| 1. |
- Adel Fahmideh, Maral, et al.
(författare)
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Parental age and risk of genetic syndromes predisposing to nervous system tumors: nested case-control study.
- 2018
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Ingår i: Clinical epidemiology. - 1179-1349. ; 10, s. 729-738
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Tidskriftsartikel (refereegranskat)abstract
- Phacomatoses are genetic syndromes that are associated with increased risk of developing nervous system tumors. Phacomatoses are usually inherited, but many develop de novo, with unknown etiology. In this population-based study, we investigated the effect of parental age on the risk of phacomatoses in offspring.The study was a population-based nested case-control study. All individuals born and residing in Sweden between January 1960 and December 2010 were eligible for inclusion. Using the Patient Register, 4625 phacomatosis cases were identified and further classified as familial or nonfamilial. Ten matched controls per case were randomly selected from the eligible population. Data were analyzed using conditional logistic regression. Analyses were conducted for neurofibromatosis alone (n=2089) and other phacomatoses combined (n=2536).Compared with offspring of fathers aged 25-29 years, increased risk estimates of nonfamilial neurofibromatosis were found for offspring of fathers aged 35-39 years (odds ratio [OR]=1.43 [95% CI 1.16-1.74]) and ≥40 years (OR =1.74 [95% CI 1.38-2.19]). For other nonfamilial phacomatoses, the risk estimate for offspring of fathers aged ≥40 years was OR =1.23 (95% CI 1.01-1.50). Paternal age was not associated with familial phacomatoses, and no consistent association was observed with maternal age.The findings show a consistent increase in risk of de novo occurrence of phacomatoses predisposing to nervous system tumors in offspring with increasing paternal age, most pronounced for neurofibromatosis, while maternal age did not seem to influence the risk. These findings suggest an increasing rate of new mutations in the NF1 and NF2 genes in spermatozoa of older fathers.
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| 3. |
- Brooke, Hannah L, et al.
(författare)
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Adult children's socioeconomic resources and mothers' survival after a breast cancer diagnosis : a Swedish population-based cohort study.
- 2017
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 7:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Socioeconomic inequalities in survival after breast cancer persist worldwide. We aim to determine whether adult offspring's socioeconomic resources contribute to inequalities in mothers' survival after breast cancer.METHODS: 14 231 women, aged 65-79 years, with a child aged ≥30 years and a first primary diagnosis of breast cancer in the National Cancer Register between 2001 and 2010 were followed until death, 10 years after diagnosis, or end of study (December 2015). Relative survival proportions and excess mortality within 10 years of diagnosis by strata of offspring's education level and disposable income were estimated using flexible parametric models accounting for measures of mothers' socioeconomic position and expected mortality in the general population.RESULTS: 4292 women died during 102 236 person-years of follow-up. Crude 10-year relative survival proportions for mothers of children with >14, 12-14 and <12 years of education were 0.89 (0.87 to 0.91), 0.87 (0.85 to 0.89) and 0.79 (0.76 to 0.81), respectively. Compared with mothers of children with >14 years of education, mothers of children with <12 or 12-14 years of education had substantially higher excess mortality (excess HR 1.69 (1.38 to 2.07) and 1.22 (1.00 to 1.48), respectively). Higher mortality did not differ between tertiles of offspring's disposable income.CONCLUSIONS: Adult offspring's education level may contribute to inequalities in mothers' survival after breast cancer. Clinicians should be aware of the educational context beyond the individual and women with less educated offsprings may require extra support. This should be considered in future research, policy frameworks and interventions aimed at reducing survival inequalities.
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| 4. |
- Brooke, Hannah L, et al.
(författare)
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Methodological choices affect cancer incidence rates : a cohort study.
