Statistics Denmark Research Articles

The risk of venous thromboembolism in adult patients with diffuse glioma: a nationwide population-based study.

Venous thromboembolism (VTE) is a cause of increased morbidity and risk of death. Studies report VTE in up to 30% of glioma patients but the results vary. The VTE risk is relevant when evaluating prophylaxis to avoid unnecessary bleeding or overdiagnosis. This study examines the VTE incidence in patients with glioma WHO grade 2-4, and when VTE occurred, risk factors, and overall survival (OS) for patients with WHO grade 4. In total 3,630 patients with WHO grade 2 (n = 230), grade 3 (n = 317), and grade 4 (n = 3,083) gliomas from 2010 to 2018 were identified using the Danish Neuro-Oncology Registry. VTE diagnoses and time of death were obtained from Statistics Denmark. The VTE incidence was 5.2, 6.3, and 6.8% in patients with WHO grade 2, 3, and 4 gliomas, respectively. The VTE incidence rate was highest during the first 3 months after the diagnosis with 53 events. Increasing age (HR 1.03, 95%CI 1.01-1.04), male sex (HR 1.47, 95%CI 1.09-1.99), poor performance status (HR 1.57, 95%CI 1.10-2.25), and post-operative long-course radiochemotherapy (HR 2.10, 95%CI 1.19-3.72) were predictors of VTE in patients with glioma WHO grade 4. There was no difference in OS comparing patients having VTE to those without (p = 0.068). In conclusion, patients with glioma WHO grade 2-4 were at high risk of VTE, especially the first 3 months after diagnosis. Increasing age, male sex, poor performance status, and long-course radiochemotherapy were associated with increased risk of VTE in patients with glioma WHO grade 4.

Ethnic disparities in clinical severity of COVID-19 as predictor of long COVID

Abstract Background Recent studies from Europe have shown a higher incidence of long COVID among ethnic minorities compared to the majority population. Little is known of these disparities, but they might be related to factors such as COVID-19 disease severity, barriers in access to health and individual factors such as working and living conditions. This study will elucidate possible predictors of long COVID related to COVID-19 disease severity in an ethnic diverse hospitalised cohort. Methods A retrospective cohort study of 1648 patients admitted with COVID-19 at three hospitals in Copenhagen, Denmark, between 1st February 2020 and 31st May 2022. Clinical data was extracted from health care records, and subsequently linked to data from Statistics Denmark on long COVID diagnosis (ICD-10 “DB948A”) as well as migration status. Results 1361 patients were discharged alive and of those, 113 (8,3%) patients got a long COVID diagnosis. Preliminary analyses show no excess risk of getting a long COVID diagnosis as a migrant compared to patients of Danish origin (RR = 1,20, p = 0,35). Some ethnic disparities are seen in disease severity among all patients discharged alive. Patients with migrant background were admitted to the hospital later (6,8 vs 5,6 days, p < 0,0001), and at a greater risk of needing high flow oxygen administration upon admission (RR = 1,46, p = 0,0012) compared to patients of Danish origin. Furthermore, a higher degree of systemic inflammation is seen among migrants with regards to lactate dehydrogenase (LDH) compared to patients of Danish origin (349,7 vs 317,2 U/L, p = 0,0014). No significant differences in c-reactive protein (CRP) levels (92,8 vs 85,9 mg/L, p = 0,11). Conclusions Preliminary analyses indicates possible ethnic disparities in COVID-19 disease severity among patients discharged alive possibly playing a role as predictors of long COVID. Low health literacy or language barriers might partly explain this. Further analyses are needed. Key messages • In preliminary analyses of 1381 patients previously admitted with COVID-19, we find no excess risk of a long COVID diagnosis (DB 948B) among patients with migrant background. • Preliminary analyses show some ethnic disparities in COVID-19 disease severity that might act as possible predictors of long COVID.

Prescription time trends in patients with high-impact chronic pain: A National Patient Registry Study.

