Deaths In Norway Research Articles

Mortality in Norway and Sweden during the COVID-19 pandemic 2020–22: A comparative study

BackgroundNorway and Sweden picked two different ways to mitigate the dissemination of the SARS-CoV-2 virus. Norway introduced the strictest lockdown in Europe with strict border controls and intense virus tracking of all local outbreaks while Sweden did not. That resulted in 477 COVID-19 deaths (Norway) and 9737 (Sweden) in 2020, respectively. MethodsWeekly number of COVID-19 related deaths and total deaths for 2020–22 were collected as well as weekly number of deaths for 2015–19 which were used as controls when calculating excess mortality. During the first 12–18 months with high rate of virus transmission in the society, excess mortality rates were used as substitute for COVID-19 deaths. When excess mortality rates later turned negative because of mortality displacement, COVID-19 deaths adjusted for bias due to overreporting were used. ResultsThere were 17521 COVID-19 deaths in Sweden and 4272 in Norway in the study period. The rate ratio (RR) of COVID-19 related deaths in Sweden vs. Norway to the end of week 43, 2022, was 2.11 (95% CI 2.05–2.19). RR of COVID-19 related deaths vs. excess number of deaths were 2.5 (Sweden) and 1.3 (Norway), respectively. RR of COVID-19 deaths in Sweden vs. Norway after adjusting for mortality displacement and lockdown, was 1.35 (95% CI 1.31–1.39), corresponding to saving 2025 life in Norway. If including all deaths in 2022, RR= 1.28 (95% CI 1.24–1.31). ConclusionsBoth COVID-19 related mortality and excess mortality rates are biased estimates. When adjusting for bias, mortality differences declined over time to about 30% higher mortality in Sweden after 30 months with pandemics.

No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions.

Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010-2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010-2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed.

Suicide in services for mental health and substance use: A national hybrid registry surveillance system.

Suicide is strongly associated with mental health and substance use disorders, which makes mental health- and substance misuse services important areas for suicide prevention. The aim of The Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services is to describe all suicide deaths in Norway that occur within one year after contact with mental health and substance misuse services. The study uses a hybrid registry case series design. It consists of a yearly linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, which is linked with a questionnaire. The linkage is conducted by using a cryptographic hash function of the deceased's personal id, thus ensuring that the project can link data across sources without the use of directly identifiable information. This indirect linkage ensures the deceased's confidentiality. Moreover, the The Norwegian Surveillance System for Suicide shows how administratively collected data can be harnessed and used for surveillance. Both use of hybrid registry designs and linkage through cryptographic hash functions might contribute to the development of health informatics as well as quality improvement in health care.

Trauma team training in Norwegian hospitals: an observational study

BackgroundTraumatic injuries are a leading cause of deaths in Norway, especially among younger males. Trauma-related mortality can be reduced by structural measures, such as organization of a trauma system. Many hospitals in Norway treat few seriously injured patients, one of the reasons for development of the Norwegian trauma system. Since its implementation, there has been continuous improvement of this system, including trauma team training. Regular trauma team training is compulsory, with the aims of compensating for lack of experience and maintaining competence. The purpose of this study was to present an overview of current trauma team training activities in Norway.MethodsFor this observational study, the authors developed an online questionnaire and mailed it to local trauma coordinators from 38 Norwegian hospitals—including four trauma centers and 34 acute hospitals with trauma function. The study was performed during April–June 2020, with a two-month response window. Trauma team training frequency was assessed in four predefined intervals: < 5, 5–9, 10–15 and > 15 times per year. The response rate was 33 of 38, 87%.ResultsAll responding hospitals conducted regular trauma team training. The frequency of training increased significantly from 2013 to 2020 (Chi square test, Chi2 8.33, p = 0.04). All hospitals described a quite homogenous approach. The trauma centres trained more frequently as compared to the acute care hospitals (Chi square test, Chi2 8.24, p = 0.04).ConclusionsAll responding hospitals performed regular trauma team training using a homogenous approach, which is in line with previous assessments. We observed a minor improvement in frequency compared to prior assessments. Our findings suggest that Norwegian trauma teams likely maintain their competence through team training. All hospitals followed the current recommendations from the National Trauma Plan.

Deaths associated with MDMA in the period 2000-2019.

