Finn Gjertsen

Sudden death in sports among young adults in Norway.

Aim The aim of the study was to explore sudden cardiac death during physical activity in young adults in Norway. Materials and methods This retrospective study examined adults aged 15-34 years during the period 1990-1997. The Cause of Death Registry was used to identify cases of sudden cardiac death in sports. These cases were validated with information from medical records and autopsy reports. Results Twenty-three sports-related sudden deaths (22 men), mean age 27 years (17-34 years), were identified. Causes of death were myocardial infarction (11), myocarditis (5), conduction abnormalities (2), aortic stenosis (1), cardiac rupture (1), hypertrophic obstructive cardiomyopathy (1), congenital coronary anomaly (1), and coronary sclerosis without defined infarction (1). The deaths were distributed across different types of sports activities. The incidence of deaths among physically active young men was 0.9 per 100 000. Conclusion The number of myocardial infarctions is higher than expected. The incidence is similar to that found in other studies. A vast majority of the cases of death were men. Eur J Cardiovasc Prev Rehabil 17:337-341

Mixed Impact of Firearms Restrictions on Fatal Firearm Injuries in Males: A National Observational Study

Introduction: Public health organizations have recommended restricted access and safe storage practices as means to reduce firearm injuries and deaths. We aimed to assess the effect of four firearm restrictions on firearm deaths in Norway 1969–2009. Methods: All deaths due to firearm discharge were included (5,660 deaths, both sexes). The statistical analysis to assess impact of firearm legislations was restricted to males because of the sex disproportionality (94% were males). Results: A total of 89% of firearm deaths (both sexes) were classified as suicide, 8% as homicide, and 3% as unintentional (accident). During the past four decades, male accidental firearm death rates were reduced significantly by 90%. Male firearms suicide rates increased from 1969 to 1991 by 166%, and decreased by 62% from 1991 to 2009. Despite the great reduction in male accidental firearm deaths, we were unable to demonstrate effects of the laws. In contrast, we found that a 1990 regulation, requiring a police permit before acquiring a shotgun, had a beneficial impact on suicide in the total sample and in those aged 15–34 years. Male firearm homicides decreased post-2003 regulation regarding storing home guard weapons in private homes. Conclusions: Our findings suggest that two laws could have contributed to reduce male firearm mortality. It is, however, a challenge to measure the role of four firearm restrictions. The null findings are inconclusive, as they may reflect no true impact or study limitations.

Comparing ICD-9 and ICD-10: The impact on intentional and unintentional injury mortality statistics in Italy and Norway

BACKGROUND The international classification of diseases (ICD) provides guidelines for the collection, classification and dissemination of official cause-of-death statistics. New revisions of the ICD can potentially disrupt time trends of cause-of-death statistics and affect between-country comparisons. The aim of this study was to measure how switching from ICD-9 to ICD-10 affected mortality statistics for external causes of death, i.e. intentional and unintentional injuries, in Italy and Norway. METHODS A sample of death certificates (N=454,897) were selected in Italy from the first year the ICD-10 was implemented (2003) and reclassified from ICD-10 to ICD-9 by the Italian National Institute of Statistics. A sample of death certificates was also selected in Norway (N=10,706) from the last year the ICD-9 was used (1995) and reclassified according to ICD-10 by Statistics Norway. The reclassification (double-coding) was performed by special trained personal in governmental offices responsible for official mortality statistics. Although the reclassification covered all causes of death (diseases and injuries) in the sample, our analysis focused on just one ICD chapter XX. This was external causes of mortality (injury deaths), and covered 15 selected categories of injuries. RESULTS The switch from ICD-9 to ICD-10 had a significant net impact on 8 of the 15 selected categories. In Italy, accidental falls decreased by 76%; traffic accidents decreased by 9%; suicide by hanging decreased by 3%; events of undetermined intent decreased by 69%; and overall injury deaths decreased by 4%. These net decreases reflect the moving of death records from injury categories in ICD-9 to other injury or disease categories in ICD-10. In Norway, the number of records in three categories decreased significantly: transport accidents, 9%; traffic accidents, 13%; and suicide by self-poisoning, 18%. No statistically significant differences (net changes) were observed in the total number of accidents, suicides and homicides in either country. CONCLUSIONS Switching to ICD-10 did not change the overall trends for accidents, homicides and suicides in either country. However, the number of records in some injury subcategories e.g. accidental falls and traffic accidents, decreased. Changing classification can thus affect the ranking of causes of injury mortality, with consequences for public health policy.

