Hospital Discharge Register Data Research Articles

High Familial Risk of Atrial Fibrillation/Atrial Flutter in Multiplex Families: A Nationwide Family Study in Sweden

BackgroundAlthough the heritability of atrial fibrillation/atrial flutter (AF/AFl) has been determined, the familial risk in multiplex families is unclear. The main aim of this nationwide study was to determine the familial risk of AF/AFl in multiplex families.Methods and ResultsWe examined the familial risk of AF/AFl in the entire Swedish population. We linked Multigeneration Register data on individuals aged 0 to 76 years with Hospital Discharge Register data for 1987–2008 and Outpatient Register data for 2001–2008 to compare AF/AFl risk among relatives of all 300 586 individuals with AF/AFl with that among relatives of unaffected individuals. We used conditional logistic regression to investigate differences in exposure between cases and controls. Parents (odds ratio [OR] 1.95 [95% CI 1.89 to 2.00]) and siblings (OR=3.08 [3.00 to 3.16]) of cases had higher odds of AF/AFl than did parents and siblings of controls. AF/AFl ORs were increased in both sexes. For 2% of cases, both parents had AF/AFl, compared with only 0.7% of controls (OR=3.60 [3.30 to 3.92]). Moreover, 3% of cases had ≥2 siblings with AF/AFl, compared with 1% of controls (OR=5.72 [5.28 to 6.19]). In premature cases (diagnosed at age <50 years), the ORs were 5.04 (4.36 to 5.82) and 8.51 (6.49 to 11.15) for AF/AFl in both parents and AF/AFl in ≥2 siblings, respectively. The overall spouse OR was 1.16 (1.13 to 1.19).ConclusionsFamily history of AF/AFl increases the odds of AF/AFl in first‐degree relatives. High familial risks were observed in multiplex families.

Familial risk of venous thromboembolism in first-, second- and third-degree relatives: a nationwide family study in Sweden

Venous thromboembolism (VTE) clusters in families, but the familial risk of VTE has only been determined in first-degree relatives. This nationwide study aimed to determine the familial risk of VTE in first-, second- and third-degree relatives of affected individuals. The Swedish Multi-Generation Register was linked to Hospital Discharge Register data for the period 1987-2009. This was a case-cohort study. Odds ratios (ORs) for VTE were calculated for individuals whose relatives were hospitalised for VTE, as determined by the International Classification of Diseases (ICD), and those whose relatives were unaffected by VTE. The familial OR for VTE was 2.49 in siblings (95% confidence interval [CI] 2.40-2.58), 2.65 in children (2.50-2.80), 2.09 in parents (2.03-2.15), 1.52 in maternal half-siblings (1.26-1.85), 2.34 in paternal half-siblings (2.00-2.73), 1.69 in nieces/nephews (1.57-1.82), 1.47 in cousins (1.33-1.64), and 1.14 in spouses of individuals diagnosed with VTE (1.09-1.18). Familial clustering was stronger at young ages. The familial transmission was slightly stronger for males compared with females but was only significant for siblings 1.13 (1.05-1.22) and parents 1.11 (1.05-1.78) of probands. The present data showing an increased VTE risk among not only first-degree relatives but also second- and third-degree relatives indicate that the genetic component of the familial clustering of VTE is strong. Family history is a potentially useful genetic surrogate marker for clinical VTE risk assessment, even in second- and third degree-relatives.