The use of MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy, has increased in Norway in recent years. Since MDMA has the potential to be toxic and cause death, we studied whether increased availability and use correlates with the increase in MDMA-associated deaths. The study includes post-mortems with findings of MDMA in blood, linked to information about cause of death from the Norwegian Cause of Death Registry. These data were compared with the number of arrested drug drivers with MDMA detected in their blood as well as annual seizure statistics from Kripos (The National Criminal Investigation Service) in the period 2000-2019. In the period 2000-2019, MDMA was detected in 142 fatalities, and the cause of death was known for 132 of these. The number of annual MDMA-associated deaths varied from 1 to 18. The median MDMA concentration among the fatalities increased from 1.9 µmol/L (interquartile range (IQR) 0.9 to 5.0) in 2000-2004 to 3.8 µmol/L (1.4 to 12.0) in 2015-2019. In 47/132 (36%) of cases, MDMA and other central nervous system (CNS) stimulant drugs contributed to the death. Among arrested drug drivers with detected MDMA, the annual number of detected cases was 7-262 in this period, but the median concentration remained stable. MDMA may have contributed to numerous deaths in Norway. Increased availability, increased use and increased strength of contents seem to be significant.

Increases in drug overdose deaths in Norway and the United States during the COVID-19 pandemic.

Little international comparative work exists describing pandemic-related spikes in overdose and related implications for drug and public health policy. We compared increases in overdose deaths during the pandemic in Norway and the United States, two countries in the top 10 for per-capita overdose mortality, yet with very different approaches to the pandemic, healthcare and drug policy. We examined monthly overdoses in 2020 versus baseline rates (the monthly average across 2017-2019). We compared excess overdose mortality to shifts in human mobility and social interaction, measured using cellphone-based mobility data, an indicator of the societal response to the pandemic. Both the US and Norway saw large magnitude exacerbations in overdose mortality during the pandemic-related lockdowns, reaching 46.8% and 57.0% above baseline, respectively. Maximum increases occurred 2-3 months after peak reductions in mobility, suggesting lagged mechanisms. While overdose mortality returned to baseline relatively quickly in Norway, rates remained elevated in the US to the end of 2020. Spikes in overdose mortality in both contexts may relate to disruptions in healthcare access and the drug supply becoming more potent. Norway's quicker return to baseline may reflect more robust access to harm reduction and addiction-related healthcare services. Nevertheless, it is notable that even in Norway - with universal access to high-quality services, low COVID-19 rates, and a highly effective public health infrastructure - a greater than 50% spike in overdose deaths was still seen at the onset of lockdown measures. This may have important implications for future pandemic and disaster planning.

Opioid related deaths in Norway in 2000–2019

AimsThe aim of the study is to present autopsy-based findings of the most prevalent opioids in overdose deaths in Norway from 2000 to 2019, as such data are lacking in the current literature. MethodsData on cause of death obtained from the Norwegian Cause of Death Registry (NCoDR) were linked with forensic toxicological results from forensic autopsies. ResultsFrom year 2000 the annual numbers of overdose deaths decreased, specifically during 2000–2003, thereafter a relatively stable annual number was observed. Opioids were detected in 93% of the cases. Heroin related deaths have decreased, whereas medical opioids for pain treatment have increased with time. Men in their early 40′s dominate the overall numbers of deaths, but significantly different sex patterns emerge when studying the specific drugs. During the past 20 years, the mean age at overdose death has increased by 10 years (from 33 to 43 years). Overdose deaths without any illicit drugs present at autopsy have increased in recent years. These deaths, where only potentially prescription medications were detected, were more common among women and with higher age. ConclusionsIn Norway during the past 20 years, we observe a dynamic shift in overdose deaths caused by heroin and illicit drugs, to include a gradually increasing trend of overdose deaths from pill based pain medications and also methadone and buprenorphine. This warrants a shift in preventive responses, as the target groups differ.

Lockdown and non-COVID-19 deaths: cause-specific mortality during the first wave of the 2020 pandemic in Norway: a population-based register study

ObjectiveTo explore the potential impact of the first wave of COVID-19 pandemic on all cause and cause-specific mortality in Norway.DesignPopulation-based register study.SettingThe Norwegian cause of Death Registry and the National...

