Swedish Cause Of Death Register Research Articles

A hypothesis - generating Swedish extended national cross-sectional family study of multimorbidity severity and venous thromboembolism

ObjectivesVenous thromboembolism (VTE) is a common worldwide disease. The burden of multimorbidity, that is, two or more chronic diseases, has increased. Whether multimorbidity is associated with VTE risk remains to...

Mortality following proximal humerus fracture—a nationwide register study of 147,692 fracture patients in Sweden

SummaryLittle is known about survival after proximal humerus fracture. In this manuscript, we found the mortality to be high (almost four times higher than in age- and sex-matched controls). While frailty hip fracture has gained attention, we hope our manuscript will shed light on frailty proximal humerus fracture patients.IntroductionProximal humerus fractures (PHF) are common and occur mostly after the 6th decade of life. While mortality following PHF has been reported previously, mortality data after longer follow-up on a national level is lacking.MethodsWe obtained data from the Swedish Hospital Discharge Register (SHDR), on all adult patients (≥ 18 years) with a diagnosis of PHF (S42.2, S42.20, or S42.21) for the period between 2001 and 2016. We used the Swedish Cause of Death Register (SCDR) to investigate mortality in the fracture cohort. We compared the mortality of fracture patients with age- and sex-matched population-based mortality data obtained from Statistics Sweden.ResultsA total of 147 692 PHF patients were identified, with a male to female ratio of 1:3. The mean age was 69 years (range, 18 to 111). Most patients were treated non-surgically (n = 126,487, 86%). The crude mortality rate was 2.2% at 1 month, 4.1% at 3 months, 8.5% at 12 months, and 24% at 48 months after sustaining a PHF. Mortality increased with age; however, the standardized mortality rate (SMR) was highest among young patients. SMR was 5.4 in the 18- to 39-year age group, 3.9 in the 40- to 64-year age group, 1.8 in the 65–79-year age group, and 1.2 in the ≥ 80-year-old population. The age-adjusted SMR was 3.9 in the whole adult PHF population.ConclusionThe mortality rate and SMR suggest that PHF patients are heterogeneous. Some older PHF patients may benefit from specialized care (e.g., orthogeriatric), and this should be evaluated in future studies.

Association of life‐course traumatic brain injury with the risk of dementia: a nationwide twin study

AbstractBackgroundTraumatic brain injury (TBI) has been related to dementia, but the impact of life‐course TBI on dementia remains unclear. We aimed to examine the association between lifespan TBI and dementia, and to explore whether genetic and early‐life environmental factors contribute to this association.MethodWithin the Swedish Twin Registry,35,312 dementia‐free twins (mean age 62.78 years) were followed for up to 18 years.Life‐course TBI was assessed based on information from the SwedishNational Patient Registry (NPR) and participants were divided into five groups according to age at TBI occurrence (≤39, 40‐49, 50‐59, 60‐69, and ≥70 years). Dementia and cardiovascular disease (CVD, including heart disease and stroke) diagnoses were ascertained based on medical records in the NPR and the SwedishCause of Death Register. Data were analyzed using generalized estimating equation (GEE) and conditional logistic regression.ResultIn multi‐adjustedGEE model, the odds ratios (ORs, 95% confidence intervals [CIs]) of dementia were 1.29 (1.05–1.60) for TBI at any age, 1.01 (0.54–1.89)for TBI at ≤39 years, 1.11 (0.65–1.88) for TBI at 40‐49 years, 1.66 (1.13–2.45) for TBI at 50‐59 years, 1.84 (1.24–2.74) for TBI at 60‐69 years, and 0.86 (0.55–1.34) for TBI at ≥70 years, respectively. In the conditional logistic regression, the OR (95% CI) of dementia for TBI at any age was 1.59 (1.04–2.45). The difference in ORs from the two models was not statistically significant (P =0.40). In joint exposure analysis, the multi‐adjusted OR (95% CI) of dementia was 1.46 (1.04–2.04) for participants with TBI but no CVD and 2.64 (1.63–4.29) for those with both TBI and CVD (reference: absence of both TBI and CVD). There was significant additive (attributable proportion0.48, 95% CI 0.17–0.78) and multiplicative interactions (OR1.98, 95% CI 1.09–3.60) betweenTBI at 50‐69 years and CVD on dementia.ConclusionTBI, especially occurring at age 50‐69 years, is associated with increased risk of dementia, and the risk becomes greater in people with CVD.Genetic and early‐life environmental factors may not account for the TBI‐dementia association.

Health locus of control and mortality: a population-based prospective cohort study

ObjectivesThe objective of the study was to estimate associations between health locus of control (HLC) and mortality. Study design & methodsThe public health survey in Scania 2008 was linked to the Swedish cause of death register. In this study of 10,757 men and 12,322 women aged 18–80 years, 421 men and 235 women died during the 5.3-year follow-up. Survival analyses were conducted. ResultsRespondents with only some or no internal HLC had significantly higher hazard rate ratios (HRRs) compared with respondents with high HLC. For women, the HRRs of those with low HLC did not significantly differ from the reference group after final adjustments for health-related behaviours. ConclusionsHLC is a predictor of mortality, and this association is to an important extent mediated by health-related behaviours.

