| 1. |
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| 2. |
- Crump, Casey, et al.
(författare)
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Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers : national cohort and co-sibling study
- 2023
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Ingår i: BMJ. - : BMJ. - 0959-8146 .- 1756-1833. ; 380
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the associations between five major adverse pregnancy outcomes and long term risks of ischemic heart disease in mothers. Design: National cohort study. Setting: Sweden. Participants: All 2 195 266 women with a first singleton delivery in Sweden during 1973-2015. Main outcome measures: The main outcome measure was incidence of ischemic heart disease from delivery to 2018, identified from nationwide inpatient and outpatient diagnoses. Cox regression was used to calculate hazard ratios for ischemic heart disease associated with preterm delivery, small for gestational age, pre-eclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and environmental) factors. Results: During 53.6 million person years of follow-up, ischemic heart disease was diagnosed in 83 881 (3.8%) women. All five adverse pregnancy outcomes were independently associated with increased risk of ischemic heart disease. In the 10 years after delivery, adjusted hazard ratios for ischemic heart disease associated with specific adverse pregnancy outcomes were 2.09 (95% confidence interval 1.77 to 2.46) for other hypertensive disorders of pregnancy, 1.72 (1.55 to 1.90) for preterm delivery, 1.54 (1.37 to 1.72) for pre-eclampsia, 1.30 (1.09 to 1.56) for gestational diabetes, and 1.10 (1.00 to 1.21) for small for gestational age. The hazard ratios remained significantly increased even 30-46 years after delivery: 1.47 (1.30 to 1.66) for other hypertensive disorders of pregnancy, 1.40 (1.29 to 1.51) for gestational diabetes, 1.32 (1.28 to 1.36) for pre-eclampsia, 1.23 (1.19 to 1.27) for preterm delivery, and 1.16 (1.13 to 1.19) for small for gestational age. These findings were only partially (<45%) explained by shared familial (genetic or environmental) factors. Women who experienced multiple adverse pregnancy outcomes showed further increases in risk (eg, <10 years after delivery, adjusted hazard ratios associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.29 (1.19 to 1.39), 1.80 (1.59 to 2.03), and 2.26 (1.89 to 2.70), respectively)). Conclusions: In this large national cohort, women who experienced any of five major adverse pregnancy outcomes showed an increased risk for ischemic heart disease up to 46 years after delivery. Women with adverse pregnancy outcomes should be considered for early preventive evaluation and long term risk reduction to help prevent the development of ischemic heart disease.
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| 3. |
- Crump, Casey, et al.
(författare)
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Association of Preterm Birth with Long-term Risk of Heart Failure into Adulthood
- 2021
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Ingår i: JAMA Pediatrics. - : American Medical Association (AMA). - 2168-6203. ; 175:7, s. 689-697
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Preterm birth has been associated with increased risk of heart failure (HF) early in life, but its association with new-onset HF in adulthood appears to be unknown. Objective: To determine whether preterm birth is associated with increased risk of HF from childhood into mid-adulthood in a large population-based cohort. Design, Setting, and Participants: This national cohort study was conducted in Sweden with data from 1973 through 2015. All singleton live births in Sweden during 1973 through 2014 were included. Exposures: Gestational age at birth, identified from nationwide birth records. Main Outcomes and Measures: Heart failure, as identified from inpatient and outpatient diagnoses through 2015. Cox regression was used to determine hazard ratios (HRs) for HF associated with gestational age at birth while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial (genetic and/or environmental) factors. Results: A total of 4193069 individuals were included (maximum age, 43 years; median age, 22.5 years). In 85.0 million person-years of follow-up, 4158 persons (0.1%) were identified as having HF (median [interquartile range] age, 15.4 [28.0] years at diagnosis). Preterm birth (gestational age <37 weeks) was associated with increased risk of HF at ages younger than 1 year (adjusted HR [aHR], 4.49 [95% CI, 3.86-5.22]), 1 to 17 years (aHR, 3.42 [95% CI, 2.75-4.27]), and 18 to 43 years (aHR, 1.42 [95% CI, 1.19-1.71]) compared with full-term birth (gestational age, 39-41 weeks). At ages 18 through 43 years, the HRs further stratified by gestational age were 4.72 (95% CI, 2.11-10.52) for extremely preterm births (22-27 weeks), 1.93 (95% CI, 1.37-2.71) for moderately preterm births (28-33 weeks), 1.24 (95% CI, 1.00-1.54) for late preterm births (34-36 weeks), and 1.09 (95% CI, 0.97-1.24) for early term births (37-38 weeks). The corresponding HF incidence rates (per 100000 person-years) at ages 18 through 43 years were 31.7, 13.8, 8.7, and 7.3, respectively, compared with 6.6 for full-term births. These associations persisted when excluding persons with structural congenital cardiac anomalies. The associations at ages 18 through 43 years (but not <18 years) appeared to be largely explained by shared determinants of preterm birth and HF within families. Preterm birth accounted for a similar number of HF cases among male and female individuals. Conclusions and Relevance: In this large national cohort, preterm birth was associated with increased risk of new-onset HF into adulthood. Survivors of preterm birth may need long-term clinical follow-up into adulthood for risk reduction and monitoring for HF.
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| 4. |
- Crump, Casey, et al.
(författare)
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Comparative risk of suicide by specific substance use disorders : A national cohort study
- 2021
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Ingår i: Journal of Psychiatric Research. - : Elsevier BV. - 0022-3956. ; 144, s. 247-254
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Tidskriftsartikel (refereegranskat)abstract
- Substance use disorders (SUDs) are important risk factors for suicide, yet little is known about how suicide risks vary by specific SUDs. We examined these risks for the first time in a large general population to facilitate comparisons across SUDs. A national cohort study was conducted of all 6,947,191 adults in Sweden. SUDs (opioid, sedative/hypnotic, hallucinogen, cannabis, amphetamine, cocaine, and alcohol use disorders) were identified using inpatient, outpatient, and crime data, and suicide deaths using nationwide death data with follow-up during 2003–2016. Cox regression was used to compute hazard ratios (HRs) for suicide death while adjusting for sociodemographic factors and psychiatric, SUD, and somatic comorbidities. Co-sibling analyses assessed for confounding by unmeasured shared familial (genetic and/or environmental) factors. In 79.8 million person-years of follow-up, 15,616 (0.2%) suicide deaths were identified. All SUDs were associated with significantly increased risks, with HRs ranging from 12- to 26-fold and 2.5- to 6.4-fold before and after adjusting for covariates, respectively. After adjusting for all covariates, opioid use disorder was the strongest risk factor (HR, 6.39; 95% CI, 5.53–7.38) (P ≤ 0.002 compared with any other SUD), followed by sedative/hypnotic use disorder (4.62; 4.06–5.27) (P ≤ 0.009 compared with any other SUD except opioid or hallucinogen). Most associations persisted after controlling for shared familial factors, consistent with causal effects. In this large national cohort, all SUDs were associated with significantly increased risks of suicide death, especially opioid and sedative/hypnotic use disorders. These findings may improve risk stratification and inform interventions to prevent suicide in the highest-risk subgroups with SUDs.
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| 5. |
- Crump, Casey, et al.