Increased risk of COVID-19-associated death in people under 70 with cardiovascular disease compared to the general population- A nationwide, registry-based study from Norway

Abstract Introduction Reports from early in the pandemic suggested that older people with comorbidities were at increased risk of severe disease and death from COVID-19, including in Norway, where by September 2020 a majority of the COVID-19-associated deaths were in people with cardiovascular disease (CVD). However, it is uncertain if the increased risk seen in people with CVD could rather be explained by age and sex, both strong risk factors. Purpose To compare the incidence and mortality of COVID-19 in people with CVD to the general Norwegian population, controlling for age and sex, to better identify the risk of death in those with CVD. Methods We used data from the Norwegian Surveillance System for Communicable Diseases and Norwegian Cardiovascular Disease Registry to identify all test-positive cases and COVID-19-associated deaths in Norway up to June 30, 2020, as well as information on previously diagnosed CVD. CVD was defined as a composite of hypertension, myocardial infarction, stroke, heart failure and atrial fibrillation between 2012 to 2019. Standardized incidence and mortality ratios (SIR and SMR) were used to provide a measure of risk in people with CVD compared to the general population, stratified by age and sex. Results There were 8809 test-positive cases and 260 COVID-19-associated deaths, with 1015 cases in people with CVD and 137 deaths. In people with CVD there was decreased incidence (SIR 0.58, 95% CI 0.55–0.62), except for people over 90, who had increased risk (SIR 2.53 (1.66–3.66) for men and SIR 2.95 (2.20–3.85) for women) (Table 1). Despite the lower incidence, mortality was marginally increased (SMR 1.20 (1.01–1.42)) which was attributable to men 20–69 years (SMR 11.90 (6.70–19.26)). People aged 70 and above had the same risk of death from COVID-19 as the comparable general population without CVD. Conclusion This nationwide analysis from the first wave of the COVID-19 pandemic provides evidence that in people under 70 years with COVID-19, CVD was associated with an increased risk of death, despite lower incidence. We hypothesise the decreased incidence to be a result of social distancing and other measures adhered to in the beginning of the pandemic. However, those over 90 were not protected from this as they were more likely in a care setting where social distancing is more difficult, or a sign of increased testing in this group, which could introduce bias. Our analysis benefits from reliable, high-quality Norwegian registry data as well as being one of few nationwide studies not dependent on highly selected hospital reporting. The study is limited by relatively small numbers of deaths, especially in younger age groups, leading to possible residual confounding by age and sex as groups had to be pooled. Also, we did not control for other comorbidities. This analysis serves to support risk mitigation strategies in people with CVD and a basis to identify different risk patterns in later waves of the pandemic. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Norwegian Institute of Public Health

The validity of cancer information on death certificates in Norway and the impact of death certificate initiated cases on cancer incidence and survival

BackgroundDeath certificates are an important source of information for cancer registries. The aim of this study was to validate the cancer information on death certificates, and to investigate the effect of including death certificate initiated (DCI) cases in the Cancer Registry of Norway when estimating cancer incidence and survival. MethodsAll deaths in Norway in the period 2011–2015 with cancer mentioned on the death certificates were linked to the cancer registry. Notifications not registered from other sources were labelled death certificate notifications (DCNs), and considered as either cancer or not, based on available information in the registry or from trace-back to another source. ResultsFrom the total of 65 091 cancers mentioned on death certificates in the period 2011–2015, 58,425 (89.8%) were already in the registry. Of the remaining 6 666 notifications, 2 636 (2 129 with cancer as underlying cause) were not regarded to be new cancers, which constitutes 4.0% of all cancers mentioned on death certificates and 39.5% of the DCNs. Inclusion of the DCI cases increased the incidence of all cancers combined by 2.6%, with largest differences for cancers with poorer prognosis and for older age groups. Without validation, including the 2 129 disregarded death certificates would over-estimate the incidence by 1.3%. Including DCI cases decreased the five-year relative survival estimate for all cancer sites combined with 0.5% points. ConclusionIn this study, almost 40% of the DCNs were regarded not to be a new cancer case, indicating unreliability of death certificate information for cancers that are not already registered from other sources. The majority of the DCNs where, however, registered as new cases that would have been missed without death certificates. Both including and excluding the DCI cases will potentially bias the survival estimates, but in different directions. This biases were shown to be small in the Cancer Registry of Norway.

Does the use of Doppler ultrasound reduce fetal mortality? A population study of all deliveries in Norway 1990-2014.