- 2017
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Ingår i: Population Health Metrics. - : Springer Science and Business Media LLC. - 1478-7954. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Incidence rates are fundamental to epidemiology, but their magnitude and interpretation depend on methodological choices. We aimed to examine the extent to which the definition of the study population affects cancer incidence rates.METHODS: All primary cancer diagnoses in Sweden between 1958 and 2010 were identified from the national Cancer Register. Age-standardized and age-specific incidence rates of 29 cancer subtypes between 2000 and 2010 were calculated using four definitions of the study population: persons resident in Sweden 1) based on general population statistics; 2) with no previous subtype-specific cancer diagnosis; 3) with no previous cancer diagnosis except non-melanoma skin cancer; and 4) with no previous cancer diagnosis of any type. We calculated absolute and relative differences between methods.RESULTS: Age-standardized incidence rates calculated using general population statistics ranged from 6% lower (prostate cancer, incidence rate difference: -13.5/100,000 person-years) to 8% higher (breast cancer in women, incidence rate difference: 10.5/100,000 person-years) than incidence rates based on individuals with no previous subtype-specific cancer diagnosis. Age-standardized incidence rates in persons with no previous cancer of any type were up to 10% lower (bladder cancer in women) than rates in those with no previous subtype-specific cancer diagnosis; however, absolute differences were <5/100,000 person-years for all cancer subtypes.CONCLUSIONS: For some cancer subtypes incidence rates vary depending on the definition of the study population. For these subtypes, standardized incidence ratios calculated using general population statistics could be misleading. Moreover, etiological arguments should be used to inform methodological choices during study design.
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| 5. |
- Brooke, Hannah L, et al.
(författare)
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Socioeconomic position and incidence of colorectal cancer in the Swedish population.
- 2016
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Ingår i: Cancer Epidemiology. - : Elsevier BV. - 1877-7821 .- 1877-783X. ; 40, s. 188-95
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The association between socioeconomic position and incidence of colorectal cancer is inconsistent and differs by global region. We aimed to clarify this association in the Swedish population.METHODS: We conducted a population-based open cohort study using data from Swedish national registers. We included all individuals, aged ≥30 years, residing in Sweden between 1993 and 2010. Socioeconomic position was indicated by (1) highest educational level (five groups), and (2) disposable income (quintiles). We used Poisson regression to estimate incidence rate ratios (IRR) and 95% confidence intervals (95% CI) of colon and rectal cancer, and colon and rectal dysplasia.RESULTS: In total, 97,827,817 person-years were accumulated and 82,686 cases of colorectal cancer were diagnosed. Compared to men with 'higher secondary' education, the adjusted IRRs (95% CI) of rectal cancer in men with 'primary or less', 'lower secondary', 'lower university' or 'higher university' education were: 1.06 (1.00, 1.11), 1.05 (0.99, 1.10), 0.96 (0.89, 1.03), and 0.92 (0.86, 0.98), respectively. In women, the corresponding figures were: 1.04 (0.95, 1.14), 1.03 (0.94, 1.13), 0.92 (0.82, 1.02) and 0.92 (0.82, 1.02). Disposable income was not associated with rectal cancer incidence. Adjusted IRRs of colon cancer did not differ between levels of education or disposable income overall or for specific colon sub-sites. Neither education nor disposable income was consistently associated with incidence of colon or rectal dysplasia.CONCLUSIONS: Prevention strategies for colon cancer should be applicable to individuals regardless of their socioeconomic position. However, factors conferred by education, e.g., health awareness, may be important for approaches aiming to reduce inequalities in incidence of rectal cancer. Further evaluation of cancer prevention and health promotion strategies among less educated groups is warranted.
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| 6. |
- Khanolkar, Amal R, et al.
(författare)
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Socioeconomic position and the risk of brain tumour : a Swedish national population-based cohort study.
