| 1. |
- Agvall, Björn, et al.
(author)
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Factors influencing hospitalization or emergency department visits and mortality in type 2 diabetes following the onset of new cardiovascular diagnoses in a population-based study
- 2024
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In: Cardiovascular Diabetology. - London : BioMed Central (BMC). - 1475-2840. ; 23:1
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Journal article (peer-reviewed)abstract
- Background: Individuals with type 2 diabetes (T2D) are at increased risk of developing cardiovascular disease (CVD) which necessitates monitoring of risk factors and appropriate pharmacotherapy. This study aimed to identify factors predicting emergency department visits, hospitalizations, and mortality among T2D patients after being newly diagnosed with CVD.Methods: In a retrospective observational study conducted in Region Halland, individuals aged > 40 years with T2D diagnosed between 2011 and 2019, and a new diagnosis of CVD between 2016 and 2019, were followed for one year from the date of CVD diagnosis. The first encounter for CVD diagnosis was categorized as inpatient-, outpatient-, primary-, or emergency department care. Follow-up included laboratory tests, blood pressure, pharmacotherapies, and healthcare utilization. Hazard ratios (HR) in two Cox regression analyses determined relative risks for emergency visits/hospitalization and mortality, adjusting for age, sex, glucose regulation, lipid levels, kidney function, blood pressure, pharmacotherapy, and healthcare utilization.Results: The study included a total of 1759 T2D individuals who received a new CVD diagnosis, with 67% diagnosed during inpatient care. The average hospitalization stay was 6.5 days, and primary care follow-up averaged 10.1 visits. Patients with CVD diagnosed in primary care had a HR 0.52 (confidence interval [CI] 0.35–0.77) for emergency department visits/hospitalization, but age had a HR 1.02 (CI 1.00-1.03). Pharmacotherapy with insulin, DPP4-inhibitors, aldosterone antagonists, and beta-blockers had a raised HR. Highest mortality risk was observed when CVD was diagnosed inpatient care, systolic blood pressure < 100 mm Hg and elevated HbA1c. Age had a HR 1.05 (CI 1.03–1.08), eGFR < 30 ml/min HR 1.46 (CI 1.01–2.11), and LDL-Cholesterol > 2,5 h 1.46 (CI 1.01–2.11) and associated with increased mortality risk. Pharmacotherapy with metformin had a HR 0.41 (CI 0.28–0.62), statins a HR 0.39 (CI 0.27–0.57), and a primary care follow-up < 30 days a HR 0.53 (CI 0.37–0.77) and associated with lower mortality risk.Conclusions: T2D individuals who had a new diagnosis of CVD were predominantly diagnosed when hospitalized, while follow-up typically occurred in primary care. Identifying factors that predict risks of mortality and hospitalization should be a focus of follow-up care, underscoring the critical role of primary care in the effective management of T2D and CVD. © The Author(s) 2024.
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| 2. |
- Alvarez, E. M., et al.
(author)
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The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019
- 2022
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In: Lancet Oncology. - : Elsevier BV. - 1470-2045. ; 23:1, s. 27-52
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Journal article (peer-reviewed)abstract
- Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.
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| 3. |
- Broberg, Gudrun, et al.
(author)
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Increasing participation in cervical cancer screening: Offering a HPV self-test to long-term non-attendees as part of RACOMIP, a Swedish randomized controlled trial.
