[Show abstract][Hide abstract] ABSTRACT: Longitudinal outcomes following stress or trauma diagnoses are receiving attention, yet population-based studies are few. The aims of the present cohort study were to examine the cumulative incidence of traumatic events and psychiatric diagnoses following diagnoses of severe stress and adjustment disorders categorized using International Classification of Diseases, Tenth Revision, codes and to examine associations of these diagnoses with all-cause mortality and suicide. Data came from a longitudinal cohort of all Danes who received a diagnosis of reaction to severe stress or adjustment disorders (International Classification of Diseases, Tenth Revision, code F43.x) between 1995 and 2011, and they were compared with data from a general-population cohort. Cumulative incidence curves were plotted to examine traumatic experiences and psychiatric diagnoses during the study period. A Cox proportional hazards regression model was used to examine the associations of the disorders with mortality and suicide. Participants with stress diagnoses had a higher incidence of traumatic events and psychiatric diagnoses than did the comparison group. Each disorder was associated with a higher rate of all-cause mortality than that seen in the comparison cohort, and strong associations with suicide were found after adjustment. This study provides a comprehensive assessment of the associations of stress disorders with a variety of outcomes, and we found that stress diagnoses may have long-lasting and potentially severe consequences.
Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.
American journal of epidemiology 08/2015; DOI:10.1093/aje/kwv066 · 4.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although asthma has recently been established as a risk factor for pneumococcal disease (PD), few studies have specifically evaluated this association in children.
We conducted a nation-wide population-based cohort study of the effect of asthma on childhood PD among all singleton live births in Denmark from 1994 to 2007, before the introduction of the 7-valent pneumococcal conjugate vaccine. All data were abstracted from Danish medical registries. Because underlying comorbidity substantially increases the PD risk in children, standard methods were used to assess the evidence of biologic interaction between comorbidity and asthma on the risk of PD.
There were 2,253 cases of childhood PD among 888,655 children born in Denmark from 1994 to 2007. The adjusted incidence rate ratio of the effect of asthma on childhood PD was 2.2 (95% confidence interval [CI]: 2.0, 2.5). Age-stratified incidence rate ratios were 2.1 (95% CI: 1.8, 2.9) in children 6 months to <24 months, 4.1 (95% CI: 3.3, 5.1) in children 24 months to <60 months, and 2.3 (95% CI: 1.6, 3.2) in children ≥60 months. Evaluation of the biologic interaction between asthma and comorbidity in older children revealed that 55% (24 months to <60 months) to 73% (≥60 months) of cases among asthma-exposed children can be accounted for by the interaction between asthma and comorbidity.
These results confirm that asthma is an important risk factor for PD in children and suggest that children with underlying comorbidities are more sensitive to the effect of asthma on PD than children without comorbidities.
[Show abstract][Hide abstract] ABSTRACT: The monogenic Lynch syndrome (LS) is associated with better survival in colorectal cancer (CRC) patients. Whether family history of CRC affects CRC prognosis in general remains unclear. We evaluated overall mortality in a Danish cohort of CRC patients comparing patients with a family history (FHpos) to those without (FHneg) with focus on patients from non-syndromic families, thus FHpos patients were further divided into a non-syndromic group (FHNS) and a HNPCC/LS group (FHHNPCC). We included CRC patients diagnosed 1995-1998. First degree relatives were identified using Danish population registries and family history was obtained by linkage to Danish medical registries. 1- and 5-year mortality were evaluated using the Kaplan-Meier method and Cox regression, with adjustment for age, sex, cancer site, cancer stage, and comorbidity. 1196 CRC patients were included in the study, 219 FHpos patients of whom 197 were FHNS patients. 1- and 5-year adjusted Mortality Rate Ratios comparing FHpos patients to FHneg patients were 0.99 (95 % CI 0.69, 1.42) and 1.07 (95 % CI 0.87, 1.32), respectively. For FHNS patients, the corresponding MRRs were 1.01 (95 % CI 0.69, 1.47) and 1.15 (95 % CI 0.93, 1.43). For the FHHNPCC patients MRRs were 0.84 (95 % CI 0.29, 2.44) and 0.66 (95 % CI 0.33, 1.31), respectively. In contrast to the lower mortality in LS patients, other types of familial CRC do not seem to affect the survival after CRC diagnosis.
