General Population In Denmark Research Articles

SARS-CoV-2 and risk of psychiatric hospital admission and use of psychopharmaceuticals: A nationwide registry study of 4,585,083 adult Danish citizens.

Current evidence on the risk of admission- or medication-requiring psychiatric sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is limited to selected populations, short durations, and loss to follow-up. This study examined if SARS-CoV-2 infection was associated with increased long-term risk of psychiatric admissions and de novo prescription of psychoactive medication in the general population of Denmark. Adults (≥18 years) were assigned to either the control or SARS-CoV-2 group based on polymerase chain reaction (PCR) tests between 1 January 2020 and 27 November 2021. Infected subjects were matched 1:5 to control subjects by propensity score. Incidence rate ratios (IRRs) were calculated. Adjusted Cox regression was applied to the unmatched population with SARS-CoV-2 infection as a time-dependent covariate. Follow-up time was 12 months or until the end of the study. A total of 4,585,083 adults were included in the study. Approximately 342,084 had a PCR-confirmed SARS-CoV-2 infection and were matched 1:5 with 1,697,680 controls. The IRR for psychiatric admission was 0.79 in the matched population (95% confidence interval [CI]: 0.73-0.85, p < 0.001). In the unmatched population, the adjusted hazard ratios (aHR) for psychiatric admission were either below 1.00 or with a 95% CI lower limit of 1.01. SARS-CoV-2 infection was associated with an increased risk of de novo prescription of psychoactive medication in both the matched (IRR 1.06, 95% CI: 1.02-1.11, p < 0.01) and unmatched population (HR 1.31, 95% CI: 1.28-1.34, p < 0.001). We found a signal of increased use of psychoactive medication, specifically benzodiazepines, among SARS-CoV-2-positive persons, but the risk of psychiatric admissions did not increase.

Mortality and cause of death in persons with chronic hepatitis B virus infection versus healthy persons from the general population in Denmark.

The study aimed to determine adjusted all-cause mortality and cause of death in persons with chronic hepatitis B virus (HBV) infection compared with age- and sex-matched persons from the general population. We used nationwide registers to identify persons aged ≥18 years with chronic HBV infection in 2002-2017 in Denmark and included 10 age- and sex-matched controls for each. Follow-up was from 6months after diagnosis until death, emigration, or 31 December 2017. Mortality rate ratios (MRRs) adjusted for age, sex, employment, origin and comorbidity were calculated using Poisson regression. Unadjusted cause-specific mortality rate ratios with 95% confidence intervals were calculated assuming a Poisson distribution. A total of 6988 persons with chronic HBV infection and 69,847 controls were included. During a median follow-up of 7.7 years (range 0.0-15.5), 315 (5%) persons with-and 1525 (2%) without-chronic HBV infection died. The adjusted all-cause MRR was 1.5 (95% CI 1.2-2.0). Persons with chronic HBV infection had increased mortality due to liver disease including hepatocellular carcinoma (MRR 12.3 [8.6-17.7]), external causes (MRR 3.3 [2.5-4.7]), endocrine disease (MRR 3.2 [1.8-5.4]), genitourinary disease (MRR 3.2 [1.2-7.6]) and neoplasms (except hepatocellular carcinoma; MRR 1.6 [1.2-2.0]). In conclusion, this study showed an increased all-cause mortality in persons with chronic HBV infection in comparison with age- and sex-matched persons without chronic HBV infection which remained after adjustment for several confounding factors. Excess mortality was mainly associated with liver disease, but also external factors, endocrine disease, genitourinary disease and neoplasms (excluding hepatocellular carcinoma).