Mortality due to occupational injury is underreported

BACKGROUND The Norwegian Labour Inspection Authority records fatal occupational injuries in mainland bases activities, i.e. all sectors except offshore, aviation, shipping, hunting and fishing; the Registrys information on these injuries has been considered complete. The present study aimed at testing this assumption. MATERIAL AND METHODS In 2000 - 03, the Labour Inspection Authority recorded 183 fatal occupational injuries; 171 of the deceased were residents in Norway. Each of these deaths were compared with fatal occupational injuries in the Norwegian Cause of Death Registry. A capture-recapture model was used to estimate the real number of fatal occupational injuries. RESULTS In 2000 - 03, 214 fatal occupational injuries were recorded among residents in Norway employed in all sectors (except offshore, aviation, shipping, hunting and fishing) in at least one of the two registries (98 cases were reported in both registries). The Norwegian Labour Inspection Authority mainly lacked information about (in comparison with the Death Registry) deaths in the military (1 of 9), in the health and social services (3 of 7), road traffic accidents (36 of 52) and deaths in Northern Norway/Spitsbergen (17 of 28). One third of all recorded cases (77 of 214) were caused by transport accidents. Risk by industry (deaths per 100 million work hours) was highest for primary industries (7.0) and for <<transport and communication>> (4.1). The real number of fatal injuries was estimated to 246, or 44 % more than the 171 deaths registered by the Labour Inspection Authority. INTERPRETATION Fatal occupational injuries are much more frequent than reported in the official registries. Underreporting, particularly of road traffic accidents/transport accidents, may lead to misinterpretation of risks and time trends and of need for preventive action.

Cause-specific mortality and cancer morbidity in 390 male workers exposed to high purity talc, a six-decade follow-up

BACKGROUND This study updates information on mortality and cancer morbidity in a cohort of Norwegian talc workers. METHODS Follow-up was extended with 24 years, covering 1953-2011. Comparisons were made with the general population and between subgroups within the cohort. RESULTS Standardized mortality ratio for non-malignant respiratory disease (NMRD) was 0.38 (95%CI: 0.18, 0.69) and for diseases of the circulatory system (CVD) 0.98 (95%CI: 0.82, 1.16). A non-significantly increased NMRD risk was observed at high dust exposures. There were no deaths from pneumoconiosis. CONCLUSIONS With the clear limitations of a small cohort, our results do hint at an effect of talc dust on mortality from NMRD other than pneumoconiosis, covered by a strong and persisting healthy worker effect. Also, an effect on CVD mortality, masked by a healthy worker selection into the cohort cannot be ruled out. Excess mortality from pneumoconiosis seen in other studies, may reflect exposure to quartz and, possibly, bias due to comparability problems.

Deaths by poisoning in Norway 2003-2012.

ABSTRACT Context: Poisoning is an important category of avoidable deaths in Norway and an important public health issue. Close monitoring of any development in this field is essential for effective preventive measures. Objective: To assess the pattern and trends of poisoning mortality in Norway from 2003 to 2012 based on official mortality data. Materials and methods: This is a population-based registry study. We analyzed the underlying external cause of death data, in order to assess poisoning deaths (ICD-10) by accidents (X40-X49); intentional self-harm (suicide) (X60-X69); assault (homicide) (X85-X90); and poisoning of undetermined intent (Y10-Y19). We compared poisoning deaths to other injury mechanisms and used multiple injury cause data to identify substances involved in poisoning deaths. Poisson regression was applied to estimate the trend. Results: Poisoning was the second leading mechanism of injury deaths in Norway from 2003 to 2012, causing between 424 and 496 deaths each year. The rates of poisoning deaths varied between 8 and 11 per 100,000 inhabitants, with a peak in 2004. About 3366 of the 4620 poisoning deaths in the decade were accidental. Opioids were the most common causative agents. Heroin caused 150 deaths in 2004. The numbers fell to 63 in 2012 but showed great yearly variations. Deaths by methadone increased from 24 in 2003 to 61 in 2012. Discussion: Poisoning mortality rates declined from 2003 to 2012. Interpretation of the data, however, should be done with caution, and comparison with other countries may be biased due to differences in data production procedures. Evaluation of the effect of preventive measures to reduce mortality should be emphasized. Conclusion: Poisonings remain a significant cause of mortality by injury in Norway. Emphasis should be placed on following the trends closely, especially regarding methadone deaths.

