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- Fall, Katja, 1971-, et al.
(författare)
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Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis : prospective cohort study
- 2009
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Ingår i: PLoS Medicine. - San Francisco, Calif. : Public Library of Science. - 1549-1277 .- 1549-1676. ; 6:12, s. e1000197-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Stressful life events have been shown to be associated with altered risk of various health consequences. The aim of the present study was to investigate whether the emotional stress evoked by a prostate cancer diagnosis increases the immediate risks of cardiovascular events and suicide.METHODS AND FINDINGS: We conducted a prospective cohort study by following all men in Sweden who were 30 y or older (n = 4,305,358) for a diagnosis of prostate cancer (n = 168,584) and their subsequent occurrence of cardiovascular events and suicide between January 1, 1961 and December 31, 2004. We used Poisson regression models to calculate relative risks (RRs) and 95% confidence intervals (CIs) of cardiovascular events and suicide among men who had prostate cancer diagnosed within 1 y to men without any cancer diagnosis. The risks of cardiovascular events and suicide were elevated during the first year after prostate cancer diagnosis, particularly during the first week. Before 1987, the RR of fatal cardiovascular events was 11.2 (95% CI 10.4-12.1) during the first week and 1.9 (95% CI 1.9-2.0) during the first year after diagnosis. From 1987, the RR for cardiovascular events, nonfatal and fatal combined, was 2.8 (95% CI 2.5-3.2) during the first week and 1.3 (95% CI 1.3-1.3) during the first year after diagnosis. While the RR of cardiovascular events declined, the RR of suicide was stable over the entire study period: 8.4 (95% CI 1.9-22.7) during the first week and 2.6 (95% CI 2.1-3.0) during the first year after diagnosis. Men 54 y or younger at cancer diagnosis demonstrated the highest RRs of both cardiovascular events and suicide. A limitation of the present study is the lack of tumor stage data, which precluded possibilities of investigating the potential impact of the disease severity on the relationship between a recent diagnosis of prostate cancer and the risks of cardiovascular events and suicide. In addition, we cannot exclude residual confounding as a possible explanation.CONCLUSIONS: Men newly diagnosed with prostate cancer are at increased risks for cardiovascular events and suicide. Future studies with detailed disease characteristic data are warranted.
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- Fall, Katja, 1971-, et al.
(författare)
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Risk for gastric cancer after cholecystectomy
- 2007
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Ingår i: American Journal of Gastroenterology. - Oxon, United Kingdom : Blackwell Publishing. - 0002-9270 .- 1572-0241. ; 102:6, s. 1180-4
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is becoming increasingly evident that chronic inflammation may predispose cancer development. In the stomach, inflammation caused by Helicobacter pylori infection is linked to gastric cancer. Cholecystectomy is regularly followed by duodenogastric bile reflux and reactive gastritis. To test whether a noninfectious long-standing inflammation impels gastric carcinogenesis as well, we assessed the risk of gastric cancer in a large, population-based cohort of cholecystectomized patients.Methods: We identified 251,672 individuals, in the Swedish National Inpatient Register, who had undergone cholecystectomy between 1970 and 1997. All incident cases of gastric cancer were identified through linkage to the Swedish Cancer Registry. Standardized incidence ratios (SIRs) were calculated for comparisons with cancer rates of the general population in Sweden.Results: We found an 11% greater overall risk of distal gastric cancer (SIR=1.11, 95% CI 1.04-1.19). The risk increase was only observed among men (SIR=1.21, 95% CI 1.10-1.32), whereas no excess risk was evident for women. For men, the risk was elevated for up to 10 yr after surgery, but this elevation disappeared with longer follow-up time. There was no clear association between cholecystectomy and cardia cancer (SIR=0.95, 95% CI 0.76-1.16).Conclusions: Inconsistency over gender strata, implausibly short induction and latency time, and disappearance of the effect over time makes a causal relationship between cholecystectomy and distal gastric cancer less likely. The findings set aside concerns of harmful long-term consequences of cholecystectomy.
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- Fang, Fang, et al.