Do baseline industry and job group skill level predict welfare dependency at 1, 3 and 5\u2009years after mental health related sickness absence? A Danish cohort study

BackgroundThe cost of mental ill health in the EU-28 nations has been estimated at approximately 4.1% of the total gross domestic products (GDP). Improved rates of return to sustainable employment among people who are sick-listed due to mental ill health would decrease spending on welfare benefits. The present cohort study provides statistical information that may be helpful in the design and prioritizing of efforts aimed at reducing the burden of sickness absence due to mental ill health among employees in the general working population of Denmark. Our primary aim was to estimate odds of being i) deceased or recipient of health related welfare benefits and ii) recipient non-health related welfare benefits, compared to being alive and self-reliant at 1, 3 and 5 years after first visit to a jobs and benefits office due to mental health related sickness absence, as a function of industrial sector and job group skill level at baseline. A secondary aim was to analyze these odds as a function of baseline age, gender, type of mental ill health, family type and employment status.MethodsThe study population consisted of 20–54 year-old persons on long-term sickness absence due to mental health problems in 21 Danish municipalities in 2010–2012 (N = 19,660). Odds ratios were estimated by use of multinomial logistic regression. The outcomes were ascertained through national registers.ResultsWe did not find any statistically significant association between baseline industrial sector or job group skill level and welfare dependency at follow-up. In the secondary analyses, the estimated odds of health and non-health related welfare dependencies at follow-up tended to increase with unemployment, age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout at baseline.ConclusionsThe present study does not support that industry and job group skill level predict welfare dependency after health related sickness absence, after adjustment for relevant covariates, in the general population of Denmark. It suggests, however, that the vulnerability lies in population groups characterized by unemployment, older age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout.

Per- and polyfluoroalkyl substances (PFAS) and male reproductive function in young adulthood; a cross-sectional study

BackgroundPer- and polyfluoroalkyl substances (PFAS) are a large family of persistent industrial chemicals with endocrine disrupting properties. ObjectivesTo examine biomarkers of reproductive function in young adult males according to current environmental exposure to single and combined PFAS. MethodsThe study population consisted of young men (n = 1041, age 18–21) from the Fetal Programming of Semen Quality (FEPOS) cohort. These men were recruited from pregnancies included in the Danish National Birth Cohort (DNBC) between 1996 and 2002. From 2017 to 2019, participants answered an online questionnaire, completed a clinical examination and provided a blood and a semen sample. Exposure to 15 PFAS was measured in plasma. Six compounds were quantified above the limit of detection in at least 80% of the participants. We applied negative binomial regression and weighted quantile sum (WQS) regression models to assess associations between single and combined exposure to PFAS and measures of semen quality, testicular volume and reproductive hormones among the young men. ResultsWe found no consistent associations between plasma concentrations of PFAS, semen quality and testicular volume. Higher levels of single and combined PFAS were associated with slightly higher levels of follicle-stimulating hormone (FSH) (WQS 4% difference, 95% confidence interval: 0, 9). Perfluorooctanoic acid (PFOA) was the main contributor to this finding with positive signals also from perfluorodecanoic acid (PFDA) and perfluorohexane sulfonic acid (PFHxS). DiscussionWe examined exposure to a range of common PFAS in relation to biomarkers of male reproductive function and found an association with higher levels of FSH among young men from the general population in Denmark. Further studies on especially combined exposure to PFAS are needed to expand our understanding of potential endocrine disruption from both legacy and emerging compounds in relation to male reproductive function.

Out-of-hospital cardiac arrest related to exercise in the general population: Incidence, survival and bystander response

BackgroundRegular exercise is known to prevent cardiovascular disorders, but it may also trigger acute cardiac events. This study examined the incidence, prognosis, and outcomes of out-of-hospital cardiac arrest (OHCA) related to exercise in the general population of Denmark. MethodsThis retrospective cohort study examined all the OHCAs in the Danish Cardiac Arrest Registry from 2016 to 2019. OHCA related to exercise was identified in a nationwide electronic database and coupled to the patient register. Descriptive statistics were used in combination with a multivariate logistic regression model to assess predefined factors. ResultsA total of 20,470 OHCAs were identified, of which 459 (2.2%) were related to exercise. Most were male (75.3%), with a median age of 61 years. Further, 95% of exercise-related OHCA received bystander cardiopulmonary resuscitation, compared to 77.4% in non-exercise-related OHCA (p < 0.001), and 38.3% received defibrillation by bystanders versus 7.5% in the non-exercise group (p < 0.001). Exercise-related OHCAs had a 30-day survival rate of 57.7% compared to 12.6% in the non-exercise group, yielding an adjusted odds ratio of 5.56. The 30-day survival rate of exercise-related subjects aged 15–35 years was 80.0%, compared to 25.0% in the non-exercise group. When comparing sports categories, team sports were associated with the greatest chance of survival (odds ratio of 18.5 versus a non-exercise odds ratio of 0.09). ConclusionExercise-related OHCA has a low incidence and is related to a significantly better prognosis when compared to non-exercise OHCA. Furthermore, many patients experiencing exercise-related OHCA received defibrillation and cardiopulmonary resuscitation by bystanders. These findings could help plan and execute campaigns and education.

