Carl Johan Wingren

Cross-national comparisons of socioeconomic differences in the prevalence of leisure-time and occupational physical activity, and active commuting in six Asia-Pacific countries

Background This study describes physical activity patterns and their association with socioeconomic factors in six countries in the Asia-Pacific region, and examines whether physical activity associations with socioeconomic status follow similar patterns across the six countries. Methods Population-wide representative surveys of non-communicable disease risk factors and socioeconomic factors conducted in Australia, China, Fiji, Malaysia, Nauru and the Philippines between 2002 and 2006 were used. Survey respondents aged 18–64 years who provided information on their socioeconomic status (age, education, income, area of residence) and physical activity level in three domains (leisure-time, occupation, commuting) were included in the study (Australia N=15 786; China N=142 693; Fiji N=6763; Malaysia N=2572; Nauru N=2085; Philippines N=3307). Results Leisure-time physical activity increased with age in China, showed inverse associations for Fiji and Nauru men, and there were no age relationships in other countries. Individuals in China, Fiji and Malaysia living in urban areas, with higher educational attainment and affluence were physically active during leisure time but less active at work and during commuting compared to those in rural areas, with lower educational attainment and lower income. Conclusion There is a link between types of physical activity participation and socioeconomic factors in developing countries. Associations with socioeconomic indicators are likely to reflect economic growth. The findings strongly support the need for a comparable non-communicable risk factors surveillance system in developing countries.

Coeliac disease in children: a social epidemiological study in Sweden

Aim:  Little is known on the possible existence of socioeconomic and geographical differences in early coeliac disease (CD) risk. Therefore, we investigated these aspects in children before age two.

Perinatal risk factors increase the risk of being affected by both type 1 diabetes and celiac disease.

This study investigated whether perinatal factors influenced the risk of a double diagnosis of type 1 diabetes and coeliac disease.

Sex differences in coeliac disease risk: A Swedish sibling design study.

BACKGROUND For unknown reasons girls are at an increased risk of coeliac disease compared to boys. However, the observed association might be confounded, since maternal coeliac disease is associated with both an increased risk of the disease in first-degree relatives as well as an increased ratio of girls to boys in offspring. AIMS We investigate the effect of sex on the risk of coeliac disease before the age of two years using sibling design. METHODS We identified all singleton children (n=792,401) born between 1987 and 1993 in Sweden using the Swedish Medical Birth Registry. Coeliac disease cases (2264) were identified using the Swedish National Inpatient Registry. We applied both conventional population-based Cox regression models and sibling designs modelling the association in sex discordant siblings. RESULTS We observed a conclusively increased risk of coeliac disease in girls compared to boys, using both sibling design (hazard ratio 1.67, 95% confidence interval 1.44-1.93) and conventional Cox regression analysis (hazard ratio 1.75, 95% confidence interval 1.61-1.91) that could not be explained by perinatal factors previously associated with the disease. CONCLUSIONS We confirm that female sex is causally associated with childhood coeliac disease, but the reasons remains unknown.

Revisiting the risk of celiac disease in children born small for gestational age: A sibling design perspective.

Abstract Objective. An association between small for gestational age (SGA) and risk for celiac disease (CD) in childhood has previously been reported. However, this association may reflect residual confounding by genetic or environmental factors. For example, presence of subclinical CD in the mother might be a common cause of both SGA and CD in the offspring. We investigate whether SGA is causally associated with CD before age six years by applying both conventional population-based regression models and sibling analysis that investigates the association in siblings discordant for SGA. Material and methods. Using the Swedish Medical Birth Registry, we identified all singleton children born in Sweden during 1987–1993 (792,401). Of these we included 681,954 children in the study and identified 2641 cases of CD using the Swedish National In-Hospital Registry. We applied both conventional Cox regression analysis and a quasi-experimental sibling design that to some extent simulates a counterfactual situation of exposure, reducing possible confounding effects of genetic and shared environmental factors. Results. We identified an increased risk of CD in both boys (hazard ratio (HR) 1.70, 95% confidence interval (CI) 1.25–2.32) and girls (HR 1.30, 95% CI 0.99–1.70) using conventional Cox regression models. Using sibling analysis, the association between SGA and CD was confirmed in boys (HR 4.23, 95% CI 1.19–15.04) but not in girls (HR 1.00, 95% CI 0.45–2.20). Conclusions. Our results support a causal association between SGA and CD risk in boys but not in girls, although the mechanisms underlying this difference are still unclear.

Analysis of pre-hospital rescue times on mortality in trauma patients in a Scandinavian urban setting

Objective To analyze if pre-hospital rescue times were associated with mortality in a trauma cohort arriving by ambulance to hospital in a Scandinavian urban setting. Methods Between 2011 and 2013, individuals and pre-hospital rescue times were identified in Emergency Medical Dispatcher Centre, hospital, and forensic records in red alarm trauma. Major trauma was defined as a New Injury Severity Score (NISS)>15. Results Overall, 89% of 378 trauma patients received hospital care within 60 min; 51% had a response time of ≤8 min, and 95% had response time within ≤20 min. The on-scene time (p < 0.05) and total pre-hospital time (p < 0.05) were longer for patients ≥65 years, in comparison with patients <65 years. The patients with penetrating trauma had shorter on-scene time (p < 0.01), total pre-hospital time (p < 0.01), and shorter transport distance from trauma scene to hospital (p = 0.004), compared to those with blunt trauma. Patients with NISS > 15 were found to have the same pre-hospital rescue times as those with NISS ≤ 15. There was a trend that the occurrence of gunshots was associated with increased mortality (p = 0.074). When entering age, NISS, penetrating versus blunt injury, response time, and on-scene time in a multivariate regression analysis, age (p < 0.001), NISS (p < 0.001), and penetrating injury (p = 0.009) remained as independent factors associated with mortality and a trend for shorter on-scene time (p = 0.093). Conclusions Pre-hospital rescue times had less impact on mortality than injury severity, age, and penetrating trauma. Even though penetrating traumas were associated with shorter on-scene time and shorter transport distance to hospital, mortality was increased in this Scandinavian urban setting.