High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported. We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011-2013, 2014-2016, 2017-2019, and 2020-2022. We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%). In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin). This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

P-779 GLP-1 receptor agonist treatment in early pregnancy and risk of pregnancy complications - A nationwide cohort study

Abstract Study question Does periconceptionally exposure to GLP-1 receptor agonist (GLP-1 RA) treatment increase the risk of pregnancy complications? Summary answer Perconceptionally exposure to GLP-1 RA had no association with pregnancy complications when compared to a control group with balanced covariates. What is known already The prevalence of obesity continues to increase globally, affecting half the adult population in Western countries, increasing the risk of infertility and obstetric and neonatal complications. Weight loss might improve risks, leading to an interest in effective weight loss methods such as GLP-1 RAs. However, none of the GLP-1 RAs are approved for use during pregnancy and at least two months before to avoid fetal toxicity. The current recommendations are based on a fetal safety principle and data from animal studies, clearly underscoring the need for more human evidence about the effect of GLP-1 RA use in the periconceptional period. Study design, size, duration A Danish nationwide observational cohort study of 522,209 pregnancies from October 2009 until June 2019 with data from health and socioeconomic registries at Statistics Denmark: the National Prescription Register, National Patient Register, Birth Register, Residential Register, and the National Diabetes Registry. All registries had complete information until June 2019, except the National Prescription Register which was until December 2018. The unique personal identification number used in Denmark enables direct linkage of individual-level information across registries. Participants/materials, setting, methods Exposure was defined as the redemption of GLP-1 RA prescription, liraglutide, +/- eight weeks from last menstruation. Primary outcome: any complication (pre-eclampsia, gestational diabetes (GDM), preterm birth (<37 + 0), low-birth-weight (<2500g), small-for-gestational-age, or large-for-gestational-age (LGA)). Evaluated risk of individual outcomes, and effect on gestational age, birth weight, and placenta weight. Outcomes were compared to an unexposed control group, weighted using fast generalized matching on propensity score estimated from relevant confounders. Risk ratio, 95% confidence interval (CI). Main results and the role of chance Within the study population of 522,209 pregnant women, we identified 93 pregnancies exposed to liraglutide in early pregnancy. The exposed women were on average older, had a higher BMI (on average 40% higher), and had a sixty times higher frequency of diabetes (DM1 or DM2) compared to unexposed women giving birth in the same period (p < 0.001). We found that liraglutide exposure was associated with a higher risk of obstetrical complications, pre-eclampsia, GDM, and preterm birth. There was no difference in the birth weight, but those exposed were more likely to give birth to an LGA child (liraglutide, p < 0.01). However, we did not find any evidence of increased risk when utilizing a propensity score matching method (liraglutid, p > 0.1). This indicates that liraglutide, in itself, is not driving the increased risk, but the indication for a GLP-1 RA prescription (e.g. diabetes or obesity) is the causal factor. The finding did not depend on the choice of method for propensity score matching. Findings pertaining to liraglutide and semaglutide, encompassing the period from 2009 to 2023, will be showcased at the primary conference. Limitations, reasons for caution Weight loss treatment was off-label for most of the study time. Wider implications of the findings The study is important for counseling women periconceptionally exposed to GLP-1 RA, that there is no evidence of an increased risk of pregnancy complications. It calls for studies on the safety profile for GLP-1 RA treatment in women, enabling early weight management for the benefit of the mother and child. Trial registration number not applicable

Social characteristics and social benefit use among premenopausal breast cancer survivors in Denmark: a population-based cohort study.

In 2020, one million women aged < 55years were diagnosed with breast cancer globally. The impact of breast cancer and its treatments on these women's ability to work and need for social benefits may differ by social characteristics. We evaluated social benefit use following breast cancer by education and cohabitation. We conducted a nationwide population-based cohort study, including women aged 18-55years diagnosed with stage I-III breast cancer in Denmark during 2002-2011. Statistics Denmark provided information on cohabitation, education, and social benefit use from 1year pre-diagnosis to 10years post-diagnosis. We calculated weekly proportions ofself-support, unemployment, disability pension, flexi jobs, and sick leave according to education and cohabitation. Of 5345 women, 81.8% were self-supporting, 4.5% received disability pensions, 1.6% had flexi jobs, 3.6% were on sick leave, and 5.5% were unemployed 1 yearpre-diagnosis. Ten years post-diagnosis, the proportions were 69.0%, 13.0%, 10.5%, 3.4%, and 2.0% of 3663 survivors. Disability pensions and flexi jobs increased from 12.1 to 26.4% and 2.8 to 13.5% in women with short education, from 4.1 to 12.8% and 1.8 to 12.2% in women with medium education, and from 0.8 to 6.0% and 0.9 to 6.9% in longer educated. Disability pensions increased more in women living alone (7.8 to 19.9%), than in cohabiting women (3.6 to 11.3%). Use of social benefits reflecting lost ability to work was highest in less educated women and in women living alone. Awareness of these groups is crucial when tailoring efforts to support work participation in cancer survivors.