Familial Cancer 05/2015; DOI:10.1007/s10689-015-9812-1 · 1.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The association between stress and cancer incidence has been studied for more than seven decades. Despite plausible biological mechanisms and evidence from laboratory studies, findings from clinical research are conflicting. The objective of this study was to examine the association between PTSD and various cancer outcomes. This nation-wide cohort study included all Danish-born residents of Denmark from 1995 to 2011. The exposure was PTSD diagnoses (n = 4131). The main outcomes were cancer diagnoses including: (1) all malignant neoplasms; (2) hematologic malignancies; (3) immune-related cancers; (4) smoking- and alcohol-related cancers; (5) cancers at all other sites. Standardized incidence ratios (SIR) were calculated. Null associations were found between PTSD and nearly all cancer diagnoses examined, both overall [SIR for all cancers = 1.0, 95 % confidence interval (CI) = 0.88, 1.2] and in analyses stratified by gender, age, substance abuse history and time since PTSD diagnosis. This study is the most comprehensive examination to date of PTSD as a predictor of many cancer types. Our data show no evidence of an association between PTSD and cancer in this nationwide cohort.
European Journal of Epidemiology 05/2015; DOI:10.1007/s10654-015-0032-7 · 5.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the validity of reaction to severe stress and adjustment disorder diagnoses registered in the Danish Psychiatric Central Research Register (DPCRR), to examine the documentation of stressful and traumatic events in the medical records, and to investigate the occurrence of stress diagnoses among persons not registered in the DPCRR.
Among 101,633 patients diagnosed with International Classification of Diseases, 10th Edition (ICD-10) F43 diagnoses between 1995 and 2011, we selected 50 patients from two hospitals (100 total), comprising one above and one below median age for each diagnosis for five time periods, and reviewed their medical records. We calculated the positive predictive value, comparing registration in the DPCRR with the original medical records, and captured data on stressful life events. Two general practitioners were queried about 50 patients without a stress diagnosis in the DPCRR, regarding whether they had ever received a stress diagnosis.
The positive predictive value was 58% for acute stress reaction, 83% for posttraumatic stress disorder, 94% for adjustment disorder, 71% for other reactions to severe stress, and 68% for reaction to severe stress, unspecified. In 80% of the records, a stressful or traumatic event was noted. Of 100 patients without an F43 diagnosis in the DPCRR, seven had a stress diagnosis.
The DPCRR represents a valid and comprehensive resource for research on reaction to severe stress and adjustment disorders, particularly for posttraumatic stress disorder and adjustment disorder.
[Show abstract][Hide abstract] ABSTRACT: Autoimmune diseases (ADs) comprise a large group of heterogeneous diseases in which the immune system attacks healthy organs. Both intrinsic changes in the body and AD treatment can compromise immune function. Impaired immune function could increase the risk of recurrent cancer. We aimed to investigate this hypothesis in a population-based epidemiological study. We examined the risk of breast cancer (BC) recurrence associated with an AD diagnosis among patients with incident stages I–III BC diagnosed during 1980–2007. Data were obtained from Danish population-based medical registries. ADs were categorized dichotomously and according to organ system of origin. Follow-up was up to 10 years or until 31 December 2009. Multivariate Cox proportional hazard regression was used to compute hazard ratios (HRs) and associated 95 % confidence intervals (95 % CIs) to evaluate the association between AD diagnosis and BC recurrence. 78,095 women with stages I–III BC were identified. Median age-at-diagnosis was 61 years (19–102 years), median follow-up was 5.7 years, and 13,545 women had a recurrence during follow-up. 6,716 women had at least one AD. In adjusted models, the association between ADs and BC recurrence was near null: HRadjusted 0.96 (95 % CI 0.89, 1.04). These results held in all AD subcategories, except for central nervous/neuromuscular system ADs, with HRadjusted 0.56 (95 % CI 0.40, 0.78). Among women with BC, a history of at least one AD diagnosis was not associated with BC recurrence, with the possible exception of ADs of the central nervous/neuromuscular system.
Breast Cancer Research and Treatment 01/2015; 149(2). DOI:10.1007/s10549-014-3258-2 · 4.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Birth certificates are an important source of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) data for surveillance and aetiologic studies, but little is known about their validity in twin pregnancies. Twins experience high rates of adverse perinatal outcomes that have been associated with BMI and GWG in singletons. Our objective was to evaluate the accuracy of birth certificate-derived pre-pregnancy BMI and GWG compared with medical record-derived data in a sample of 186 twin pregnancies at a teaching hospital in Pennsylvania (2003–2010). Twelve strata were created by simultaneous stratification on pre-pregnancy BMI (underweight, normal weight/overweight, obese class 1, obese classes 2 and 3) and GWG (<20th, 20–80th, >80th percentile). The agreement of birth certificate-derived pre-pregnancy BMI category with medical record BMI category was lowest among underweight mothers [75% (95% confidence interval 51–91%) ] and highest among normal/overweight [97% (90–99%) ] and obese classes 2 and 3 mothers [97% (85–99%) ]. Agreement for GWG category from the birth certificate varied from 57% (41–70%) for GWG >80th percentile to 80% (65–91%) and 82% (72–89%) for GWG <20th and 20th–80th percentiles, respectively. The misclassification of BMI and GWG was primarily due to error in pre-pregnancy weight rather than weight at delivery or height. Agreement proportions for twins were not meaningfully different from the proportions in a comparable sample of singleton pregnancies. These data suggest that birth certificate-based BMI and GWG data are prone to error in twin pregnancies. Those who use these data should conduct internal validation studies and adjust their results using bias analyses.