(författare)
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Early-Life Cardiorespiratory Fitness and Long-term Risk of Prostate Cancer
- 2020
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 29:11, s. 2187-2194
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adolescence is a period of rapid prostatic growth, yet is understudied for susceptibility for future risk of prostate cancer. We examined cardiorespiratory fitness (CRF) in late adolescence in relation to long-term prostate cancer risk.Methods: A population-based cohort study was conducted of all 699,125 Swedish military conscripts during 1972–1985 (97%–98% of 18-year-old men) in relation to risk of prostate cancer overall, aggressive prostate cancer, and prostate cancer mortality during 1998–2017 (ages 50–65 years). CRF was measured by maximal aerobic workload, and prostate cancer was ascertained using the National Prostate Cancer Register. Muscle strength was examined as a secondary predictor.Results: In 38.8 million person-years of follow-up, 10,782 (1.5%) men were diagnosed with prostate cancer. Adjusting for sociodemographic factors, height, weight, and family history of prostate cancer, high CRF was associated with a slightly increased risk of any prostate cancer [highest vs. lowest quintile: incidence rate ratio (IRR), 1.10; 95% CI, 1.03–1.19; P = 0.008], but was neither significantly associated with aggressive prostate cancer (1.01; 0.85–1.21; P = 0.90) nor prostate cancer mortality (1.24; 0.73–2.13; P = 0.42). High muscle strength also was associated with a modestly increased risk of any prostate cancer (highest vs. lowest quintile: IRR, 1.14; 95% CI, 1.07–1.23; P < 0.001), but neither with aggressive prostate cancer (0.88; 0.74–1.04; P = 0.14) nor prostate cancer mortality (0.81; 0.48–1.37; P = 0.43).Conclusions: High CRF or muscle strength in late adolescence was associated with slightly increased future risk of prostate cancer, possibly related to increased screening, but neither with risk of aggressive prostate cancer nor prostate cancer mortality.Impact: These findings illustrate the importance of distinguishing aggressive from indolent prostate cancer and assessing for potential detection bias.
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| 6. |
- Crump, Casey, et al.
(författare)
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Health care utilization prior to suicide in adults with drug use disorders
- 2021
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Ingår i: Journal of Psychiatric Research. - : Elsevier BV. - 0022-3956. ; 135, s. 230-236
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Tidskriftsartikel (refereegranskat)abstract
- Drug use disorders (DUD) are associated with psychiatric illness and increased risks of suicide. We examined health care utilization prior to suicide in adults with DUD, which may reveal opportunities to prevent suicide in this high-risk population. A national cohort study was conducted of all 6,947,191 adults in Sweden, including 166,682 (2.4%) with DUD, who were followed up for suicide during 2002–2015. A nested case-control design examined health care utilization among persons with DUD who died by suicide and 10:1 age- and sex-matched controls from the general population. In 86.7 million person-years of follow-up, 15,662 (0.2%) persons died by suicide, including 1946 (1.2%) persons with DUD. Unadjusted and adjusted relative risks of suicide associated with DUD were 11.03 (95% CI, 10.62–11.46) and 2.84 (2.68–3.00), respectively. 30.4% and 52.3% of DUD cases who died by suicide had a health care encounter within 2 weeks or 3 months before the index date, respectively, compared with 5.9% and 24.3% of controls (unadjusted prevalence ratio and difference, <2 weeks: 5.20 [95% CI, 4.76–5.67] and 24.6 percentage points [22.5–26.6]; <3 months: 2.15 [2.05–2.26] and 27.9 [25.6–30.2]). However, after adjusting for psychiatric comorbidities, these differences were much attenuated. Among DUD cases, 72.5% of last encounters within 2 weeks before suicide were in outpatient clinics, mostly for non-psychiatric diagnoses. In this large national cohort, suicide among adults with DUD was often shortly preceded by outpatient clinic encounters. Clinical encounters in these settings are important opportunities to identify suicidality and intervene accordingly in patients with DUD.
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| 7. |
- Crump, Casey, et al.
(författare)
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Healthcare utilisation prior to suicide in persons with alcohol use disorder : National cohort and nested case-control study
- 2020
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 217:6, s. 710-716
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Tidskriftsartikel (refereegranskat)abstract
- Background Alcohol use disorder (AUD) is common and associated with increased risk of suicide. Aims To examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention. Method A national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case-control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls. Results In 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated with AUD were 8.15 (95% CI 7.86-8.46) and 2.22 (95% CI 2.11-2.34). Of the people with AUD who died by suicide, 39.7% and 75.6% had a healthcare encounter <2 weeks or <3 months before the index date respectively, compared with 6.3% and 25.4% of controls (adjusted prevalence ratio (PR) and difference (PD), <2 weeks: PR = 3.86, 95% CI 3.50-4.25, PD = 26.4, 95% CI 24.2-28.6; <3 months: PR = 2.03, 95% CI 1.94-2.12, PD = 34.9, 95% CI 32.6-37.1). AUD accounted for more healthcare encounters within 2 weeks of suicide among men than women (P = 0.01). Of last encounters, 48.1% were in primary care and 28.9% were in specialty out-patient clinics, mostly for non-psychiatric diagnoses. Conclusions Suicide among persons with AUD is often shortly preceded by healthcare encounters in primary care or specialty out-patient clinics. Encounters in these settings are important opportunities to identify active suicidality and intervene accordingly in patients with AUD.
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| 8. |
- Crump, Casey, et al.
(författare)
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Pre-term delivery and long-term risk of heart failure in women : a national cohort and co-sibling study
- 2022
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 43:9, s. 895-904
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Women who deliver pre-term have higher future risks of hypertension and ischaemic heart disease, but long-term risks of heart failure (HF) are unknown. We examined these risks in a large national cohort.METHODS AND RESULTS: All 2 201 284 women with a singleton delivery in Sweden during 1973-2015 were followed up for inpatient or outpatient HF diagnoses through 2015. Cox regression was used to compute hazard ratios (HRs) for HF associated with pregnancy duration, adjusting for other maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic and/or environmental) factors. In 48.2 million person-years of follow-up, 19 922 women were diagnosed with HF (median age: 60.7 years). Within 10 years after delivery, the adjusted HR was 2.96 [95% confidence interval (CI): 2.48-3.53] for HF associated with pre-term (gestational age: <37 weeks) compared with full-term (39-41 weeks) delivery. Stratified HRs were 4.27 (2.54-7.17) for extremely pre-term (22-27 weeks), 3.39 (2.57-4.48) for moderately pre-term (28-33 weeks), 2.70 (2.19-3.32) for late pre-term (34-36 weeks), and 1.70 (1.45-1.98) for early term (37-38 weeks). These HRs declined but remained elevated at 10-19 years (pre-term vs. full term: HR: 2.19; 95% CI: 1.94-2.46), 20-29 years (1.80; 1.67-1.95), and 30-43 years (1.56; 1.47-1.66) after delivery, and were not explained by shared familial factors.CONCLUSION: Pre-term and early term delivery were associated with markedly increased future hazards for HF, which persisted after adjusting for other maternal and familial factors and remained elevated 40 years later. Pre-term and early-term delivery should be recognized as risk factors for HF across the life course.KEY QUESTION: What are the long-term hazards for heart failure (HF) across the life course in women who deliver preterm?KEY FINDING: Preterm and early term delivery were associated with ∼3- and 1.7-fold adjusted hazards for HF in the next 10 years vs. full-term delivery. These hazards declined but remained elevated 40 years later, and were not explained by shared familial factors.TAKE HOME MESSAGE: Preterm and early term delivery were associated with increased future hazards for HF, which persisted for 40 years after adjusting for other maternal and familial factors. Preterm and early term delivery should be recognized as lifelong risk factors for HF.
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| 9. |
- Crump, Casey, et al.
(författare)
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Pre-Term Delivery and Risk of Ischemic Heart Disease in Women
- 2020
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 76:1, s. 57-67
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Tidskriftsartikel (refereegranskat)abstract
- Background: Women who deliver pre-term have been reported to have increased future risks of cardiometabolic disorders. However, their long-term risks of ischemic heart disease (IHD) and whether such risks are due to shared familial factors are unclear. A better understanding of these risks may help improve long-term clinical follow-up and interventions to prevent IHD in women. Objectives: The purpose of this study was to determine the long-term risks of IHD in women by pregnancy duration. Methods: A national cohort study was conducted of all 2,189,190 women with a singleton delivery in Sweden from 1973 to 2015, who were followed up for IHD through the end of 2015. Cox regression was used to compute adjusted hazard ratios (aHRs) for IHD associated with pregnancy duration, and cosibling analyses assessed the influence of shared familial (genetic and/or environmental) factors. Results: In 47.5 million person-years of follow-up, 49,955 (2.3%) women were diagnosed with IHD. In the 10 years following delivery, the aHR for IHD associated with pre-term delivery (<37 weeks) was 2.47 (95% confidence interval [CI]: 2.16 to 2.82), and further stratified was 4.04 (95% CI: 2.69 to 6.08) for extremely pre-term (22 to 27 weeks), 2.62 (95% CI: 2.09 to 3.29) for very pre-term (28 to 33 weeks), 2.30 (95% CI: 1.97 to 2.70) for late pre-term (34 to 36 weeks), and 1.47 (95% CI: 1.30 to 1.65) for early-term (37 to 38 weeks), compared with full-term (39 to 41 weeks). These risks declined but remained significantly elevated after additional follow-up (pre-term vs. full-term, 10 to 19 years: aHR: 1.86; 95% CI: 1.73 to 1.99; 20 to 29 years: aHR: 1.52; 95% CI: 1.45 to 1.59; 30 to 43 years: aHR: 1.38; 95% CI: 1.32 to 1.45). These findings did not appear attributable to shared genetic or environmental factors within families. Additional pre-term deliveries were associated with further increases in risk. Conclusions: In this large national cohort, pre-term delivery was a strong independent risk factor for IHD. This association waned over time but remained substantially elevated up to 40 years later. Pre-term delivery should be recognized as a risk factor for IHD in women across the life course.