Urban-rural inequalities in IV thrombolysis for acute ischemic stroke: A nationwide study.

Rural residency has been associated with lower reperfusion treatment rates for acute ischemic stroke in many countries. We aimed to explore urban-rural differences in IV thrombolysis rates in a small country with universal health care, and short transport times to stroke units. In this nationwide cohort study, adult ischemic stroke patients registered in the Danish Stroke Registry (DSR) between 2015 and 2020 were included. The exposure was defined by residence rurality. Data from the DSR, Statistics Denmark, and the Danish Health Data Authority, were linked on the individual level using the Civil Registration Number. Adjusted treatment rates were calculated by balancing baseline characteristics using inverse probability of treatment weights. Among the included 56,175 patients, prehospital delays were shortest for patients residing in capital municipalities (median 4.7 h), and longest for large town residents (median 7.1 h). Large town residents were predominantly admitted directly to a comprehensive stroke center (98.5%), whereas 30.9% of capital residents were admitted to a hospital with no reperfusion therapy available (non-RT unit). Treatment rates were similar among all non-rural residents (18.5%-18.7%), but slightly lower among rural residents (17.2% [95% CI 16.5-17.8]). After adjusting for age, sex, immigrant status, and educational attainment, rural residents reached treatment rates comparable to capital and large town residents at 18.5% (95% CI 17.7-19.4). While treatment rates varied minimally by urban-rural residency, substantial differences in median prehospital delay and admission to non-RT units underscored marked urban-rural differences in potential obstacles to reperfusion therapies.

Volition and Perception: Why patients choose to continue or discontinue ADHD medication

IntroductionThe present study examines self-reported factors related to discontinuation of ADHD medication in Danish adults. Based on insights from six patient interviews, a questionnaire was developed with themes such as perception of ADHD, perceived beneficial- and adverse effects of the medication, to examine patients’ reasons for continuation or discontinuation of the prescribed medication.ObjectivesADHD medication has proven effective for treating ADHD in adults. Large registry-based studies have generally shown high discontinuation rates over time and focused on different risk factors, such as comorbidity, gender and socioeconomic status. However, in the present study we explore patient reported reasons for continuation or discontinuation of ADHD medication as well as what drives their choice of living with or without medication despite ADHD.MethodsThe present research is a questionnaire study consisting of 1,050 Danish adults who redeemed a prescription of ADHD medication for the first time between 2017-2019. Questionnaires were sent out by Statistics Denmark to 4.748 adults, a representative sample from the 17.334 Danish adults who redeemed a prescription within that period. A gap of 12 months between redemptions was defined as discontinuation and questionnaires were sent out to an equal number of patients who continued or discontinued the ADHD-medication. Chi2-tests were performed to examine the differences between adults who continued vs. discontinued ADHD-medication in relation to different main themes.ResultsThe patients who continued medical treatment more strongly perceived ADHD as a biological illness whereas patients who discontinued, more strongly perceived ADHD as an illness constructed by society. Furthermore, patients who continued medical treatment reported that the medication has a more positive influence on their lives whereas patients who discontinued the medication reported that the treatment involved more negative feelings and decreased the positive sides of themselves. Finally, patients who continued the prescribed ADHD-drugs reported more strongly that they continued the treatment for themselves, to be able to work and be social than the patients who discontinued the medical treatment.Conclusions The present findings suggest that the perception of ADHD as being either a biological or social construct is central to why patients choose to continue or discontinue ADHD-medication. Moreover, patients who continued the medical treatment generally reported more positive effects of the ADHD-drugs whereas patients who discontinued the medical treatment reported different negative effects of the medication. From a clinical perspective, these findings show the importance of understanding the individual patient’s perception of ADHD. These perspectives should be addressed in the clinic alongside with awareness of how ADHD-drugs may have a positive and negative effect on the individual patient.Disclosure of InterestNone Declared

Lung cancer among the Elderly in Denmark – A comprehensive population-based cohort study

