Knud Juel

Long term follow up study of survival associated with cleft lip and palate at birth.

Abstract Objective To assess the overall and cause specific mortality of people from birth to 55 years with cleft lip and palate. Design Long term follow up study. Setting Danish register of deaths. Participants People born with cleft lip and palate between 1943 and 1987, followed to 1998. Main outcome measures Observed and expected numbers of deaths, summarised as overall and cause specific standardised mortality ratios. Results 5331 people with cleft lip and palate were followed for 170 421 person years. The expected number of deaths was 259, but 402 occurred, corresponding to a standardised mortality ratio of 1.4 (95% confidence interval 1.3 to 1.6) for males and 1.8 (1.5 to 2.1) for females. The increased risk of mortality was nearly constant for the three intervals at follow up: first year of life, 1-17 years, and 18-55 years. The participants had an increased risk of all major causes of death. Conclusions People with cleft lip and palate have increased mortality up to age 55. Children born with cleft lip and palate and possibly other congenital malformations may benefit from specific preventive health measures into and throughout adulthood.

The Danish National Health Survey 2010.: Study design and respondent characteristics.

Aims: In 2010 the five Danish regions and the National Institute of Public Health at the University of Southern Denmark conducted a national representative health survey among the adult population in Denmark. This paper describes the study design and the sample and study population as well as the content of the questionnaire. Methods: The survey was based on five regional stratified random samples and one national random sample. The samples were mutually exclusive. A total of 298,550 individuals (16 years or older) were invited to participate. Information was collected using a mixed mode approach (paper and web questionnaires). A questionnaire with a minimum of 52 core questions was used in all six subsamples. Calibrated weights were computed in order to take account of the complex survey design and reduce non-response bias. Results: In all, 177,639 individuals completed the questionnaire (59.5%). The response rate varied from 52.3% in the Capital Region of Denmark sample to 65.5% in the North Denmark Region sample. The response rate was particularly low among young men, unmarried people and among individuals with a different ethnic background than Danish. Conclusions: The survey was a result of extensive national cooperation across sectors, which makes it unique in its field of application, e.g. health surveillance, planning and prioritizing public health initiatives and research. However, the low response rate in some subgroups of the study population can pose problems in generalizing data, and efforts to increase the response rate will be important in the forthcoming surveys.

Abstention from smoking extends life and compresses morbidity: a population based study of health expectancy among smokers and never smokers in Denmark

OBJECTIVE To estimate health expectancy— that is, the average lifetime in good health—among never smokers, ex-smokers, and smokers in Denmark. DESIGN A method suggested by Peto and colleagues in 1992 for estimating smoking attributable mortality rates was used to construct a life table for never smokers. This life table and relative risks for death for ex-smokers and smokers versus never smokers were used to estimate life tables for ex-smokers and smokers. Life tables and prevalence rates of health status were combined and health expectancy was calculated by Sullivans method. SETTING The Danish adult population. MAIN OUTCOME MEASURES The expected lifetime in self rated good health or without longstanding illness for never smokers and smokers. RESULTS The expected lifetime of a 20 year old man who will never begin to smoke is 56.7 years, 48.7 (95% confidence interval (CI), 46.8 to 50.7) years of which are expected to be in self rated good health. The corresponding figures for a man who smokes heavily are 49.5 years, 36.5 (95% CI 35.0 to 38.1 ) years of which are in self rated good health. A 20 year old woman who will never begin to smoke can expect to live a further 60.9 years, with 46.4 (95% CI 44.9 to 47.8) years in self rated good health; if she is a lifelong heavy smoker, her expected lifetime is reduced to 53.8 years, 33.8 (95% CI 31.7 to 35.9) years of which are in self rated good health. Health expectancy based on long standing illness is reduced for smokers when compared with never smokers. CONCLUSIONS Smoking reduces the expected lifetime in good health and increases the expected lifetime in poor health.

Addictive behaviors related to opioid use for chronic pain: A population-based study