BackgroundThe aim of the present study was to examine the effect that the introduction of Doppler ultrasound in obstetric care has had on fetal death in Norway. One mechanism by which Doppler ultrasound may reduce fetal death may be through the increased use of Caesarean delivery. Therefore, we also examined the effect that the use of Doppler ultrasound has had on the use of Caesarean delivery.MethodsThe Medical Birth Registry of Norway provided detailed medical information for ∼1.2 million deliveries from 1990 to 2014. Information about the year of introduction of Doppler ultrasound was collected directly from the maternity units, using a questionnaire. The data were analysed using a hospital fixed-effects regression model with fetal death as the outcome measure. The key independent variable was the introduction of Doppler ultrasound at each maternity ward. Hospital-specific trends and risk factors of the mother for fetal death were included as covariates.ResultsFor pre-term deliveries, the introduction of Doppler ultrasound contributed to a reduction in fetal death of ∼30% and to an increase in planned Caesarean section of ∼15%. There were no effects for emergency Caesarean sections or inductions pre-term. The introduction of Doppler ultrasound had no effect on fetal death or Caesarean section for term deliveries.ConclusionsThe introduction of Doppler ultrasound during the 1990s and 2000s made a significant contribution to the decline in the number of pre-term fetal deaths in Norway. Increased use of Caesarean section may have contributed to this reduction.

Sex-specific deaths in Norway and Sweden during the COVID-19 pandemic: Did mandates make a difference?

To determine whether differences between Norway's and Sweden's attempts to contain SARS-CoV-2 infection coincided with detectably different changes in their all-cause mortality sex ratios. Measuring temporal variation in the all-cause mortality sex ratio before and during the pandemic in populations exposed to different constraints on risky behavior would allow us to better anticipate changes in the ratio and to better understand its association with infection control strategies. I apply time Box-Jenkins modeling to 262 months of pre-pandemic mortality sex ratios to arrive at counterfactual values of 10 intra-pandemic ratios. I compare counterfactual to observed values to determine if intra-pandemic ratios differed detectably from those expected as well as whether the Norwegian and Swedish differences varied from each other. The male to female mortality sex ratio in both Norway and Sweden increased during the pandemic. I, however, find no evidence that the increase differed between the two countries despite their different COVID-19 containment strategies. Societal expectations of who will die during the COVID-19 pandemic will likely be wrong if they assume pre-pandemic mortality sex ratios because the intra-pandemic ratios appear, at least in Norway and Sweden, detectably higher. The contribution of differences in policies to reduce risky behavior to those higher ratios appears, however, small.

Non-COVID-19 deaths after social distancing in Norway.

Lay persons and policy makers have speculated on how national differences in the imposition of social distancing to reduce SARS CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has affected non-COVID-19 deaths. No rigorous estimation of the effect appears in the scholarly literature. We use time-series methods to compare non-COVID-19 deaths in Norway during its 9 weeks of mandated social distancing to those expected from history as well as from non-COVID-19 deaths in relatively less restricted Sweden. We estimate that 430 fewer Norwegians than expected died from causes other than COVID-19. We argue that failing to account for averted non-COVID-19 deaths will lead to an underestimate of the benefits of social distancing policies.

Negotiating the turning point in the transition from curative to palliative treatment: a linguistic analysis of medical records of dying patients

BackgroundMany deaths in Norway occur in medical wards organized to provide curative treatment. Still, medical departments are obliged to meet the needs of patients at the end of life. Here, we analyse the electronic patient record regarding documentation of the transition from curative to palliative care (i.e. the ‘turning point’). Considering the consequences of these decisions for patients, they have received surprisingly little attention from researchers. This study aims to investigate how the patient record denotes reasons for the shift from curative treatment to palliation and how texts involve voices of the patient and their families.MethodsThe study comprised excerpts from electronic patient records retrieved from medical wards in three urban hospitals in Norway. We executed a retrospective analysis of anonymized extracts from 16 electronic patient records, searching for documentation on the transition from curative to palliative care.ResultsIn the development of the turning point, the texts usually shift from statements about the patient’s clinical status and technical findings to displaying uncertainty and openness to negotiation with different textual voices. This shift may represent a need to align or harmonize the attitudes of colleagues, family, and patient towards the turning-point decision. The patient’s voice is mostly absent or reported only briefly when, in their notes, nurses gave an account of the patient’s opinion. None of the physicians’ notes provided a detailed account of patient attitudes, wishes, and experiences.ConclusionIn this article, we have analysed textual representations of patient transitions from curative to end-of-life care. The ‘reality’ behind the text has not been our concern. As the only documentation left, the patient record is an adequate basis for considering how patients are estimated and cared for in their last days of life.