Age-and sex-specific seasonal variation of venous thromboembolism in patients with and without family history: a nationwide family study in Sweden

Seasonal variation in venous thromboembolism (VTE) risk in individuals with familial predisposition to VTE has not been explored. This nationwide study aimed to determine whether there are age- and sex-specific seasonal differences in risk of hospitalisation of VTE among individuals with and without a family history of VTE. The Swedish Multi-Generation Register was linked to Hospital Discharge Register data for the period 1964-2010. Seasonal variation in first VTE events in 1987-2010 for individuals with and without a family history of VTE (siblings or parents) was determined by several independent methods. Stratified analyses were performed according to age, sex, and VTE subtype (pulmonary embolism [PE] or deep venous thrombosis [DVT]). Seasonal variation in VTE incidence, mostly with a peak during the winter, was observed in both sexes in individuals with and without family history with overall peak-to-low ratios (PLRs) of 1.15 and 1.21, respectively. The peak day was December 25 and February 1 for those with and without a family history of VTE, respectively. Seasonal variation was strongest among individuals aged >50 years. Among individuals aged 0-25 years with a family history, the peak for VTE was in July (PLR = 1.20). Significant seasonal variation was observed for PE and DVT with the exception of DVT among those with a family history (PLR = 1.01). In conclusion, our data support the presence of a modest seasonal variation of VTE among individuals with and without a family history of VTE. However, young age and family history may modify and attenuate the effect of season on VTE.

Decreasing perinatal mortality in placental abruption

To study perinatal mortality associated with placental abruption. Retrospective population study using the Finnish Hospital Discharge Register and Medical Birth Register data. Finland, 1987-2005. Pregnancies with placental abruption and all other births without placental abruption. The national Hospital Discharge Register and Medical Birth Register were used to identify all pregnancies with placental abruption. Demographic data and delivery outcomes were collected retrospectively. Perinatal mortality associated with placental abruption was compared with that in other births. Potential risk factors were analysed. Perinatal mortality in placental abruption. The study consisted of 618 735 women with 1.14 million pregnancies, 4336 of whom had placental abruption. Overall perinatal mortality with abruption was 119 per 1000 births. Placental abruption explained 7% of all perinatal deaths. The mortality among singleton births (125 per 1000) was higher than among multiple births (40 per 1000). The majority of deaths (77%) occurred in utero. Singleton perinatal mortality with abruption decreased from 173 per 1000 in 1987-1990 to 98 per 1000 in 2000-2005 (p < 0.001). In singleton births at <32 gestational weeks, overall perinatal mortality was high (345 per 1000) and was not increased by placental abruption. Prematurity, low birthweight, male fetal sex and maternal smoking were independent risk factors for placental abruption-related perinatal mortality. Although mortality associated with placental abruption decreased during the study period, placental abruption still remains an important cause of perinatal mortality.

Family history as a risk factor for recurrent hospitalization for lone atrial fibrillation: a nationwide family study in Sweden

BackgroundAlthough the heritability of atrial fibrillation (AF) has been determined, the relevance of family history of AF for the likelihood of recurrent hospitalization for AF is unknown. The aim of this nationwide study was to determine whether family history of AF is a risk factor of recurrent hospitalization for lone AF (LAF), i.e., AF with unknown etiology. The familial risk for first time LAF hospitalization was also determined and compared to the risk of recurrent hospitalization for LAF.MethodsWe examined whether family history of AF is a risk factor for recurrent hospitalization for LAF in the whole Swedish population. We linked Multigeneration Register data on individuals aged 0–60 years to Hospital Discharge Register data for the period 1987–2009 to compare LAF recurrent hospitalization risk among individuals with and without parental or sibling history of AF. We calculated hazard ratios (HRs) to determine the familial HR of recurrent hospitalization for LAF. Odds ratios (OR) were calculated for familial risk of first time LAF hospitalization.ResultsThe risk of recurrent LAF hospitalization was 1.23 (95% CI 1.17-1.30) for individuals with affected parents compared to 1.30 (95% CI 1.22-1.38) for those with affected siblings. After 10 years of follow up 50% of those without and 60% of those with family history had recurrent hospitalization for LAF. The risk of recurrent LAF hospitalization in individuals with two affected parents was 1.65 (95% CI 1.44-1.90). There was an interaction between age and family history, with family history having a weaker effect on LAF hospitalization risk in older age groups. The OR for first time LAF hospitalization was 2.08 (95% CI 2.02-2.15) for offspring with affected parents and 3.23 (95% CI 3.08-3.39) for individuals with affected siblings.ConclusionsFamily history of AF is a novel risk factor for recurrent LAF hospitalization. The higher recurrence hospitalization risk in multiplex families and younger individuals suggests a genetic contribution. However, the familial risk for recurrent LAF hospitalization was much lower than the risk for first time LAF hospitalization, suggesting that familial and possibly genetic factors are more important for first time LAF hospitalization than recurrent LAF hospitalization.