ObjectiveLung cancer primarily occurs in the elderly with a median age at diagnosis in Denmark of 73 years. However, elderly patients are under-represented in clinical trials as well as in screening studies. In this study, we aim to characterize elderly patients with lung cancer and explore the diagnostic intensity, treatment patterns, and survival. MethodPatients diagnosed with lung cancer between 2014 and 2017 according to the Danish Cancer Registry, and with clinical information in the Danish Lung Cancer Registry were included. Patient information was linked by the unique social identification number to information from Statistics Denmark. ResultsWe included n = 17,835 patients in this study, of whom 2,871 (16.1 %) were 80 years or older. Fewer elderly patients had lung biopsies (47 % vs 53 %) or mediastinal procedures (34 % vs 26 %), compared to the younger patients (p < 0.001). Fewer elderly patients had treatment registration (60 % vs 85 %), and fewer received treatment with curative intent (23 % vs 42 %) compared to patients younger than 80 years (p < 0.001). The elderly patients had 2.1 (CI 95 % 1.9 – 2.2) times higher odds of dying within 12 months after diagnosis than younger patients. ConclusionThe diagnostic intensity among lung cancer patients aged eighty years or above is lower compared to younger patients. Being elderly is associated with not undergoing surgical treatment or treatment with curative intent. Across all treatment groups, being older than eighty years of age was associated with an adverse prognosis.

Mortality of the Danish Nationwide AQP4 Antibody-Seropositive Neuromyelitis Optica Spectrum Disorder Patient Cohort.

We aimed to evaluate the mortality of patients with AQP4 antibody-seropositive (AQP4-Ab+) neuromyelitis optica spectrum disorder (NMOSD) in Denmark compared with that in the general population. We identified patients with AQP4-Ab+ NMOSD fulfilling the 2015 International Panel for Neuromyelitis Optica Diagnosis (IPND) criteria from multiple sources (laboratories and the Danish Multiple Sclerosis Registry). We obtained detailed information about patients from hospital records and about the general population matched on age, sex, and calendar year from Statistics Denmark. We calculated standardized mortality ratio (SMR), excess number of deaths per 1,000 person-years (EDR), and life expectancies compared with those of the matched general population. We examined predictive factors of mortality and the cause of death. Of 66 patients with AQP4-Ab+ NMOSD between 2008 and 2020, 15 died. Overall, the SMR was 2.54 (95% CI 1.47-4.09), and the EDR was 16.8 (95% CI 4.6-34.3). The median life expectancy for patients with AQP4-Ab+ NMOSD was 64.08 years (95% CI 53.02-83.9), compared with 83.07 years for the general population. Risk of death over time was increased in the patient population with a hazard ratio (HR) of 2.22 (1.34-3.68; p = 0.002). The cause of death was directly related to NMOSD in 93% of the cases. The age at disease onset was an independent predictor of death (HR 1.042; 95% CI 1.006-1.079; p = 0.02). AQP4-Ab+ NMOSD is associated with increased mortality and shorter life expectancy compared with that in the general population, underlining the need for highly effective treatment approaches.

Characteristics associated with non-initiation and non-completion of human papillomavirus vaccination among Danish girls: a nationwide register-based cohort study.

The aim was to identify maternal and paternal socioeconomic and demographic characteristics for non-initiation and non-completion of the human papillomavirus (HPV) vaccination among Danish girls including time-trends. This nationwide register-based cohort study included all girls residing in Denmark who were offered free-of-charge HPV vaccination as a part of the childhood vaccination program between 2009 and 2018 (birth cohorts 1996-2005). The study samples included 296,461 daughter-mother dyads and 291,025 daughter-father dyads. Data from the Danish Vaccination Register were linked with socioeconomic and demographic data from Statistics Denmark. HPV vaccination status was classified as 'non-initiation' for girls who received no HPV vaccine and as 'non-completion' for girls who initiated the HPV vaccination program but did not receive all the scheduled HPV vaccines. Data were analyzed using logistic regression models. Non-initiation of HPV vaccination was 13.7%, and non-completion was 24.2% among girls who initiated the HPV vaccination program. Girls of parents who were descendants of immigrants (adjusted odds ratio: 1.50; 95% confidence interval: 1.35-1.68), were at least 35-years old at time of birth, had basic or no education, had a low income, were not in the labor market, and were unmarried had the highest non-initiation and non-completion odds. The associations between socioeconomic and demographic characteristics and HPV vaccination uptake were similar for mothers and fathers. Despite free-of-charge availability to HPV vaccination in Denmark, we found disparities in non-initiation and non-completion of HPV vaccination among Danish girls by both mothers' and fathers' socioeconomic and demographic characteristics.