Suicide and Suicide Attempts Among Asylum-Seekers in Denmark

Objective There are concerns that asylum-seekers are at increased risk of suicide attempt and suicide mortality. Yet, largescale nationwide studies are limited. Our aim was to examine whether asylum-seekers in Denmark had higher rates of suicide attempt and suicide when compared to the general population. Methods A retrospective cohort design was used. Data on asylum-seekers and the general population living in Denmark during 2009–2019 were obtained from the Immigration services and national registers. Indirect standardization was applied to adjust for differences with respect to age group and sex and Incidence Rate Ratios (IRR) with 95% confidence intervals were calculated. Results In a population of 78,666 asylum-seekers, a total of 601 suicide attempts and 9 suicides were recorded. The rate of suicide attempt was 842.0 per 100,000 person-years for asylum-seekers and 92.3 per 100,000 person-years for the general population. When adjusting for differences related to age group and sex, an IRR of 8.5 (95% CI: 7.6−9.5) was found for suicide attempt between 2014-2019. The IRR for suicide attempt unaccompanied minors between 2015 and 2019 was 5.8 (95% CI: 4.3−7.5) when adjusting for age group. We did not find an elevated rate of suicide among asylum-seekers (IRR: 1.6, 95% CI: 0.6−3.5). Conclusions Asylum-seekers were found to have higher rates of suicide attempt than the general population in Denmark. This also applied to unaccompanied minors. Our study emphasizes the need for awareness and preventive measures targeting mental health and suicidal behavior among asylum-seekers. HIGHLIGHTS Asylum-seekers had an 8-fold higher rate of suicide attempt than the general population. The suicide attempt rate for asylum-seekers reached its lowest levels during recent years. Unaccompanied minors had a 5-fold higher frequency of suicide attempt when compared to peers in the general population. We did not find elevated rates of death by suicide among asylum-seekers. No suicide deaths were recorded among unaccompanied minors

An Observational Prospective Cohort Study of Incidence and Outcome of Streptococcus pneumoniae and Hemophilus influenzae Infections in Adult Solid Organ Transplant Recipients.

Background: Streptococcus pneumoniae (S. pneumoniae) and Hemophilus influenzae (H. influenzae) are among the main vaccine-preventable bacterial infections in immunocompromised individuals including solid organ transplant (SOT) recipients. There is a lack of information about incidence and outcomes of these infections in SOT recipients. Methods: We determined the incidence of S. pneumoniae and H. influenzae, the related hospitalization, and 30- and 180-days mortality in a large cohort of 1182 adult SOT recipients. We calculated 95% confidence intervals (CI) of incidence rate (IR) using Byar’s approximation to the Poisson distribution. Results: The overall IR of S. pneumoniae and H. influenzae were 1086 (95% CI, 796–1448) and 1293 (95% CI, 974–1687) per 100,000 person-years of follow-up (PYFU), respectively. The IR of invasive infections were 76 (95% CI, 21–202) and 25 (95% CI, 2.3–118) per 100,000 PYFU, respectively. Hospital admission was required in >50%, 30-days mortality was 0, and 180-days mortality was 8.8% and 4.5% after S. pneumoniae and H. influenzae infections, respectively. Conclusions: The IR of invasive S. pneumoniae and H. influenzae infections in SOT recipients were much higher than reports from the general population in Denmark. Furthermore, a large proportion of infected SOT recipients were hospitalized. These findings highlight the need for further studies to assess uptake and immunogenicity of vaccines against S. pneumoniae and H. influenzae in SOT recipients.

Making smoking history: temporal changes in support for a future smoking ban and increasing taxes in the general population of Denmark

BackgroundAn end date for smoking has been adopted in several countries and is now being discussed by governments all over the world. However, little is known about temporal changes in...