Family history and risk of hospital treatment for varicose veins in Sweden

Family history has been suggested as a risk factor for varicose veins, but recall bias may inflate the familial risks. The aim of this nationwide study was to determine familial risks for hospital treatment for varicose veins. Data from the Swedish Multi-Generation Register of people aged 0-76 years were linked to Hospital Discharge Register data for 1964-2008. Standardized incidence ratios (SIRs) were calculated for individuals whose relatives were treated in hospital for varicose veins and compared with those whose relatives were not. Only main diagnoses of varicose veins were considered. A total of 39 396 people had hospital treatment for varicose veins. The familial SIR among offspring with one affected parent was 2·39 (95 per cent confidence interval 2·32 to 2·46). The SIR for those with one affected sibling was 2·86 (2·76 to 2·97). SIRs were increased in both men and women. The SIR for individuals with two or more affected siblings or with two affected parents was 5·88 (5·28 to 6·53) and 5·52 (4·77 to 6·36) respectively. The SIR for the wives of men treated for varicose veins was 1·69 (1·59 to 1·80); that for the husbands of women treated for varicose veins was 1·68 (1·58 to 1·79). Using the Swedish Hospital Discharge Register, and thereby eliminating recall bias, family history of hospital treatment for varicose veins was associated with an increased risk of similar treatment among relatives. The increased spousal risk suggests a contribution from non-genetic factors.

The use of coercive measures in adolescent psychiatric inpatient treatment: a nation-wide register study

To evaluate the extent and trends in the use of seclusion/restraint in psychiatric inpatient treatment of adolescents aged 12-17 years in Finland. The National Hospital Discharge Register data comprising all psychiatric inpatient treatment periods of 12- to 17 year-olds in Finland during the period 1996-2003 was used. Time trends, regional variation and patient characteristics related to the risk of being subjected to seclusion/restraint in psychiatric inpatient treatment are reported. The average prevalence of use of seclusion and restraint was 1.71/10,000/year over the study period. Use of seclusion/restraint in adolescent psychiatric inpatient care first increased, peaking in 1999-2001, and then decreased. The decrease occurred after stricter legislative control of use of seclusion/restraint was introduced in 2002, despite that involuntary treatment periods did not decrease. Considerable regional variation was seen in the use of seclusion/restraint. A greater proportion of girls than boys were secluded/restrained. Seclusion/restraint was most common in schizophrenia, mood disorders and conduct disorder. Legislative control had the desired immediate impact on the use of seclusion/restraint in adolescent psychiatric inpatient care. Legislative control is, however, not strong enough to ensure homogenous practices across the country, as there is many-fold regional variation in figures for using seclusion and restraint.