Estimating the burden of skin diseases using patient‐reported daily time trade‐off as a measure of disease impact and unmet needs

AbstractBackgroundDermatological diseases may cause significantly impaired quality of life, however patient reported outcomes are often disease specific, and not comparable across diseases.ObjectivesTo examine daily time trade‐off (dTTO), as a measure of disease burden.MethodsAn epidemiological study based on patient data from Danish Skin Cohort (prospective cohort of Danish dermatology patients) was conducted. Data were linked with routinely collected data from Statistics Denmark. We included adults with either alopecia areata (AA), atopic dermatitis (AD), hidradenitis suppurative (HS), psoriasis, or rosacea. All patients with a diagnostic code listed above were invited to participate. The primary outcome was defined as a dTTO of more than 30 minutes daily.ResultsA total of 680, 1605, 611, 1664, and 1698 adults with AA, AD, HS, psoriasis, and rosacea, respectively, were included. In multiple regression models, patients with AA were most likely to have a dTTO of more than 30 minutes, followed by patients with HS, AD, psoriasis and rosacea. A total of 33.7% (AA), 29.3% (HS), 14.6% (AD), 11.1% (psoriasis), and 9.0% (rosacea) of patients were willing to spend two hours or more per day. The dTTO correlated with disease severity and DLQI across disease groups.ConclusionsPatients with AA, followed by HS were willing to spend most time on treatment, possibly reflecting unmet needs in these patient groups. Daily TTO correlated with perceived disease severity in all groups and may be a useful measure of dermatological disease burden.

Suicide trends in Denmark-An ecological study exploring suicide methods from 1995 to 2019.

Suicide is a major public health problem and complex phenomenon, affecting many people around the world. However, the incidence of suicide varies by sex and age, which includes differences in the means used. Therefore, to implement effective preventative interventions, it is important to study these differences to design effective, preventative interventions. This study investigates the trends in suicide rates in Denmark from 1995 to 2019 by analysing changes based on sex, age, and the means used for suicide. Data on all suicide deaths in the study period were extracted from the Danish Register of Causes of Death, and data on the background population were obtained from Statistics Denmark. We used negative binomial regression models to analyse the data, and the obtained estimates as a logarithm of the rate ratios allowed us to compare the results across groups and years. An overall decline in Danish suicide rates was observed during the study period, with the exception of young females aged 15-29 years. The demographic composition did not change significantly, and suicide rates are still highest for males and the elderly aged 60+. Hanging, self-poisoning and firearms remain the most prevalent means of suicide. Suicide prevention initiatives are required, especially interventions targeting males and the elderly. Restricting access to the means of suicide for these groups with high fatality rates may help reduce the overall suicide rate. Moreover, more research is needed to understand the factors that lead to suicide and affect the choice of means, which should also include studying the effects of different suicide prevention strategies on males and females from different age groups.

Body height and spinal pain in adolescence: a cohort study from the Danish National Birth Cohort

ObjectivesTo investigate how body height and trajectories of height from infancy through childhood and adolescence were associated with spinal pain in pre- and late adolescence.MethodsThis prospective study included 43,765 individuals born into The Danish National Birth Cohort (DNBC) from 1996 to 2003. DNBC-data were linked with health and social data identified from Statistics Denmark registers. Spinal pain was self-reported in both the 11-year- and 18-year follow-up of DNBC and classified according to severity. Body height was measured from birth and onwards and further modelled as distinct developmental height trajectories by using latent growth curve modelling. Associations were estimated by using multinomial logistic regression models.ResultsTaller body height in childhood and adolescence was associated with approximately 20% increased likelihood of spinal pain in pre- and late adolescence among girls compared to their peers in the normal height group. For boys, taller body height was associated with spinal pain by late adolescence only. Spinal pain in pre-adolescence almost doubled the likelihood of spinal pain in late adolescence regardless of body height at age 18. Height trajectories confirmed the relationship for girls with the tall individuals being most likely to have spinal pain in both pre- and late adolescence.ConclusionTall body height during childhood and adolescence predisposes to spinal pain among girls in both pre-and late adolescence, and among boys in late adolescence. Body height is a contributing factor to the pathogenesis of spinal pain in adolescence; however, the mechanisms may be related to growth velocity, but for now uncertain.