- 2014
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In: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 134:9, s. 2223-2230
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Journal article (peer-reviewed)abstract
- RACOMIP is a population-based, randomized trial of the effectiveness and cost-effectiveness of different interventions aimed at increasing participation in a well-run cervical cancer screening program in western Sweden. In this article, we report results from one intervention, offering non-attendees a high-risk human papillomavirus (HPV) self-test. Comparison was made with standard screening invitation routine or standard routine plus a telephone call. Women (8,800), aged 30-62, were randomly selected among women without a registered Pap smear in the two latest screening rounds. These women were randomized 1:5:5 to one of three arms: 800 were offered a high-risk HPV self-test, 4,000 were randomized to a telephone call (reported previously) and 4,000 constituted a control group (standard screening invitation routine). Results were based on intention to treat analysis and cost-effectiveness was calculated as marginal cost per cancer case prevented. The endpoint was the frequency of testing. The total response rate in the self-testing arm was 24.5%, significantly higher than in the telephone arm (18%, RR 1.36, 95% CI 1.19-1.57) and the control group (10.6%, RR 2.33, 95% CI 2.00-2.71). All nine women who tested positive for high-risk HPV attended for a cervical smear and colposcopy. From the health-care sector perspective, the intervention will most likely lead to no additional cost. Offering a self-test for HPV as an alternative to Pap smears increases participation among long-term non-attendees. Offering various screening options can be a successful method for increasing participation in this group.
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| 4. |
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| 5. |
- Bryazka, D., et al.
(author)
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Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020
- 2022
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In: Lancet. - 0140-6736. ; 400:10347, s. 185-235
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Journal article (peer-reviewed)abstract
- Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0.603 (0.400-1.00) standard drinks per day, and the NDE varied between 0.002 (0-0) and 1.75 (0.698-4.30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0.114 (0-0.403) to 1.87 (0.500-3.30) standard drinks per day and an NDE that ranged between 0.193 (0-0.900) and 6.94 (3.40-8.30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59.1% (54.3-65.4) were aged 15-39 years and 76.9% (7.0-81.3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
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| 6. |
- Cousin, E., et al.
(author)
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Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019
- 2022
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In: Lancet Diabetes & Endocrinology. - : Elsevier BV. - 2213-8587. ; 10:3, s. 177-192
-
Journal article (peer-reviewed)abstract
- Background Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990-2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73.7% (68.3 to 77.4) were classified as due to type 1 diabetes. The age-standardised death rate was 0.50 (0.44 to 0.58) per 100 000 population, and 15 900 (97.5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0.13 (0.12 to 0.14) per 100 000 population in the high SDI quintile, 0.60 (0.51 to 0.70) per 100 000 population in the low-middle SDI quintile, and 0.71 (0.60 to 0.86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r(2)=0.62). From 1990 to 2019, age-standardised death rates decreased globally by 17.0% (-28.4 to -2.9) for all diabetes, and by 21.0% (-33.0 to -5.9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (-13.6% [-28.4 to 3.4]) and for type 1 diabetes (-13.6% [-29.3 to 8.9]). Interpretation Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
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| 7. |
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| 8. |
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| 9. |
- Eriksson, Erik, 1977, et al.
(author)
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Participation in a Swedish cervical cancer screening program among women with psychiatric diagnoses: a population-based cohort study.
- 2019
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In: BMC public health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19:1
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Journal article (peer-reviewed)abstract
- In Sweden, organized screening programs have significantly reduced the incidence of cervical cancer. For cancers overall, however, women with psychiatric diagnoses have lower survival rates than other women. This study explores whether women with psychiatric diagnoses participate in cervical cancer screening programs to a lesser extent than women on average, and whether there are disparities between psychiatric diagnostic groups based on grades of severity.Between 2000 and 2010, 65,292 women within screening ages of 23-60 had at least two ICD-10 (International Statistical Classification of Diseases and Related Health Problems - Tenth Revision) codes F20*-F40* registered at visits in primary care or psychiatric care in Region Västra Götaland, Sweden. Participation in the cervical cancer screening program during 2010-2014 was compared with the general female population using logistic regression adjusted for age.Relative risk for participation (RR) for women diagnosed within psychiatric specialist care RR was 0.94 compared with the general population, adjusted for age. RR for diagnoses outside specialist care was 0.99. RR for psychoses (F20*) was 0.81.Women with less-severe psychiatric diagnoses participate in the screening program to the same extent as women overall. Women who have received psychiatric specialist care participate to a lesser extent than women overall. The lowest participation rates were found among women diagnosed with psychoses.