Validation of histological diagnoses in a national cervical screening register

Background. Monitoring and evaluation of cancer screening programmes require accurate data on invitations, visits, test results, diagnoses and management. The purpose of this study was to evaluate the completeness and accuracy of histological diagnoses (cervical precancerous lesions and cancer) in the Finnish cervical cancer screening register by comparing data with the cancer register and the administrative hospital discharge register. Material and methods. Screening data covering all 16 353 screening episodes that resulted in a referral for colposcopy over the period of 1998–2007 were individually linked with hospital discharge and cancer register data using the unique personal identifier. Agreement between registers, as well as sensitivity, coverage and positive predictive values (PPV) for the screening register and the hospital discharge register diagnosis, were estimated. Invasive cases in the cancer register and pooled cases of precancerous lesions were used as reference case populations. Results. The sensitivity of the screening register for cervical cancer was 69%, the coverage 100% and the PPV 77%. Corresponding values for the hospital discharge register were 81%, 100% and 83%, respectively. Sensitivity of the screening register for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) against the pooled case population was 89% and coverage 99%. Corresponding values for the hospital discharge register were 78% and 93%. Kappa-values for pair-wise agreement between the three registers ranged between 0.73 and 0.79, often the lesion grade was lower in the screening register than in the other two registers. Conclusions. The data in the screening register has high coverage and is thus useful for statistical and evaluation purposes. However, in order to improve the accuracy of diagnostic information, there are grounds to consider data retrieval through systematic linkage to other health care registers.

Cost-effectiveness of Percutaneous Transluminal Angioplasty (PTA) Versus Vascular Surgery in Limb-threatening Ischaemia.

The purpose of this study was to analyze the cost and cost-effectiveness of femoropopliteal PTA compared to femoropopliteal bypass surgery in chronic critical ischaemia of the lower limb. A total of 772 patients were treated either by femoropopliteal PTA or vascular reconstruction in two of the three largest vascular centers in Finland 1991-1992. A subset of 124 cases with chronic critical leg ischaemia, which according to a retrospective independent analysis by a vascular surgeon and a radiologist could have been treated with either modality, were included in the study. Eighty-six of those were treated with PTA and 38 with surgery. The patients were followed up for to three years after treatment. Clinical outcomes were measured as change in the ABI (ankle-brachial pressure index) and avoidance of reoperation and amputation. The hospital costs covering all events from preoperative examinations to the three-year follow-up visit were identified by using hospital discharge register and accounting data. Cost-effectiveness was calculated as cost per reoperation-free year and year of leg saved. Surgery cases were found to have a more severe disease as indicated by lower distal pressures and longer occlusions and they also showed a slightly better clinical outcome, although the differences were not statistically significant. PTA costs were half of those of vascular surgery. The cost-effectiveness rates were significantly better for the PTA patients. PTA is a feasible and cost-effective procedure in chronic critical ischaemia of the lower limb and should be the treatment of choice in the subset of patients where both procedures are possible.

The Impact of Hypertension and Diabetes on Outcome in Patients Undergoing Percutaneous Coronary Intervention

Objective Information relating the outcome of percutaneous coronary intervention to diabetes mellitus or hypertension is limited. The study objective was to describe the outcome in patients undergoing percutaneous coronary intervention in relation to diabetes and hypertension. Methods Data were extracted from 5 national registers: the Swedish Coronary Angiography and Angioplasty Register (all percutaneous coronary interventions), the Prescribed Drug Registry (all prescribed pharmaceuticals purchased in Swedish pharmacies), the Swedish Hospital Discharge Register (data on myocardial infarction, revascularization, stroke, and congestive heart failure from in-hospital and specialist health care), and the National Population Register and Cause of Death Register (data on death). We included all “first percutaneous coronary interventions” between January 1, 2006, and December 31, 2008 (n = 44,268; followed an average of 1.9 [± 0.9] years). Results Mortality was 6.4% and highest in patients with diabetes plus hypertension. Hypertension per se did not increase mortality or the risk for repeat intervention, but carried a 10% increased risk for subsequent myocardial infarction, increasing to a 4-fold increase when combined with diabetes. Stroke occurred in 2%; the importance of hypertension was evident in nondiabetic patients, but even stronger in diabetic patients. Congestive heart failure caused hospital admission in 8%, with a negative influence from hypertension with and without diabetes. Conclusion After percutaneous coronary intervention and with modern pharmacotherapy, diabetes had a negative effect on the outcome, especially when combined with hypertension. Hypertension per se was not associated with increased mortality but with an increased risk for myocardial infarction, stroke, and congestive heart failure, probably related to widespread coronary artery disease. Improved diabetes care might improve the prognosis.