475 Fatal occupational injuries in Norway: surveillance data are biassed and underestimated risk

Background The Norwegian Labour Inspection Authority (NLIA) compiles and publishes statistics on fatal occupational injuries. Other institutions also register such information on a national level: Statistics Norway (SN) (from Cause of Death Registry (CDR), recently transferred to the Norwegian Institute of Public Health), the National Insurance Administration (NIA) and Finance Norway (FN) (from private insurance companies). The aim of this study was to examine completeness and quality of NLIA statistics, and see if use of additional sources could improve surveillance of risk. Methods Residents in Norway have a unique personal identification numbers. This was used to compare cases of death from occupational injuries 2000–2003 registered in NLIA, NIA and FN – with information in CDR. Results NLIA had registered 171 deaths from occupational injuries 2000–2003. 75 more deaths were identified from the three other sources. Of all the 246 deaths, NLIA had information on 171 (70%), NIA 158 (64%), SN 141 (57%) and FN 50 (20%). NLIA was most complete, but completeness varied between industries, from 24% for Public administration and defence, compulsory social security to 81% for Construction (Standard Industrial Classification (SIC2002)). Completeness also varied according to external cause of death, and was particularily low (32%) for transport accidents with car (ICD-10 V4). All 246 deaths were found in CDR, but due to incomplete information in death certificates, only 57% were identified as occupational injuries. Conclusions The NLIA registry was most complete, but biassed, and grossly underestimated risk in some subgroups. Administrative changes could improve completeness and quality and make it a better tool for surveillance of risk. The CDR is potentially the most complete source of information. If death certificates for accidental deaths have incomplete data, the certifier could more often be asked to provide missing information. Validation by casewise comparison between NLIA and CDR with regular intervals is recommended.

Fatal occupational injuries are underreported in Norway

Objectives The Norwegian Labour Inspection Authority records fatal occupational injuries in all sectors (except offshore, aviation, shipping and fishing). For 2000–03 the Labour Inspection Authority recorded 171 fatal occupational injuries where the deceased were residents in Norway. The aim of the study was to examine the quality and completeness of the record. Methods Each of the deaths was compared with fatal occupational injuries recorded by the national Cause of Death Registry by means of the unique personal identification number. Widows, widowers and children are covered by social insurance and a particular private insurance scheme. Individual comparison was carried out with cases recorded by the National Social Insurance Administration and/or the joint registry of private insurance companies. Results The total number identified from comparison with the Death Registry was 214. The Labour Inspection Authority mainly lacked information about road traffic accidents. The true number of deaths estimated on the basis of these two sources by a capture-recapture model was 246, or 44% more than the 171 deaths registered by the Labour Inspection Authority. Comparison with the two insurance sources identified 38 additional deaths bringing the total number of deaths to 252. Only 129 (51%) were recorded as occupational injuries by the National Social Insurance and/or by private insurance companies. Conclusions Use of several sources improve completeness in registration of fatal occupational injuries, and misinterpretation of risk can be avoided. Many bereaved families may not receive the compensation they are entitled to.

Fatal occupational injuries underreported in Norway

Background 2/3 of all fatal occupational injuries (OI) in Norway are recorded by the Norwegian Labour Inspection Authority (NLIA). The other 1/3 is recorded by authorities of oil production, shipping, fishing and aviation. The register at NLIA has been regarded as being complete. The validity of this statement was studied. Material and method 183 fatal OI for 2000–2003 were found at NLIA, 171 related to persons resident in Norway. The records of these were found in the national death register (NDR) by the unique personal number. In addition 43 fatal OI within the sphere of authority of NLIA were identified in NDR. The real number of fatal OI was estimated by a capture-recapture model. Results 214 fatal OI were identified, 98 in both registers. Missing injuries in NLIA were related to national defence (1 of 9), health and social services (3 of 7), road traffic injuries (36 of 52), fatalities occurring in North of Norway and Spitsbergen (17 of 28). The highest risks for fatal injury (per 100 million working hours) were found in agriculture and forestry (7.0), and in transport and communication (4.1). The number of fatal OI to should have been recorded by NLIA was found to be 246. Conclusion The risk for a fatal OI in Norway seems to be 44% higher than shown in official statistics. Insufficient registration, especially of transport injuries, might result in misjudgements of size and trends of the occupational injury problem, and the need for prevention.