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| 10. |
- Feigin, Valery L., et al.
(author)
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Global, regional, and national burden of stroke and its risk factors, 1990-2019 : a systematic analysis for the Global Burden of Disease Study 2019
- 2021
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In: Lancet Neurology. - : Elsevier. - 1474-4422 .- 1474-4465. ; 20:10, s. 795-820
-
Journal article (peer-reviewed)abstract
- Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12.2 million (95% UI 11.0-13.6) incident cases of stroke, 101 million (93.2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6.55 million (6.00-7.02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11.6% [10.8-12.2] of total deaths) and the third-leading cause of death and disability combined (5.7% [5.1-6.2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70.0% (67.0-73.0), prevalent strokes increased by 85.0% (83.0-88.0), deaths from stroke increased by 43.0% (31.0-55.0), and DALYs due to stroke increased by 32.0% (22.0-42.0). During the same period, age-standardised rates of stroke incidence decreased by 17.0% (15.0-18.0), mortality decreased by 36.0% (31.0-42.0), prevalence decreased by 6.0% (5.0-7.0), and DALYs decreased by 36.0% (31.0-42.0). However, among people younger than 70 years, prevalence rates increased by 22.0% (21.0-24.0) and incidence rates increased by 15.0% (12.0-18.0). In 2019, the age-standardised stroke-related mortality rate was 3.6 (3.5-3.8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3.7 (3.5-3.9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62.4% of all incident strokes in 2019 (7.63 million [6.57-8.96]), while intracerebral haemorrhage constituted 27.9% (3.41 million [2.97-3.91]) and subarachnoid haemorrhage constituted 9.7% (1.18 million [1.01-1.39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79.6 million [67.7-90.8] DALYs or 55.5% [48.2-62.0] of total stroke DALYs), high body-mass index (34.9 million [22.3-48.6] DALYs or 24.3% [15.7-33.2]), high fasting plasma glucose (28.9 million [19.8-41.5] DALYs or 20.2% [13.8-29.1]), ambient particulate matter pollution (28.7 million [23.4-33.4] DALYs or 20.1% [16.6-23.0]), and smoking (25.3 million [22.6-28.2] DALYs or 17.6% [16.4-19.0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.
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| 11. |
- Gross, Christel, et al.
(author)
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Prognosis and mortality within 90 days in community-acquired acute kidney injury in the Southwest of Sweden.
- 2023
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In: BMC nephrology. - 1471-2369. ; 24:1
-
Journal article (peer-reviewed)abstract
- Community-acquired acute kidney injury (CA-AKI) is common among hospitalized patients and has a poor prognosis. Research is scarce on the impact of a CA-AKI episode among patients without preexisting kidney disease and has not previously been investigated in Sweden. The aim was to describe the outcomes of patients with normal pre-hospitalization kidney function, admitted with community-acquired AKI and to investigate the association between AKI severity with outcomes.A retrospective population-based study was applied including patients with CA-AKI according to KDIGO classification, admitted via emergency department (ED) 2017-2019 and with a 90-day follow-up period from the ED-admission, collecting data from the Regional Healthcare Informative Platform. Age, gender and AKI stages, mortality and follow-up regarding recovery and readmission was registered. Hazard ratio (HR) and 95% confidence Interval (CI) for mortality was analyzed using Cox regression adjusted for age, comorbidities, and medication.There were 1646 patients included, mean age was 77.5 years. CA-AKI stage 3 occurred in 51% of patients<65 years of age and 34% among those>65 years. In this study, 578 (35%) patients died and 233 (22%) recovered their kidney function. Mortality rate peaked within the first two weeks and among those at AKI stage 3. Nephrology referral post discharge occurred in 3% and 29% were readmitted. HRs for mortality was 1.9 (CI 1.38-2.62) for those who are >65 years, 1.56 (CI 1.30-1.88) for atherosclerotic-cardiovascular disease. Medication with RAASi related to a decreased HR 0.27 (95% CI 0.22-0.33).CA-AKI is associated with high mortality within 90 days, increased risk for developing chronic kidney disease (CKD) and only one fifth recover their kidney function after hospitalization with an AKI. Nephrology referral was sparse. Patient follow-up after a hospitalization with AKI should be carefully planned during the first 90 days and focused on identifying those with a higher risk of developing CKD.