- 2016
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 70:12, s. 1222-1228
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim was to investigate associations between different measures of socioeconomic position (SEP) and incidence of brain tumours (glioma, meningioma and acoustic neuroma) in a nationwide population-based cohort.METHODS: We included 4 305 265 individuals born in Sweden during 1911-1961, and residing in Sweden in 1991. Cohort members were followed from 1993 to 2010 for a first primary diagnosis of brain tumour identified from the National Cancer Register. Poisson regression was used to compute incidence rate ratios (IRR) by highest education achieved, family income, occupational group and marital status, with adjustment for age, healthcare region of residence, and time period.RESULTS: We identified 5735 brain tumours among men and 7101 among women during the study period. Highly educated men (≥3 years university education) had increased risk of glioma (IRR 1.22, 95% CI 1.08 to 1.37) compared to men with primary education. High income was associated with higher incidence of glioma in men (1.14, 1.01 to 1.27). Women with ≥3 years university education had increased risk of glioma (1.23, 1.08 to 1.40) and meningioma (1.16, 1.04 to 1.29) compared to those with primary education. Men and women in intermediate and higher non-manual occupations had increased risk of glioma compared to low manual groups. Compared to those married/cohabiting, being single or previously married/cohabiting was associated with decreased risk of glioma in men. Men in non-manual occupations had ∼50% increased risk of acoustic neuroma compared to men in low manual occupations.CONCLUSIONS: We observed consistent associations between higher SEP and higher risk of glioma. Completeness of cancer registration and detection bias are potential explanations for the findings.
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| 7. |
- Lagergren, Jesper, et al.
(författare)
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Marital status, education, and income in relation to the risk of esophaegal and gastric cancer by histological type and site
- 2016
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Ingår i: Cancer. - Stockholm : Wiley. - 0008-543X .- 1097-0142. ; 122:2, s. 207-212
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDMarital status, income, and education might influence the risk of esophageal and gastric cancer, but the literature is limited. A large study addressing subtypes of these tumors was used to clarify these associations.METHODSA nationwide, Swedish population–based cohort study from 1991 to 2010 included individuals who were 50 years old or older. Data on exposures, covariates, and outcomes were obtained from well-maintained registers. Four esophagogastric tumor subtypes were analyzed in combination and separately: esophageal adenocarcinoma, esophageal squamous cell carcinoma, cardia adenocarcinoma, and noncardia gastric adenocarcinoma. Poisson regression was used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and adjusted for confounders.RESULTSAmong 4,734,227 participants (60,634,007 person-years), 24,095 developed esophageal or gastric cancer. In comparison with individuals in a long marriage, increased IRRs were found among participants who were in a shorter marriage or were never married, remarried, divorced, or widowed. These associations were indicated for each tumor subtype but were generally stronger for esophageal squamous cell carcinoma. Higher education and income were associated with decreased IRRs in a seemingly dose-response manner and similarly for each subtype. In comparison with the completion of only primary school, higher tertiary education rendered an IRR of 0.64 (95% CI, 0.60-0.69) for men and an IRR of 0.68 (95% CI, 0.61-0.75) for women. Comparing participants in the highest and lowest income brackets (highest 20% vs lowest 20%) revealed an IRR of 0.74 (95% CI, 0.70-0.79) for men and an IRR of 0.83 (95% CI, 0.76-0.91) for women.CONCLUSIONSDivorce, widowhood, living alone, low educational attainment, and low income increase the risk of each subtype of esophageal and gastric cancer. These associations require attention when high-risk individuals are being identified.
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| 8. |
- Meyer, Anna C., et al.
(författare)
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Parents survive longer after stroke than childless individuals : a prospective cohort study of Swedes over the age of 65
- 2019
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:6, s. 1090-1095
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Tidskriftsartikel (refereegranskat)abstract
- Background: Parents have lower mortality than childless individuals, and one possible explanation is support provided by adult children. Since stroke often results in functional limitations, support from children may be of particular importance. Here, we examine whether the presence of children matters for survival after stroke among older Swedish men and women. Methods: This prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older hospitalized for their first ischemic stroke between 1998 and 2002 (33 960 men and 36 189 women) were followed 12 years for survival. Hazard ratios for all-cause mortality were calculated by number of children using Cox proportional hazard regression stratified by sex and marital status and adjusted for education, income and comorbidities. Results: Childlessness and having only one child was associated with higher mortality after stroke compared with having two children among men and women. The relative survival disadvantage of childless individuals was largest among married women [HR 1.28 (1.18-1.39)] and smallest among married men [1.09 (1.03-1.15)]. The differences in predicted median survival between childless individuals and those with two children were 4 and 7 months among married and unmarried men, and 15 and 9 months among married and unmarried women, respectively. Conclusions: Having children is associated with a longer survival after stroke among men and women regardless of marital status. Our findings further suggest that the presence of children is especially connected to married women's survival. These results may have implications for the improvement of informal care for childless older individuals.