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| 10. |
- Crump, Casey, et al.
(författare)
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Preterm birth and risk of type 1 and type 2 diabetes : a national cohort study
- 2020
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 63:3, s. 508-518
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: Preterm birth (gestational age <37 weeks) has been associated with insulin resistance early in life. However, no large population-based studies have examined risks of type 1 and type 2 diabetes and potential sex-specific differences from childhood into adulthood. Clinicians will increasingly encounter adults who were born prematurely and will need to understand their long-term risks. We hypothesised that preterm birth is associated with increased risks of type 1 and type 2 diabetes into adulthood. Methods: A national cohort study was conducted of all 4,193,069 singletons born in Sweden during 1973–2014, who were followed up for type 1 and type 2 diabetes identified from nationwide diagnoses and pharmacy data to the end of 2015 (maximum age 43 years; median age at the end of follow-up 22.5 years). Cox regression was used to adjust for potential confounders, and co-sibling analyses assessed the influence of shared familial (genetic and/or environmental) factors. Results: In 92.3 million person-years of follow-up, 27,512 (0.7%) and 5525 (0.1%) people were identified with type 1 and type 2 diabetes, respectively. Gestational age at birth was inversely associated with both type 1 and type 2 diabetes risk. Adjusted HRs for type 1 and type 2 diabetes at age <18 years associated with preterm birth were 1.21 (95% CI, 1.14, 1.28) and 1.26 (95% CI, 1.01, 1.58), respectively, and at age 18–43 years were 1.24 (95% CI, 1.13, 1.37) and 1.49 (95% CI, 1.31, 1.68), respectively, compared with full-term birth. The associations between preterm birth and type 2 (but not type 1) diabetes were stronger among females (e.g. at age 18–43 years, females: adjusted HR, 1.75; 95% CI, 1.47, 2.09; males: 1.28; 95% CI, 1.08, 1.53; p < 0.01 for additive and multiplicative interaction). These associations were only partially explained by shared genetic or environmental factors in families. Conclusions/interpretation: In this large national cohort, preterm birth was associated with increased risk of type 1 and type 2 diabetes from childhood into early to mid-adulthood. Preterm-born children and adults may need early preventive evaluation and long-term monitoring for diabetes.
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| 11. |
- Crump, Casey, et al.
(författare)
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Preterm birth, low fetal growth and risk of suicide in adulthood : A national cohort and co-sibling study
- 2021
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 50:5, s. 1604-1614
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adverse perinatal exposures have been associated with psychiatric disorders and suicidal behaviours later in life. However, the independent associations of gestational age at birth or fetal growth with suicide death, potential sex-specific differences, and causality of these associations are unclear. Methods: A national cohort study was conducted of all 2 440 518 singletons born in Sweden during 1973-98 who survived to age 18 years, who were followed up through 2016. Cox regression was used to compute hazard ratios (HRs) for suicide death associated with gestational age at birth or fetal growth while mutually adjusting for these factors, sociodemographic characteristics and family history of suicide. Co-sibling analyses assessed the influence of unmeasured shared familial (genetic and/or environmental) factors. Results: In 31.2 million person-years of follow-up, 4470 (0.2%) deaths by suicide were identified. Early preterm birth (22-33 weeks) was associated with an increased risk of suicide among females [adjusted hazard ratio (HR), 1.97; 95% confidence interval CI), 1.29, 3.01; P = 0.002) but not males (0.90; 0.64, 1.28; P = 0.56), compared with full-term birth (39-41 weeks). Small for gestational age was associated with a modestly increased risk of suicide among females (adjusted HR, 1.27; 95% CI, 1.08, 1.51; P = 0.005) and males (1.14; 1.03, 1.27; P = 0.02). However, these associations were attenuated and non-significant after controlling for shared familial factors. Conclusions: In this large national cohort, preterm birth in females and low fetal growth in males and females were associated with increased risks of suicide death in adulthood. However, these associations appeared to be non-causal and related to shared genetic or prenatal environmental factors within families.
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| 12. |
- Crump, Casey, et al.
(författare)
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Preterm delivery and long term mortality in women : National cohort and co-sibling study
- 2020
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Ingår i: The BMJ. - : BMJ. - 0959-8146. ; 370
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To examine the long term mortality associated with preterm delivery in a large population based cohort of women, and to assess for potential confounding by shared familial factors. Design National cohort study. Setting Sweden. Participants All 2 189 477 women with a singleton delivery in 1973-2015. Main outcome measures All cause and cause specific mortality up to 2016, identified from nationwide death records. Cox regression was used to calculate hazard ratios while adjusting for confounders, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and environmental) factors. Results In 50.7 million person years of follow-up, 76 535 (3.5%) women died (median age at death was 57.6). In the 10 years after delivery, the adjusted hazard ratio for all cause mortality associated with preterm delivery (<37 weeks) was 1.73 (95% confidence interval 1.61 to 1.87), and when further stratified was 2.20 (1.63 to 2.96) for extremely preterm delivery (22-27 weeks), 2.28 (2.01 to 2.58) for very preterm delivery (28-33 weeks), 1.52 (1.39 to 1.67) for late preterm delivery (34-36 weeks), and 1.19 (1.12 to 1.27) for early term delivery (37-38 weeks) compared with full term delivery (39-41 weeks). These risks declined but remained significantly raised after longer follow-up times: for preterm versusfull term births, 10-19 years after delivery, the adjusted hazard ratio was 1.45 (95% confidence interval 1.37 to 1.53); 20-44 years after delivery, the adjusted hazard ratio was 1.37 (1.33 to 1.41). These findings did not seem to be attributable to shared genetic or environmental factors within families. Several causes were identified, including cardiovascular and respiratory disorders, diabetes, and cancer. Conclusions In this large national cohort of women, the findings suggested that preterm and early term delivery were independent risk factors for premature mortality from several major causes. These associations declined over time but remained raised up to 40 years later.
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| 13. |
- Crump, Casey, et al.
