Susanna Calling

Shared and non-shared familial susceptibility of coronary heart disease, ischemic stroke, peripheral artery disease and aortic disease

BACKGROUND Little is known about whether the four main manifestations of arterial vascular disease (coronary heart disease = CHD, ischemic stroke, peripheral artery disease = PAD, and aortic (i.e. atherosclerosis/aneurysm) disease = AD) share familial susceptibility. The aim of this nationwide study was to determine the familial risks of concordant (same disease in proband and exposed relative) and discordant (different disease in proband and exposed relative) cardiovascular disease (CVD). METHODS Data from the Swedish Multigeneration Register on individuals aged 0-76 years were linked to Swedish Hospital Discharge Register data for the period 1964-2008. Standardized incidence ratios (SIRs) for CHD (n = 140,708 cases), ischemic stroke (n = 73,771), PAD (n = 18,982) and AD (n = 7879) were calculated for siblings of individuals hospitalized due to CHD, stroke, PAD or AD compared to those of unaffected siblings. The procedure was repeated for parent-offspring and spouses. RESULTS All concordant and discordant sibling risks were increased for both males and females. Concordant risks were generally higher than discordant risks. The highest sibling risks were observed for premature concordant disease (<55 years for males and <65 years for females): SIR for CHD = 1.93 (95% CI: 1.90-1.96), SIR for ischemic stroke = 1.45 (1.39-1.50), SIR for PAD = 2.76 (2.54-3.00), and SIR for AD = 6.36 (5.28-7.59). Premature parent-offspring transmission followed the same pattern. The disease risk was modestly increased in spouses, highest for AD (SIR = 1.48 (1.28-1.69)) and PAD (SIR = 1.27 (1.21-1.32)). CONCLUSIONS The four main manifestations of CVD share familial susceptibility, but unique site-specific familial factors may exist.

Socioeconomic inequalities and infant mortality of 46 470 preterm infants born in Sweden between 1992 and 2006

Studies on possible sociodemographic inequities in the survival of preterm infants are scarce. Individual and neighbourhood sociodemographic factors are related to preterm birth and to infant mortality in full-term infants. The aim here was to examine whether infant mortality in Swedish preterm infants is related to individual and neighbourhood sociodemographic factors, and to study whether the hypothesised association between neighbourhood deprivation and infant mortality persists after accounting for individual sociodemographic factors. The study included 46,470 infants with a gestational length of <37 weeks, born in Sweden between 1992 and 2006. Neighbourhood deprivation was assessed by an index (education, income, unemployment, welfare assistance) in small geographical units, and categorised into low, moderate and high deprivation. Adjusted odds ratios for infant mortality were examined in relation to individual and neighbourhood sociodemographic factors. After adjusting for maternal age, infant mortality was associated with the following sociodemographic variables: maternal non-married/non-cohabiting status, low family income, low maternal education and rural status. After full adjustment, the odds ratio [95% confidence interval] was 2.98 [2.42, 3.67] for low family income compared with high family income. An increase in infant mortality was also associated with high neighbourhood deprivation; however, this increased risk no longer remained statistically significant after adjusting for individual sociodemographic factors. In conclusion, this study showed an increased infant mortality in preterm infants born to women with a less favourable sociodemographic profile.

Neighborhood deprivation and risk of cervical cancer morbidity and mortality: A multilevel analysis from Sweden

OBJECTIVES To analyze whether there is an association between neighborhood deprivation and cervical cancer morbidity and mortality, beyond individual level characteristics. DESIGN The entire Swedish population aged 25 to 74, a total of 1.9 million women, were followed from January 1, 1990, until hospital admission due to cervical cancer during the study period, or the end of the study on December 31, 2008. Multilevel logistic regression was used in the analysis with individual level characteristics (age, marital status, family income, education, immigration status, urban/rural status, mobility, comorbidities, parities, and number of partners) at the first level and level of neighborhood deprivation at the second level. Neighborhood deprivation was measured at small area market statistics level by the use of an index. RESULTS There was a strong association between level of neighborhood deprivation and cervical cancer morbidity and mortality. In the full model, which took account of the individual level characteristics, the risks of cervical cancer morbidity and mortality were 1.25 and 1.36, respectively, in the most deprived neighborhoods. The between neighborhood variance was over twice the standard error, indicating significant differences in cervical cancer morbidity and mortality between neighborhoods. CONCLUSIONS This study is the largest to date of the influences of neighborhood deprivation on cervical cancer morbidity and mortality. The results suggest that neighborhood characteristics affect cervical cancer morbidity and mortality independently of individual level sociodemographic characteristics. Both individual and neighborhood level approaches are important in health care policies.

