| 1. |
- Hansson, Jenny, et al.
(författare)
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Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies
- 2012
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 27:10, s. 771-779
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Tidskriftsartikel (refereegranskat)abstract
- The use of snus (also referred to as Scandinavian or Swedish moist smokeless tobacco), which is common in Sweden and increasing elsewhere, is receiving increasing attention since considered a tobacco smoke "potential reduction exposure product". Snus delivers a high dose of nicotine with possible hemodynamic effects, but its impact on cardiovascular morbidity and mortality is uncertain. The aim of this study was to investigate whether snus use is associated with risk of and survival after acute myocardial infarction (AMI). Data from eight prospective cohort studies set in Sweden was pooled and reanalysed. The relative risk of first time AMI and 28-day case-fatality was calculated for 130,361 men who never smoked. During 2,262,333 person-years of follow-up, 3,390 incident events of AMI were identified. Current snus use was not associated with risk of AMI (pooled multivariable hazard ratio 1.04, 95 % confidence interval 0.93 to 1.17). The short-term case fatality rate appeared increased in snus users (odds ratio 1.28, 95 % confidence interval 0.99 to 1.68). This study does not support any association between use of snus and development of AMI. Hence, toxic components other than nicotine appear implicated in the pathophysiology of smoking related ischemic heart disease. Case fatality after AMI is seemingly increased among snus users, but this relationship may be due to confounding by socioeconomic or life style factors.
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| 2. |
- Hergens, Maria-Pia, et al.
(författare)
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Risk factors for COVID-19-related death, hospitalization and intensive care : a population-wide study of all inhabitants in Stockholm
- 2022
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Ingår i: European Journal of Epidemiology. - : Springer. - 0393-2990 .- 1573-7284. ; 37:2, s. 157-165
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Tidskriftsartikel (refereegranskat)abstract
- Since the beginning of the Covid-19 pandemic, the scientific community has explored determinants of Covid 19 disease severity. However, the majority of studies are based on in-hospital patients with high risk of collider- or selection bias. The present investigation details risk factors associated with overall mortality, hospitalization and intensive care unit (ICU) admission in Covid-19 infections, with complete population coverage and high-resolution data on patient characteristics and comorbid conditions This population-based observational study comprises all residents 18 years and older in Stockholm Region-1.8 million inhabitants-using the real-time Covid-19 monitoring framework. The observation period lasted between March 1 to December 31, 2020. Hazard ratios (HR) for risk factors of Covid-19 disease severity were assessed using Cox proportional hazard models. In total, 3322 deaths, 11,508 hospitalizations and 1423 ICU-admissions related to Covid-19 occurred during the study period. Kidney failure, diabetes and obesity increased risk of mortality and so did heart failure and ischemic heart disease. However, atrial fibrillation and hypertension did not. Risk of hospitalization follow a similar pattern, whereas admission to intensive care differs; triage processes where clearly present as certain co-morbid conditions were associated with lower ICU admission. Observed differences in risk of mortality and hospitalization among patients with Covid 19 raise important questions about potentially protective comedication which will be further addressed using the real-time Covid-19 monitoring framework.
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| 3. |
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| 4. |
- Arefalk, Gabriel, et al.
(författare)
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Smokeless tobacco (snus) and risk of heart failure : results from two Swedish cohorts
- 2012
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Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation. - : Sage Publications. - 1741-8267 .- 1741-8275 .- 2047-4873 .- 2047-4881. ; 19:5, s. 1120-1127
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Tidskriftsartikel (refereegranskat)abstract
- Background: Oral moist snuff (snus) is discussed as a safer alternative to smoking, and its use is increasing. Based on its documented effect on blood pressure, we hypothesized that use of snus increases the risk of heart failure.Design: Two independent Swedish prospective cohorts; the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based sample of 1076 elderly men, and the Construction Workers Cohort (CWC), a sample of 118,425 never-smoking male construction workers. Methods: Cox proportional hazards models were used to investigate possible associations of snus use with risk of a first hospitalization for heart failure.Results: In ULSAM, 95 men were hospitalized for heart failure, during a median follow up of 8.9 years. In a model adjusted for established risk factors including past and present smoking exposure, current snus use was associated with a higher risk of heart failure [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03-4.22] relative to non-use. Snus use was particularly associated with risk of non-ischaemic heart failure (HR 2.55, 95% CI 1.12-5.82). In CWC, 545 men were hospitalized for heart failure, during a median follow up of 18 years. In multivariable-adjusted models, current snus use was moderately associated with a higher risk of heart failure (HR 1.28, 95% CI 1.00-1.64) and non-ischaemic heart failure (HR 1.28, 95% CI 0.97-1.68) relative to never tobacco use.Conclusion: Data from two independent cohorts suggest that use of snus may be associated with a higher risk of heart failure.
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| 5. |
- Bell, Max, et al.
(författare)
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Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic : a population-based cohort study
- 2023
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Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden — like other Nordic countries — have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19.Methods: This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register “RTB” (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research “LISA” (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19.Results: Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization.Conclusions: Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions.
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| 6. |
- Bergqvist, Rita, et al.