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| 12. |
- Guo, Yanfei, 1984, et al.
(author)
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Frailty Trajectories in Chinese Older Adults : Evidence From the China Health and Retirement Longitudinal Study
- 2024
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In: Innovation in Aging. - : Oxford University Press. - 2399-5300. ; 8:1, s. 1-9
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Journal article (peer-reviewed)abstract
- Background and Objectives The individual heterogeneity in the progression of frailty has not been fully disclosed. Studies on frailty trajectories in Chinese older adults are rare and lack evidence suggesting that the frailty trajectories follow similar patterns to those in other countries. This study aims to identify distinct frailty trajectories in a nationwide cohort of community-dwelling older adults in China and explore the relationship between demographic, socioeconomic, and behavioral factors, and frailty trajectories.Research Design and Methods We included an analytical sample of 8,993 individuals aged 50 and older from the China Health and Retirement Longitudinal Study. We used group-based trajectory models to identify patterns of frailty trajectories over time. Multinomial logistic regression was used to estimate the relationship between demographic, socioeconomic, and behavioral factors, and group membership.Results Three frailty trajectories were identified: "Low and stable trajectory" (56.8% of the respondents), "Moderate and increasing trajectory" (34.4%), and "High and increasing trajectory" (8.8%). Older age (odds ratio [OR] = 7.37, 95% confidence interval [CI]: 5.90-9.20), being female (OR = 1.79, 95% CI: 1.42-2.27), no formal education (OR = 4.91, 95% CI: 2.33-10.36), living in rural areas (OR = 1.22, 95% CI: 1.01-1.47), low level of physical activity (OR = 2.65, 95% CI: 1.94-3.62), and residing in Northeast China (OR = 3.53, 95% CI: 2.56-4.88) were associated with the rapid progression of frailty, whereas moderate alcohol consumption appears to be associated with low and stable frailty trajectory (OR = 0.45, 95% CI: 0.35-0.58).Discussion and Implications The findings of the study emphasize a significant number of older adults with moderate and increasing as well as high and increasing frailty trajectories in China, which is cause for concern.
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| 13. |
- Hendryx, Michael, et al.
(author)
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Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women.
- 2020
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In: The journals of gerontology. Series B, Psychological sciences and social sciences. - : Oxford University Press (OUP). - 1758-5368. ; 75:7, s. 1597-1608
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Journal article (peer-reviewed)abstract
- We examined whether social relationship variables (social support, social strain, social network size, and stressful life events) were associated with risk of developing type 2 diabetes among postmenopausal women.139,924 postmenopausal women aged 50-79 years without prevalent diabetes at baseline were followed for a mean of 14 years. 19,240 women developed diabetes. Multivariable Cox proportional hazard models tested associations between social relationship variables and diabetes incidence after consideration of demographics, depressive symptoms, and lifestyle behaviors. We also examined moderating effects of obesity and race/ethnicity, and we tested whether social variable associations were mediated by lifestyle or depressive symptoms.Compared with the lowest quartile, women in the highest social support quartile had lower risk of diabetes after adjusting for demographic factors, health behaviors, and depressive symptoms (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.89-0.97). Social strain (HR = 1.09, 95% CI = 1.04-1.13) and stressful life events (HR = 1.10, 95% CI = 1.05-1.15) were associated with higher diabetes risks. The association between diabetes and social strain was stronger among African American women. Social relationship variables had direct relationships to diabetes, as well as indirect effects partially mediated by lifestyle and depressive symptoms.Social support, social strain, and stressful life events were associated with diabetes risk among postmenopausal women independently of demographic factors and health behaviors. In addition to healthy behaviors such as diet and physical activity, healthy social relationships among older women may be important in the prevention of diabetes.