COVID-19 vaccine willingness amongst patients with mental illness compared with the general population.

Patients with mental illness are at an increased risk of COVID-19 infection, morbidity, and mortality, and prioritisation of this group for COVID-19 vaccination programmes has therefore been suggested. Vaccine uptake may, however, be compromised by vaccine hesitancy amongst patients with mental illness, posing a critical public health issue. We conducted two surveys to provide weighted estimates of vaccine willingness amongst patients with mental illness and the general population of Denmark. Vaccine willingness was high in both groups, but slightly lower amongst patients with mental illness (84.8%), compared with the general population (89.5%) (p<.001). Based on these findings, vaccine hesitancy does not appear to be a major barrier for vaccine uptake amongst patients with mental illness in Denmark, but may be so in other countries with lower general vaccine willingness. Replication of the present study in other countries is strongly warranted.

The role of circumcision, tobacco, and alcohol use in genital human papillomavirus infection among men from Denmark.

It is crucial to understand the natural history of genital human papillomavirus (HPV) infection in men to prevent the increasing male HPV-related disease burden. We evaluated the associations between HPV infection and circumcision, smoking, and alcohol use after accounting for sexual behavior. The study included 2331 male personnel from Danish barracks. Penile swabs were tested for HPV DNA with a polymerase chain reaction assay, INNO-LiPA. All men completed a self-administered questionnaire providing data on potential risk factors for HPV such as lifestyle and sexual habits. Using multivariable logistic regression, associations between potential risk factors and HPV infection were estimated and expressed as odds ratios (ORs) with 95% confidence intervals (CI). Current cigarette smoking was associated with increased odds of HPV detection (OR = 1.2; 95% CI: 1.0-1.4), but we found no association with alcohol use in the analysis adjusted for sexual behavior. Circumcision reduced the odds of a prevalent HPV infection (OR = 0.7; 95% CI: 0.5-1.0) although not statistically significantly. Strong associations with lifetime and recent number of female sex partners were observed, but in contrast to uncircumcised men, increasing number of sex partners was not associated with higher HPV prevalence in circumcised men. In conclusion, smoking was associated with increased odds of penile HPV in men from the general population in Denmark, whereas circumcision seemed to reduce the risk. Moreover, our results indicated that there might be differences in the viral susceptibility between circumcised and uncircumcised men.

Smoking and stress in the general population in Denmark.

INTRODUCTIONThe social pressure placed on smokers today might potentially lead to an increasing level of stress. We investigated if the proportion of persons with high stress level had increased over time more in smokers than in non-smokers.METHODSData were obtained from repeated cross-sectional surveys of The Capital Region Health Survey conducted in 2010, 2013 and 2017. Survey data were weighted for survey design and non-response, and linked to national register data. Cohens Perceived Stress Scale (PSS-10) score was used. Logistic regression analyses, based on 136608 citizens’ self-reports, were adjusted for sex, age, education level, employment, and alcohol intake (and loneliness, in analysis investigating the associations between tobacco consumption and high stress level).RESULTSA significantly higher proportion of citizens reported a high stress level in 2017 compared with 2010 and 2013 but there was not a greater increase in smokers than in non-smokers. Daily smoking men had 69% higher odds of reporting perceived high stress level and daily smoking women had 36% higher odds, than never smokers of the same sex. There was a significant trend between higher daily tobacco consumption and a higher proportion of smokers with high stress level.CONCLUSIONSThe increase in high stress level over time occurred independently of smoking status. Daily smokers had the highest odds of perceived high stress level, and a higher daily tobacco consumption was associated with a higher proportion of smokers with high stress level. Smoking cessation programs should, to a higher degree, consider implementing stress-coping elements to prevent relapse.

Soy Intake and Possible Adverse Health Effects in Nordic Children and Pregnant Women (Unborn Children)

Aim: To explore possible adverse health effects of high soy intake among children and pregnant women (unborn children) in the Nordic countries. Methods: A dietary exposure scenario with a high soy ...

