Deaths In Denmark Research Articles

Life and Death in Denmark

The prevalence of diabetes mellitus, primarily type 2 diabetes mellitus, is increasing at epidemic rates in the United States and worldwide, driven largely by increasing rates of obesity and advancing age for populations living in westernized countries. Diabetes mellitus is associated with a 2- to 4-fold increase in the risk of coronary heart disease, and among people with diabetes, about two thirds of deaths are due to cardiovascular disease, including ischemic heart disease, congestive heart failure, and stroke.1 The increase in mortality for patients with diabetes mellitus after myocardial infarction is seen both acutely and in a sustained manner and holds true for both men and women. Indeed, many have suggested diabetes mellitus to be a coronary heart disease risk equivalent, because multiple studies have demonstrated that patients with diabetes but without prior cardiovascular disease have the same event rates as individuals without diabetes but with prior cardiovascular disease.2,3 However, this suggestion has remained somewhat controversial, especially for patients at younger ages.2,4,5 Article p 1945 Thus, to address whether diabetes mellitus accelerates the atherosclerotic process to such an extent that the presence of diabetes confers the same excess risk as that associated with prior myocardial infarction for the patient without diabetes, Schramm and colleagues,6 in the current issue of Circulation , report on the aggregate experience from the country of Denmark. All inhabitants of Denmark could be assessed with patient-level information through the Danish Civil Registration system, prescription drug use could be determined using The Danish Registry of Medicinal Product Statistics, and deaths could be identified via the Central Population Register. Integration of information from these administrative healthcare registries, together with uniform access of the population to health care, provides a definitive assessment of clinically significant risk. Furthermore, in a very large and complete population-based sample, …

Cancer care in Denmark

Denmark is a small country with a little more than 5 million inhabitants. Placed in Scandinavia and considered being a rich and affluent society, Denmark has the honour of having a high-quality health-care system delivering quality treatment and care for all groups of patients. According to international standards and costs, it is a highly efficient system. Health care and hospitals in Denmark are funded by taxes paid by the citizens. All citizens are guaranteed access to medical assistance without having a private insurance. That means that most medical treatments and care are freeFno one has to calculate the expenses before attending a physician or a hospital. The health care services in Denmark are the responsibility of 14 counties and the main capitol area. Cancer patients are admitted into both surgical and medical departments all over the country, but the specialised oncological and radio therapeutic treatment is placed in 5–6 special departments geographically spread all over the country, which means that most of the cancer patients are admitted to general surgical and medical departmentsFonly those requiring specialised treatment reach the specialised wards. Every year about 25,000 Danes are diagnosed with cancer. The number is increasing and it is assumed that about 200,000 Danes are living with cancer or side effects of a cancer disease. The most common cancers in Denmark are breast cancer, colon cancer, lung cancer, skin cancer and cancer of the prostate. Furthermore, Denmark has the highest incidence of cancer and the lowest overall 5year survival among all the Scandinavian countries (National Cancer Strategy, 2002; Cancer Statistics 1998–2002, 2003). Also, in 1999 cancer became the most frequent cause of deaths in Denmark overtaking heart diseasesFthe most common cause of death in most other western countries (National Cancer Strategy, 2002; Cancer Statistics 1998– 2002, 2003; Cancer Report, 2003). Therefore, the Danish Ministry of Health and the National Board of Health in 1998 appointed a group of experts to develop a National Cancer Strategy. The group analysed current practice to identify possible reasons for this trend and to point out areas for improvement. The analysis showed that the number of cases will increase in the future. Prevention and health campaigns have not been a successFDanes and especially Danish women smoke more than their counterparts in the rest of Scandinavia, and cancer patients do not change their lifestyle after diagnosis (National Cancer Strategy, 2002). The group pointed out that there are general differences of lifestyle in the Scandinavian countries. Smoking, high caloric diet and a higher consumption of alcohol are contributing factors to the higher cancer incidence in Denmark (National Cancer Strategy, 2002). Patients with some cancer diseases have poorer survival rate than patients with the same kind of disease in other countries, especially compared to Sweden (National Cancer Strategy, 2002). There may be a delay in diagnosis and treatment, while the general practitioners are more reluctant to refer the patient for further examinations as well as lack of capacity to carry out the examinations and start treatment quickly. Based on their assessment the expert group identified the following needs in their report (National Cancer Strategy, 2002):