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| 14. |
- Jonasson, Junmei Miao, et al.
(author)
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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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In: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 31:8, s. 1536-1540
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Journal article (peer-reviewed)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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| 15. |
- Kocarnik, J. M., et al.
(author)
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Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019 A Systematic Analysis for the Global Burden of Disease Study 2019
- 2022
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In: Jama Oncology. - : American Medical Association (AMA). - 2374-2437 .- 2374-2445. ; 8:3, s. 420-488
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Journal article (peer-reviewed)abstract
- IMPORTANCE The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3%(95% UI, 20.3%-32.3%) increase in new cases, a 20.9%(95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4%(1.1%-1.8%) in the low SDI quintile to 5.7%(4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and YDALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.
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| 16. |
- Li, Suyang, et al.
(author)
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Association between social capital and oral health among adults aged 50 years and over in China: a cross-sectional study
- 2022
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In: Bmc Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 22:1
-
Journal article (peer-reviewed)abstract
- Background Social capital has a potential effect in protecting oral health among population. However, no study has explored the association between social capital and oral health in the Chinese context. Due to the unique culture, political, social context in China, it is important to understand their association in the Chinese context. The study aims to investigate the association between cognitive and structural dimensions of social capital with edentulism among adults aged 50 years and over in China. Method The study used data from the WHO SAGE (Study on Global AGEing and Adult Health) wave 1 China component. Structural social capital was operationalized as social participation. Cognitive social capital was operationalized as perceived community trust and perceived community safety. Community-level social capital was measured by aggregating individual-level social capital into community level. Oral health was measured using a final marker of oral health status, self-reported edentulism. A 2-level multilevel logistic regression was used to evaluate the association between different dimensions of social capital and oral health. Results In total, 12,856 individuals were included in the study, the overall prevalence of edentulism was 9.1% (95% CI 8.3-10.0). Multilevel logistic analysis revealed that individual-level social capital and community-level social capital are independently associated with edentulism. Individuals with low structural social capital and living in areas with low structural social capital have, respectively, 1.54 (95% CI 1.18-2.01) and 2.14 (95% CI 1.47-3.12) times higher odds for edentulism, after adjustment for potential confounders (age, sex, marital status, residence locality, wealth, education level, chronic conditions) and a potential mediator(smoking). Conclusions Living in a community with lower structural social capital and individual with low structural social capital is associated with higher risk for edentulism among adults aged 50 years and over in China.
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| 19. |
- Luo, Juhua, et al.
(author)
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Personality traits and diabetes incidence among postmenopausal women.
- 2019
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In: Menopause (New York, N.Y.). - 1530-0374. ; 26:6, s. 629-636
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Journal article (peer-reviewed)abstract
- We examined whether personality traits, including optimism, ambivalence over emotional expressiveness, negative emotional expressiveness, and hostility, were associated with risk of developing type 2 diabetes (hereafter diabetes) among postmenopausal women.A total of 139,924 postmenopausal women without diabetes at baseline (between 1993 and 1998) aged 50 to 79 years from the Women's Health Initiative were prospectively followed for a mean of 14 (range 0.1-23) years. Multivariable Cox proportional hazards regression models were used to assess associations between personality traits and diabetes incidence adjusting for common demographic factors, health behaviors, and depressive symptoms. Personality traits were gathered at baseline using questionnaires. Diabetes during follow-up was assessed via self-report of physician-diagnosed treated diabetes.There were 19,240 cases of diabetes during follow-up. Compared with women in the lowest quartile of optimism (least optimistic), women in the highest quartile (most optimistic) had 12% (hazard ratio [HR], 0.88; 95% confidence interval [CI]: 0.84-0.92) lower risk of incident diabetes. Compared with women in the lowest quartile for negative emotional expressiveness or hostility, women in the highest quartile had 9% (HR, 1.09; 95% CI: 1.05-1.14) and 17% (HR, 1.17; 95% CI: 1.12-1.23) higher risk of diabetes, respectively. The association of hostility with risk of diabetes was stronger among nonobese than obese women.Low optimism and high NEE and hostility were associated with increased risk of incident diabetes among postmenopausal women independent of major health behaviors and depressive symptoms. In addition to efforts to promote healthy behaviors, women's personality traits should be considered to guide clinical or programmatic intervention strategies in diabetes prevention.