Postmortem heart weight modelled using piecewise linear regression in 27,645 medicolegal autopsy cases

The interpretation of postmortem heart weight is often difficult, and references for normal heart weight are important. However, to assess the cause of death at a medicolegal autopsy it is also important to have references based on an unselected population of medicolegal autopsy cases with non-natural causes of death (not due directly to disease). We aimed at studying and deriving references for adult heart weight by considering sex, age and body size in cases with an external cause of death. We identified all medicolegal autopsies in Sweden from 1999 to 2013 (n=79,778) and included 27,645 cases. We applied multivariate piecewise linear regression models in three strata of body mass-underweight, normal-/overweight and obesity. We observed that approximately 50% of the variation in heart weight was explained by age, sex and body size. These variables were slightly less important in explaining the variation in heart weight in the underweight and obese compared to in those normal or overweight. Based on the linear regression models we present equations to calculate the predicted heart weight with reference intervals using age, sex, body weight and height. We provide an online heart weight calculator (http://lundforensicmedicine.com) based on these equations. In the forensic interpretation of postmortem heart weights, we suggest that heart weight references derived in cases with an external cause of death is an important complement to references solely based on healthy and normal hearts. Furthermore, the heart weight references presented are derived from a large population, with sufficient numbers for separate models in underweight, normal-/overweight and obese populations.

Congenital Anomalies and Childhood Celiac Disease: A Swedish Register-based Study.

ABSTRACT Previously, chromosomal anomalies and, to a lesser extent, other congenital anomalies have been associated with an increased risk of celiac disease (CD). We investigated these associations using a systematic approach. We identified all of the singleton children (792,401) born in Sweden between 1987 and 1993, and obtained cases of CD using the Swedish National Inpatient Registry. We applied Cox regression models as well as sibling designs to study the association between congenital anomalies and childhood CD. We observed that anomalies of face, neck, ear, heart, digestive tract, or chromosomes were associated with CD.

The association between obesity and lethal blood alcohol concentrations: A nationwide register-based study of medicolegal autopsy cases in Sweden.

Obesity is a global problem and in aspects of lethal ethanol intoxications virtually unexplored. The cause of death in ethanol intoxication is generally considered to be suppression of the respiratory function. Previous research indicates that respiratory function is more vulnerable in obese subjects than in those of normal weight. We hypothesized that lethal blood alcohol concentration (BAC) is lower in obese subjects compared to those of normal weight. We used the Swedish medicolegal autopsy register and identified all medicolegal autopsy cases in Sweden during the period from 1999 to 2013 (N=79,060), and identified 1545 cases with ethanol intoxication identified as the primary cause of death. We studied the association between body mass index and lethal BAC using logistic regression models that we adjusted using several potential confounders such as age, sex, drugs, and extent of decomposition. We observed an association between obesity and lower lethal BACs. The estimated adjusted odds ratio of the association between obesity and a lethal BAC >3‰, using subjects of normal weight as reference, was 0.54, 95% confidence interval: 0.39-0.74. The result indicates that in obese subjects the lethal BAC is lower than in those of normal weight.

Socio-economic status and major trauma in a Scandinavian urban city: A population-based case-control study:

Aims: Epidemiological studies of patients with major trauma, including both hospitalized and immediately deceased whom are undergoing medico-legal autopsy, are very rare. We studied the incidence and mortality of major trauma in all 10 districts in the Scandinavian city of Malmö, Sweden, and the association between socio-economic status and major trauma. Methods: Major trauma was defined as a New Injury Severity Score > 15, or a lethal outcome due to trauma. Cases with a registration address in Malmö between 1 January 2011 and 31 December 2013 were identified from the red trauma alarm list in the hospital and the autopsy register in the Forensic Department. Statistics Sweden matched each case with four randomly selected age-, gender- and district-matched controls. Social assistance within the household, level of education, income and capital income were compared. Results: We identified 117 cases (80 men and 37 women) with a median age of 48.0 years (IQR 28.5–65.0). The incidence of major trauma in Malmö was 12.7 (95% CI 10.4–15.0) per 100,000 person-years; and 69 died due to major trauma, with 8.4 (95% CI 6.4–10.4) per 1000 deaths. Lower income (p = 0.024), no income (OR 1.6; 95% CI 1.0–2.4; p = 0.037) and social assistance (OR 2.3; 95% CI 1.3–4.1; p = 0.003) were associated with major trauma. The level of education was not found to be related to major trauma (p = 0.47). Conclusions: Low income and social assistance within the household were associated with major trauma in the city of Malmö, but not the level of education; in this age-, gender- and district-matched case-control study of major trauma.