John Carstensen

Mortality in relation to cigarette and pipe smoking: 16 years' observation of 25,000 Swedish men.

In a random sample of 25,129 Swedish men who responded to a questionnaire on smoking habits in 1963 the cause specific mortality was followed through 1979. In the cohort, 32% smoked cigarettes, 27% a pipe, and 5% cigars. There were clear covariations (p less than 0.001) between the amount of tobacco smoked and the risk of death due to cancer of the oral cavity and larynx, oesophagus, liver, pancreas, lung, and bladder as well as due to bronchitis and emphysema, ischaemic heart disease, aortic aneurysm, and peptic ulcer. Pipe smokers showed similar risk levels to cigarette smokers. There was a close to linear increase in lung cancer risk in relation to the amount of tobacco smoked for cigarette, pipe, and cigar smokers, respectively. An increasing risk of ischaemic heart disease with amount smoked was seen among both cigarette and pipe smokers. A similar fraction of inhalers in Swedish cigarette and pipe smokers may explain the similarity in risks.

c-erbB-2 expression and benefit from adjuvant chemotherapy and radiotherapy of breast cancer

Frozen tissue from primary tumours of 152 premenopausal breast cancer patients, who participated in a trial comparing radiotherapy with adjuvant chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil, CMF), was analysed for c-erbB-2 protein expression, measured by flow cytometry. The relative risk of distant recurrence or death in the chemotherapy group as compared with the radiotherapy group was 3.0 (95% confidence interval (CI) 1.1-7.8) for patients whose tumours showed high c-erbB-2 levels and 0.87 (95% CI 0.43-1.7) for those with tumours with low levels of c-erbB-2 protein. Patients with highly proliferative tumours that did not overexpress c-erbB-2 benefited most, in terms of survival, from CMF. In addition, we found an increased risk of locoregional recurrence for tumours overexpressing c-erbB-2 when radiotherapy was replaced by chemotherapy.

BREAST CANCER RISK IN RELATION TO SERUM CHOLESTEROL, SERUM BETA-LIPOPROTEIN, HEIGHT, WEIGHT, AND BLOOD PRESSURE

The relation between breast cancer risk and serum levels of cholesterol and beta-lipoprotein (BLP), height, weight, Quetelets index and blood pressure was studied in a cohort of 46,570 Swedish women less than 75 years of age. The cohort was examined between 1963 and 1965 and followed up in the Swedish Cancer Registry until 1983. During this period 1,182 cases of breast cancer were reported. Of those, 196 were reported among women less than 50 years of age. Statistically significant positive associations were observed between height, weight, and systolic blood pressure and breast cancer risk. No clear trend in cancer risk related to serum cholesterol or BLP was seen in the total material. In a stepwise Cox multiple regression analysis only the associations with height and blood pressure remained significant. Among women, having their cancer diagnosed before the age of 50, higher Quetelets index was associated with a lower cancer risk, whereas a positive correlation was seen among women greater than or equal to 50 years. In the group of younger women a high BLP level was associated with an increased risk of breast cancer. This relation became even stronger when studied in a multivariate analysis, which also showed a negative correlation between serum cholesterol and cancer risk.

Malnutrition in a home-living older population : prevalence, incidence and risk factors. A prospective study

AIMS AND OBJECTIVES To prospectively investigate and describe the prevalence and incidence of malnutrition among home-living older people, related to demographic and medical factors, self-perceived health and health-related quality of life. Another aim was to find predictors for developing risk of malnutrition. BACKGROUND Risk factors for malnutrition have previously been identified as diseases, several medications, low functional status, symptoms of depression and inadequate nutrient intake. Most studies are cross-sectionally performed at hospitals or in nursing care settings. DESIGN A prospective study with a sample of 579 home-living older people, randomly selected from a local national register. Examinations were performed at baseline and yearly follow-ups two to four times. METHOD Questionnaires validated and tested for reliability, to detect risk of malnutrition (Mini Nutritional Assessment), symptoms of depression (Geriatric Depression Scale-20), cognitive function (Mini Mental State Examination), health-related quality of life (Nottingham Health Profile), well-being (Philadelphia Geriatric Center Multilevel Assessment Instrument) self-perceived health, demographic factors, anthropometry and biochemical examinations. Predictors were searched for through multiple logistic regression analysis with the MNA as dependent factor. RESULTS The prevalence of risk for malnutrition was 14.5%, according to the MNA. Two risk factors for malnutrition were lower handgrip strength and lower self-perceived health. The incidence of risk for malnutrition at follow-ups was between 7.6% and 16.2%. Predictors for developing malnutrition were higher age, lower self-perceived health and more symptoms of depression. Men with symptoms of depression had a higher risk of developing malnutrition. CONCLUSION Lower self-perceived health had the highest power to predict risk for malnutrition, with increased number of depression symptoms and higher age as second and third predictors. RELEVANCE TO CLINICAL PRACTICE A regular and combined assessment using the Mini Nutrition Assessment, Geriatric Depression Scale-20 and self-perceived health as a base for identifying people in need, is one way to prevent the development of malnutrition.

Prognostic factors in thin cutaneous malignant melanoma

Background. Thin melanomas can metastasize and be lethal. The predictive importance of tumor thickness in thin melanomas and the specific features identifying the patients at risk have not been investigated fully.

