal variation in lung cancer risk after CLL, or its histological composition. We investigated the occurrence of second cancers in a large cohort of CLL patients with particular emphasis on lung cancer and its major subtypes. We followed all patients diagnosed with CLL in Denmark in the period 1943-2003 (n = 12,373) for the occurrence of second cancers. The relative risk was expressed as the standardized incidence ratio (SIR), i.e. the ratio of observed to expected number of cancers, based on incidence rates for the Danish population. During follow-up 1,105 cancers occurred among the CLL patients (SIR = 1.59 (95% CI 1.50-1.69)). SIR for all cancers combined remained elevated more than 10 years after CLL (SIR = 1.80 (1.56-2.08)). Lung cancer occurred in 141 patients (SIR = 1.61 (1.37-1.90)). The relative risk of lung cancer did not vary by gender, or time of follow-up, but was higher in younger (SIR(<60 years) = 2.22 (1.62-3.06)) than in older (SIR(70-79 years) = 1.21 (0.88-1.68)) age-groups. Elevated risks were observed for adenocarcinoma (SIR = 2.20 (1.57-3.08)) and squamous cell carcinoma (SIR = 1.52 (1.06-2.17)) of the lung. We speculate that shared genetic risk factors may explain the accumulation of lung and other cancers in CLL patients.
International Journal of Cancer 07/2007; 121(1):151-6. · 5.44 Impact Factor