The disease burden of paroxysmal nocturnal hemoglobinuria in Denmark: Epidemiology, survival, healthcare resource utilization, costs, treatment gaps, and labor market attachment.

To establish epidemiology, healthcare costs, and labor market attachment in patients with paroxysmal nocturnal hemoglobinuria (Pt-PNH) in Denmark. Data were from Statistics Denmark and the Danish Health Data Authority national population registers (2005-2021). Descriptive baseline statistics characterized the Pt-PNH analytic population; ordinary least squares and adjusted Cox proportional hazards regressions measured outcomes in the Pt-PNH versus Danish general population matched comparators. Overall PNH incidence in Denmark was n = 11 during 2007-2009, n = 25 during 2016-2018 and n = 7 during 2019-2020; prevalence increased from n = 13 in 2006 to n = 62 in 2021. Of the overall n = 85 Pt-PNH; n = 24 were treated with complement-5 inhibitors (Pt-C5i) and n = 61 not treated with C5i (Pt-nC5i). Versus respective comparators, all patients had significantly greater annual per-patient costs (from inpatient hospital admissions, outpatient contacts, PNH treatments; indirect costs from lost earnings + transfer payments; post-diagnosis for Pt-PNH and Pt-nC5i, post-treatment initiation for Pt-C5i). The Pt-C5i incurred the greatest healthcare and indirect cost differences (€709 119; €152 832, respectively) followed by the Pt-PNH (€189 323; €29 159, respectively) and Pt-nC5i (€95 548; €4713, respectively). The Pt-PNH versus comparators also had an increased hazard of death (2.71 [95% CI, 1.63 - 4.51]). Although a rare disease, PNH is associated with significant patient, healthcare system, and societal burdens in Denmark.

Challenges in communicating evidence and policies in relation to the COVID-19 pandemic – experiences from Denmark

Abstract Early during the COVID-19 pandemic health authorities and media in the Scandinavian countries identified an increased incidence of infections among migrants compared to the majority population. Specific neighbourhoods and communities were presented as having high incidence rates, hospitalisations and mortality. These populations were profiled by country of birth - in Denmark often categorised as non-Western immigrants which is a broad label generally presented in policy debates and by Statistics Denmark. The public discourse quickly associated this category with common Danish concepts such as parallel societies or ghetto's - the latter being a label that officially was used recently to identify communities with many immigrants and social challenges. The debate signified a frequent view that these population groups were less caring about their health, more suspicious or less motivated to comply with information from public authories and with little interest in engaging in testing and preventive activities- thereby representing a risk for the further spread of the disease and an additional burdon for health care. Only after intensive interference from migrant health experts and initiatives from the National Health Authority a more nuanced public communication gave room for description of housing and working characteristics that were common in some of the migrant communities.This slowly created more insights and acceptance of real causes of the disparities and a platform for more respectful, inclusive and efficient preventive interventions. The presentation will report on the process involved and the way the change of language had an impact on the public health policies and practice during the pandemic in Denmark.

Geographical inequality in health: results from a population-based health survey

Abstract Background The greatest public health concern is social inequality in health, which also includes a geographic dimension. Residents of less resourceful areas are often disproportionately exposed to health risks, and the negative health effects of both low social position and unhealthy surroundings can exacerbate each other. This study aims to explore the relationship between sociodemographic characteristics of local areas, health behavior and mental health. Methods The study used self-reported data from the ‘How are you? 2021’ health survey conducted in the Central Denmark Region (N = 33,925), and parish-level data from Statistics Denmark. Latent Profile Analysis was used to group parishes into five socio-geographic groups based on social composition, where deprived areas were characterized by low income, high unemployment, and low education. Health behavior and mental health were compared across socio-geographic groups using linear regression, contrasts and linear hypothesis tests. Results Citizens in less resourceful areas exhibit higher prevalence rates of daily smoking, physical inactivity, unhealthy diet, and obesity, alongside higher levels of perceived stress and depressive symptoms, as compared to citizens in more affluent areas. However, a higher proportion of individuals in affluent areas exceeded the Danish Health Authority's low-risk recommendations for alcohol consumption. Conclusions The health outcomes of citizens living in less resourceful areas are inferior to those of citizens in more affluent areas. Residents in less resourceful areas exhibit poorer health outcomes across health behaviors and mental health. Based on the study's findings, implementing health promotion initiatives at the local level and addressing the underlying social inequality through structural efforts are necessary. This could potentially help to reduce the disparities in health outcomes in citizens in less resourceful areas compared to those in more affluent areas. Key messages • Health outcomes of citizens in less resourceful areas are inferior to those living in affluent areas. • Local health promotion initiatives and structural efforts addressing social inequality is needed.

