Karin Modig

Age-Specific Trends in Morbidity, Mortality and Case-Fatality from Cardiovascular Disease, Myocardial Infarction and Stroke in Advanced Age: Evaluation in the Swedish Population

Background It is not clear if the downward trend in cardiovascular disease (CVD) observed for ages up to 85 years can be extended to the oldest old, those 85 years and above. Methods and Findings This nationwide cohort study presents age specific trends of CVD as well as for myocardial infarction (MI) and stroke separately for the period 1994 to 2010 for individuals 85 to 99 years old in Sweden. Data were extracted from national registries. All analyses were based on one-year age- and sex- specific figures. The risk for CVD increased with every age above 85 years although the rate of increase leveled off with age. Over time, the risk for CVD and MI decreased for all ages, and for stroke for ages up to 89 years. However, the risk of MI increased until around 2001 in all age groups and both sexes but decreased after that. The overall mortality improved for all outcomes over the period 1994 to 2010, so did the survival within 28 days from an event. The average annual decline in mortality over all ages, 85 and above was 3% for MI, 2% for stroke and for 2% CVD. Corresponding figures for ages 60–84 was 4% for each of MI, stroke and CVD. The results were similar for men and women. Conclusions Improvements in CVD risks observed among ages up to 85 years appear to have extended also to ages above 85 years, even if the rate of improvement plateaued with age. The improvements in survival for all ages up to 99 years give no support to the hypothesis that more fragile individuals reach higher ages. Additional research is needed to find out if improvement in survival can be seen also for the second and third event of CVD, stroke and MI.

Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival - A nationwide study of the Swedish population 60 years and older

BACKGROUND Hip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. MATERIAL AND METHODS The entire Swedish population 60 years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occurring from age 60 and above, and the expected mean age of the first hip fracture. RESULTS The age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94 years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5 years for men and by 2.2 years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. CONCLUSIONS The age-specific hip fracture incidence has decreased over time. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved.

Trends in age at first hospital admission in relation to trends in life expectancy in Swedish men and women above the age of 60

Objectives To examine whether the first admission to hospital after the age of 60 has been postponed to higher ages for men and women in Sweden, in line with the shift in mortality. Design This nationwide observational study was based on data obtained from national registries in Sweden. The study cohort was created by linking the Register of the Total Population in Sweden with the National Patient Register and the Swedish Cause of Death Register. Setting The entire Swedish population born between 1895 and 1950 was followed up between 1987 and 2010 with respect to hospital admissions and deaths using the national registry data. Primary outcome measures The time from age 60 until the first admission to the hospital, regardless of the diagnosis, and the time from age 60 until death (remaining life expectancy, LE) were estimated for the years 1995–2010. The difference between these two measures was also estimated for the same period. Results Between 1995 and 2010 mortality as well as first hospital admission shifted to higher ages. The average time from age 60, 70, 80 and 90 until the first hospital admission increased at all ages. The remaining LE at age 60, 70 and 80 increased for men and women. For the 90-year-olds it was stable. Conclusions In Sweden, the first hospital admission after the age of 60 has been pushed to higher ages in line with mortality for the ages 60 and above. First admission to the hospital could indicate the onset of first severe morbidity; however, the reorganisation of healthcare may also have influenced the observed trends.

High IQ in Early Adolescence and Career Success in Adulthood: Findings from a Swedish Longitudinal Study

To what extent do intellectually talented adolescents pursue educational and vocational careers that match their intellectual resources? Career outcomes were compared between groups within different IQ ranges with a focus on comparing those with high IQ (top 10%IQ > 119) to those with average IQ. Data were analyzed from the longitudinal Swedish IDA study (N = 1,326) with career outcomes measured in midlife (age 43–47). To obtain at least a master’s degree was almost 10 times more common for those of high IQ than for those of average IQ. Stillthe proportion of high-IQ adolescents who did this was not high (13% of females34% of males) and as much as 20% of them did not even graduate from 3-year high school. For men onlythere was a graded raise in income by IQ group. Within the high-IQ group there was no significant relationship between parents’ socioeconomic status and income. For menhigh IQ predicted a strongly increased income/vocational level in midlife beyond what was predicted from a linear model of the IQ-outcome relationship.

The era of centenarians : mortality of the oldest old in Sweden

Dear Sir, Demographic evidence has shown that life-expectancyhasbeen improving formore than160 years [1, 2]. This remarkable trend was first fuelled by reductions in infant andchildmortality; however, since the 1950smostof thereductionhasbeenbecauseofadecrease inmortality in the elderly. The annual decline inmortality at older ages is continuing inmanycountries, including Sweden [3]. According to the Human Mortality Database, Swedish life-expectancy at the age of 80 years increased by 1.84 years for men and 2.78 years for women between 1969 and 2009 [4]. The number of Swedish centenarians has risen almost exponentially in recent years,mainlybecauseof thedecrease inmortality below the age of 100 [5]. The increase in mortality has been accompanied by a steady and almost linear increase in the maximum ageatdeath [6].

