Morten Grønbæk

Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study.

Both the incidence of and mortality from bleeding and perforated peptic ulcers are increasing. We assessed the association between smoking, intake of alcohol (including type of alcoholic beverage), and risk of a complicated peptic ulcer in a population-based study of 26,518 Danish subjects followed up for an average of 13.4 years. There were 214 cases of incident bleeding and 107 cases with perforated ulcers. We estimated relative risks (RRs) for incident bleeding and perforated peptic ulcers using Poisson regression analysis. Smoking more than 15 cigarettes per day compared with never smoking increased the risk of a perforated ulcer more than threefold [RR = 3.5; 95% confidence interval (CI) = 1.7-7.1)]. Drinking more than 42 drinks per week increased the risk of a bleeding ulcer fourfold (RR = 4.4; 95% CI = 2.3-8.3) compared with drinking less than one drink per week. Using the same comparison group, subjects who drank more than 21 drinks per week but no wine were at a higher risk of a bleeding ulcer (RR = 8.8; 95% CI = 2.2-35) than drinkers of the same amount of alcohol, but with more than 25% of their intake as wine (RR = 2.4; 95% CI = 1.0-6.0).

Alcohol Intake, Type of Beverage, and Risk of Breast Cancer in Pre- and Postmenopausal Women

BACKGROUNDnMost studies of the relation between alcohol consumption and breast cancer have shown a modestly increased risk, although the results are still conflicting.nnnMETHODSnThe aim of this prospective population-based cohort study was to assess the influence of alcohol intake and type of beverage (beer, wine, or spirits) on breast cancer risk in relation to menopausal status. Among 13,074 women aged 20 to 91 years, we examined the relationship between breast cancer risk, total alcohol intake, and type of alcohol in relation to menopausal status. The women were classified as premenopausal or as postmenopausal at younger than 70 years or 70 years or more.nnnRESULTSnDuring follow-up, 76 premenopausal and 397 postmenopausal women developed breast cancer. Premenopausal women who had an intake of more than 27 drinks per week had a relative risk of breast cancer of 3.49 (95% confidence limits, 1.36-8.99) compared with light drinkers (p = 0.011), whereas there were no differences in risk in the lower-intake categories. The increased risk of breast cancer among premenopausal women was independent of the type of alcohol. Postmenopausal women older than 70 years of age who had an intake of more than six drinks per week of spirits had a relative risk of breast cancer of 2.43 (95% confidence limits, 1.41-4.20) compared with women who consumed less than one drink of spirits per week (p = 0.0014).nnnCONCLUSIONSnTotal alcohol intake of more than 27 drinks per week increases breast cancer risk in premenopausal women independently of the type of alcohol. Among postmenopausal women, an intake of spirits of more than six drinks per week increases breast cancer risk.

Incidence and characteristics of falls leading to hospital treatment: a one-year population surveillance study of the Danish population aged 45 years and over

Aims: The aim was to quantify and characterize the incidence of fall injury events among middle-aged and older adults who require acute medical attention at Danish hospitals. Methods: A one-year population surveillance study was carried out, based on the Danish National Hospital Register (DNHR), which covers all somatic hospital discharges and accident and emergency (A&E) services at hospitals in Denmark. Results: During 1996 a total of 81,121 fall injury events were treated at A&E departments or resulted in admission to a somatic hospital department among Danes aged 45 years and over. Up to age 50 years the incidence rates of injurious fall events requiring medical attention were similar in men and women. At age 50 years, the incidence rates in women exceeded the rates in men and remained 1.2—1.8 times higher thereafter. After age 70 years, the rates increased exponentially in both sexes: from 27.4 and 49.3 per 1,000 person-years in men and women, respectively, to peaks of 112.8 and 170.8 per 1,000 person-years, respectively, at age 85 years and over. The proportion of falls occurring indoors and in institutional settings increased with advancing age. Compared with men, women had higher rates of fall-related contusions, distortions and fractures at all ages. Conclusions : Fall-prevention programmes should be directed towards the population aged 70 years and over, in particular towards women and hazards in residential environments. Our finding of an increasing incidence of injurious fall events among women around the time of the menopause raises the hypothesis that loss of oestrogen production plays a role in the aetiology of falls in women.

Generalized additive models applied to analysis of the relation between amount and type of alcohol and all-cause mortality.

The J-shaped relation between alcohol intake and mortality is well established, whereas the nadir of the curve is not determined. Due to non-linearity of the relation, categorical alcohol variables have been used to model the relation. In Generalized Additive Models (GAM) non-linear relations can be modelled without the disadvantages of categorization and without assumptions regarding the functional form. The aim of this study was to use GAM to evaluate the relation between alcohol intake, amount and type, and mortality. The relation was investigated using data from the Copenhagen City Heart Study (11,920 participants of whom 5552 died during 20xa0years follow-up). Using GAM, a smooth J-shaped relation between alcohol and mortality was found. However, if non-drinkers were categorized separately there was a positive association between alcohol and mortality even for low alcohol intake. For equal total alcohol intake, men and women drinking wine or spirits had lower mortality than beer drinkers. The nadir of the relation between alcohol and mortality was sensitive to the handling of non-drinkers. When non-drinkers were categorized separately we found no indication of a beneficial influence of low alcohol intake on mortality.

Stroke incidence and case fatality in two populations: the Auckland Stroke Study and the Copenhagen City Heart Study.

Comparison of stroke incidence and case fatality in different parts of the world provides information that may lead to a better understanding of the disease. In this report we have investigated these two aspects in two large populations, one in Auckland, New Zealand, and the other in Copenhagen, Denmark (the Copenhagen City Heart Study, CCHS). Incidence rates of stroke are higher for men than women in both studies. The stroke incidence rate ratios between Auckland men and CCHS men are significantly different in most age groups, whereas in women the incidence rates differ only in one age group. The age- and sex-adjusted incidence rates are higher in the CCHS for both men and women as compared to the Auckland Stroke Study. The age-adjusted incidence rate ratio is higher for men than women in both studies: 1.29 in the Auckland Stroke Study and 1.54 in the CCHS. The 28-day case fatality is also higher in the CCHS than in Auckland and is higher for women than men in both studies. The incidence rate of stroke and the 28-day case fatality is higher in the CCHS as compared to the Auckland Stroke Study in both men and women. A very high proportion of smokers in CCHS may explain some of the differences in incidence rates in the two populations.