Sex differences in mortality in Denmark during half a century, 1943-92

The emphasis of this study is on the relative mortality of 45-74-year-old men and women in Denmark in 1943-92, following economic and political changes that have affected the social meaning of gender over the last 50 years, and which have diminished former sex differences in health behaviour. Sex ratios of total mortality and mortality from major non-sex-specific causes of death were calculated on computerized mortality data from the Danish National Cause of Death Register that covers all deaths in Denmark since 1943. In the early 1940s the sex ratio of all-cause mortality was low, 1.0-1.1, it increased to a peak level in the late 1970s and early 1980s, but has since decreased due to an increase in female mortality and a more favourable trend in male mortality. Gender equality, employment, and economic autonomy may have beneficial health effects on both men and women, but the effects are inconsistent. The trend in smoking is the major explanatory factor for the more recent trends in gender differentials in mortality in Denmark.

Mortality and life expectancy in Denmark and in other European countries. What is happening to middle-aged Danes?

Background: The trend in life expectancy in Denmark has been less favourable than in other European countries for several years. The aim of this study was to compare mortality in Denmark with that in selected European countries, focusing on age groups and causes of death for which the Danish trends are particularly unfavourable. Methods: Comparisons were made for the period 1952–1993 between Denmark and Norway, the former Federal Republic of Germany, The Netherlands, the UK, France, Italy and former Czechoslovakia of age-specific mortality rates and changes in life expectancy specific for each age group and cause of death. Results: At the end of the period only the former Czechoslovakia had a lower life expectancy than Denmark; the difference in life expectancy between Denmark and the other six countries varied between 5 and 48 months. Almost all of the difference was due to a higher mortality rate in the 35–74 years age group. All heart diseases and ‘symptoms and ill-defined conditions’ were responsible for a large proportion of the Danish high mortality, the decrease in mortality from this group of diseases being moderate in comparison with the other countries. Lung cancer contributed to a loss of 1–6 months more of life expectancy for Danish women than in the other countries. In comparison with Norway, The Netherlands and the UK, Danish men lost 2 more months' life expectancy due to liver cirrhosis and Danish women lost 1 month more. Conclusions: A considerable proportion of the extra deaths in Denmark could be prevented.

Accuracy of recorded asthma deaths in Denmark in a 12-months period in 1994/95

Many studies of asthma mortality rely on official registration. The aim of this study was to evaluate the accuracy of death certificates, where asthma was coded as cause of death.In a 12-month period, medical information on all subjects with asthma officially coded as the underlying cause of death in Denmark, was obtained by reviewing hospital records, contacting general practitioners and sometimes close relatives. A panel of four pulmonologists each examined the obtained information and independently assessed the cause of death.Of a total of 218 death certificates, 39 were excluded as the cause of death could not be validated. In 16 (9%) of the subjects death from asthma was judged to be the definite cause of death and in 12 (7%) death from asthma was possible. Of 151 non-asthma deaths coded as due to asthma, 109 were judged to have suffered or died from COPD and 14 from heart disease.The accuracy of Danish death certification in asthma deaths is poor, especially in the elderly, where COPD is often classified as asthma. We conclude that the true asthma mortality in Denmark is substantially lower than officially recorded.

The development of reporting systems for causes of deaths in Denmark.

Une classification des causes de la mortalite a Copenhague a ete etablie en fonction des differentes parties du corps, puis en fonction des differents types de fievres, et des maladies specifiques des enfants, des femmes puis des personnes âgees

Editorial. Why has health in Denmark failed to improve?