Genome-wide association study of patients with atrioventricular nodal reentry tachycardia

Abstract Background Supraventricular tachycardias (SVTs) originate from the atria or the area close to the AV node. AV nodal reentry tachycardia (AVNRT) is one of the tachyarrhytmias comprising the group of SVTs. The typical patient is female, young at disease onset, with a structurally normal heart. At present we do not know the etiology of AVNRT. We therefore hypothesized that AVNRT might be caused by changes in the DNA. Methods DNA from purified blood was obtained from patients with AVNRT verified by an invasive electrophysiological study. Patients were recruited from five ablation centers in Denmark and individuals from the general population of Denmark (the BEFUS cohort) served as controls. DNA was subjected to chip genotyping, imputation and analyses in a genome-wide association study (GWAS) setup. Results A GWAS on 1,143 AVNRT patients and 3,004 controls revealed one locus close to the gene MYH6 to reach genome-wide significance for association with AVNRT (P=4.8x10–8). MYH6 encodes the α-isoform of the protein myosin heavy chain important for the contractile units of the heart, the sarcomeres. The gene is predominantly expressed in the atria. Additional subthreshold loci located close to other plausible arrhythmia genes were identified. Conclusion We report the first genetic locus to be associated with AVNRT close to the sarcomere gene MYH6. This is, to our knowledge, the first gene ever associated with AVNRT. Manhattan plot Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Rigshospitalets Forskningspulje - 3 years PhD salary

Assessment of the Risk of Psychiatric Disorders, Use of Psychiatric Hospitals, and Receipt of Psychiatric Medication Among Patients With Lyme Neuroborreliosis in Denmark

The association of Lyme neuroborreliosis with the development of psychiatric disease is unknown and remains a subject of debate. To investigate the risk of psychiatric disease, the percentage of psychiatric hospital inpatient and outpatient contacts, and the receipt of prescribed psychiatric medications among patients with Lyme neuroborreliosis compared with individuals in a matched comparison cohort. This nationwide population-based matched cohort study included all residents of Denmark who received a positive result on an intrathecal antibody index test for Borrelia burgdorferi (patient cohort) between January 1, 1995, and December 31, 2015. Patients were matched by age and sex to a comparison cohort of individuals without Lyme neuroborreliosis from the general population of Denmark. Data were analyzed from February 2019 to March 2020. Diagnosis of Lyme neuroborreliosis, defined as a positive result on an intrathecal antibody index test for B burgdorferi. The 0- to 15-year hazard ratios for the assignment of psychiatric diagnostic codes, the difference in the percentage of psychiatric inpatient and outpatient hospital contacts, and the difference in the percentage of prescribed psychiatric medications received among the patient cohort vs the comparison cohort. Among 2897 patients with Lyme neuroborreliosis (1646 men [56.8%]) and 28 970 individuals in the matched comparison cohort (16 460 men [56.8%]), the median age was 45.7 years (interquartile range [IQR], 11.5-62.0 years) for both groups. The risk of a psychiatric disease diagnosis and the percentage of hospital contacts for psychiatric disease were not higher among patients with Lyme neuroborreliosis compared with individuals in the comparison cohort. A higher percentage of patients with Lyme neuroborreliosis compared with individuals in the comparison cohort received anxiolytic (7.2% vs 4.7%; difference, 2.6%; 95% CI, 1.6%-3.5%), hypnotic and sedative (11.0% vs 5.3%; difference, 5.7%; 95% CI, 4.5%-6.8%), and antidepressant (11.4% vs 6.0%; difference, 5.4%; 95% CI, 4.3%-6.6%) medications within the first year after diagnosis, after which the receipt of psychiatric medication returned to the same level as the comparison cohort. In this population-based matched cohort study, patients with Lyme neuroborreliosis did not have an increased risk of developing psychiatric diseases that required hospital care or treatment with prescription medication. The increased receipt of psychiatric medication among patients with Lyme neuroborreliosis within the first year after diagnosis, but not thereafter, suggests that most symptoms associated with the diagnosis subside within a short period.

