Måns Rosén

The Impact of Organized Mammography Service Screening on Breast Carcinoma Mortality in Seven Swedish Counties A Collaborative Evaluation

The evaluation of organized mammographic service screening programs is a major challenge in public health. In particular, there is a need to evaluate the effect of the screening program on the mortality of breast carcinoma, uncontaminated in the screening epoch by mortality from 1) cases diagnosed in the prescreening period and 2) cases diagnosed among unscreened women (i.e., nonattenders) after the initiation of organized screening.

Health in Sweden : the National Public Health Report 2005.

Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

Cancer Survival in Sweden 1960–1998 Developments Across Four Decades

This paper summarizes a comprehensive study of cancer survival in Sweden from 1960 to 1998. A total of 1 021 421 persons and 40 different cancer sites were included in the analyses. The main outcome measure is the relative survival rate (RSR) for different sites and follow-up times after diagnosis. The 10-year RSR for all sites combined has increased steadily—from 26.6% among men and 41.8% among women in the 1960s, to 44.6% (men) and 57.6% (women) in the 1990s. The expectation of life for a person diagnosed with cancer today is about 7 years longer than that of one diagnosed during the mid-1960s. About 3 years are gained due to changes in the relative distribution of various cancer types and about 4 years due to improved relative survival. During the 1990s substantial survival improvements were observed not only for uncommon types, such as testicular cancer, Hodgkins lymphoma and some other haematologic malignancies, but also for cancer of the rectum, kidney and malignant melanoma. Survival for breast and cervical cancer also improved during the 1990s, but not that for pancreatic, liver or lung cancer.

Inappropriate Drug Use in the Elderly: A Nationwide Register-Based Study

Background: Potentially inappropriate drug use (IDU) is an important and preventable safety concern in the care of elderly patients and has been associated with adverse drug reactions, hospitalization, and mortality. Objective: To estimate the prevalence of potentially IDU among the elderly in Sweden and investigate whether age. sex, and number of dispensed drugs are associated with IDU. Methods: We analyzed data on age, sex, and dispensed drugs for people aged 75 years and older who were listed in the Swedish Prescribed Drug Register from October–December 2005 (N = 732 226). The main outcome measures of IDU were prescription of anticholinergics, prescription of long-acting benzodiazepines, concurrent use of 3 or more psychotropic drugs, and an indication of potentially serious drug-drug interactions. Results: Prevalence for IDU was 17%; for anticholinergic drugs 6%, long-acting benzodiazepines 5%, 3 or more psychotropic drugs 5%, and potentially serious drug–drug interactions 4%. After adjustment for age and sex, number of dispensed drugs was strongly associated with all 4 measures of IDU. After adjustment for sex and number of dispensed drugs, increasing age was moderately associated with a higher probability of IDU, long-acting benzodiazepines, and 3 or more psychotropic drugs, After adjustment for age and number of dispensed drugs, women had a slightly increased probability of IDU, anticholinergic drugs, long-acting benzodiazepines, and 3 or more psychotropic drugs. Conclusions: IDU was fairly common among the elderly in Sweden in 2005 and was strongly connected to the number of dispensed drugs they were taking. Older age and female sex were related to inappropriate use of psychotropic drugs, whereas the opposite relationship prevailed for potentially serious drug–drug interactions. Future research is needed to determine whether IDU will become more common due to increasing use of drugs among elderly persons. The challenge is to balance the problems related to IDU without denying older people potentially valuable drug therapy.

Does tobacco smoke prevent atopic disorders? A study of two generations of Swedish residents

Background Earlier studies have given conflicting results regarding the effect of exposure to tobacco smoke on atopic sensibilization.

Mortality among lone mothers in Sweden: a population study.