Diagnosis and treatment of breast cancer in Denmark during the COVID-19 pandemic: a nationwide population-based study

Background The COVID-19 pandemic was a global health crisis with population-wide behavioural restrictions imposed worldwide to reduce transmission of infection and to limit the potential burden on the healthcare systems. We examined whether there was any change in the diagnosis or treatment of breast cancer during the pandemic as compared to previous years. Material and Methods The study population comprised all women aged ≥18 years diagnosed with breast cancer in 2015-2021 with data obtained from the clinical quality registry of the Danish Breast Cancer Cooperative Group (DBCG). Data on socioeconomic factors were retrieved from Statistics Denmark. Prevalence ratios (PR) with 95% confidence intervals (CI) were estimated from a generalised linear model (GLM) with a log link for the Poisson family with robust standard errors (SE) of each outcome, using the COVID-19 pandemic period in Denmark as the exposure of interest. Results In total, 30,598 breast cancers were diagnosed during the study period. There was a small decrease (4.5%) in the total number of breast cancer cases in 2020 compared with previous years. During the pandemic, a lower proportion of the patients diagnosed with breast cancer had a short educational level (28.5 vs. 26.9%; PR = 0.91; 95% CI: 0.88–0.95), a low income (20.5 vs. 19.0%; PR = 0.90; 0.85-0.95) and fewer than expected in the age group 60-69 years (27.8 vs. 25.3; PR = 0.90; 0.86-0.94) were diagnosed, as compared with the pre-pandemic period. No difference in type of surgery or tumour size was observed. A higher proportion of patients received neo-adjuvant chemotherapy (49.0 vs 55.0%; PR = 1.15; 1.06–1.24), whereas a lower proportion received adjuvant chemotherapy (93.5 vs 85.6%; PR = 0.92; 0.90–0.93) during the pandemic, compared with the pre-pandemic period. Conclusions During the pandemic, a small decrease in the number of breast cancer diagnoses was observed particularly among socially disadvantaged groups. Overall, the quality of breast cancer treatment was maintained.

Development of geographic inequality in dental caries and its association with socioeconomic factors over an 18-year period in Denmark

BackgroundFew studies have examined the development of geographic and socioeconomic inequalities in caries over time or have simultaneously assessed individual-level socioeconomic position (SEP) and neighborhood-level factors as a multi-layered phenomenon influencing caries inequalities. This study examined (i) the trends in geographic inequalities in caries among adolescents in Denmark and (ii) how the association between SEP and caries has progressed over time, when accounting for individual and neighborhood-level confounding factors.MethodsThis nationwide repeated cross-sectional study included 15-year-olds in Denmark from 1995, 2003, and 2013 (n = 149,808). The outcome was caries experience (measured by the decayed, missing, and filled tooth surfaces [DMFS] index). The exposure of interest was SEP, indicated by the previous year’s parental education, occupational social class, and (equivalized) disposable household income. Covariates included individual-level factors (immigration status, country of origin, number of children and persons in the family, and household type) and neighborhood (residence municipality)-level factors (Gini index; proportion of unemployed, low-educated, and unmarried/non-cohabiting individuals; proportion of single-parent households and households with overcrowding). Data sources included the Danish national dental and administrative social registers and Statistics Denmark’s statistics database (StatBank). Data were analyzed using spatial and spatiotemporal modelling utilizing zero-inflated negative binomial regressions and integrated nested Laplace approximations for Bayesian parametric inference. Observed caries experience geo-maps of the Danish municipalities for 1995, 2003, and 2013 were created.ResultsBetween 1995 and 2013, caries prevalence in the 15-year-olds declined sharply (1995, 71%; 2013, 45%). Caries experience declined in nearly all socioeconomic subgroups and municipalities. However, geographic inequalities persisted with higher caries levels largely concentrated in the relatively deprived areas of Denmark. Increasing relative socioeconomic inequalities in caries over time were observed with significant graded associations between SEP and caries despite adjustment for the various individual and neighborhood-level covariates and the effect of assessment year (e.g., 15-year-olds with parents having basic education had 1.91-fold [95% CI: 1.86–1.95] higher caries experience than those having parents with high education).ConclusionsReducing these enduring inequalities will likely require additional resources and targeted supportive and preventive measures for adolescents from lower SEP backgrounds and those residing in municipalities with higher caries prevalence.