STAGNATING LIFE EXPECTANCY IN DENMARK By the early 1990s Danish health authorities realised that, among countries in Western Europe, Denmark had had the smallest improvement in life expectancy since the 1970s.' This difference was particularly noticeable when Denmark was contrasted with neighbouring countries. While Norway and Sweden had experienced increases in male life expectancy at birth of 1.2 and 2.0 years respectively between 1980 and 1990, the corresponding figure for Denmark was only 0.9 years. For females the increases were 1.1,1.6 and 0.3 respectively. In 1990 life expectancy at birth in Denmark was 72.2 years for men and 77.7 years for women compared with 73.4 and 79.8 years in Norway and 74.8 and 80.1 in Sweden. The excess mortality for 0-74 years olds in Denmark was nearly 6,000 deaths a year compared to what would be expected on the basis of rates in Norway and Sweden, which corresponds to 25% more deaths overall. Compared to the rate in the European Union (EU) as a whole there was an excess of nearly 4,000 deaths in Denmark (10% of total mortality). During the past six years the situation has become worse. In 1996 life expectancy at birth in Denmark was 72.9 years for men and 78.0 years for women compared with 75.4 and 81.1 years in Norway and 76.5 and 81.5 years in Sweden, respectively.-' The excess mortality for 0-74 year olds in Denmark is now more than 6,500 deaths a year compared to what would be expected on the basis of rates in Norway and Sweden. The relatively greater mortality has been most marked in women and in the age group 35—74 years. A wide range of diseases contribute to the slower improvement in life expectancy in Denmark, but it has mainly been a result of differences in respiratory cancers, cirrhosis and cardiovascular diseases. Breast cancer, accidents and suicides have also contributed to the unfavourable situation. ' However, with respect to suicide the situation has improved in the past year. Possible explanations for the stagnating life expectancy in Denmark have been examined by comparing developments in social conditions, environment and lifestyle between Denmark and other Western European countries. The main conclusion has been that there is no single explanation but most of the excess mortality is from causes

Drug-related mortality in Denmark 1970-93

We analysed drug-related mortality in Denmark with respect to secular trends, gender, and regional variations, for the period 1970-93, for all deaths from poisoning and among drug addicts. The study was based on the Register of Causes of Death in Denmark and included 6,229 drug-related deaths, defined by specific combinations of manner of death, underlying cause of death, and contributory cause of death. The main outcome measure is age-specific mortality rate. A total of 63% of the drug-related deaths were registered as unnatural deaths. During the period studied, mortality increased for men in the 25 49 year age group and for women in all age groups over 25 years of age. For both men and women, the youngest birth cohorts from the mid-1950s and 1960s suffered much higher mortality than those born before 1950; however, the three youngest birth cohorts had almost the same mortality. During the entire period, mortality in the capital, Copenhagen, was much higher than in the provinces, but in the last years, a more favourable trend has been seen in Copenhagen.

Intrapartum death of nonmalformed fetuses in Denmark and Sweden in 1991. A perinatal audit.

In 1991 the rate of intrapartum death of non-malformed fetuses was higher in Denmark than in Sweden (4.2 vs. 1.9 per 10,000, OR 2.24). However, it is not clear whether this difference reflects potentially avoidable cases and/or suboptimal care. Short descriptions were made from medical records of all 50 intrapartum deaths in Denmark and Sweden in 1991. Ten obstetricians, two from each of the Nordic countries, reviewed the cases to determine whether (1) intra-uterine death might have occurred before admission, (2) surveillance and intervention were insufficient, (3) fetal death was potentially avoidable by improved obstetric care; and, if so, to suggest ways of improved health care. There was a statistically higher rate of insufficient care (surveillance and intervention) (high or less degree) in the Danish cases (66% vs. 55%). The proportion of potentially avoidable fetal deaths was also higher in Denmark (59% vs. 52%) although the difference was not statistically significant. The significantly higher rate of intrapartum death of non-malformed infants in 1991 in Denmark compared to Sweden might be reduced by improved intrapartum surveillance and interventions.