Prevalence of herpes -, measles morbillivirus-, parvovirus B19 - and rubella viruses immunoglobulin G among women with chronic hepatitis B of reproductive age in Denmark: A cross-sectional study

ObjectivesThe aim of this study was to investigate whether the seroprevalence of IgG antibodies against seven viruses (cytomegalovirus, herpes simplex virus 1&2, measles morbillivirus, parvovirus B19, rubella, and varicella-zoster virus), which can potentially compromise maternal and fetal wellbeing, differs based on country of origin among women with chronic hepatitis B (CHB). MethodThis study was a single-center, hospital-based cross-sectional study. The study included women with CHB 15–45 years of age, included in the Danish Database for Hepatitis B and C. Seroprevalence estimates were calculated with a 95% confidence interval and were compared between age groups, regions of origin, and to the general population. Results177 women were included in the study. Overall, the seroprevalences of antibodies were similar among women with CHB with origin outside Denmark and compared to the general population in Denmark, but there was a notable difference in the seroprevalence of antibodies against herpes simplex 2 between women from Africa (37.1% CI 95% 22.0;55.1) and women from the Middle East (2.5% CI 95% 0.1;14.7). ConclusionWomen with CHB whose origin is outside Denmark do not appear to differ, based on origin, or be at greater risk of acquiring these viruses during pregnancy than their Danish counterparts.

Adverse life events in the general population - a validation of the cumulative lifetime adversity measure

ABSTRACT Background: Negative life events are a predictor for mental illness. However, most research has focused on selected domains, e.g. childhood or recent adversity. The Cumulative Lifetime Adversity Measure (CLAM), a newly introduced questionnaire not yet validated, examines cumulative effect of a range of events including number of exposure to the same event. This measure gives opportunity to collect detailed data on lifetime adversity in large cohort studies. Objective: The aim of this study was translation of the CLAM into Danish and validation of the CLAM in a large general population cohort. Secondly, we aimed to describe the occurrence of adverse life events in a large representative sample of the general population in Denmark. Methods: Translation and validation followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) for formative models. Content and construct validity were evaluated including hypothesis testing of accumulated lifetime adversity having a U-shaped pattern with low levels of cumulated lifetime adversity as opposed to no or high levels being associated with lower emotional distress, functional impairment, and pain impairment. The field testing sample was the DanFunD cohort (n = 7493) randomly drawn in a Danish population and examined between 2012 and 2015. Results: Pilot interviews showed that the questions were confronting but not offensive, straight forward, and easy to answer. Acceptability was good. U-shaped patterns between accumulated lifetime adversity and the outcome measures were found. Quadratic term: Emotional distress (β(95%CI) 0.007(0.002;0.012), p < 0.007), functional impairment (β(95%CI) −0.002(−0.003;−0.001), p < 0.001), and pain impairment (β(95%CI) 0.004(0.002;0.006), p = 0.001). Field testing provided basic numbers for adverse life events for the Danish general population, with a cumulated lifetime adversity mean (SD), 5.9 (3.7). Compared to the US there were lower rates of violence, social/environmental stress, and disaster. Conclusions: The results from the original version were replicated, indicating high construct validity. Furthermore, content validity was good.

Mortality Among Patients with Cold Agglutinin Disease in the United States: An Electronic Health Record (EHR)-Based Analysis