Determination of age-specific and sex-specific familial risks for the different manifestations of venous thromboembolism: A nationwide family study in Sweden

This nationwide study aimed to determine whether differences exist in age-specific and sex-specific familial risks for pulmonary embolism (PE), venous thrombosis of the lower limbs (VT) and other forms of venous thromboembolism (OVTE) among offspring, siblings and spouses of affected individuals. The Swedish Multi-Generation Register was linked to the Hospital Discharge Register data for the period 1987-2007. Standardised incidence ratios (SIRs) were calculated for individuals whose relatives were hospitalised for venous thromboembolism (VTE), as determined by the International Classification of Diseases (ICD), and those whose relatives were unaffected by VTE. The total number of hospitalised VTE patients was 45,362. All VTE patients were categorised as PE, VT or OVTE according to ICD at first hospitalisation. For example, the parental SIRs for PE, VT and OVTE in offspring at age 10-19 years were 2.89 (95% CI 1.48-5.06), 4.99 (95% CI 3.22-6.10) and 3.89 (95% CI 2.51-5.75), respectively. The low spousal risks of PE (1.08; 95% CI 1.02-1.13), VT (1.06; 95% CI 1.011.12) and OVTE (1.07; 95% CI 1.00-1.15) suggest the familial risks to be largely genetic. In both men and women, familial relative risks were increased for all the different manifestations of VTE with the exception of those older than 70 years. Familial history is a risk indicator in both sexes, and is potentially useful for clinical risk assessment for the different manifestations of VTE.

Pneumococcal serotype distribution in invasive paediatric disease in Southern Finland before the introduction of vaccine

Vaccination with pneumococcal conjugate vaccines (PCV) has been started in many countries, resulting in a marked decrease in the incidence of invasive pneumococcal disease (IPD). After the decline, an increase in the incidence of IPD caused by non-vaccine serotypes has been observed. Finland has just decided to incorporate PCV into the national immunization programme, starting 1 September 2010. We describe the patients treated for IPD in one hospital in Finland before the use of PCV. Details of patients treated for IPD at the Children's Hospital, University of Helsinki between 2002 and 2007, were sought using the hospital discharge register and laboratory data. In total 118 cases of IPD were diagnosed in 113 children between 1 January 2002 and 31 December 2007. The yearly number of cases of IPD increased from 10 in 2002 to 26 in 2007. There were 5 deaths, all in patients with meningitis (5/19, 26%), and the total mortality was 4% (5/113). Seventy-five (77%) of the 97 pneumococcal isolates for which serotype was available were covered by the 7-valent PCV; 77% were also in the 10-valent PCV and 91% in the 13-valent PCV. Considering the serotype distribution of the pneumococcal isolates, a marked benefit is expected from including PCV in the vaccination programme.

Male fetal sex is associated with earlier onset of placental abruption

Placental abruption is an important cause of preterm birth, and perinatal morbidity and mortality. Although more common with male fetuses, outcomes have not been evaluated by sex. Our aim was to find out whether short-term morbidity differs by infant sex in cases with placental abruption and in controls. Register-based case-control study. National Hospital Discharge Register and Medical Birth Register data 1987-2005. The study population consisted of 4,081 women with placental abruption and singleton infant. Three control women without placental abruption were selected for each case matched by maternal age, parity, year of birth, and hospital district. A total of 3,688 cases and 12,695 controls had liveborn infants. Data on pregnancy, delivery, and perinatal outcomes were collected. Placental abruption. The sex ratio (proportion of male) of cases was 0.548 and of controls 0.516 (p = 0.001). Compared with females, male fetuses in the placental abruption group were born earlier (p = 0.018). Compared with controls, cases with placental abruption were born earlier (p < 0.001), had lower birthweight (p < 0.001), were more often growth restricted (p < 0.001), had lower Apgar scores (p < 0.001) and pH (p < 0.001). Newborn cases needed special care, respirator treatment, antimicrobial and phototherapy more often (p < 0.001) than controls. There was no difference in perinatal outcomes between female and male infants in the placental abruption group. Placental abruption occurred earlier in pregnancy with male fetal sex but otherwise the outcomes were similar. Compared with controls newborns in the placental abruption group had a worse outcome.