Relationship of place of death with care capacity and accessibility: a multilevel population study of system effects on place of death in Norway

BackgroundWhile the majority of deaths in high-income countries currently occur within institutional settings such as hospitals and nursing homes, there is considerable variation in the pattern of place of death. The place of death is known to impact many relevant considerations about death and dying, such as the quality of the dying process, family involvement in care, health services design and health policy, as well as public versus private costs of end-of-life care. The objective of this study was to analyse how the availability and capacity of publicly financed home-based and institutional care resources are related to place of death in Norway.MethodsThis study utilized a dataset covering all deaths in Norway in the years 2003–2011, contrasting three places of death, namely hospital, nursing home and home. The analysis was performed using a multilevel multinomial logistic regression model to estimate the probability of each outcome while considering the hierarchical nature of factors affecting the place of death. The analysis utilized variation in health system variables at the local community and hospital district levels. The analysis was based on data from two public sources: the Norwegian Cause of Death Registry and Statistics Norway.ResultsHospital accessibility, in terms of short travel time and hospital bed capacity, was positively associated with the likelihood of hospital death. Higher capacity of nursing home beds increased the likelihood of nursing home death, and higher capacity of home care increased the likelihood of home death. Contrasting three alternative places of death uncovered a pattern of service interactions, wherein hospital and home care resources together served as an alternative to end-of-life care in nursing homes.ConclusionsNorway has a low proportion of home deaths compared with other countries. The proportion of home deaths varies between local communities. Increasing the availability of home care services is likely to enable more people to die at home, if that is what they prefer.

Death-scene investigations contribute to legal protection in unexpected child deaths in Norway.

This study reviewed cases of sudden unexpected child deaths in Norway to determine the significance of death-scene investigations (DSIs) in establishing cause and manner of death, and thereby it is relevance to legal protection. Data from forensic autopsy reports and DSIs were collected and analysed for cases of unexpected deaths in children below 4years of age in Norway during 2010-2016. Out of 141 cases, the death scene was investigated as a voluntary procedure in 75 cases and by the police in 41 cases. The cause of death remained unexplained in 81/141 (57%) of the cases, of which 46/141 (33%) met the criteria for sudden infant death syndrome (SIDS) or sudden unexplained death in early childhood (SUDC). The manner of death was determined in 102/141 (72%). Voluntary DSI increased the ability to rule out accidental suffocation, facilitated evaluations of environmental risk factors and enabled detection of possible neglect. Death-scene investigations illuminate uncertainty about the cause of death, especially in grey-area cases where accidental suffocation, neglect or abuse is suspected. Knowledge about the course of events and the cause of death enhances both the child's and the caregiver's legal protection. Death-scene investigations should therefore be mandatory.

In-hospital deaths attributable to healthcare-associated infections.

It is estimated that approximately one-third of in-hospital deaths in Norway are attributable to adverse events, while the proportion caused by infection is unknown. Oslo University Hospital provides a full range of medical specialties on a national and regional level while serving as a local hospital for a population of approximately 300 000. We wished to investigate in-hospital deaths associated with fatal adverse events, and healthcare-associated infections in particular. The study is based on a review of the medical records for all patients who died in Oslo University Hospital's somatic units in 2011. Infections were classified according to the criteria of the Centers for Disease Control and Prevention, USA. Out of a total of 82 341 admitted patients, 1 126 died while in hospital. We identified life-shortening adverse events in 128 (11.4%) of these. The 87patients at Ullevål hospital had a mean age of 73 years, while the 41patients at Rikshospitalet/the Norwegian Radium Hospital had a mean age of 62 years. A total of 108patients (9.6%) died from a healthcare-associated infection, 49 of whom had a predicted survival of more than four weeks (4.4% of the fatalities). Fifty-eight patients had pneumonia. The proportion of deaths that were attributable to adverse events was lower than previously estimated in Norway. Oslo University Hospital, with its combined functions and broad patient base, can provide representative figures for healthcare-associated infections with fatal outcome in Norwegian hospitals.

Advance care planning in Norwegian nursing homes \u2013 limited awareness of the residents\u2019 preferences and values? A qualitative study

Background52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals’ views on ACP is vital. The objective of this study is to explore nurses and physicians’ aims and experiences with carrying out ACP in nursing homes.MethodsSemi-structured group interviews were conducted with 20 health care professionals, recruited from nursing homes where ACP was performed regularly. Qualitative content analysis was used to analyse the data.ResultsThe primary aim of the nursing home professionals when doing ACP in nursing homes were to build alliances with next of kin to avoid misunderstandings and future conflicts. Two main experiences with ACP were described: i) due to the sensitivity of ACP issues, it was important to balance directness with being sensitive, and ii) when the physicians raised questions concerning future medical treatment, the answers from residents as well as next of kin were often hesitant and unclear.ConclusionOur study add insights into how ACP is practiced in nursing homes and the professionals’ agenda. A focus on medical issues and achieving consensus with next of kin may result in lack of involvement of the residents and limited awareness of the residents’ needs. Interdisciplinary approaches, ACP-training and tailored guidelines may improve the implementation and practice of ACP.