(författare)
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Amyotrophic lateral sclerosis in Sweden, 1991-2005
- 2009
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Ingår i: Archives of Neurology. - Chicago, USA : American Medical Association. - 0003-9942 .- 1538-3687. ; 66:4, s. 515-9
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the temporal trend of amyotrophic lateral sclerosis (ALS) incidence in Sweden between January 1, 1991, and December 31, 2005, and to explore incidence variations according to major demographic factors.Design: Population-based study.Setting: Academic research.Participants: All incident cases of ALS identified through the Swedish Inpatient Register between January 1, 1991, and December 31, 2005.Main outcome measure: Age-standardized incidence rates were calculated by applying the observed age-specific incidence rates to the age distribution of the Swedish population in 1991. A linear regression model was used to assess the potential trend of the incidence during calendar years. We also followed up the entire population registered in the 1990 Population and Housing Census for incidence of ALS. Relative risk and 95% confidence interval of ALS associated with demographic variables were estimated using Poisson regression models.Results: The age-standardized incidence rates increased from 2.32 per 100,000 person-years in 1991-1993 to 2.98 per 100,000 person-years in 2003-2005, representing an annual increase of approximately 2% during the 15 years (P value for trend, .002). The age-specific incidence rates increased in all age groups except those younger than 50 years. The observed increase remained significant when restricting the analysis to individuals born in Sweden (P value for trend, <.001). Compared with individuals born from April through June, those born from October through December were at 11% increased risk of ALS (95% confidence interval, 1.01-1.23).Conclusions: The incidence of ALS has been increasing during the last 15 years in Sweden. Further studies are warranted to explore the underlying reasons for this observed trend.
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| 5. |
- Fang, Fang, et al.
(författare)
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Loss of a child and the risk of amyotrophic lateral sclerosis
- 2008
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Ingår i: American Journal of Epidemiology. - Cary, USA : Oxford University Press. - 0002-9262 .- 1476-6256. ; 167:2, s. 203-10
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Tidskriftsartikel (refereegranskat)abstract
- Between 1987 and 2005, the authors conducted a case-control study nested within the entire Swedish population to investigate whether loss of a child due to death is associated with the risk of amyotrophic lateral sclerosis (ALS). The study comprised 2,694 incident ALS cases and five controls per case individually matched by year of birth, gender, and parity. Odds ratios and their corresponding 95% confidence intervals for ALS were estimated by using conditional logistic regression models. Compared with that for parents who never lost a child, the overall odds ratio of ALS for bereaved parents was 0.7 (95% confidence interval (CI): 0.6, 0.8) and decreased to 0.4 (95% CI: 0.2, 0.8) 11-15 years after the loss. The risk reduction was also modified by parental age at the time of loss, with the lowest odds ratio of 0.4 (95% CI: 0.2, 0.9) for parents older than age 75 years. Loss of a child due to malignancy appeared to confer a lower risk of ALS (odds ratio = 0.5, 95% CI: 0.3, 0.8) than loss due to other causes. These data indicate that the risk of developing ALS decreases following the severe stress of parental bereavement. Further studies are needed to explore potential underlying mechanisms.
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| 6. |
- Fang, Fang, et al.
(författare)
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Suicide among patients with amyotrophic lateral sclerosis
- 2008
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Ingår i: Brain. - Oxford, United Kingdom : Oxford University Press (OUP). - 0006-8950 .- 1460-2156. ; 131, s. 2729-2733
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Tidskriftsartikel (refereegranskat)abstract
- Studies on the suicide risk among patients with amyotrophic lateral sclerosis (ALS) in countries without legalized euthanasia or assisted suicide are important additions to data on the wish to die of these patients. We conducted a population-based cohort study in Sweden between 1965 and 2004, which comprised of 6642 patients with incident ALS identified from the Swedish Inpatient Register. We calculated the standardized mortality ratios (SMRs) of suicide among the patients using the suicide rates of the general Swedish population as a reference. In total, 21 patients committed suicide during follow-up, compared to the predicted 3.6 suicides. Thus, we noted an almost 6-fold increased risk for suicide among ALS patients [SMR 5.8, 95% confidence interval (CI) 3.6-8.8]. Patients who committed suicide were, on average, around 7 years younger at the time of their first period of hospitalization than patients who did not commit suicide. The highest relative risk for suicide was observed within the first year after the patients first period of hospitalization (SMR 11.2, 95% CI 5.8-19.6). After that, the relative risks decreased with time after hospitalization (P-value for trend = 0.006), but remained elevated 3 years later. The relative risks of suicide among ALS patients did not show a clear trend over time in contrast to the decreasing trend of relative risks for suicide among patients with cancer during the same period. Patients with ALS are at excess risk of suicide in Sweden and the relative risk is higher during the earlier stage of the disease.
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| 7. |
- Hammarstedt, Lalle, et al.
(författare)
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The incidence of tonsillar cancer in Sweden is increasing.