(författare)
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Preterm Delivery and Long-term Risk of Hypertension in Women
- 2022
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Ingår i: JAMA Cardiology. - : American Medical Association (AMA). - 2380-6583. ; 7:1, s. 65-74
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Preterm delivery has been associated with future cardiometabolic disorders in women. However, the long-term risks of chronic hypertension associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment, clinical monitoring, and cardiovascular prevention strategies in women. Objective: To examine the long-term risks of chronic hypertension associated with preterm delivery in a large population-based cohort of women. Design, Setting, and Participants: This national cohort study assessed all 2195989 women in Sweden with a singleton delivery from January 1, 1973, to December 31, 2015. Data analyses were conducted from March 8, 2021, to August 20, 2021. Exposures: Pregnancy duration identified from nationwide birth records. Main Outcomes and Measures: New-onset chronic hypertension identified from primary care, specialty outpatient, and inpatient diagnoses using administrative data. Cox proportional hazards regression was used to compute hazard ratios (HRs) while adjusting for preeclampsia, other hypertensive disorders of pregnancy, and other maternal factors. Cosibling analyses were assessed for potential confounding by shared familial (genetic and/or environmental) factors. Results: In 46.1 million person-years of follow-up, 351189 of 2195989 women (16.0%) were diagnosed with hypertension (mean [SD] age, 55.4 [9.9] years). Within 10 years after delivery, the adjusted HR for hypertension associated with preterm delivery (gestational age <37 weeks) was 1.67 (95% CI, 1.61-1.74) and when further stratified was 2.23 (95% CI, 1.98-2.52) for extremely preterm (22-27 weeks of gestation), 1.85 (95% CI, 1.74-1.97) for moderately preterm (28-33 weeks of gestation), 1.55 (95% CI, 1.48-1.63) for late preterm (34-36 weeks of gestation), and 1.26 (95% CI, 1.22-1.30) for early-term (37-38 weeks of gestation) compared with full-term (39-41 weeks of gestation) delivery. These risks decreased but remained significantly elevated at 10 to 19 years (preterm vs full-term delivery: adjusted HR, 1.40; 95% CI, 1.36-1.44), 20 to 29 years (preterm vs full-term delivery: adjusted HR, 1.20; 95% CI, 1.18-1.23), and 30 to 43 years (preterm vs full-term delivery: adjusted HR, 95% CI, 1.12; 1.10-1.14) after delivery. These findings were not explained by shared determinants of preterm delivery and hypertension within families. Conclusions and Relevance: In this large national cohort study, preterm delivery was associated with significantly higher future risks of chronic hypertension. These associations remained elevated at least 40 years later and were largely independent of other maternal and shared familial factors. Preterm delivery should be recognized as a lifelong risk factor for hypertension in women.
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| 14. |
- Crump, Casey, et al.
(författare)
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Preterm Delivery and Long-Term Risk of Stroke in Women : A National Cohort and Cosibling Study
- 2021
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Ingår i: Circulation. - 0009-7322. ; 143:21, s. 2032-2044
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stroke has a high burden of disease in women, and adverse pregnancy outcomes have been identified as important risk factors for stroke later in life. However, long-term risks of stroke associated with preterm delivery and whether such risks are attributable to familial confounding are unclear. Such knowledge is needed to improve long-term risk assessment and stroke prevention in women. Methods: A national cohort study was conducted of all 2 188 043 women with a singleton delivery in Sweden in 1973 through 2015 who were followed up for stroke identified from nationwide diagnoses through 2015. Cox regression was used to compute adjusted hazard ratios (aHRs) for stroke associated with pregnancy duration, and cosibling analyses assessed for confounding by shared familial (genetic or environmental) factors. Results: In 48.0 million person-years of follow-up, 36 372 (1.7%) women were diagnosed with stroke. In the 10 years after delivery, the aHR for stroke associated with preterm delivery (gestational age <37 weeks) was 1.61 (95% CI, 1.45-1.79) and further stratified was 2.81 (95% CI, 2.02-3.91) for extremely preterm (22-27 weeks), 2.07 (95% CI, 1.74-2.46) for very preterm (28-33 weeks), 1.38 (95% CI, 1.21-1.57) for late preterm (34-36 weeks), and 1.15 (95% CI, 1.06-1.24) for early term (37-38 weeks), compared with full-term (39-41 weeks) delivery. These risks remained similarly elevated at 10 to 19 years after delivery (preterm versus full-term: aHR, 1.61 [95% CI, 1.50-1.74]) and then declined but remained significantly elevated at 20 to 29 years (aHR, 1.35 [95% CI, 1.28-1.44]) and 30 to 43 years (aHR, 1.35 [95% CI, 1.27-1.42]). Preterm delivery was associated with both hemorrhagic (aHR, 1.31 [95% CI, 1.25-1.38]) and ischemic (aHR, 1.54 [95% CI, 1.47-1.61]) stroke across the entire follow-up period (up to 43 years). These findings were not explained by shared determinants of preterm delivery and stroke within families. Stroke risks were higher after either spontaneous or medically indicated preterm delivery, and recurrent preterm delivery was associated with further increases in risk. Conclusions: In this large national cohort, preterm delivery was associated with higher future risks of both hemorrhagic and ischemic stroke. These associations remained substantially elevated at least 40 years later, and were largely independent of covariates and shared familial factors. Preterm delivery should be recognized as a risk factor for stroke in women across the life course.
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| 15. |
- Crump, Casey, et al.
(författare)
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Preterm or early term birth and long-term risk of asthma into midadulthood : A national cohort and cosibling study
- 2023
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 78:7, s. 653-660
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Tidskriftsartikel (refereegranskat)abstract
- Background Preterm birth is associated with pulmonary complications early in life; however, long-term risks of asthma into adulthood are unclear. Objective To determine asthma risks from childhood into adulthood associated with gestational age at birth in a large population-based cohort. Methods A national cohort study was conducted of all 4 079 878 singletons born in Sweden during 1973-2013, followed up for asthma identified from primary care, specialty outpatient and inpatient diagnoses in nationwide registries through 2018 (up to 46 years). Cox regression was used to adjust for potential confounders, and cosibling analyses assessed the influence of unmeasured shared familial (genetic and/or environmental) factors. Results In 91.9 million person-years of follow-up, 607 760 (14.9%) persons were diagnosed with asthma. Preterm birth was associated with increased risk of asthma at ages <10 years (adjusted HR 1.73; 95% CI 1.70 to 1.75), 10-17 years (1.29; 1.27 to 1.32) and 18-46 years (1.19; 1.17 to 1.22). Across all ages, adjusted HRs further stratified were 3.01 (95% CI 2.88 to 3.15) for extremely preterm (22-27 weeks), 1.76 (1.72 to 1.79) for very or moderately preterm (28-33 weeks), 1.31 (1.29 to 1.32) for late preterm (34-36 weeks) and 1.13 (1.12 to 1.14) for early term (37-38 weeks), compared with full-term (39-41 weeks) birth. These findings were not explained by shared familial factors. Asthma risks were elevated after spontaneous or medically indicated preterm birth and with or without perinatal respiratory complications. Conclusions In this large national cohort, preterm and early term birth were associated with increased risks of asthma from childhood into midadulthood. Persons born prematurely need long-term follow-up into adulthood for timely detection and treatment of asthma.
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| 16. |
- Crump, Casey, et al.
(författare)
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Preterm or early term birth and risk of attention-deficit/hyperactivity disorder : a national cohort and co-sibling study
- 2023
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Ingår i: Annals of Epidemiology. - 1047-2797. ; 86, s. 4-125
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To examine risks of attention-deficit/hyperactivity disorder (ADHD) in preterm and early term birth survivors, and potential sex-specific differences. Methods: A national cohort study was conducted of all 4061,795 singletons born in Sweden in 1973–2013 who survived infancy, followed up for ADHD identified from nationwide diagnoses and medications through 2018. Poisson regression was used to compute prevalence ratios (PRs), adjusting for sociodemographic and perinatal factors. Co-sibling analyses assessed for confounding by unmeasured shared familial (genetic or environmental) factors. Results: ADHD prevalences by gestational age at birth were 12.1% for extremely preterm (22–27 weeks), 7.0% for moderately preterm (28–33 weeks), 5.7% for late preterm (34–36 weeks), 6.1% for all preterm (<37 weeks), 5.2% for early term (37–38 weeks), and 4.5% for full-term (39–41 weeks). Adjusted PRs comparing extremely preterm, all preterm, or early term versus full-term, respectively, were 2.35 (95% CI, 2.15–2.57), 1.28 (1.25–1.31), and 1.12 (1.10–1.13) among males, and 2.46 (2.17–2.78), 1.24 (1.20–1.28), and 1.08 (1.06–1.10) among females (P < .001 for each). These associations were virtually unchanged after controlling for shared familial factors. Both spontaneous and medically indicated preterm birth were associated with ADHD (adjusted PRs, 1.21; 95% CI, 1.18–1.24; and 1.39; 1.34–1.43, respectively). Conclusions: In this large cohort, preterm and early term birth were associated with increased risks of ADHD in males and females, independently of covariates and shared familial factors.
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| 17. |
- Crump, Casey, et al.