External Validation of the Swedvasc Registry: A First-time Individual Cross-matching with the Unique Personal Identity Number

ObjectiveTo study external validity of the Swedvasc registry concerning numbers of procedures and mortality. Materials and methodsVascular registry data for carotid, infrainguinal bypass and aortic aneurysm (AAA) procedures were compared to the Swedish Hospital Discharge Register (SHDR) data, and the National Population Registry (for mortality) by matching every individual patient using the unique personal identity numbers (PINs). The time-period studied was 2000–2004 (5 years) for carotid and infrainguinal procedures. A separate analysis was performed for AAA-surgery in 2006. ResultsThe external validity for carotid, infrainguinal bypass and AAA repair was 93.4%, 93.0% and 93.1%, respectively. The 30-day mortality was 0.86% after carotid and 2.9% after infrainguinal bypass procedures. Mortality was 2.6% after planned and 25.9% after unplanned AAA repair.Although there was a general trend towards inferior outcomes after procedures not registered in the Swedvasc, those procedures were so few that in none of the analyses did the inclusion of non-registered procedures affect general outcomes significantly.Combining data from both registries, the incidence for carotid, infrainguinal bypass and AAA procedures was 7.8, 15.2 and 13.6 per 100,000 person-years, respectively.In the hospital-specific analysis for 2006 it was shown that the non-registered procedures for AAA were localized to one non-compliant county hospital, and small district hospitals not performing elective AAA-surgery but only rare emergency operations. ConclusionThe external and internal validity of the Swedvasc registry allows to confidently assess volumes of, and mortality after, vascular surgery in Sweden.

Early risk factors for lumbar discectomy: an 11-year follow-up of 57,408 adolescents.

There is a lack of longitudinal studies on the risk factors of lumbar discectomy. Using combined population survey and hospital discharge register data in a prospective longitudinal design, we investigated the association between adolescent risk factors and lumbar discectomy until early middle age. A prospective cohort of health survey respondents (n = 57,408) aged 14-18 years was followed for 651,000 person-years (average follow-up, 11.3 years). Study endpoints were lumbar discectomy, death or end of follow-up. Participants' mean age at the end of follow-up was 27 years. In multivariate Cox's regression analysis, the significant risk factor for lumbar discectomy among male respondents was daily smoking, HR being 1.5 (95% CI 1.1-2.2). In females, frequent participation in sports clubs (HR 2.7, 95% CI 1.1-6.3) and overweight (HR 2.1; 95% CI 1.1-4.1) were significantly associated with an increased risk of lumbar discectomy. Daily smoking in males and frequent participation in sports clubs and overweight in females measured at adolescence were statistically associated with lumbar discectomy at an 11-year follow-up, although the hazard ratios were relatively small. Further study of these common risk factors and their modifications may lead to a better understanding of the causes of lumbar disc herniation.