Introduction Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia (AIHA). It is characterized by both IgM-mediated agglutination of erythrocytes and hemolysis mediated by activation of the classical complement pathway. Recent studies have shown an increased risk of thromboembolic events (TE) in CAD patients. In addition, a recent analysis using the Danish National Patient Registry demonstrated a significant increase in mortality for CAD patients compared with matched individuals from the general population in Denmark (Bylsma et al, HemaSphere, 2018). Mortality among CAD patients has not been assessed in a US population. This study evaluated mortality risk in the largest cohort of CAD patients in the US. Methods Patients were retrospectively identified from the Optum® de-identified EHR dataset. Between January 2007 and September 2018 (study period), patients with ≥1 AIHA-related medical encounter and ≥3 mentions from physician notes of CAD-related terms ("cold agglutinin disease," "cold autoimmune hemolytic anemia," or "cold agglutinin hemoglobinuria") were included in the CAD cohort ("case"). For this cohort, the first mention of CAD terms was set as the index date. Patients without an AIHA-related medical encounter were included in the non-CAD cohort ("control"). For the control cohort, the index date was assigned based on the average occurrence of index date in the CAD population for the duration in the EHR database. For both cohorts, the baseline period was defined as the interval from the start of the medical activity in the EHR database or study period (whichever occurs later) to the index date, and the follow-up period was defined as the interval from the index date to the end of the study period, the end of medical activity, or death (whichever occurs earlier). The case and control cohorts were matched by age, gender, race, region, index year, and follow-up period using 1:5 nearest neighbor matching. Both cohorts were stratified according to the presence or absence of ≥1 TE during the study period. Mortality rate per 100,000 patients was calculated as the number of patients who died in each cohort divided by the number of patients in each cohort, from 2007 to 2018, multiplied by 100,000. Mortality rate was compared between matched cohorts using a Poisson test. An independent t-test was used to compare age at death between matched CAD and control groups; and time to death (starting from the index date) was analyzed using Kaplan-Meier curves and compared between matched cohorts using log-rank P test. Results In total, 651 CAD patients and 3,255 matched non-CAD controls were identified. Of these, 35% (n=228) of CAD patients and 20% (n=641) of non-CAD patients experienced ≥1 TE (P&lt;0.001). Median age at index date for both cohorts was 72 years. Most patients were female (CAD 64%; non-CAD 65%) and Caucasian (CAD 85%; non-CAD 85%). Median follow-up duration was 42 months for the CAD cohort and 51 months for the control cohort. Mean (standard deviation [SD]) Elixhauser Comorbidity Index Score was 8.0 (4.9) for CAD patients and 4.5 (4.1) for matched controls. The overall mortality rate was significantly higher for the CAD cohort than the matched-control cohort (CAD: 17,512 vs non-CAD: 11,306; P&lt;0.001). For patients that experienced ≥1 TE during the study period, the mortality rate in the CAD cohort was 23,684 compared with 15,913 in the matched-control cohort (P&lt;0.001; Table 1). During the study period, 114 CAD patients and 368 matched non-CAD patients died. The mean (SD) age at death in the CAD cohort (77 [12] years) was lower compared with the matched controls (82 [8] years; P&lt;0.001). For patients with ≥1 TE, mean (SD) age at death was 77 (13) years vs 82 (7) years for the CAD and control cohorts, respectively (P&lt;0.001; Table 1). A Kaplan-Meier analysis demonstrated a significantly decreased survival probability among CAD patients compared with matched controls (P&lt;0.001; Figure 1). In addition, CAD patients with ≥1 TE also had a significant decrease in survival when compared with matched controls with ≥1 TE (P&lt;0.001). Conclusions CAD patients in the US have an increased mortality risk compared with a matched non-CAD population. The associated increased TE risk observed among CAD patients may be a contributing factor to this mortality. Further studies are needed to better define this association and elucidate other potential contributors to mortality in these patients. Disclosures Hill: Apellis: Honoraria; Novartis: Speakers Bureau; Bioverativ, a Sanofi company: Honoraria; Alexion: Research Funding. Punekar:Sanofi: Employment, Equity Ownership. Morales Arias:Sanofi: Employment, Equity Ownership. Broome:Cellphire: Research Funding; Alexion: Honoraria, Research Funding; Sanofi Genzyme: Honoraria, Research Funding; Incyte: Research Funding; Rigel: Research Funding. Su:Sanofi Genzyme: Employment, Equity Ownership.

Occurrence, thromboembolic risk, and mortality in Danish patients with cold agglutinin disease

AbstractCold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia with limited epidemiological and clinical data. We used the Danish National Patient Registries to examine CAD occurrence and risk of thromboembolic events (TEs) and mortality in CAD patients compared with a matched cohort from the general population in Denmark. We identified 72 patients diagnosed with CAD and 720 matched controls between 1999 and 2013. For 2013, the most recent year of study, crude incidence of CAD was 0.18 per 100 000 inhabitants per year and prevalence was 1.26 per 100 000 inhabitants. Risk of TEs was higher in the CAD patient cohort than in the comparison cohort at 1 year (7.2% of CAD patients had TEs vs 1.9% of comparisons), 3 years (9.0% vs 5.3%), and 5 years (11.5% vs 7.8%) after the index date. The median survival was 8.5 years. CAD patients had increased mortality compared with the general population cohort (adjusted hazard ratio [aHR], 1.84; 95% confidence interval [CI], 1.10-3.06; P = .020), with the highest mortality observed during the first 5 years after diagnosis (aHR, 2.27; 95% CI, 1.32-3.89; P = .003). Mortality rates 1 and 5 years after diagnosis were 17% and 39% in the CAD group vs 3% and 18% in the comparison cohort, respectively. CAD is a rare illness characterized by increased risk of TEs and mortality.