(författare)
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Preterm or early term birth and risk of autism
- 2021
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 148:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Preterm birth has been linked with increased risk of autism spectrum disorder (ASD); however, potential causality, sex-specific differences, and association with early term birth are unclear. We examined whether preterm and early term birth are associated with ASD in a large population-based cohort. METHODS: A national cohort study was conducted of all 4 061 795 singleton infants born in Sweden during 1973–2013 who survived to age 1 year, who were followed-up for ASD identified from nationwide outpatient and inpatient diagnoses through 2015. Poisson regression was used to determine prevalence ratios for ASD associated with gestational age at birth, adjusting for confounders. Cosibling analyses were used to assess the influence of unmeasured shared familial (genetic and/or environmental) factors. RESULTS: ASD prevalences by gestational age at birth were 6.1% for extremely preterm (22–27 weeks), 2.6% for very to moderate preterm (28–33 weeks), 1.9% for late preterm (34–36 weeks), 2.1% for all preterm (<37 weeks), 1.6% for early term (37–38 weeks), and 1.4% for term (39–41 weeks). The adjusted prevalence ratios comparing extremely preterm, all preterm, or early term versus term, respectively, were 3.72 (95% confidence interval, 3.27–4.23), 1.35 (1.30–1.40), and 1.11 (1.08–1.13) among boys and 4.19 (3.45–5.09), 1.53 (1.45–1.62), and 1.16 (1.12–1.20) among girls (P < .001 for each). These associations were only slightly attenuated after controlling for shared familial factors. CONCLUSIONS: In this national cohort, preterm and early term birth were associated with increased risk of ASD in boys and girls. These associations were largely independent of covariates and shared familial factors, consistent with a potential causal relationship.
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| 18. |
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| 19. |
- Crump, Casey, et al.
(författare)
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Response to Lao, Guan, Wang, et al.
- 2024
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Ingår i: Journal of the National Cancer Institute. - 0027-8874. ; 116:5, s. 770-770
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Tidskriftsartikel (refereegranskat)
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| 20. |
- Crump, Casey, et al.
(författare)
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Risk of hypertension into adulthood in persons born prematurely : A national cohort study
- 2020
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 41:16, s. 1542-1550
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Preterm birth has been associated with elevated blood pressure early in life; however, hypertension risks from childhood into adulthood remain unclear. We conducted a large population-based study to examine gestational age at birth in relation to hypertension risks from childhood into adulthood. Methods and results: A national cohort study was conducted of all 4 193 069 singleton live births in Sweden during 1973-2014, who were followed up for hypertension identified from nationwide inpatient and outpatient (specialty and primary care) diagnoses from any health care encounters through 2015 (maximum age 43 years; median 22.5). Cox regression was used to examine gestational age at birth in relation to hypertension risk while adjusting for other perinatal and maternal factors, and co-sibling analyses assessed the potential influence of unmeasured shared familial (genetic and/or environmental) factors. In 86.8 million person-years of follow-up, 62 424 (1.5%) persons were identified with hypertension (median age 29.8 years at diagnosis). Adjusted hazard ratios for new-onset hypertension at ages 18-29 years associated with preterm (<37 weeks) and extremely preterm (22-27 weeks) birth were 1.28 [95% confidence interval (CI), 1.21-1.36] and 2.45 (1.82-3.31), respectively, and at ages 30-43 years were 1.25 (1.18-1.31) and 1.68 (1.12-2.53), respectively, compared with full-Term birth (39-41 weeks). These associations affected males and females similarly and appeared substantially related to shared genetic or environmental factors in families. Conclusions: In this large national cohort, preterm birth was associated with increased risk of hypertension into early adulthood. Persons born prematurely may need early preventive evaluation and long-Term monitoring for the development of hypertension.
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| 21. |
- Crump, Casey, et al.
(författare)
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Risks of alcohol and drug use disorders in prostate cancer survivors : a national cohort study
- 2023
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Ingår i: JNCI CANCER SPECTRUM. - : Oxford University Press (OUP). - 2515-5091. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prostate cancer (PC) survivors may potentially use substances to cope with psychological distress or poorly controlled physical symptoms. Little is known, however, about the long-term risks of alcohol use disorder (AUD) or drug use disorders in men with PC.Methods: A national cohort study was conducted in Sweden of 180 189 men diagnosed with PC between 1998 and 2017 and 1 801 890 age-matched population-based control men. AUD and drug use disorders were ascertained from nationwide records through 2018. Cox regression was used to compute hazard ratios (HRs) while adjusting for sociodemographic factors and prior psychiatric disorders. Subanalyses examined differences by PC treatment from 2005 to 2017.Results: Men with high-risk PC had increased risks of both AUD (adjusted HR = 1.44, 95% confidence interval [CI] = 1.33 to 1.57) and drug use disorders (adjusted HR = 1.93, 95% CI = 1.67 to 2.24). Their AUD risk was highest in the first year and was no longer significantly elevated 5 years after PC diagnosis, whereas their drug use disorders risk remained elevated 10 years after PC diagnosis (adjusted HR = 2.26, 95% CI = 1.45 to 3.52), particularly opioid use disorder (adjusted HR = 3.07, 95% CI = 1.61 to 5.84). Those treated only with androgen-deprivation therapy had the highest risks of AUD (adjusted HR = 1.91, 95% CI = 1.62 to 2.25) and drug use disorders (adjusted HR = 2.23, 95% CI = 1.70 to 2.92). Low- or intermediate-risk PC was associated with modestly increased risks of AUD (adjusted HR = 1.38, 95% CI = 1.30 to 1.46) and drug use disorders (adjusted HR = 1.19, 95% CI = 1.06 to 1.34).Conclusions: In this large cohort, men with PC had significantly increased risks of both AUD and drug use disorders, especially those with high-risk PC and treated only with androgen-deprivation therapy. PC survivors need long-term psychosocial support and timely detection and treatment of AUD and drug use disorders.
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| 22. |
- Crump, Casey, et al.
(författare)
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Risks of Depression and Suicide After Diagnosis With Heart Failure : A National Cohort Study
- 2022
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Ingår i: JACC: Heart Failure. - : Elsevier BV. - 2213-1779. ; 10:11, s. 819-827
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Tidskriftsartikel (refereegranskat)abstract
- Background: Heart failure (HF) has been associated with psychosocial distress, but other long-term mental health sequelae are unclear. Objectives: In this study, the authors sought to determine risks of major depression and suicide, susceptible time periods, and sex-specific differences after HF diagnosis in a large population-based cohort. Methods: A national cohort study was conducted of all 154,572 persons diagnosed with HF at ages 18-75 years during 2002-2017 in Sweden and 1,545,720 age- and sex-matched population-based control subjects who were followed up for major depression and suicide ascertained from nationwide inpatient, outpatient, and death records through 2018. Poisson regression was used to compute incidence rate ratios (IRRs) while adjusting for sociodemographic factors and comorbidities. Results: HF was associated with increased risks of major depression and death by suicide in both men and women, with highest risks in the first 3 months, then declining to modest risks at ≥12 months after HF diagnosis. Within 3 months after HF diagnosis, adjusted IRRs for new-onset major depression were 3.34 (95% CI: 3.04-3.68) in men and 2.78 (95% CI: 2.51-3.09) in women, and for suicide death were 4.47 (95% CI: 2.62-7.62) in men and 2.82 (95% CI: 1.11-7.12) in women. These risks were elevated regardless of age at HF diagnosis. HF was associated with significantly more depression cases in women (P < 0.001). Conclusions: In this large national cohort, HF was associated with substantially increased risks of depression and suicide in men and women, with highest risks occurring within 3 months after HF diagnosis. Men and women with HF need timely detection and treatment of depression and suicidality.
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| 23. |
- Crump, Casey, et al.