Estimating disease prevalence using a population-based administrative healthcare database

Aims: In Östergötland County, Sweden, all data on hospital care and primary healthcare (PHC) have been entered in a diagnosis-related administrative database since 1999. This database was used to estimate the prevalence of four chronic diseases and to examine the capture of data in PHC, outpatient hospital care, and inpatient hospital care, considered in different time frames. Methods: A case-finding algorithm identified patients with at least one healthcare contact involving a diagnosis of diabetes, hypertension, asthma, or chronic obstructive pulmonary disease (COPD) in 1999—2003. Prevalence rates were calculated as the ratio of the number of identified patients alive to the total number of inhabitants on 31 December 2003 (n~415,000). Results: Prevalence rates were 4.4% for diabetes, 10.3% for hypertension, 4.5% for asthma, and 1.2% for COPD. For all four diagnoses, the proportions of patients identified on only one healthcare level were greatest for PHC, reaching rates of 23%, 68%, 53%, and 48%, respectively. The cases identified solely in PHC comprised larger proportions of women and patients over the age of 65 years. Considering the proportion of patients identified in 2003 in relation to the total five-year period gave values of 71%, 50%, 38%, and 58%, respectively, for the four diagnoses. Conclusions: The administrative healthcare databases in Sweden today can be important tools in epidemiological research. However, data on several consecutive years and both PHC and hospital data are needed to achieve valid prevalence estimates.

Risk factors for disability pension in a population-based cohort of men and women on long-term sick leave in Sweden

BACKGROUND Knowledge on predictors of disability pension is very limited. The aim was to assess the importance of sick-leave diagnosis and socio-demographic variables as risk factors for disability pension among individuals on long-term sickness absence and to compare these factors by gender and over time. METHODS A prospective population-based cohort study in Ostergötland County, Sweden, included 19,379 individuals who, in 1985-87, were aged 16-60 years and had a new spell of long-term sickness absence lasting > or =56 days. Follow-up was done in two time frames: 0-5 and 6-10 years after inclusion. The risk of disability pension in relation to sick-leave diagnosis and socio-demographic factors was assessed by Cox proportional hazard regression analysis. RESULTS In 5 years, after inclusion, 28% of the cohort had been granted disability pension. Those with higher age, low income, previous sick leave, no employment and non-Swedish origin had higher risk of disability pension, while those with young children had lower risk. Considering the inclusion diagnosis, the pattern differed between men and women (P < 0.001). Among men, those with mental disorders had the highest risk and among women those with musculoskeletal disorders. Except for income, the effect of which was reversed over time, the overall pattern of disability pension predictors remained 6-10 years after inclusion but was attenuated. CONCLUSION Besides socio-demographic risk factors, the sick-leave diagnoses constitute an important both medium and long-term predictor of disability pension among both men and women on long-term sickness absence.

Cancer incidence in female smokers: A 26-year follow-up

A random sample of 26,000 Swedish women who were asked about their smoking habits in the early 1960s have now been followed for 26 years with respect to cancer incidence. Most findings regarding tobacco smoking and cancer from studies of men were confirmed also among the women. Elevated relative risk for current smokers compared with women who never smoked regularly were seen for cancers of the lung, upper aerodigestive sites, pancreas, bladder, cervix and all cancers combined, as well as a notably high relative risk for cancers of organs of the urinary tract other than kidney and bladder. Relative risk increased with dose, measured as grams of tobacco smoked per day, for cancers of the upper aerodigestive sites, lung, cervix, bladder, organs of the urinary tract other than kidney and bladder and all cancers combined. For cancers of the lung, bladder and cervix, there was an inverse relationship with age when starting to smoke tobacco. The reported inverse relationship between smoking and endometrial cancer could not be corroborated, nor was there any significant relationship between smoking and colorectal or breast cancer. Int. J. Cancer73:625–628.

Risks of cancer of the colon and rectum in relation to serum cholesterol and beta-lipoprotein.

We studied the risk of colorectal cancer in relation to serum cholesterol and beta-lipoprotein in more than 92,000 Swedish subjects less than 75 years old. The cohort was examined between 1963 and 1965 and followed by means of the Swedish Cancer Register until 1979. During this period, 528 colon cancers and 311 rectal cancers developed. A positive association was observed between the serum cholesterol level and the risk of rectal cancer among men (P less than 0.05), with a relative risk of 1.65 in men with levels greater than or equal to 276 mg per deciliter (7.1 mmol per liter). An association was also observed between the serum beta-lipoprotein level and the risk of rectal cancer among men (P less than 0.05). When cholesterol and beta-lipoprotein levels were considered together, they were associated with both rectal and colon cancer in men. The relative risk in men with both cholesterol greater than or equal to 250 mg per deciliter (6.5 mmol per liter) and beta-lipoprotein greater than or equal to 12 units (2.2 g per liter) was 1.62 for colon cancer (95 percent confidence interval, 1.18 to 2.22) and 1.70 for rectal cancer (1.18 to 2.44). Similar trends were observed in women, although they were not statistically significant.

Intergenerational effects of preterm birth and reduced intrauterine growth: a population‐based study of Swedish mother–offspring pairs

Objective  To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.