Age at first intercourse, number of partners and sexually transmitted infection prevalence among Danish, Norwegian and Swedish women: estimates and trends from nationally representative cross-sectional surveys of more than 100000 women.

Sexual behavior at the population level impacts on public health. Recent representative sexual behavior data are lacking. Cross-sectional surveys in 2005 and 2012 on women age 18-45years randomly selected from the general population in Denmark (n=40804), Norway (n=30331) and Sweden (n=32114). Median (interquartile range) age at first intercourse was 16 (15-18)years in Denmark, 17 (16-18)years in Norway, and 17 (15-18)years in Sweden. Women in the most recent birth cohort had sexual debut at the lowest age, and were most likely to have sexual debut before the legal age of consent. Proportions with debut age ≤14 years among women born 1989-1994 vs 1971-1976, odds ratio (95% confidence interval) were: 18.4% vs 10.9%, 1.95 (1.74-2.18) in Denmark, 12.9% vs 6.3%, 2.38 (2.01-2.82) in Norway, 17.8% vs 11.4%, 1.75 (1.55-1.98) in Sweden. Median (interquartile range) number of lifetime sexual partners was 6 (3-10) in Denmark, 5 (2-10) in Norway, and 6 (3-11) in Sweden. The proportion of women reporting >10 sexual partners was also highest in the most recent survey. The percentage with odds ratio (95% confidence interval) in 2012 vs 2005 surveys were: 24.9% vs 22.8%, 1.13 (1.07-1.18) for Denmark; 23.8% vs 19.8%, 1.27 (1.19-1.34) for Norway; and 28.3% vs 23.8%, 1.31 (1.24-1.38) for Sweden. Similarly, the proportion of women reporting ever having had a sexually transmitted infection among women age <30 years were: 29.4% vs 26.4%, 1.21 (1.13-1.31) in Denmark, 28.9% vs 25.0%, 1.20 (1.10-1.31) in Norway, and 29.4% vs 22.2%, 1.45 (1.33-1.58) in Sweden. Scandinavian women reported lower age at first intercourse in younger birth cohorts. Moreover, they reported more lifetime sexual partners and a higher prevalence of ever having a sexually transmitted infection in 2012 than in 2005. Our findings may inform the interpretation of trends in outcomes associated with sexual health, and public health policies.

Second primary cancers in pediatric head and neck cancer survivors in Denmark during 1980–2014: A nationwide study

IntroductionThe survival among children with cancer has improved considerably the past decades. Consequently, more children are at risk of second primary cancers (SPC). This study aimed to investigate the incidence of SPC among pediatric head and neck cancer (HNC) patients. Methods and materialsData on children aged 0–17 years registered with a HNC in the Danish Registry of Childhood Cancer and the Danish National Patient Registry during the period 1980–2014 was obtained. SPC was defined as registration with any second malignancy that was not simultaneous with the first primary cancer (FPC) or a relapse hereof. All information was validated through review of medical charts. Standardized incidence rates (SIR) were calculated using the average incidence of all cancers in the general population of Denmark during the study period as reference. ResultsAmong 234 pediatric HNC patients, six patients (four females) were registered with a SPC (2.6%), corresponding to an overall SIR of 4.8. No patients were diagnosed with more than one SPC. The median age at FPC and SPC was 15.2 years (range 9–16 years) and 35.0 years (range 19–41 years). The most common tumor histology and location among the patients with SPC was nasopharyngeal lymphoepithelial carcinoma for FPC and basal cell carcinoma of the skin for SPC. ConclusionDuring 1980–2014 we identified six cases of SPC among 234 pediatric head and neck cancer patients in Denmark, corresponding to an overall SIR of 4.8.