(författare)
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Risks of depression, anxiety, and suicide in partners of men with prostate cancer : a national cohort study
- 2024
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Ingår i: Journal of the National Cancer Institute. - 0027-8874. ; 116:5, s. 745-752
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Tidskriftsartikel (refereegranskat)abstract
- Background: A diagnosis of prostate cancer (PC) may cause psychosocial distress not only in a man but also in his intimate partner. However, long-term risks of depression, anxiety, or suicide in partners of men with PC are largely unknown. Methods: A national cohort study was conducted of 121 530 partners of men diagnosed with PC during 1998-2017 and 1 093 304 population-based controls in Sweden. Major depression, anxiety disorder, and suicide death were ascertained through 2018. Cox regression was used to compute hazard ratios (HRs) while adjusting for sociodemographic factors. Results: Partners of men with high-risk PC had increased risks of major depression (adjusted HR ¼ 1.34, 95% confidence interval [CI] ¼ 1.30 to 1.39) and anxiety disorder (adjusted HR ¼ 1.25, 95% CI ¼ 1.20 to 1.30), which remained elevated 10 or more years later. Suicide death was increased in partners of men with distant metastases (adjusted HR ¼ 2.38, 95% CI ¼ 1.08 to 5.22) but not other high-risk PC (adjusted HR ¼1.14, 95% CI ¼ 0.70 to 1.88). Among partners of men with high-risk PC, risks of major depression and anxiety disorder were highest among those 80 years of age or older (adjusted HR ¼ 1.73; 95% CI ¼ 1.53 to 1.96; adjusted HR ¼ 1.70, 95% CI ¼ 1.47 to 1.96, respectively), whereas suicide death was highest among those younger than 60 years of age (adjusted HR ¼ 7.55, 95% CI ¼ 2.20 to 25.89). In contrast, partners of men with low- or intermediate-risk PC had modestly or no increased risks of these outcomes. Conclusions: In this large cohort, partners of men with high-risk PC had increased risks of major depression and anxiety disorder, which persisted for 10 or more years. Suicide death was increased 2-fold in partners of men with distant metastases. Partners as well as men with PC need psychosocial support and close follow-up for psychosocial distress.
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| 24. |
- Crump, Casey, et al.
(författare)
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Stroke risks in adult survivors of preterm birth : National cohort and cosibling study
- 2021
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Ingår i: Stroke. - 0039-2499. ; 52:8, s. 2609-2617
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Clinicians will increasingly encounter adult patients who were born preterm and will need to understand their long-term sequelae. Adult survivors of preterm birth have been reported to have increased risks of hypertension and other stroke risk factors. However, their stroke risks have seldom been examined and the findings are discrepant, possibly due to small sample sizes, insufficient follow-up, or survivor bias. We examined whether preterm birth is associated with stroke in a large population-based cohort. Methods: A national cohort study was conducted of all 2 140 866 singletons born in Sweden from 1973 to 1994 who survived to age 18 years, who were followed up for first-time stroke through 2015 (maximum age 43 years). Cox regression was used to examine stroke risks associated with gestational age at birth, adjusting for other perinatal and parental factors. Cosibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors. Results: In 28.0 million person-years of follow-up, 4861 (0.2%) people were diagnosed with stroke. At ages 18 to 43 years, the adjusted hazard ratio for stroke associated with preterm birth (<37 weeks) was 1.26 (95% CI, 1.12-1.43; P<0.001), and further stratified was 1.42 (1.11-1.81; P=0.005) for early preterm (22-33 weeks) and 1.22 (1.06-1.40; P=0.004) for late preterm (34-36 weeks), compared with full-term (39-41 weeks). Positive associations were found with both hemorrhagic stroke (early preterm: Adjusted hazard ratio, 1.42 [95% CI, 1.04-1.94]; any preterm: 1.15 [0.97-1.35]) and ischemic stroke (early preterm: Adjusted hazard ratio, 1.33 [95% CI, 0.87-2.03]; any preterm: 1.31 [1.07-1.60]). These findings were similar in men and women and only partially explained by shared determinants of preterm birth and stroke within families. Conclusions: In this large national cohort, preterm birth was associated with increased risks of both hemorrhagic and ischemic stroke in adulthood. Preterm birth survivors need early preventive evaluation and long-term clinical follow-up to reduce their lifetime risk of stroke.
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| 25. |
- Dahlman, Disa, et al.
(författare)
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Drug use disorder and risk of incident and fatal prostate cancer among Swedish men : a nationwide epidemiological study
- 2022
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Ingår i: Cancer Causes and Control. - : Springer Science and Business Media LLC. - 0957-5243 .- 1573-7225. ; 33:2, s. 213-222
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden. Methods: We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD. Results: DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis. Conclusions: Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment.
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| 26. |
- Edwards, Alexis C., et al.
(författare)
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Alcohol use disorder and non-fatal suicide attempt : findings from a Swedish National Cohort Study
- 2022
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 117:1, s. 96-105
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: Alcohol use disorder (AUD) is associated with increased risk of non-fatal suicide attempt. We aimed to measure the strength and mechanistic nature of the association between AUD and increased suicide attempt and determine any causal pathways and/or shared risk factors. Design: We used Cox proportional hazards models in population-level and co-relative analyses to evaluate the risk of first non-fatal suicide attempt as a function of previous AUD. Setting and Participants: We used continuously updated longitudinal nationwide Swedish registry data on native Swedes born from 1950 to 1970 (n = 2 229 619) and followed from age 15 until 2012. Measurements: AUD and suicide attempt were identified using International Classification of Diseases (ICD)-8, ICD-9, and ICD-10 codes. AUD was also identified using pharmacy and criminal records. Genetic and family environmental risks were derived based on relatedness via the Multi-Generation Register and shared residency via the Population and Housing Census and the Total Population Register. Findings: AUD was robustly associated with suicide attempt in crude models (hazard ratio [HR] = 15.24 [95% CI: 14.92, 15.56]). In models adjusted for sociodemographic factors and psychiatric comorbidity, the association was attenuated: for women, HRs declined gradually across time, ranging from 5.55 (3.72, 8.29) during the observation period that ranged from age 15 to 19 years to 1.77 (1.65, 1.90) at age 40 or older. For men, the corresponding figures were 6.12 (4.07, 9.19) and 1.83 (1.72, 1.94); in contrast to women, risk of suicide attempt among men increased from age 15 to 29 before declining. In co-relative models, a residual association remained, consistent with a causal path from AUD to suicide attempt. Conclusions: In Sweden, alcohol use disorder appears to be an important predictor of suicide attempt even in the context of other psychiatric disorders. The observed association is likely the result of features that jointly impact risk of alcohol use disorder and suicide attempts (genetic liability, psychiatric illness, and childhood stressors) and a potentially causal pathway, acting independently or in conjunction with one another.
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| 27. |
- Edwards, Alexis C., et al.
(författare)
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Alcohol use disorder and risk of specific methods of suicide death in a national cohort
- 2024
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Ingår i: Acta Psychiatrica Scandinavica. - 0001-690X. ; 149:6, s. 479-490
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Alcohol use disorder (AUD) is among the strongest correlates of suicide death, but it is unclear whether AUD status is differentially associated with risk of suicide by particular methods. Methods: The authors used competing risks models to evaluate the association between AUD status and risk of suicide by poisoning, suffocation, drowning, firearm, instruments, jumping, or other means in a large Swedish cohort born 1932–1995 (total N = 6,581,827; 48.8% female). Data were derived from Swedish national registers, including the Cause of Death Register and a range of medical registers. Results: After adjusting for sociodemographic factors and familial liability to suicidal behavior, AUD was positively associated with risk of suicide for each method evaluated (cumulative incidence differences: 0.006–1.040 for females, 0.046–0.680 for males), except the association with firearm suicide in females. AUD was most strongly associated with risk of suicide by poisoning. Sex differences in the effects of AUD and family liability were observed for some, but not all, methods. Furthermore, high familial liability for suicidal behavior exacerbated AUD's impact on risk for suicide by poisoning (both sexes) and suffocation and jumping (males only), while the inverse interaction was observed for firearm suicide (males only). Conclusions: AUD increases risk of suicide by all methods examined and is particularly potent with respect to risk of suicide by poisoning. Differences in risk related to sex and familial liability to suicidal behavior underscore AUD's nuanced role in suicide risk. Future research should investigate targeted means restriction effectiveness among persons with AUD.
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| 28. |
- Edwards, Alexis C., et al.