Marital status and 5-year mortality: A population-based prospective cohort study

ObjectivesThe aim was to investigate the association between baseline marital status and mortality using survival (Cox-regression) analysis. Study designThis is a prospective cohort study. MethodsThe public health survey by Scania in 2008 was linked to the Swedish cause of death register. This prospective cohort study includes 12,245 men and 14,969 women aged 18–80 years, and 538 men and 362 women of them died during the 5.3-year follow-up. ResultsUnmarried, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than married/cohabitating men. For women, the HRRs of these groups did not significantly differ from those of the married/cohabitating reference group. ConclusionsThe results are in accordance with a previous study that only compared those living alone with those cohabitating.

Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated.

Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden. We analysed individual-level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000 to 2014, and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years. Child deaths from all causes were 7914, and 2006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100 000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%). Childhood deaths showed a sustained decline from 2000 to 2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths.

Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: a population-based study

BackgroundWhether the suggested inverse association between total cholesterol and mortality in old age varies according to cause of death and use of cholesterol medications remains to be elucidated. The aim of this study was to assess the associations of total cholesterol with cardiovascular and non-cardiovascular mortality in old age, and to explore whether their associations vary by use of cholesterol-lowering medications.MethodsThe study participants included 3090 older adults (age ≥ 60 years, 63.7% women) from a population-based cohort study, i.e., the Swedish National study on Aging and Care in Kungsholmen, Stockholm. At baseline (2001–2004), data on demographic factors, lifestyles, cardiovascular risk factors, use of medications, global cognitive function, mobility limitation, and apolipoprotein E genotype were collected through interviews, clinical examinations, laboratory tests as well as from the Swedish national patient register. Vital statistics data (e.g., date and causes of death) till December 31, 2011 for all participants were derived from Swedish cause of death register. Data were analyzed using Cox proportional hazards model for all-cause mortality and Fine-Gray competing risks regression model for cause-specific mortality controlling for multiple potential confounders.ResultsDuring 23,196 person-years of follow-up (median per person, 7.5 years), 1059 (34.3%) participants died. Compared to normal total cholesterol (<5.18 mmol/l), borderline-high (5.18–6.21 mmol/l) and high (≥6.22 mmol/l) total cholesterol were associated with a decreased risk of all-cause mortality, with the multiple-adjusted hazard ratio (95% confidence interval, CI) of 0.71 (0.61–0.83) and 0.68 (0.57–0.80), respectively (P for trend <0.001). The competing risk regression models revealed that the reduced all-cause mortality associated with high total cholesterol (≥6.22 mmol/l)) was mainly due to the reduced risk of non-cardiovascular mortality (hazard ratio = 0.67, 95% CI = 0.51–0.88). These associations were statistically evident only among individuals without use of cholesterol-lowering medications.ConclusionsThe inverse association between high total cholesterol and reduced all-cause mortality in older adults is primarily due to non-cardiovascular mortality, especially among those who are not treated with cholesterol-lowering medications.

The Swedish cause of death register

Sweden has a long tradition of recording cause of death data. The Swedish cause of death register is a high quality virtually complete register of all deaths in Sweden since 1952. Although originally created for official statistics, it is a highly important data source for medical research since it can be linked to many other national registers, which contain data on social and health factors in the Swedish population. For the appropriate use of this register, it is fundamental to understand its origins and composition. In this paper we describe the origins and composition of the Swedish cause of death register, set out the key strengths and weaknesses of the register, and present the main causes of death across age groups and over time in Sweden. This paper provides a guide and reference to individuals and organisations interested in data from the Swedish cause of death register.

Mortality of subjects with mood disorders in the Lundby community cohort: A follow-up over 50 years

AimsTo compare causes of death and mortality among subjects with and without mood disorder in the Lundby Cohort and to analyse additional mental disorders as risk factors for mortality in subjects with mood disorders. BackgroundThe Lundby study is a longitudinal study that investigated mental health in an unselected population. The study commenced in 1947; the population was further investigated in 1957, 1972, and 1997. MethodsExperienced psychiatrists performed semi-structured diagnostic interviews, and best estimate consensus diagnoses of mental disorders were assessed at each field investigation. Subjects with mood disorder (n=508, 195 males, 313 females) were identified until 1997. Causes and dates of death between 1947 and 2011 were obtained from the Swedish cause of death register and were compared between subjects diagnosed with mood disorder and other participants.Mortality was compared between those with mood disorders and the remaining cohort with Cox regression analyses. Other mental disorders were considered as risk factors for death for subjects with mood disorders. ResultsThe hazard ratio for mortality in mood disorders was HR=1.18. However, the mortality was elevated only for males, HR=1.5. Comorbid anxiety disorders, organic disorders, dementia and psychotic disorders were significant risk factors for death. A total of 6.3% of the participants with mood disorder and 1.2% of the remaining participants committed suicide. ConclusionsAs expected, the suicide rate was higher among participants with mood disorders. Only males with mood disorders had elevated mortality. The impact on mortality from other mental disorders seems to vary between the genders.