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| 20. |
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| 21. |
- Mehlig, Kirsten, 1964, et al.
(author)
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Physical Activity, Weight Status, Diabetes and Dementia: A 34-Year Follow-Up of the Population Study of Women in Gothenburg
- 2014
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In: Neuroepidemiology. - : S. Karger AG. - 0251-5350 .- 1423-0208. ; 42:4, s. 252-259
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Journal article (peer-reviewed)abstract
- Background: There is evidence of a synergistic interaction between obesity and sedentary lifestyle with respect to diabetes. Although diabetes is a known risk factor for dementia, it is unclear if both diseases have common aetiologies. Methods: A community-based sample of 1,448 Swedish women, aged 38-60 years and free of diabetes and dementia in 1968, was followed by means of up to 5 examinations spread over 34 years. 9.6% of all women developed diabetes and 11.4% developed dementia (over 40,000 person-years of follow-up for each disease). Cox proportional hazard regression was used to assess the influence of selected risk factors on both diseases, and the relation between diabetes and dementia. Results: Comparing risk factors for incident diabetes and dementia, both diseases showed a synergistic association with obesity combined with a low level of leisure time physical activity [hazard ratio (HR) for interaction = 2.7, 95% confidence interval (Cl) = 1.2-6.3 for diabetes and HR = 3.3, 95% Cl = 1.1-9.9 for dementia]. Development of diabetes doubled the risk for subsequent dementia (HR = 2.2, 95% Cl = 1.1-4.4), which was slightly reduced upon adjustment for common risk factors. Conclusions: Shared risk factors suggest a similar aetiology for diabetes and dementia and partially explain the association between diseases. (C) 2014 S. Karger AG, Basel
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| 22. |
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| 23. |
- Miao Jonasson, Junmei
(author)
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Epidemiological studies on complications in type 1 diabetes
- 2008
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Doctoral thesis (other academic/artistic)abstract
- The main threat to the health of patients with type 1 diabetes (T1DM) is its complications. This thesis aimed to assess the risks of hip fracture, non-trauma lower extremity amputation (LEA) and myocardial infarction in patients with T1DM as well as the fertility in women with T1DM. In the Swedish Inpatient Register, we identified a population-based cohort of T1DM patients who were first hospitalized for diabetes before age 31. Follow-up for outcomes of interest was done through cross-linkage of the Inpatient Register or linkage to the Causes of Death, Multi-Generation or Medical Birth Register. Standardized Hospitalization / Incidence / Fertility Ratios (SHRs, SIRs and SFRs) with 95% Confidence Interval (CI), were used to estimate relative rates. Poisson Regression modeling was used to compare the relative effects of the SHRs/SIRs/SFRs and the risk of LEAs in different calendar periods. The Kaplan-Meier method was used to estimate the cumulative probability of the outcome of interest. Compared with the general population, more than 7-fold and 9-fold excess risks for hip fracture were observed in men and women, respectively. The cumulative probability of hip fracture was 6.58% until age 65. The risk of LEAs had decreased by 40% in the most recent calendar period (2000-2004) compared to the previous period. However, these patients still had an extremely high risk compared with the general population. By the age of 65, the cumulative probability of a LEA was 11.0% for women, and 20.7% for men. The SIRs for myocardial infarction among T1DM patients decreased from 32.3 for the period 1975-1984 to 15.3 for 1985-1994, and then decreased further to 9.7 for 1995-2004. The relative risk during the follow-up period 1995-2004 decreased by 50% compared to 1975-1984. Similar trends were observed for men and women, non-fatal and fatal myocardial