BACKGROUND An increasing number of lone mothers are experiencing financial and health disadvantages. Our aim was to assess mortality among lone mothers compared with mothers with partners. METHODS In this population-based study, overall and cause-specific mortality, between 1991 and 1995, was estimated for 90,111 lone mothers and 622,368 mothers with partners from data collected in the Swedish Population and Housing Census 1990. We estimated relative risks by Poisson regression, adjusted for socioeconomic status, and, to handle health-selection effects, we adjusted for previous inpatient history from 1987 to 1990. FINDINGS Lone mothers showed an almost 70% higher premature risk of death than mothers with partners. The excess risk remained significantly increased (relative risk 1.2 [95% CI 1.1-1.4]) after adjustments for socioeconomic status and previous severe somatic and psychiatric inpatient history. Increased mortality was especially pronounced for suicides (2.2 [1.5-3.1]), violence (3.0 [0.9-10.6]), and alcohol-related mortality (2.4 [1.4-4.1]) among mothers who were without a partner in 1985 and in 1990. INTERPRETATION The increase of lone mothers in society shows financial, social, and health disadvantages. Nevertheless, the increased mortality risk of lone mothers seems to be partly independent of socioeconomic status and health selection into lone motherhood. For long-term lone mothers the risks may be underestimated when adjusting for selection bias by taking hospital discharge history into account, since these events may be part of the consequences of the stress of lone motherhood.

Use of Disease Registers

Routine data are data collected continuously or at least repeatedly with some time intervals. They could be collected in various ways, e.g. registration by the health services or by interviews with patients or population groups. For epidemiological purposes, it is necessary that the disease cases collected can be related to a specified population base, thus providing the ability to calculate different epidemiological measures as incidence, prevalence etc. The data could then be stored and administered in registers. Health data or disease registers are restricted to persons with diseases or health-related events. The coverage can vary from a total registration to a sample of the population and from national to regional coverage. Data can be routinely collected for various reasons, from economic and administrative purposes to more strict epidemiological purposes.

Cancer patient survival in Sweden at the beginning of the third millennium--predictions using period analysis.

Estimates of cancer patient survival made using traditional, cohort-based, methods can be heavily influenced by the survival experience of patients diagnosed many years in the past and may not be particularly relevant to recently diagnosed patients. Period-based survival analysis has been shown to provide better predictions of survival for recently diagnosed patients and earlier detection of temporal trends in patient survival than cohort analysis. We aim to provide predictions of the long-term survival of recently diagnosed cancer patients using period analysis. The period estimates are compared with the latest available cohort-based estimates. Our results, based on period analysis for the years 2000–2002, suggest an improvement in survival for many forms of cancer during recent years. For all sites combined the 5-, 10-, 15-, and 20-year relative survival ratios were 62, 53, 48, and 47 for males and 67, 62, 60, and 59, for females. These estimates were 3–14 units higher than those obtained using the latest available cohorts with the respective lengths of follow-up. The interval-specific relative survival stabilised for males at 97 after 8 years of follow-up and for females at 98 after 7 years for both period and cohort analyses.

Inequality in access to coronary revascularization in Sweden

Objectives—To investigate social and gender equality in access to coronary revascularization for those treated for coronary heart disease in Sweden between 1991 and 2000. Design—All Swedish residents between 25 and 74 years old with a hospital stay for coronary heart disease were eligible for the study, in total about 153 000 persons. The Swedish Hospital Discharge Register from 1988 through 2000 was used to define the study population. Poisson regression analyses were used to estimate the effect of socio‐economic status on the likelihood for coronary artery bypass grafting (CABG) within 2 years. In the analysis of gender differences, the likelihood for percutaneous coronary intervention (PCI) was also included. Results—Males were 1.5 times more likely to undergo revascularization procedures than females even after adjusting for confounding factors and the fact that women are less eligible for interventions. The analyses also showed significant socio‐economic inequalities in access to CABG among men, but not among women. Conclusions—There are gender and socio‐economic inequalities in access to cardiac procedures in Sweden.

Education and drug use in Sweden--a nationwide register-based study.

To analyse educational variations in prescriptions dispensed in Sweden. A better knowledge of the use of drugs in the population, including socioeconomic distribution, is a prerequisite in efforts to estimate whether drugs are being prescribed and used according to need. This knowledge may also facilitate the identification of selection or confounding factors when analysing outcome or adverse side effects of drug treatment.