Mortality of eating disorders: A follow‐up study of treatment in a specialist unit 1974–2000

To study excess mortality, causes of death, and co-morbidity in patients with eating disorder (ED), treated in a Swedish specialist facility. A retrospective cohort study of 201 patients with ED followed from 1974 to year 2001 in the Swedish Causes of Death Register (SCODR). Standardized mortality ratio (SMR) was calculated with respect to the Swedish population, by gender, age, and calendar time. In the complete follow-up of 201 patients, 23 had died. At a mean follow-up of 14.3 years the overall SMR was 10. Patients with body mass index (BMI) over 11.5 had an average SMR of about 7 and for those with BMI lower than 11.5 had SMR above 30. Six patients died from AN/starvation, nine due to suicide, and eight from other causes. SMR in anorexia nervosa (AN) is high but not in bulimia nervosa. A risk stratification of AN, based on BMI is suggested.

Apolipoprotein A1 Is a Stronger Prognostic Marker Than Are HDL and LDL Cholesterol for Cardiovascular Disease and Mortality in Elderly Men

The aim of this study was to compare apolipoprotein A1 (ApoA1) and B (ApoB) with high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) as markers for cardiovascular mortality and morbidity in elderly men. We analyzed serum ApoA1, ApoB, total cholesterol, HDL-C, and LDL-C in a group of 77-year-old men (n = 785). The results were correlated with data from the Swedish cause of death registry. Receiver-operating characteristic curves showed that, of the studied serum markers, ApoA1 was the best predictor for ischemic heart disease mortality (area under the curve = 0.724, 95% confidence interval, 0.691-0.755). There were also significant correlations between the apolipoproteins and other known risk markers for cardiovascular disease such as triglycerides, high-sensitivity C-reactive protein (hsCRP), and cystatin C. Serum ApoA1 is a better risk marker than are ApoB, ApoB/ApoA1 ratio, HDL-C, and LDL-C for cardiovascular disease and mortality in elderly men.

Smoking at age 18-20 and suicide during 26 years of follow-up-how can the association be explained?

Several studies have shown a relation between smoking and suicide. It is not clear if this relation should be considered causal, or if other risk factors for suicide, left unmeasured in many studies, might explain the smoking-suicide association. The aim of this cohort study was to analyse the role of smoking and other potential risk factors measured in adolescence on subsequent suicide. Information on smoking, and other potential risk factors from childhood and adolescence was collected among 49 323 men, born 1949-1951, at conscription for compulsory military training in the years 1969-1970. Mortality data were obtained from the Swedish cause of death register for the years 1971-1996. There was a clear trend of increasing suicide risk with increasing intensity of smoking reported at conscription. Those smoking >20 cigarettes/day had a strongly increased relative risk of suicide (OR = 3.03, 95% CI: 1.72, 5.34) during the first 13 years of follow-up. From 14 to 26 years after conscription, the risk was only slightly weaker (OR = 2.53, 95% CI: 1.36, 4.72). When we adjusted for other risk factors for suicide measured at the conscription examination (psychiatric diagnosis, parental divorce, low emotional control, medication for nervous problems, contact with police and childcare, heavy alcohol consumption, drug use, and education) in a multivariate analysis, the trend with smoking intensity disappeared, and there was no longer an increased relative risk for the heavy smokers (follow-up years 1-13: OR = 0.98, 95% CI: 0.53, 1.82; years 14-26: OR = 1.31, 95% CI: 0.91, 1.87). The increased risk of suicide among smokers was almost entirely explained by an increased prevalence of heavy alcohol consumption and low mental well-being among smokers. That is, the association between smoking and suicide is probably due to confounding by these other factors. These results do not support the hypothesis that tobacco consumption itself is a risk factor for suicide.

Mortality and cancer incidence in Swedish battery workers exposed to cadmium and nickel.

OBJECTIVE: To follow up cancer incidence and mortality in a group of Swedish battery workers exposed to nickel hydroxide and cadmium oxide. METHODS: 869 workers, employed at least one year...

Mortality from circulatory diseases, especially ischaemic heart disease in sea pilots and boatmen in Sweden 1951-84: a retrospective cohort study.

A cohort of 1455 sea pilots and boatmen employed after 1921 was established. Those identified and alive in 1951 (n = 1323) were linked to the Swedish cause of death register 1951-84. In 21 352 person-years 383 deaths were observed among sea pilots compared with 379.3 expected (SMR = 101;95% CI between 99 and 112) and in 12,127 person-years the observed number of deaths among boatmen was 136, expected 135.9 (SMR = 100) when Swedish men were used as a reference population. For ischaemic heart disease (IHD) (ICD-8: 410-414) the SMR was equal to 96 (obs = 131, exp = 137.2) for sea pilots and 91 (obs = 44, exp = 48.4) for boatmen. No trend over time or geographical differences could be observed. A healthy worker effect could not explain why there was no excess mortality from IHD.