Longitudinal trends in good self-rated health: effects of age and birth cohort in a 25-year follow-up study in Sweden

ObjectivesAlthough average life expectancy has increased considerably in Sweden, there is less evidence for improved self-rated health (SRH). We analyzed longitudinal trends in SRH between 1980/1981 and 2004/2005 in age and birth cohort subgroups.Methods2,728 males and 2,770 females, aged 16–71 years, were interviewed every eighth year. Mixed models with random intercepts were used to estimate changes in SRH within different age groups and birth cohorts, adjusting for potential confounders.ResultsDuring the 25-year follow-up, SRH improved in individuals aged ≥48 years, but became poorer or was unchanged in those aged 16–47 years. All birth cohorts showed poorer SRH with increasing age, with an adjusted odds ratio (95% confidence interval) of 0.94 (0.93–0.95) in males and 0.92 (0.91–0.93) in females.ConclusionsWhile SRH in the older age groups improved, SRH became poorer in the youngest. Poorer SRH is deeply worrying for the affected individuals, and may also have a negative impact on the health care system. Although mental illness, socioeconomic factors, and lifestyle may be potential mechanisms, future studies are needed to investigate the reasons behind this trend.

Mothers, places and risk of hospitalization for childhood asthma: a nationwide study from Sweden: epidemiology of allergic disease.

This study examines whether neighbourhood deprivation increases the risk of hospitalization for childhood asthma, after accounting for individual‐level maternal socio‐demographic characteristics.

Neighborhood, family, and childhood and adolescent epilepsy: a nationwide epidemiological study from Sweden.

PURPOSE To examine whether neighborhood deprivation increases the odds of hospital registration for childhood and adolescent epilepsy, after accounting for family- and individual-level sociodemographic characteristics. METHODS An open cohort of all children aged 2-17 years was followed between January 1, 2000 and December 31, 2010. Childrens residential addresses were geocoded and classified according to neighborhood deprivation. Data were analyzed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighborhood deprivation at the second level. RESULTS During the study period, among a total of 1,020,766 children, 9309 (0.9%) were registered with childhood and adolescent epilepsy. Age-adjusted cumulative hospital rates of childhood and adolescent epilepsy increased with increasing neighborhood-level deprivation across all family- and individual-level sociodemographic categories. The odds ratio (OR) for hospital registration for childhood and adolescent epilepsy for those living in high-deprivation neighborhoods versus those living in low-deprivation neighborhoods was 1.15. High level deprivation remained significantly associated with higher odds of childhood and adolescent epilepsy after adjustment for family- and individual-level sociodemographic characteristics (OR=1.12, 95% CI=1.04-1.21, p=0.003). CONCLUSIONS Our results suggest that neighborhood characteristics modestly affect the odds of hospital registration for childhood and adolescent epilepsy independently of family- and individual-level sociodemographic characteristics.

Preterm birth and unintentional injuries: risks to children, adolescents and young adults show no consistent pattern.

Preterm birth is associated with a number of physical and mental health issues. The aim of this study was to find out whether there was also any association between individuals born preterm in Sweden between 1984 and 2006 and the risk of unintentional injuries during childhood, adolescence and young adulthood.

Study protocol: a multi-professional team intervention of physical activity referrals in primary care patients with cardiovascular risk factors—the Dalby lifestyle intervention cohort (DALICO) study

BackgroundThe present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness.Methods/DesignThe study is designed as a long-term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients’ health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling.DiscussionsBy helping patients to overcome practical, social and cultural obstacles and increase their internal motivation for physical activity we aim to improve their physical health in a long-term perspective. The targeted patients belong to a patient category that is supposed to benefit from increased physical activity in terms of improved physiological values, mental status and quality of life, decreased risk of complications and maybe a decreased need of medication.

Women's Health in the Lund Area (WHILA) study. Health problems and acute myocardial infarction in women – A 17-year follow-up study

OBJECTIVES The literature has highlighted the importance of identifying symptoms predictive of acute myocardial infarction (AMI) in women, in addition to traditional cardiovascular risk factors. The objective was to study subjective health problems, in relation to later AMI, in a large sample of women, adjusted for age, educational status, smoking, waist/hip ratio, blood pressure, total cholesterol/HDL ratio, diabetes and neighbourhood socioeconomic status. STUDY DESIGN From December 1995 to February 2000 a cohort of 6711 women aged 50-59 years in southern Sweden underwent a physical examination and answered a questionnaire that had 18 items on health problems such as stress symptoms, tiredness and pain. MAIN OUTCOME MEASURES Incidence of AMI during a mean follow-up of 17 years, drawn from national registers. RESULTS The number of health problems showed a J-shaped relationship with AMI, with the lowest hazard ratio (HR) in women with a median of 4 health problems. The HR for AMI in women with 0 health problems was 1.58 (95% CI: 0.95-2.63) and in those with 13 problems HR 1.65 (95% CI 1.16-2.36), after adjusting for potential confounding factors. CONCLUSIONS The presence of several health problems, including pain and stress symptoms, is associated with an increased risk of later AMI in middle-aged women. Awareness among clinicians of predictive risk factors for AMI is important for the early identification of individuals at higher risk.