Maternal and Child Nutrition 01/2015; DOI:10.1111/mcn.12160 · 2.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the association between exacerbation frequency and mortality following an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Cohort study using medical databases.
On 1 January 2005, we identified all patients with prevalent hospital-diagnosed chronic obstructive pulmonary disease (COPD) who had at least one AECOPD during 1 January 2005 to 31 December 2009. We followed patients from the first AECOPD during this period until death, emigration or 31 December 2009, whichever came first. We flagged all AECOPD events during follow-up and characterised each by the exacerbation frequency (0, 1, 2 or 3+) in the prior 12-month period.
Using Cox regression, we computed 0-30-day and 31-365-day age-adjusted, sex-adjusted, and comorbidity-adjusted mortality rate ratios (MRRs) with 95% CIs entering exacerbation frequency as a time-varying exposure.
We identified 16 647 eligible patients with prevalent COPD, of whom 6664 (40%) developed an AECOPD and were thus included in the study cohort. The 0-30-day MRRs were 0.97 (95% CI 0.80 to 1.18), 0.90 (95% CI 0.70 to 1.15) and 1.03 (95% CI 0.81 to 1.32) among patients with AECOPD with 1, 2 and 3+ AECOPDs versus no AECOPD within the past 12 months, respectively. The corresponding MRRs were 1.47 (95% CI 1.30 to 1.66), 1.89 (95% CI 1.59 to 2.25) and 1.59 (95% CI 1.23 to 2.05) for days 31-365.
Among patients with AECOPD, one or more exacerbations in the previous year were not associated with 30-day mortality but were associated with an increased 31-365-day mortality.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ Open 12/2014; 4(12):e006720. DOI:10.1136/bmjopen-2014-006720 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent studies show an association between statin therapy and a reduced risk of heart failure among breast cancer survivors. Our goal was to evaluate whether statin therapy for prevention of cardiovascular disease (CVD) would ameliorate declines in left ventricular ejection fraction (LVEF) often observed during anthracycline-based chemotherapy (Anth-bC).Methods
In 51 participants (33 women and 18 men; aged 48±2 years), we performed CV magnetic resonance (CMR) measurements of LVEF before and 6 months after initiation of Anth-bC for patients with breast cancer, leukemia, or lymphoma. Fourteen individuals received statin therapy, and 37 received no statin. MR image analysts were blinded to participant identifiers.ResultsThose receiving statins were older and often had diabetes (DM), hypertension (HTN), and hyperlipidemia (HLD). For those receiving statins, LVEF was 56.6±1.4% at baseline and 54.1±1.3% 6 months after initiating anthracycline (p=0.15). For those not receiving a statin, LVEF was 57.5±1.4% at baseline and decreased to 52.4±1.2% over a similar 6 month interval (p=0.0003). In a multivariable model accounting for age, sex, DM, HTN, HLD, and cumulative amount of anthracycline received, LVEF remained unchanged in participants receiving a statin (+ 1.1±2.6%) versus a -6.5±1.5% decline among those not receiving a statin (p=0.03).Conclusion
In conclusion, these data highlight that individuals receiving statin therapy for prevention of CVD may experience less deterioration in LVEF upon early receipt of Anth-bC than individuals not receiving a statin. Further studies with large numbers of participants are warranted to determine if statins protect against LVEF decline in patients receiving Anth-bC.
The Canadian journal of cardiology 11/2014; 31(3). DOI:10.1016/j.cjca.2014.11.020 · 3.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: -In a murine anthracycline-related cardiotoxicity model, increases in cardiovascular magnetic resonance (CMR) myocardial contrast-enhanced T1-weighted signal intensity are associated with myocellular injury and decreases in left ventricular ejection fraction (LVEF). We sought to determine if T1- and T2-weighted measures of signal intensity associate with decreases in LVEF in human subjects receiving potentially cardiotoxic chemotherapy.