How much wood do we use and how do we use it? Estimating Danish wood flows, circularity, and cascading using national material flow accounts

Understanding how much wood we use and how we use it has important implications for forest management, economic policy, and climate action. While individual wood streams are documented by various sources, a comprehensive, economy-wide mapping of wood use has been lacking in Denmark.Our study set out to produce a comprehensive national wood flow analysis for all wood products, to include harvest, import, export, and domestic flows through the economy, as well as to assess the level of circular and cascading wood resource use. We used the Physical Supply-Use Tables compiled by Statistics Denmark in combination with other sources to construct wood flows in m3 solid wood equivalent (SWE), enabling comparison throughout the processing chain with the standing natural resource.We estimated total Danish use of wood fibre in 2018 to be around 17.7 million m3 SWE, of which more than 15 million m3 was used for energy production. Most wood used in Denmark is imported, with a net import of more than 11 million m3 SWE. Apart from energy use the domestic wood processing, construction, and furniture industries are the largest users.By using mass balancing principles, we identified significant undocumented flows of wood from nature to the economy which are currently used for energy purposes, representing more than 1 million m3 SWE per year from 2015 to 2021, and we estimated the output of secondary wood products from the wood industry to be around 400,000 m3 SWE in 2018.According to Eurostat's Circular Material Use rate indicator, 8.4% of wood used is recycled and reused domestically, though with imported wood for energy excluded, the rate would be higher, around 17.8%. The overall cascading factor for wood in the Danish economy was calculated to 1.44, indicating that wood is used almost one and a half times before oxidation or final consumption.Ongoing monitoring of Danish wood flows would permit further analysis of any changes in patterns of use and reuse, and our estimates of wood flows could likely be improved with investigation of currently undocumented streams and country specific conversion factors.

Socioeconomic factors and colorectal cancer incidence, stage and quality of care in Denmark during the COVID-19 pandemic

AimEfforts to control the COVID-19 pandemic might reduce accessibility for diagnostics and treatment of colorectal cancer. A universal public healthcare system may modify the availability of healthcare services. The aim of this study was to investigate changes in the quality of care for patients with colorectal cancer during the COVID-19 pandemic. MethodNationwide data from the Danish Colorectal Cancer database and Statistics Denmark on the number of new diagnoses, disease and health behaviour measures, socioeconomic measures, clinical quality measures and time to adjuvant chemotherapy were retrieved. Measures during the COVID-19 pandemic in 2020 and the different pandemic periods were compared to the pre-pandemic period. ResultIn 2020, 4035 patients were diagnosed with colorectal cancer, compared with 4346 in 2019 and 4496 in 2018. During the pandemic, patients were more likely to have UICC stage I disease (25.0% vs 23.4%; PR=1.07(95% confidence interval: 1.00;1.15)), belonging to the highest income quintile (PR=1.06(0.98;1.14), receive surgery with a curative aim (PR=1.02(1.01;1.03)), and to be operated on by a specialist (PR=1.07(1.06;1.08)), and less likely to be 60–69 years of age (PR=0.93(0.86;1.00)), non-western immigrants (PR=0.93(0.86;1.00)), diagnosed by screening (PR=0.79(0.73;0.86)) and receiving an acute operation (PR=0.77(0.66;0.91)). Furthermore, during the pandemic, 11.4% fewer patients waited 28 days or longer for initiation of adjuvant oncological treatment. ConclusionBased on nationwide data, we observed no major adverse effect on disease measures or clinical quality in a tax funded health care system. However, small changes in the socioeconomic composition of the patient population were observed.