Summary An intricate relationship between chronic pain, opioid use and addictive behaviors was demonstrated, and certain addictive behaviors seem to predict or be associated with opioid use in chronic non‐cancer pain. Abstract The growing body of research showing increased opioid use in patients with chronic pain coupled with concerns regarding addiction encouraged the development of this population‐based study. The goal of the study was to investigate the co‐occurrence of indicators of addictive behaviors in patients with chronic non‐cancer pain in long‐term opioid treatment. The study combined data from the individual‐based Danish Health Survey in 2010 and the official Danish health and socio‐economic, individual‐based registers. From a simple random sample of 25,000 adults (16 years or older) living in Denmark, 13,281 individuals were analyzed through multiple logistic regression analyses to assess the association between chronic pain (lasting ≥6 months), opioid use, health behavior, and body mass index. Six potential addictive behaviors were identified: daily smoking; high alcohol intake; illicit drug use in the past year; obesity; long‐term use of benzodiazepines; and long‐term use of benzodiazepine‐related drugs. At least 2 of the 6 addictive behaviors were observed in 22.6% of the long‐term opioid users with chronic pain compared with 11.5% of the non‐opioid users with chronic pain and 8.9% of the individuals without chronic pain. Thus, a strong association was demonstrated between long‐term opioid use and the clustering of addictive behaviors. An intricate relationship between chronic pain, opioid use, and addictive behaviors was observed in this study, which deserves both clinical attention and further research.

Chronic pain, opioid prescriptions, and mortality in Denmark: A population-based cohort study

Summary The risk of all‐cause mortality is high among long‐term opioid users with chronic pain, and opioid use increases the risk of injuries and toxicity/poisoning. ABSTRACT This study aimed to investigate the risk of death, development of cancer, and hospital inpatient admissions resulting from injuries and toxicity/poisoning among opioid users with chronic noncancer pain. A population‐based cohort of 13,127 adults, who have participated in the Danish Health Interview Surveys in 2000 or 2005 and have been followed up prospectively by registers until the end of 2011, were classified according to the absence or presence of chronic pain (ie, pain lasting ≥6 months) and long‐term or short‐term opioid use (individuals using at least 1 prescription per month for 6 months in the previous year and at least 1 prescription in the previous year, respectively). The risk of all‐cause mortality was 1.72 (95% confidence interval [CI] = 1.23–2.41) times higher among long‐term opioid users than among individuals without chronic pain. The risk of death was lower, but still significantly higher in short‐term (1.36, 95% CI = 1.07–1.72) and non‐opioid users with chronic pain (1.39, 95% CI = 1.22–1.59) than in the background population. There was no statistically significant association between long‐term opioid use and cardiovascular and cancer mortality. No deaths among opioid users were caused by accidents or suicides, although opioid users had higher risks of injuries and toxicity/poisoning resulting in hospital inpatient admissions than individuals without chronic pain. The risk of all‐cause mortality was significantly higher among long‐term opioid users, but no obvious associations between long‐term opioid use and cause‐specific mortality were observed. However, opioid use increased the risk of injuries and toxicity/poisoning resulting in hospital inpatient admissions.

The burden of chronic pain: a cross-sectional survey focussing on diseases, immigration, and opioid use.

Summary The prevalence of chronic pain and the use of opioids in Denmark are alarmingly high and the relevance of the opioid consumption is unknown. ABSTRACT Chronic pain is currently considered a public health problem with high costs to the individual and society. To improve prevention and treatment of chronic pain, epidemiologic studies are mandatory for assessing chronic pain. The aims of this study were to estimate the prevalence of chronic pain in the adult Danish population and to analyze associated factors such as diseases, immigration, and opioid use. This cross‐sectional survey combines individual‐based information from the Danish Health Survey (2010) and official Danish health and socioeconomic, individual‐based registers. The simple random sample consisted of 25000 individuals (⩾16 years old) living in Denmark. In all, 60.7% completed a mailed or online questionnaire. Associations were examined with multiple logistic regression analysis. The study population consisted of 14925 individuals in whom a high prevalence of chronic pain (26.8%, 95% confidence interval: 26.1 to 27.5) and a high prevalence of opioid consumption (4.5%) were observed. Other aspects of particular note: (1) a higher prevalence of chronic pain occurred among individuals with cardiovascular and chronic pulmonary diseases than among individuals with cancer; and (2) individuals with a non‐Western background reported a higher pain prevalence, higher pain intensities, and more widespread pain than individuals with Danish background; however, opioids were more frequently used by native Danes. The prevalence of chronic pain as well as opioid use in Denmark are alarmingly high, and the relevance of opioid consumption is unknown.