(författare)
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Exposure to alcohol outlets and risk of suicidal behavior in a Swedish cohort of young adults
- 2023
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Ingår i: Alcoholism: Clinical and Experimental Research. - 0145-6008. ; 47:5, s. 930-939
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Tidskriftsartikel (refereegranskat)abstract
- Background: Greater alcohol accessibility, for example in the form of a high density of alcohol outlets or low alcohol taxation rates, may be associated with increased risk of suicidal behavior. However, most studies have been conducted at the aggregate level, and some have not accounted for potential confounders such as socioeconomic position or neighborhood quality. Methods: In a Swedish cohort of young adults aged 18 to 25, we used logistic regressions to evaluate whether living in a neighborhood that included bars, nightclubs, and/or government alcohol outlets was associated with risk of suicide attempt (SA) or suicide death (SD) during four separate 2-year observation periods. Neighborhoods were defined using pre-established nationwide designations. We conducted combined-sex and sex-stratified analyses, and included as covariates indicators of socioeconomic position, neighborhood deprivation, and aggregate genetic liability to suicidal behavior. Results: Risk of SA was increased in some subsamples of individuals living in a neighborhood with a bar or government alcohol outlet (odds ratios [ORs] = 1.05 to 1.15). Risk of SD was also higher among certain subsamples living in a neighborhood with a government outlet (ORs = 1.47 to 1.56), but lower for those living near a bar (ORs = 0.89 to 0.91). Significant results were driven by, but not exclusive to, the male subsample. Individuals with higher aggregate genetic risk for SA were more sensitive to the effects of a neighborhood government alcohol outlet, pooled across observation periods, in analyses of the sexes combined (relative excess risk due to interaction [RERI] = 0.05; 95% confidence intervals [CI] 0.01; 0.09) and in the male subsample (RERI = 0.06; 95% CI 0.001; 0.12). Conclusions: Although effect sizes are small, living in a neighborhood with bars and/or government alcohol outlets may increase suicidal behavior among young adults. Individuals with higher genetic liability for SA are slightly more susceptible to these exposures.
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| 29. |
- Edwards, Alexis C., et al.
(författare)
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Genetic differences between suicide deaths and deaths of undetermined intent
- 2023
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Ingår i: Suicide and Life-Threatening Behavior. - : Wiley. - 0363-0234 .- 1943-278X. ; 53:1, s. 100-109
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Few, if any, prior studies have considered whether undetermined intent (UDI) deaths and suicide deaths differ with respect to genetic liability for suicidal behavior or psychopathology. Methods: The authors used Swedish national registry data to identify suicide deaths (N = 31,835) and UDI deaths (N = 10,623); sociodemographic covariates; and registrations for psychopathology. Family genetic risk scores (FGRS) were derived for each form of psychopathology. The authors used LASSO models to assess genetic and phenotypic differences across outcomes. Results: In the multivariate LASSO regressions, higher FGRS for major depression, bipolar disorder, and suicide death were associated with lower odds of UDI relative to unambiguous suicide (OR = 0.91–0.95), while those for alcohol and drug use disorders, ADHD, and criminal behavior were associated with higher odds of UDI relative to unambiguous suicide (OR = 1.04–1.12). When the corresponding phenotypic registration status for these outcomes was included in a subsequent model, the associations were attenuated and of small magnitude, but many remained different from OR = 1. Conclusions: Aggregate genetic differences between unambiguous suicide decedents and UDI deaths are small, particularly when accounting for psychiatric comorbidity, but in some cases, statistically significant. These findings suggest that different analytic treatment of UDI deaths may be warranted depending on the research question. Replication in other samples, and using molecular genetic data, is necessary.
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| 30. |
- Edwards, Alexis C., et al.
(författare)
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Oral contraceptive use and risk of suicidal behavior among young women
- 2022
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Ingår i: Psychological Medicine. - 0033-2917. ; 52:9, s. 1710-1717
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Tidskriftsartikel (refereegranskat)abstract
- Background. Oral contraceptive use has been previously associated with an increased risk of suicidal behavior in some, but not all, samples. The use of large, representative, longitudinally-assessed samples may clarify the nature of this potential association. Methods. We used Swedish national registries to identify women born between 1991 and 1995 (N = 216 702) and determine whether they retrieved prescriptions for oral contraceptives. We used Cox proportional hazards models to test the association between contraceptive use and first observed suicidal event (suicide attempt or death) from age 15 until the end of follow-up in 2014 (maximum age 22.4). We adjusted for covariates, including mental illness and parental history of suicide. Results. In a crude model, use of combination or progestin-only oral contraceptives was positively associated with suicidal behavior, with hazard ratios (HRs) of 1.73-2.78 after 1 month of use, and 1.25-1.82 after 1 year of use. Accounting for sociodemographic, parental, and psychiatric variables attenuated these associations, and risks declined with increasing duration of use: adjusted HRs ranged from 1.56 to 2.13 1 month beyond the initiation of use, and from 1.19 to 1.48 1 year after initiation of use. HRs were higher among women who ceased use during the observation period. Conclusions. Young women using oral contraceptives may be at increased risk of suicidal behavior, but risk declines with increased duration of use. Analysis of former users suggests that women susceptible to depression/anxiety are more likely to cease hormonal contraceptive use. Additional studies are necessary to determine whether the observed association is attributable to a causal mechanism.
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| 31. |
- Edwards, Alexis C., et al.
(författare)
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Shared genetic and environmental etiology between substance use disorders and suicidal behavior
- 2023
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Ingår i: Psychological Medicine. - 0033-2917. ; 53:6, s. 2380-2388
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Tidskriftsartikel (refereegranskat)abstract
- Background Previous studies have demonstrated substantial associations between substance use disorders (SUD) and suicidal behavior. The current study empirically assesses the extent to which shared genetic and/or environmental factors contribute to associations between alcohol use disorders (AUD) or drug use disorders (DUD) and suicidal behavior, including attempts and death. Methods The authors used Swedish national registry data, including medical, pharmacy, criminal, and death registrations, for a large cohort of twins, full siblings, and half siblings (N = 1 314 990) born 1960-1980 and followed through 2017. They conducted twin-sibling modeling of suicide attempt (SA) or suicide death (SD) with AUD and DUD to estimate genetic and environmental correlations between outcomes. Analyses were stratified by sex. Results Genetic correlations between SA and SUD ranged from rA = 0.60-0.88; corresponding shared environmental correlations were rC = 0.42-0.89 but accounted for little overall variance; and unique environmental correlations were rE = 0.42-0.57. When replacing attempt with SD, genetic and shared environmental correlations with AUD and DUD were comparable (rA = 0.48-0.72, rC = 0.92-1.00), but were attenuated for unique environmental factors (rE = -0.01 to 0.31). Conclusions These findings indicate that shared genetic and unique environmental factors contribute to comorbidity of suicidal behavior and SUD, in conjunction with previously reported causal associations. Thus, each outcome should be considered an indicator of risk for the others. Opportunities for joint prevention and intervention, while limited by the polygenic nature of these outcomes, may be feasible considering moderate environmental correlations between SA and SUD.
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| 32. |
- Edwards, Alexis C., et al.
(författare)
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The role of substance use disorders in the transition from suicide attempt to suicide death : a record linkage study of a Swedish cohort
- 2024
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Ingår i: Psychological Medicine. - 1469-8978. ; 54:1, s. 90-97
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Suicidal behavior and substance use disorders (SUDs) are important public health concerns. Prior suicide attempts and SUDs are two of the most consistent predictors of suicide death, and clarifying the role of SUDs in the transition from suicide attempt to suicide death could inform prevention efforts. METHODS: We used national Swedish registry data to identify individuals born 1960-1985, with an index suicide attempt in 1997-2017 (N = 74 873; 46.7% female). We assessed risk of suicide death as a function of registration for a range of individual SUDs. We further examined whether the impact of SUDs varied as a function of (i) aggregate genetic liability to suicidal behavior, or (ii) age at index suicide attempt. RESULTS: In univariate models, risk of suicide death was higher among individuals with any SUD registration [hazard ratios (HRs) = 2.68-3.86]. In multivariate models, effects of specific SUDs were attenuated, but remained elevated for AUD (HR = 1.86 95% confidence intervals 1.68-2.05), opiates [HR = 1.58 (1.37-1.82)], sedatives [HR = 1.93 (1.70-2.18)], and multiple substances [HR = 2.09 (1.86-2.35)]. In secondary analyses, the effects of most, but not all, SUD were exacerbated by higher levels of genetic liability to suicide death, and among individuals who were younger at their index suicide attempt. CONCLUSIONS: In the presence of a strong predictor of suicide death - a prior attempt - substantial predictive power is still attributable to SUDs. Individuals with SUDs may warrant additional suicide screening and prevention efforts, particularly in the context of a family history of suicidal behavior or early onset of suicide attempt.