- 2007
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 127:9, s. 988-92
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSIONS: The incidence of tonsillar cancer in Sweden is increasing, particularly among men. Risk factors other than smoking may have contributed to the observed secular trend in men. In women, however, smoking can be a part of the explanation. Further studies to look at changes in other environmental factors, such as human papilloma virus (HPV) infection, are clearly warranted. OBJECTIVES: Head and neck cancer is related to smoking habits and smoking has decreased substantially during the last 30 years in Sweden. However, there is suspicion that the incidence of tonsillar cancer has increased in the last 30 years as it has in the USA and Finland, in spite of reduced prevalence of known risk factors. The time trends of oral and oropharygeal cancer have been studied in Sweden, but not tonsillar cancer specifically. SUBJECTS AND METHODS: We used the Swedish Cancer Registry to assess the secular trend of incidence of tonsillar cancer in Sweden since 1960. For comparison we investigated the incidence of other oral cancers and lung cancer, which are also smoking-related. The prevalence of smoking was investigated for reference. Age-standardized incidence rates were calculated and linear regression was used to evaluate secular trends. RESULTS: The incidence of tonsillar cancer increased by 2.6% per year in men and 1.1% in women. No similar increase was seen in the other oral cancers. For lung cancer there was a decrease in the incidence in men, but in women the incidence is still increasing.
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| 8. |
- Hergens, Maria-Pia, et al.
(författare)
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Smokeless tobacco and the risk of stroke
- 2008
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Ingår i: Epidemiology. - 1044-3983 .- 1531-5487. ; 19:6, s. 794-799
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:: In Sweden, use of smokeless tobacco (oral moist snuff) is common among adult men. Research on cerebrovascular effects associated with long-term use of snuff is limited and inconclusive. We aimed to study whether long-term use of snuff affects the risk of stroke. METHODS:: Information on tobacco use was collected by questionnaire among Swedish construction workers attending health check-ups between 1978 and 1993. In total, 118,465 never-smoking men without a history of stroke were followed through 2003. We used the Inpatient Register and Causes of Death Register to identify subsequent morbidity and mortality from stroke and its subtypes (ischemic, hemorrhagic, and unspecified stroke). Relative risk estimates were derived from Cox proportional hazards regression model. RESULTS:: Almost 30% of the nonsmoking men had ever used snuff. Overall, 3248 cases of stroke were identified during follow-up. Compared with nonusers of tobacco, the multivariable-adjusted relative risks for ever-users of snuff were 1.02 (95% confidence interval; 0.92-1.13) for all cases and 1.27 (0.92-1.76) for fatal cases. Further analyses on subtypes of stroke revealed an increased risk of fatal ischemic stroke associated with current snuff use (1.72; 1.06-2.78), whereas no increased risk was noted for hemorrhagic stroke. CONCLUSION:: Snuff use may elevate the risk of fatal stroke, and particularly of fatal ischemic stroke.
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| 9. |
- Hergens, Maria-Pia, et al.
(författare)
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Snuff Use and Stroke Reponse
- 2009
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Ingår i: Epidemiology. - 1044-3983 .- 1531-5487. ; 20:3, s. 469-470
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Tidskriftsartikel (refereegranskat)
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| 10. |
- Jonasson, Junmei Miao, et al.
(författare)
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Risks of nontraumatic lower-extremity amputations in patients with type 1 diabetes - A population-based cohort study in Sweden
- 2008
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 31:8, s. 1536-1540
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - The purpose of this study was to estimate the risks of nontraumatic lower-extremity amputations (LEAS) in patients With type 1 diabetes. RESEARCH DESIGN AND METHODS - We identified 31,354 patients with type 1 diabetes (15,001 women and 16,353 men) in the Swedish Inpatient Register between 1975 and 2004. The incidence of nontraumatic LEAs was followed up until 31 December 2004 by cross-linkage in the Inpatient Register and linkage to the Death and Migration registers. Poisson regression modeling was used to compare the risks of nontraumatic LEAs during different calendar periods of follow-up, with adjustment for both sex and attained age at follow-up. Standardized incidence ratios (SIRs) were used to estimate the relative risks (RRs) with the age-, sex-, and calendar period-matched general Swedish population as reference. The cumulative probability of nontraumatic LEAs was calculated by the Kaplan-Meier method. RESULTS - In total, 465 patients with type 1 diabetes undenwent nontraumatic LEAS. The risk was lower during the most recent calendar period (2000-2004) than during the period before 2000 (RR 0.6 [95% CI 0.5-0.8]). However, even in this most recent period, the risk for nontraumatic LEAs among these relatively young patients was 86-fold higher than that in the matched general population (SIR 85.8 [72.9-100.3]). By age 65 years, the cumulative probability of having a nontraumatic LEA was 11.0% for women with type 1 diabetes and 20.7% for men with type 1 diabetes. CONCLUSIONS - Although the risks appeared to have declined in recent years, patients with type 1 diabetes still have a very high risk for nontraumatic LEAs.
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