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| 9. |
- Modig, Karin, et al.
(författare)
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"Obesity Paradox" Holds True for Patients with Hip Fracture
- 2019
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : Wolters Kluwer. - 0021-9355 .- 1535-1386. ; 101:10, s. 888-895
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hip fractures are associated with high mortality and reduced quality of life. Studies have reported a high body mass index (BMI) as being positively associated with survival when linked to old age and some chronic diseases. This phenomenon is called the “obesity paradox.” The association between BMI and survival after hip fracture has not been thoroughly studied in large samples, nor has to what extent the association is altered by comorbidities, sex, and age. The objective of this study was to investigate the association of BMI with survival after hip fracture and with the probability of returning to living at home after hip fracture.Methods: This cohort study was based on data from a prospectively maintained national registry of patients with hip fracture. A total of 17,756 patients ‡65 years of age who were treated for hip fracture during the period of 2013 to 2016, and followed until the end of 2017, were included. BMI was clinically assessed at hospital admission, comorbidity was measured with the American Society of Anesthesiologists (ASA) score, and the date of death was retrieved from a national database. Self-reported data on living arrangements were assessed on admission and 4 months after fracture. Multivariable regression models were used to estimate the associations.Results: Despite ASA scores being similar among all BMI groups, obese patients had the highest 1-year survival and patients with a BMI of <22 kg/m2 had the lowest. Adjustment for potential confounders strengthened the associations. For the chance of returning to living at home, no advantage was seen for obese patients, but patients with a BMI of <22 kg/m2 had clearly worse odds compared with patients who were of normal weight, overweight, or obese.Conclusions: The obesity paradox appears to be true for hip fracture patients aged 65 and older. Attention should be given to patients with malnutrition and underweight status rather than to those with overweight status or obesity when developing the orthogeriatric care.
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| 10. |
- Modig, Karin, et al.
(författare)
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"Obesity Paradox" Holds True for Patients with Hip Fracture : A Registry-Based Cohort Study
- 2019
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Ingår i: Journal of Bone and Joint Surgery. American volume. - : LIPPINCOTT WILLIAMS & WILKINS. - 0021-9355 .- 1535-1386. ; 101:10, s. 888-895
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hip fractures are associated with high mortality and reduced quality of life. Studies have reported a high body mass index (BMI) as being positively associated with survival when linked to old age and some chronic diseases. This phenomenon is called the "obesity paradox." The association between BMI and survival after hip fracture has not been thoroughly studied in large samples, nor has to what extent the association is altered by comorbidities, sex, and age. The objective of this study was to investigate the association of BMI with survival after hip fracture and with the probability of returning to living at home after hip fracture.Methods: This cohort study was based on data from a prospectively maintained national registry of patients with hip fracture. A total of 17,756 patients >= 65 years of age who were treated for hip fracture during the period of 2013 to 2016, and followed until the end of 2017, were included. BMI was clinically assessed at hospital admission, comorbidity was measured with the American Society of Anesthesiologists (ASA) score, and the date of death was retrieved from a national database. Self-reported data on living arrangements were assessed on admission and 4 months after fracture. Multi-variable regression models were used to estimate the associations.Results: Despite ASA scores being similar among all BMI groups, obese patients had the highest 1-year survival and patients with a BMI of <22 kg/m(2) had the lowest. Adjustment for potential confounders strengthened the associations. For the chance of returning to living at home, no advantage was seen for obese patients, but patients with a BMI of <22 kg/m(2) had clearly worse odds compared with patients who were of normal weight, overweight, or obese.Conclusions: The obesity paradox appears to be true for hip fracture patients aged 65 and older. Attention should be given to patients with malnutrition and underweight status rather than to those with overweight status or obesity when developing the orthogeriatric care.
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