(författare)
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HMG-CoA reductase inhibitors and COVID-19 mortality in Stockholm, Sweden : A registry-based cohort study
- 2021
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Ingår i: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 18:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: The relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterogeneity and ambiguities. Here, we aim to determine the relationship between statin treatment and COVID-19 mortality.Methods and findings: This cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins.In the cohort (51.6% female), 169,642 individuals (17.6%) were statin users. Statin users were older (71.0 versus 58.0 years), more likely to be male (53.3% versus 46.7%), more often diagnosed with comorbidities (for example, ischemic heart disease 23.3% versus 1.6%), more frequently on anticoagulant and antihypertensive treatments, less likely to have a university-level education (34.5% versus 45.4%), and more likely to have a low disposable income (20.6% versus 25.2%), but less likely to reside in crowded housing (6.1% versus 10.3%).A total of 2,545 individuals died from COVID-19 during follow-up, including 765 (0.5%) of the statin users and 1,780 (0.2%) of the nonusers. Statin treatment was associated with a lowered COVID-19 mortality (adjusted HR, 0.88; 95% CI, 0.79 to 0.97, P = 0.01), and this association did not vary appreciably across age groups, sexes, or COVID-19 risk groups. The confounder adjusted HR for statin treatment initiators was 0.78 (95% CI, 0.59 to 1.05, P = 0.10) in the emulated target trial. Limitations of this study include the observational design, reliance on dispensation data, and the inability to study specific drug regimens.Conclusions: Statin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.
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| 7. |
- Hergens, Maria-Pia, et al.
(författare)
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Smokeless tobacco and the risk of stroke
- 2008
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Ingår i: Epidemiology. - 1044-3983 .- 1531-5487. ; 19:6, s. 794-799
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: In Sweden, use of smokeless tobacco (oral moist snuff) is common among adult men. Research on cerebrovascular effects associated with long-term use of snuff is limited and inconclusive. We aimed to study whether long-term use of snuff affects the risk of stroke. METHODS:: Information on tobacco use was collected by questionnaire among Swedish construction workers attending health check-ups between 1978 and 1993. In total, 118,465 never-smoking men without a history of stroke were followed through 2003. We used the Inpatient Register and Causes of Death Register to identify subsequent morbidity and mortality from stroke and its subtypes (ischemic, hemorrhagic, and unspecified stroke). Relative risk estimates were derived from Cox proportional hazards regression model. RESULTS:: Almost 30% of the nonsmoking men had ever used snuff. Overall, 3248 cases of stroke were identified during follow-up. Compared with nonusers of tobacco, the multivariable-adjusted relative risks for ever-users of snuff were 1.02 (95% confidence interval; 0.92-1.13) for all cases and 1.27 (0.92-1.76) for fatal cases. Further analyses on subtypes of stroke revealed an increased risk of fatal ischemic stroke associated with current snuff use (1.72; 1.06-2.78), whereas no increased risk was noted for hemorrhagic stroke. CONCLUSION:: Snuff use may elevate the risk of fatal stroke, and particularly of fatal ischemic stroke.
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| 8. |
- Hergens, Maria-Pia, et al.
(författare)
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Snuff Use and Stroke Reponse
- 2009
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Ingår i: Epidemiology. - 1044-3983 .- 1531-5487. ; 20:3, s. 469-470
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Tidskriftsartikel (refereegranskat)
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| 9. |
- Hergens, Maria-Pia
(författare)
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Swedish moist snuff and the risk of cardiovascular diseases
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The snuff consumption in Sweden has increased substantially during recent decades and today more than every fifth male adult uses snuff daily. However, the evidence on health effects from long-term use of snuff is limited, especially regarding cardiovascular diseases. The overall objective of this thesis was to study the association between snuff use and cardiovascular diseases. Two epidemiological materials were used and both were restricted to men only. One material included a population based case-control study with 1 437 cases of myocardial infarction and 1 810 matched controls, aged 45-70 years and living in Stockholm or Västernorrland county between 1992 and 1994. The second material was a large nationwide cohort based on construction workers who attended at least one health check-up between 1978 and 1993. We found that snuff use was highly correlated with smoking and some cardiovascular risk factors. Furthermore, snuff users were generally younger than the non snuff users and there were geographical differences with a higher prevalence of snuff use in northern Sweden. To avoid confounding from smoking the main analyses were restricted to never smokers. We found no evidence that the snuff use increased the overall risk of myocardial infarction. In the large prospective cohort, consisting of more than 100 000 non-smoking construction workers, we observed an increased risk of fatal myocardial infarction among current snuff users compared to never users, the risk being even higher among heavy users, with relative risk estimates of 1.32 (95% CI, 1.08-1.68) and 1.96 (95% CI, 1.08-3.58), respectively. Furthermore, no increased overall risk of stroke was observed among the snuff users. However, the relative risk for fatal cases was 1.38 (95% CI 0.99-1.91) among current snuff users and for fatal ischemic stroke the relative risk was 1.72 (95% CI 1.06-2.78). For those who suffered non-fatal myocardial infarction or non-fatal ischemic stroke we found an increased mortality both overall and in cardiovascular diseases among snuff users compared to never tobacco users. We also found associations between snuff use and high blood pressure as well as hypertension. The prevalence of high blood pressure was significantly higher among snuff users than non-users at the time of first blood pressure measurement. During follow-up, snuff users who were normotensive at the first blood pressure measurement, had an increased risk of developing hypertension or high blood pressure at a subsequent measurement with relative risks of 1.36 (95% CI, 1.07-1.72) and 1.39 (95% CI 1.08-1.79), respectively. In conclusion, snuff use does not seem to increase the risk of myocardial infarction or stroke. However, an increased risk of fatal diseases was observed among snuff users, both for myocardial infarction and stroke, suggesting that snuff use could influence the severity of these outcomes. Snuff use was also associated with an increased risk for high blood pressure and hypertension.
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| 10. |
- Hergens, Maria-Pia, et al.
(författare)
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Use of Scandinavian Moist Smokeless Tobacco (Snus) and the Risk of Atrial Fibrillation
- 2014
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Ingår i: Epidemiology. - 1044-3983 .- 1531-5487. ; 25:6, s. 872-876
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate.METHODS:: To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression.RESULTS:: The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers.CONCLUSION:: Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.
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