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| 33. |
- Huang, Wuqing, et al.
(författare)
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Risk of being born preterm in offspring of survivors with childhood or adolescent central nervous system tumour in Sweden
- 2020
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 147:1, s. 100-106
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Tidskriftsartikel (refereegranskat)abstract
- An increasing number of patients with central nervous system (CNS) tumour could survive to reproductive age. However, it is largely unknown whether the history of CNS tumour might affect pregnancy outcome. We aimed to explore the risk of being born pretem among children of CNS tumour survivors. By linking several nationwide registers in Sweden, we identified 1369 children whose parents were childhood or adolescent CNS tumour survivors. Children whose parents did not have CNS tumour were matched randomly with a 5:1 ratio to generate the reference group. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI). The prevalence of preterm birth (PTB) was 6.9% among children of survivors with CNS tumour and 5.2% among the matched controls. Children of survivors had an increased risk of PTB (adjusted OR=1.29, 95%CI 1.01-1.65) compared to the matched controls. This risk was increased specifically among offspring of those diagnosed in childhood (adjusted OR=1.53, 95%CI 1.14-2.06) but not adolescence (adjusted OR=0.89, 95%CI 0.56-1.41). For families with more than one child, the risk was slightly lower among the second child as compared to the first child. The risk was negatively associated with time interval between parental diagnosis and childbirth. Parental medulloblastoma and ependymoma were most strongly associated with a higher risk of PTB. Children of survivors with CNS tumour experienced an elevated risk of PTB. However, the risk diminishes gradually following parental diagnosis of CNS tumour. Offspring of childhood CNS tumour survivors and medulloblastoma or ependymoma survivors may have the highest risk of PTB. This article is protected by copyright. All rights reserved.
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| 34. |
- Li, Xinjun, et al.
(författare)
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Neighborhood deprivation in relation to lung cancer in individuals with type 2 diabetes—A nationwide cohort study (2005–2018)
- 2023
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Ingår i: PLoS ONE. - 1932-6203. ; 18:7 July
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Tidskriftsartikel (refereegranskat)abstract
- Background Neighborhood deprivation has been found associated with both type 2 diabetes and lung cancer. The aim of this study was to examine the potential association between neighborhood deprivation and lung cancer incidence or mortality in individuals diagnosed with type 2 diabetes. The results may identify a new risk or prognostic factor for lung cancer in this important subgroup and help develop a more contextual approach to prevention that includes neighborhood environment. Methods and findings The study population included adults (n = 613,650) aged ≥ 30 years with type 2 diabetes during 2005 to 2018 in Sweden. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incidence or mortality of lung cancer associated with neighborhood deprivation. All models were conducted in both men and women and adjusted for individual-level characteristics (e.g. age, smoking- and alcohol-related comorbidities, sociodemographic factors). The cumulative incidence and mortality for lung cancer were 1.08% (95% CI, 1.06 to 1.11) and 0.93% (0.90 to 0.95), respectively, in the study population during the study period. Neighborhood deprivation was associated with both incidence and mortality of lung cancer in patients with type 2 diabetes independently of the individual-level characteristics. In the fully adjusted models, comparing high- with low-deprivation neighborhoods, the HRs for lung cancer incidence were 1.21 (1.10 to 1.33) in men and 1.08 (0.95 to 1.21) in women. The corresponding HRs for lung cancer mortality were 1.04 (1.00 to 1.07) in men and 0.97 (0.94 to 1.00) in women. Competing risk analyses including cardiovascular mortality attenuated the results. Conclusion In this large cohort of individuals with type 2 diabetes, we found higher lung cancer incidence and mortality in patients living in areas with high neighborhood deprivation, even after adjusting for individual-level characteristics. These findings may help develop a more contextual approach that includes the neighborhood environment when allocating resources for disease prevention and care in patients with type 2 diabetes. These findings could also help inform clinical care for patients with type 2 diabetes, particularly those living in deprived neighborhoods.
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| 35. |
- Wändell, Per, et al.
(författare)
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Diabetes risk during pregnancy among second-generation immigrants : A national cohort study in Sweden
- 2023
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Ingår i: Nutrition, Metabolism and Cardiovascular Diseases. - 0939-4753 .- 1590-3729. ; 33:10, s. 2028-2034
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Gestational diabetes is more common in many first-generation immigrant women in Europe and other Western countries. Less is known about second-generation immigrant women; such knowledge is needed to understand generational influences on diabetes risk. We aimed to study second-generation immigrant women regarding the presence of all types of diabetes during pregnancy. Methods and results: A cohort study was conducted using the Swedish National Birth Register, the National Patient Register, and the Total Population Register. We used Cox regression analysis to compute hazard ratios (HRs) and 99% confidence intervals (99% CI) for any diabetes during pregnancy and specific subtypes (gestational diabetes, pre-existing diabetes type 1, pre-existing diabetes type 2) in second-generation immigrant women compared with Swedish-born women with two Swedish-born parents while adjusting for sociodemographic factors, family history of diabetes, body mass index, smoking habits, and comorbidities. The study population included a total of 989,986 deliveries and 17,938 diabetes cases. The fully adjusted HR (with 99% CI) for any type of diabetes during pregnancy among second-generation immigrant women was 1.11 (1.05–1.18). Higher risks were found in women with parents from Africa, Asia, or Eastern Europe, as well as Denmark. A lower risk for pre-existing type 1 diabetes was found overall and for women with parents from most geographic regions. Conclusion: In this national cohort study, the risk of all types of diabetes during pregnancy was increased in second-generation immigrant women. Diabetes prevention and treatment is especially important in these women both before and during pregnancy.
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| 36. |
- Wändell, Per, et al.
(författare)
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Hypertension in Pregnancy Among Immigrant and Swedish Women : A Cohort Study of All Pregnant Women in Sweden
- 2024
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 13:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little is known about risks of hypertensive disorders of pregnancy in both first-and second-generation immigrant women in Europe and other Western countries; such knowledge may help elucidate the influence of genetic versus social factors on such risks. We aimed to study both first-and second-generation immigrant women for the presence of all types of hypertension (preexisting hypertension, gestational hypertension, preeclampsia, and eclampsia) during pregnancy. METHODS AND RESULTS: A cohort study was conducted using data derived from the Swedish National Birth Register, the National Patient Register, and the Total Population Register. We used Cox regression analysis to compute hazard ratios (HRs) and 99% CIs while adjusting for sociodemographic factors and comorbidities. The first-generation study included a total of 1 084 212 deliveries and 68 311 hypertension cases, and the second-generation study included 989 986 deliveries and 67 505 hypertension cases. The fully adjusted HR (with 99% CI) for hypertension in pregnancy among first-generation immigrant women was 0.69 (0.66–0.72), and among second-generation immigrant women, it was 0.88 (0.86–0.91), compared with Swedish-born women with 2 Swedish-born parents. Women born in Finland or with parent(s) from Finland had higher risks, with fully adjusted HRs (99% CIs) of 1.30 (1.18–1.43) and 1.12 (1.07–1.17), respectively. CONCLUSIONS: Both first-and second-generation immigrant women had overall lower risks of hypertension in pregnancy compared with other Swedish women. However, the risk reduction was less pronounced in second-generation compared with first-generation immigrant women, suggesting that environmental factors in Sweden may have an important influence on risk of hypertension during pregnancy.
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