Mortality from circulatory diseases by specific country of birth across six European countries: Test of concept

BACKGROUND Important differences in cardiovascular disease (CVD) mortality by country of birth have been shown within European countries. We now focus on CVD mortality by specific country of birth across European countries. METHODS For Denmark, England and Wales, France, The Netherlands, Scotland and Sweden mortality information on circulatory disease, and the subcategories of ischaemic heart disease, and cerebrovascular disease, was analysed by country of birth. Information on population was obtained from census data or population registers. Directly age-standardized rates per 100 000 were estimated by sex for each country of birth group using the WHO World Standard population 2000-25 structure. For differences in the results, at least one of the two 95% confidence intervals did not overlap. RESULTS Circulatory mortality was similar across countries for men born in India (355.7 in England and Wales, 372.8 in Scotland and 244.5 in Sweden). For other country of birth groups-China, Pakistan, Poland, Turkey and Yugoslavia-there were substantial between-country differences. For example, men born in Poland had a rate of 630.0 in Denmark and 499.3 in England and Wales and 153.5 in France; and men born in Turkey had a rate of 439.4 in Denmark and 231.4 in The Netherlands. A similar pattern was seen in women, e.g. Poland born women had a rate of 264.9 in Denmark, 126.4 in England and Wales and 54.4 in France. The patterns were similar for ischaemic heart disease mortality and cerebrovascular disease mortality. CONCLUSION Cross-country comparisons are feasible and the resulting findings are interesting. They merit public health consideration.

Effect of survey mode on response patterns: comparison of face-to-face and self-administered modes in health surveys

BACKGROUND While face-to-face interviews are considered the gold standard of survey modes, self-administered questionnaires are often preferred for cost and convenience. This article examines response patterns in two general population health surveys carried out by face-to-face interview and self-administered questionnaire, respectively. METHOD Data derives from a health interview survey in the Region of Southern Denmark (face-to-face interview) and The Danish Health and Morbidity Survey 2010 (self-administered questionnaire). Identical questions were used in both surveys. Data on all individuals were obtained from administrative registers and linked to survey data at individual level. Multiple logistic regression analyses were used to examine the effect of survey mode on response patterns. RESULTS The non-response rate was higher in the self-administered survey (37.9%) than in the face-to-face interview survey (23.7%). Marital status, ethnic background and highest completed education were associated with non-response in both modes. Furthermore, sex and age were associated with non-response in the self-administered mode. No significant mode effects were observed for indicators related to use of health services, but significant mode effects were observed for indicators related to self-reported health-related quality of life, health behaviour, social relations and morbidity (long-standing illness). CONCLUSIONS The same factors were generally associated with non-response in both modes. Indicators based on factual questions with simple answers categories were overall more comparable according to mode than indicators based on questions that involved more subjective assessments. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection.

Risk factors and public health in Denmark

ISSN 1403–4948 Editorial comment 2 Preface 3 Contributors 4 1 Summary 11 2 Background and purpose 36 3 Data sources 43 4 Methods 46 5 Smoking 60 6 Alcohol 75 7 Drug abuse 92 8 Physical inactivity 100 9 Overweight 114 10 Unhealthy diet 128 11 Unsafe sex 140 12 Hypertension 148 13 Occupational accidents 152 14 Occupational diseases 158 15 Psychosocial job strain 164 16 Passive smoking 176 17 Home and leisure accidents 181 18 Traffi c accidents 187 19 Weak social relations 193 20 Education 208 21 Disability-adjusted life years 222 22 Expected impact on mortality of intervention scenarios for selected risk factors ......... 226 Scandinavian Journal of Public Health Volume 36 Supplement 1 November 20082004‐now Postdoctoral research associate in Bioinformatics, Department of Chemistry & Biochemistry, UCSD, U.S.A. 2002‐2004 Postdoctoral research associate in Computer‐aided drug design, College of Chemistry & Molecular Engineering, Peking University, Beijing, China. 1999‐2004 Technical adviser of the Neotrident Company (the agent of Accelrys and MDL in China) for the training of InsightII, Catalyst, Cerius2, and MDL databases and information system, Beijing, China. 2000‐2004 Technical adviser of the ChemBay Company (the agent of Tripos in China) for the training of SYBYL, Beijing, China.

Suicide and mental illness in parents and risk of suicide in offspring : A birth cohort study

BackgroundA family history of completed suicide and psychiatric illness has been identified as risk factors for suicide.AimsTo examine the risk of offspring suicide in relation to parental history of suicide and other parental risk factors.MethodThe study population consisted of 7,177 adult offspring born 1959–1961 and their parents from the Copenhagen Perinatal Cohort. Cohort members and their parents who had committed suicide were identified in the Danish Causes of Death Registry (follow-up until December 31, 2005), while information on psychiatric hospitalisation history was obtained from the Danish Psychiatric Central Research Register.ResultsForty-eight cohort members, 77 mothers and 133 fathers had committed suicide during the follow-up. Independent of parental psychiatric illness and social status, parental suicide significantly increased suicide risk in offspring (hazard ratio 4.40 with 95% CI 1.81–10.69). A stronger effect of parental suicide was observed in offspring without a history of psychiatric hospitalisation.ConclusionParental history of suicide is a risk factor for suicide in offspring, but primarily in offspring without psychiatric hospitalisation.