Deaths among drug addicts in Denmark in 1987–1991

In the period 1987–1991 a total of 739 fatalities among drug addicts was investigated at the three University Institutes of Forensic Medicine in Denmark. The annual number rose from 130–140 in the first 4 years to 192 in 1991, and 80% were males. The mean and median age for both males and females increased by 1 year in the period. The main drug of abuse was heroin, in most cases supplemented by various other drugs, and in almost all cases taken intravenously. In about one-third of the cases each year there was information of abuse of alcohol in addition. In the poisoning cases, the main drug of poisoning was morphine/heroin, constituting 35–55% of the cases each year. As regards methadone-poisoning cases, the number increased significantly in 1991 compared to the first 4 years. Furthermore, the number and proportion of addicts dying while in methadone treatment increased during the 5-year period. In about half of the methadone poisoning cases, there was information of methadone treatment at the time of death. The other half obviously obtained the methadone completely illegally. Ketobemidone was the third most frequent drug of poisoning, while propoxyphene and barbituric acid only were found in a very few cases each. The results are compared to those from an earlier investigation concerning drug deaths in Denmark in 1968–1986. The importance of registering drug deaths is emphasized.

Suicide in Relation to other Causes of Death in Denmark, 1922–1991

During the past 70 years, Danish rates of registered suicide have increased by more than one-third. Variations in the ratio of death by suicide to death by other causes distributed by sex and age are discussed, the conclusion being that death by suicide constitutes an increasing proportion of all deaths. Especially among people not yet in their middle age, the proportion has increased markedly from a few per cent in 1922 to approximately 20% today. Among young people below the age of 30 years every fifth death is due to suicide, and among the somewhat older - that is, those 30-40 years old - suicide is the most frequent cause of death.

Sudden Death and Human Insulin: Is There a Link?

Case reports from the United Kingdom (UK) in 1989 have suggested that the introduction of human insulin in 1985 was associated with an increased risk of sudden death in insulin-treated diabetic patients. If human insulin increases the risk of sudden death, the number of these should have increased during the period where human insulin was introduced. We therefore identified all cases of sudden death in Denmark in younger insulin-treated diabetic patients, age at death below 50 years. During this period the consumption of human insulin went from 0.2% to 70% of the total consumption in Denmark. The total number of cases fulfilling the inclusion criteria was 226, and the annual number of sudden deaths did not change during the study period (p = 0.14). The number of deaths due to hypoglycaemia and cases with unexplained cause of death also remained constant (test for trend: p = 0.44). Chronic alcohol abuse or acute alcohol intoxication was found in 50% of the 135 patients dying from hypoglycaemia, ketoacidosis or unknown cause of death (including found dead in bed), while this was the case in only 16% of the remaining 91 cases dying from other natural causes. We conclude that introduction of human insulin in Denmark was not followed by an increase in sudden deaths among younger insulin-treated diabetic patients.

Sudden Infant Death Syndrome (SIDS) in Denmark: Evaluation of the Increasing Incidence of Registered SIDS in the Period 1972 to 1983 and Results of a Prospective Study in 1987 through 1988

To investigate a reported increase, from 0.4 to 1.3 per thousand live births, in the Danish incidence of sudden infant death syndrome (SIDS), a retrospective analysis of SIDS in Denmark from 1972 to 1983 was carried out. Based on data registered with the National Board of Health, a notable regional difference in SIDS rate between the western and eastern parts of Denmark was found. This difference did not correlate with the overall postneonatal mortality by region. Danish law requires medicolegal investigation in all cases of sudden unexpected death. Medicolegal autopsies are performed only in the three forensic institutes which cover all of Denmark. Despite the law and a uniform organization of the forensic medical services, differing application of postmortem examinations and individual interpretation of the history and autopsy in cases of sudden infant death existed. Differences in reporting of respiratory infections, suffocation, and cardiac malformation were found to contribute to the increase and to regional disparities in SIDS incidence. The three Danish forensic institutes examined all cases of sudden infant deaths in Denmark 1987 and 1988. These cases were classified as explained cause of death, pure SIDS, and atypical SIDS; atypical cases were evaluated by consensus. The SIDS incidence (the number of classic SIDS and atypical SIDS per thousand live births) was 1.9 in 1987 and 1.3 in 1988, and it was identical in the eastern and western part of Denmark; however, a higher incidence both of overall postneonatal and SIDS mortality was found in the middle region of Denmark.(ABSTRACT TRUNCATED AT 250 WORDS)

Life table analysis of infant mortality and feto-infant mortality distributed on causes of death in Denmark 1983-1987.