P6563Time trends in incidence rates of atrial fibrillation in Norway 2004–2014. A CVDNOR project

Abstract Background The reported incidence and prevalence of atrial fibrillation (AF) has been inconsistent among studies. Purpose We aimed to study time trends in incidence (first time) of AF hospitalizations or AF deaths in Norway in the period 2004–2014 by age and sex. Methods Nationwide hospital discharge diagnoses in the Cardiovascular Disease in Norway (CVDNOR) database and in the National Patient Registry were linked to the National Cause of Death Registry. All hospitalizations with AF as primary or secondary diagnosis and out-of-hospital deaths with AF as underlying cause (ICD-9: 427.3 or ICD 10: I48; AF or atrial flutter) in individuals ≥18 years were obtained during 1994–2014. Incident AF was defined as first hospitalization or out-of-hospital death due to AF with no previous hospitalization for AF the past 10 years. Age-standardized incidence rates with 95% confidence intervals (CIs) were calculated using direct standardization to the age-distribution in the Norwegian population per Jan 1st 2004. Age-adjusted average yearly incidence rate ratios (IRR) with 95% CIs were estimated by Poisson regression analyses. Accumulated prevalence during 1994–2014 was assessed in Norwegian residents 18 years and older per Dec 31st 2014. Results During 39,865,498 person years of follow up from 2004 to 2014 we identified 175,979 incident AF cases of which 30% were registered with AF as primary diagnosis, 69% as secondary diagnosis and 1% as out-of-hospital cause of death. The age-standardized incidence rate of AF hospitalization or out-of-hospital death per 100,000 person years was stable at 433 (426–440) in 2004 and 440 (433–447) in 2014. IRR were stable or declining across age groups of both sexes, except for the youngest age group 18–44 years, where incidence rates of AF hospitalization or out-of-hospital death increased by 2% per year, IRR 1.02 (1.01, 1.03). By 2014, the prevalence of AF assessed from hospital or death records was 2.9% in the adult population 18 years and older. Conclusion We found overall stable incidence rates of AF from 2004 to 2014 in the adult Norwegian population. Increased incidence rates of AF in the population 18–44 years are worrying and need further investigation. Acknowledgement/Funding The Norwegian Atrial Fibrillation Reseach Network

Psychoactive substances in natural and unnatural deaths in Norway and Sweden \u2013 a study on victims of suicide and accidents compared with natural deaths in psychiatric patients

BackgroundThe extent of post-mortem detection of specific psychoactive drugs may differ between countries, and may greatly influence the national death register’s classification of manner and cause of death. The main objective of the present study was to analyse the magnitude and pattern of post-mortem detection of various psychoactive substances by the manner of death (suicide, accidental, undetermined and natural death with a psychiatric diagnosis) in Norway and Sweden.MethodsThe Cause of Death Registers in Norway and Sweden provided data on 600 deaths in 2008 from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of death and 200 as natural deaths in individuals with a diagnosis of mental disorder as the underlying cause of death. We examined death certificates and forensic reports including toxicological analyses.ResultsThe detection of psychoactive substances was commonly reported in suicides (66 and 74% in Norway and Sweden respectively), accidents (85 and 66%), undetermined manner of deaths (80% in the Swedish dataset) and in natural deaths with a psychiatric diagnosis (50 and 53%). Ethanol was the most commonly reported substance in the three manners of death, except from opioids being more common in accidental deaths in the Norwegian dataset. In cases of suicide by poisoning, benzodiazepines and z-drugs were the most common substances in both countries. Heroin or morphine was the most commonly reported substance in cases of accidental death by poisoning in the Norwegian dataset, while other opioids dominated the Swedish dataset. Anti-depressants were found in 22% of the suicide cases in the Norwegian dataset and in 29% of suicide cases in the Swedish dataset.ConclusionsPsychoactive substances were detected in 66 and 74% of suicides and in 85 and 66% of accidental deaths in the Norwegian and Swedish datasets, respectively. Apart from a higher detection rate of heroin in deaths by accident in Norway than in Sweden, the pattern of detected psychoactive substances was similar in the two countries. Assessment of a suicidal motive may be hampered by the common use of psychoactive substances in suicide victims.