Childhood family structure and personality disorders in adulthood

Background The association between childhood family structure and sociodemographic characteristics and personality disorders (PDs) in a general population sample was studied. Methods This study is a substudy of the prospective Northern Finland 1966 Birth Cohort Project with 1588 young adult subjects. The case-finding methods according to the DSM-III-R criteria for PDs were: (1) Structured Clinical Interview for DSM-III-R (SCID) for 321 cases who participated in a 2-phase field study, (2) Finnish Hospital Discharge Register data, and (3) analysis of the patient records in public outpatient care in 1982–1997. Statistical analyses were performed on the association between PDs and family background factors. Results Altogether 110 (7.0%) of the subjects had at least one probable or definite PD. After adjusting for confounders (gender, parental social class and parental psychiatric disorder) the results indicated that single-parent family type in childhood was associated with cluster B PDs in adulthood. Being an only child in childhood was associated with cluster A PDs. No special childhood risk factors were found for cluster C PDs. Conclusions Results suggest that single-parent family type at birth and being an only child in the 1960s are associated with PD in adulthood. Further studies are needed to explore the psychosocial aspects of family environment which may nowadays promote vulnerability to PDs in adulthood.

National Registry Quantifies Family Depression Risk

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessNational Registry Quantifies Family Depression RiskJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:18 Jan 2008https://doi.org/10.1176/pn.43.2.0030Even during their Viking days, the Scandinavians tended to keep very good records. Keeping with that tradition, researchers in Sweden have harnessed various population databases to learn more about the familial transmission of depression.Specifically, all men and women born in Sweden from 1932 on have been registered, together with their parents, in its Multigeneration Register. Moreover, the government started recording, as of 1987, complete data on all hospital discharges for depression in Sweden in the Swedish Hospital Discharge Register. So Xinjun Li, M.D., Ph.D., of the Karolinska Institute in Huddinge, Sweden, and coworkers used both the Multigeneration Register and Swedish Hospital Discharge Register data from 1987 to 2004 to determine which Swedes had been hospitalized for depression between 1987 and 2004, and which had one or more parents who had also been hospitalized for depression during the same period. They then used that information to calculate familial risks of depression during the period.For example, if individuals had one affected parent, their chance of being hospitalized for depression as well was about three times greater than that of individuals with unaffected parents. When a male had two affected parents, his risk of being hospitalized for depression was five times greater than that of males with unaffected parents. When a female had two affected parents, her risk of being hospitalized was seven times greater than that of females with unaffected parents. But the greatest risks of all were noted for males and females aged 15 to 29 with two affected parents. The risk was eight times greater for males and 11 times greater for females.Li and his coworkers also determined that depression risk in men with an affected mother was similar to that in men with an affected father, but that the risk in women with an affected mother was greater than the risk in women with an affected father.Finally, the researchers compared age-specific incidence rates of depression in Swedes according to their parental history of depression. All age-specific incidence rates were higher in those who had one or more affected parents than they were in those with unaffected ones. And while the incidence rate of depression in Swedes with unaffected parents gradually increased with age, the incidence rate of depression in those with affected ones shot up between ages 15 and 20, took another small upward turn between ages 40 and 44, and rose even higher after age 60.So all in all, there seems to be a strong familial impact on depression risk, and even on age-specific depression risk, Li and his team concluded in their study report, which is in press with the Journal of Psychiatric Research. Why this is the case is not clear, they admitted.“It could be assumed that it is due to a genetic basis for depression. However, it is also possible that depression running in families is due to children learning depressive strategies from their parents.” Such strategies might be negative cognitions or dysfunctional behaviors, they speculated.The study was funded by the National Institutes of Health, the Swedish Research Council, and the Swedish Council for Working Life and Social Research.An abstract of “Age-Specific Familial Risks of Depression: A Nation-Wide Epidemiological Study From Sweden” can be accessed at<www.sciencedirect.com> by clicking on “J” under “Browse by Title,” then“ Journal of Psychiatric Research.” ▪ ISSUES NewArchived

Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients

Objective To determine the accuracy of hospital discharge diagnoses in identifying severe infections among intensive care unit (ICU) patients, and estimate the impact of misclassification on incidence and 1-year mortality. Study Design and Setting Sepsis, pneumonia, and central nervous system (CNS) infections among 7,615 ICU admissions were identified using ICD-9 and ICD-10 diagnoses from the Swedish hospital discharge register (HDR). Sensitivity, specificity, and likelihood ratios were calculated using ICU database diagnoses as reference standard, with inclusion in sepsis trials (IST) as secondary reference for sepsis. Results CNS infections were accurately captured (sensitivity 95.4% [confidence interval (CI) = 86.8–100] and specificity 99.6% [CI = 99.4–99.8]). Community-acquired sepsis (sensitivity 51.1% [CI = 41.0–61.2] and specificity 99.4% [CI = 99.2–99.6]) and primary pneumonia (sensitivity 38.2% [CI = 31.2–45.2] and specificity 98.6% [CI = 98.2–99.0]) were more accurately detected than sepsis and pneumonia in general. One-year mortality was accurately estimated for primary pneumonia but underestimated for community-acquired sepsis. However, there were only small differences in sensitivity and specificity between HDR and ICU data in the ability to identify IST. ICD-9 appeared more accurate for sepsis, whereas ICD-10 was more accurate for pneumonia. Conclusion Accuracy of hospital discharge diagnoses varied depending on diagnosis and case definition. The pattern of misclassification makes estimates of relative risk more accurate than estimates of absolute risk.

The National Hospital Discharge Register Data on Lower Limb Amputations

Aim To study if data on lower limb amputations and vascular operations in the National Hospital Discharge Register can be used for comparison of diabetes care between hospital districts. Methods We identified diabetic persons from the National Hospital Discharge Register (1988–2002), the National Social Security Institute (since 1964) and pharmacies (since 1994). A search for lower limb amputations and vascular operations was made through the Hospital Discharge Register. An analysis of the correlation of the age and gender adjusted incidence of first major amputations and the age and gender adjusted incidence of first vascular operations for diabetics was made between 14 hospitals districts with the largest diabetic population. Results A total of 308,447 diabetics were identified. There were 11,070 diabetics who had a lower extremity amputation and 9530 diabetics who had a vascular operation in Finland in 1988–2002. The annual number of first amputations decreased from 924 to 387 per 100,000 diabetics during the study period. There were up to three-fold differences in age and gender adjusted indexed numbers of first amputations between different hospital districts during the last follow-up period from year 2000 to 2002. There was a clear inverse correlation between the incidence of first major amputations and first vascular operations and particularly between incidence of first major amputations and infrapopliteal reconstructions. Conclusion The incidence of major amputation is declining in the diabetic population. This positive development can be explained by more active vascular operative treatment. Regional differences are wider than acceptable.

HUNC‐93B1, a novel gene mainly expressed in the heart, is related to left ventricular diastolic function, heart failure morbidity and mortality in elderly men

The hUNC-93B1 gene has the highest expression in the heart. We aimed to explore relationships between the hUNC-93B1 gene and cardiac function, morbidity and mortality in elderly men. Two sub-samples of the population-based ULSAM-cohort (n=330, mean age 71 years and n=152, mean age 75 years, respectively) were used to explore and validate relationships between genotypes of the hUNC-93B1 gene and cardiac phenotypes (ejection fraction, E/A-ratio, left ventricular mass index and relative wall thickness). In the two samples, subjects homozygous for haplotype H3 had 34% and 35% higher level of E/A-ratio compared to non-carriers (p=0.0002 and 0.017, respectively) independent of cardiovascular disease and medication. Using national cause-of-death and hospital-discharge register data with 29 years of follow-up, no heart failure patients homozygous for haplotype H3 were hospitalised for heart failure before the age of 75 years, compared to 25% for heterozygous and 55% for non-carriers (p<0.03). No homozygous subjects died during follow-up while 17% of the heterozygous and 15% of the non-carriers died (p=0.01). Haplotype H3 of the hUNC-93B1 gene seems related to E/A-ratio in elderly men. The relationship between the hUNC-93B1 gene and the age at onset of heart failure and mortality support a view of a clinically relevant impact of the gene.