The survival function of 263,322 singletons of the 1983-1987 Danish birth cohorts (262,159 liveborn and 1163 stillborn babies) with mortality distributed on functional groups of underlying causes of death is presented in two graphic forms on the basis of Kaplan-Meier estimates. About half of all first-day deaths in liveborn babies occurred during the first 4 hours. More than half of all first-week deaths happened during the first day. More than half of all deaths from 31 weeks to 76 weeks after the first day of the last menstrual period (LMP) were either fetal deaths prior to the onset of labour unexplained by fetal factors or unexplained sudden infant death syndrome (SIDS) deaths. Graphic presentation of feto-infant mortality distributed on functional cause-of-death groups improved the expression of the relative contribution and timing of the different causes of deaths. Despite a high autopsy rate and a uniform coding practice the distribution on causes of deaths from register data should be interpreted with caution. Full use of the feto-infant approach is only achieved with data which include late abortions. Thus the feto-infant approach is of special interest in countries which have registers of live births and fetal deaths from week 22 of gestation or earlier. The integration of the life table approach and analysis of underlying causes of deaths should be further explored as a way of utilizing vital statistic databases for the evaluation of perinatal care.

Skin cancer as a cause of death in Denmark

Denmark has a well-established nation-wide registration system for cancer incidence and mortality. In 1984, 2984 new cases of non-melanoma skin cancer were notified to the Danish Cancer Registry and 40 deaths were attributed to this cause. An evaluation and validation of the death certificates indicate that the true number of deaths caused by non-melanoma skin cancer was 18. Basal cell and squamous cell carcinoma accounted for three and 15 of the deaths, respectively. The estimated lethality is 4.3% for squamous cell carcinoma and 0.12% for basal cell carcinoma.

Death in Denmark: reply to Lamb.

Death in Denmark: reply to Lamb.

Death in Denmark: a reply.

This reply to Martyn Evans's support for a cardiac-centered concept of death attempts to meet some objections to the brainstem definition of death. Evans's appeal to Wittgenstein's philosophy is also criticised.

Legally-induced abortions in Denmark after Chernobyl

During the months following the accident in Chernobyl, Denmark experienced an increasing rate of induced abortion, especially in regions with the largest measured increase in radiation. As the increase in radiation in Denmark was so low that almost no increased risk of birth defects was expected, the public debate and anxiety among the pregnant women and their husbands “caused” more fetal deaths in Denmark than the accident. This underlines the importance of public debate, the role of the mass media and of the way in which National Health authorities participate in this debate.

Death in Denmark.

Does it matter that the hearts of 'brainstem dead' patients may persist in beating spontaneously? Hostile reactions, to the Danish inclusion of cardiac criteria in the determination of death, betray reductionist views of human life at the core of 'brainstem' conceptions of death. Such views (whether centred on neurological function or on abstractions concerning 'personhood') supplant the richness of human life and death with the poverty of essentialism: and mask the lethal nature of beating-heart organ retrieval. The affirmation of cardiac criteria for death is not an alternative form of essentialism as some critics suppose, but part of an understanding of human life and death which rejects essentialism altogether. The spontaneously persistent heartbeat does not constitute human life, but most certainly counts for it.

Rates and survival of individuals with trisomy 13 and 18. Data from a 10-year period in Denmark.

Rates and survival figures for trisomy 13 and trisomy 18 have been calculated for Denmark (DK) based on a 10-year period (1977-86). The data have been ascertained through The Danish Central Cytogenetic Register, all cytogenetic laboratories in DK, paediatric departments throughout the country. The Medical Birth Register and The Register of Causes of Death in DK. Nineteen liveborn probands with trisomy 13 and 76 liveborn probands with trisomy 18 were found. No stillborn cases with trisomy 13 but 6 with trisomy 18 were found. By prenatal diagnosis 19 probands with trisomy 13 and 46 with trisomy 18 were found. Based on liveborn and stillborn probands, the prevalence at birth was 1 per 29,374 for trisomy 13 and 1 per 6806 for trisomy 18. The median survival for trisomy 13 was 2.5 days, while the same figure for trisomy 18 was 6.0 days. The rates calculated seem rather low compared to earlier studies.