Losing Ground - Swedish Life Expectancy in a Comparative Perspective

Background In the beginning of the 1970s, Sweden was the country where both women and men enjoyed the worlds longest life expectancy. While life expectancy continues to be high and increasing, Sweden has been losing ground in relation to other leading countries. Methods We look at life expectancy over the years 1970–2008 for men and women. To assess the relative contributions of age, causes of death, and smoking we decompose differences in life expectancy between Sweden and two leading countries, Japan and France. This study is the first to use this decomposition method to observe how smoking related deaths contribute to life expectancy differences between countries. Results Sweden has maintained very low mortality at young and working ages for both men and women compared to France and Japan. However, mortality at ages above 65 has become considerably higher in Sweden than in the other leading countries because the decrease has been faster in those countries. Different trends for circulatory diseases were the largest contributor to this development in both sexes but for women also cancer played a role. Mortality from neoplasms has been considerably low for Swedish men. Smoking attributable mortality plays a modest role for women, whereas it is substantially lower in Swedish men than in French and Japanese men. Conclusions Sweden is losing ground in relation to other leading countries with respect to life expectancy because mortality at high ages improves more slowly than in the leading countries, especially due to trends in cardiovascular disease mortality. Trends in smoking rates may provide a partial explanation for the trends in women; however, it is not possible to isolate one single explanatory factor for why Sweden is losing ground.

Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy

Limitless longevity: Comment on the Contribution of rectangularization to the secular increase of life expectancy

Does improved survival lead to a more fragile population: time trends in second and third hospital admissions among men and women above the age of 60 in Sweden.

Background Life expectancy and time to first hospitalization have been prolonged, indicating that people live longer without needing hospital care. Life expectancy increased partially due to improved survival from severe diseases, which, however, could lead to a more fragile population. If so, time to a subsequent hospitalization could decrease. Alternatively, the overall trend of improved health could continue after the first hospitalization, prolonging also the time to subsequent hospitalizations. This study analyzes trends in subsequent hospitalizations among Swedish men and women above the age of 60, relating them to first hospitalization. It also looks at trends in the proportion of never hospitalized. Methods Individuals were followed in national registers for hospital admissions and deaths between 1972 and 2010. The proportion of never hospitalized individuals at given ages and time points, and the annual change in the risks of first and subsequent hospitalizations, were calculated. Findings An increase in the proportion of never hospitalized was seen over time. The risks of first as well as subsequent hospitalizations were reduced by almost 10% per decade for both men and women. Improvements were observed mainly for individuals below the ages of 90 and up to the year 2000. Conclusions The reduction in annual risk of both first and subsequent hospitalizations up to 90 years of age speaks in favor of a postponement of the overall morbidity among the elderly and provides no support for the hypothesis that the population becomes more fragile due to increased survival from severe diseases.

How long do centenarians survive? Life expectancy and maximum lifespan

The purpose of this study was to explore the pattern of mortality above the age of 100 years. In particular, we aimed to examine whether Scandinavian data support the theory that mortality reaches a plateau at particularly old ages. Whether the maximum length of life increases with time was also investigated.

Genetics of the association between intelligence and nicotine dependence: a study of male Swedish twins

AIMS Previous studies have found inverse associations between intelligence quotient (IQ) and cigarette smoking, but the causal pathways linking IQ with smoking status and nicotine dependence (ND) are not well understood. The aim of this study was to explore the associations between IQ and ND using a genetically informative twin design to detect whether any association is because of shared genetic or environmental factors. DESIGN A population-based twin cohort with IQ measured in adolescence and ND later in life, analysed by classical twin modeling based on linear structural equations. SETTING Swedish national registry data. PARTICIPANTS A total of 5040 male twins born 1951-84. MEASUREMENTS IQ was measured at military conscription at a mean age of 18 years. ND was self-reported at the ages of 22-57 years using the Fagerström Test for ND scale (FTND). Both cigarette smoking and Swedish snus use were analysed. FINDINGS Both IQ and ND showed moderate heritability (0.58 and 0.39, respectively). The heritability of ND was similar for cigarette smoking and snus use. The phenotypic correlation between IQ and ND was weak: -0.11 (-0.16, -0.06) for total ND. Bivariate analysis revealed that this correlation was mainly because of genetic factors, but still the genetic correlation between IQ and ND from cigarette smoking was only -0.24. CONCLUSIONS Nicotine dependence, as measured by the Fagerström Test for Nicotine Dependence, shows moderate heritability in both smokers and snus users but is only weakly associated with intelligence quotient; common genetic factors underlying nicotine dependence and intelligence quotient probably account for little of the observed association between smoking and intelligence quotient.