infarction, although excess risks were notable for fatal myocardial infarction in women. No excess risk of myocardial infarction was observed for their non-DM brothers, while a modest excess risk was noted for their non-DM sisters. At age 65 the cumulative probability of a myocardial infarction was 28% for T1DM patients, while the corresponding figure for their non-T1DM siblings was 6%. The presence of diabetes complications conferred much higher risks for hip fracture, non-trauma LEAs and myocardial infarction. Reduced fertility was confined to women first hospitalized before 1985 and a normalization of fertility was observed in women who were first hospitalized after 1985. The presence of diabetes complications was associated with subfertility in all calendar-year strata. The proportions of newborns with congenital malformations decreased from 11.7% during 1973 1984 to 6.9% during 1995 2004, but were still higher compared to that of the women in the general Swedish population. In conclusion, although relative risks for myocardial infarction, non-trauma LEAs decreased markedly with time and also fertility normalized in recent period, T1DM patients are still at increased risk for these complications, especially among those with diabetes complications. Better treatment of hyper-glycemia and hyper-lipidemia as well as hypertension are most probably the cause of the reduced risks. Effective early preventive programs should be further designed and implemented.
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| 24. |
- Miao Jonasson, Junmei, 1972, et al.
(author)
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Excess Body Weight and Cancer Risk in Patients with Type 2 Diabetes Who Were Registered in Swedish National Diabetes Register - Register-Based Cohort Study in Sweden
- 2014
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 9:9
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Journal article (peer-reviewed)abstract
- Aim: To assess the association between excess body weight and cancer risk in patients with type 2 diabetes (T2D) who were registered in the Swedish National Diabetes Register (NDR). Methods: This is a cohort study based on 25,268 patients with T2D and baseline BMI >= 18.5 kg/m(2) from NDR 1997-1999. Subjects were grouped according to BMI into normal weight (18.5 to 24.9), overweight (25 to 29.9) or obesity (30 or more). All subjects were followed until the first occurrence of cancer, or death, or the end of follow-up (December 31, 2009). Adjusted hazard ratios (HRs) and 95% confidence interval (CI) for cancer risks were estimated by Cox regression. Results: In men with T2D, overweight was associated with increased risks of all cancer [1.13 (1.02-1.27)], gastrointestinal cancer [1.34 (1.07-1.72)] and colorectal cancer [1.59 (1.18-2.13)]; obesity was related to higher risks of all cancer [1.17 (1.04-1.33)], gastrointestinal cancer [1.40 (1.08-1.82)] and colorectal cancer [1.62 (1.17-2.24)]. In women with T2D, obesity was associated with increased risk of all cancer [1.30 (1.12-1.51)], gastrointestinal cancer [1.40 (1.03-1.91)] and postmenopausal breast cancer [1.39 (1.00-1.91)]. Conclusions: Excess body weight was associated with increased risks of all cancer, gastrointestinal cancer and colorectal cancer in men with T2D. Obesity was related with elevated risks of all cancer, gestational cancer and postmenopausal breast cancer in women with T2D.
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| 25. |
- Miao Jonasson, Junmei, 1972, et al.
(author)
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HbA1C and Cancer Risk in Patients with Type 2 Diabetes - A Nationwide Population-Based Prospective Cohort Study in Sweden
- 2012
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 7:6
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Journal article (peer-reviewed)abstract
- Background: Diabetes is associated with increased cancer risk. The underlying mechanisms remain unclear. Hyperglycemia might be one risk factor. HbA1c is an indicator of the blood glucose level over the latest 1 to 3 months. This study aimed to investigate association between HbA1c level and cancer risks in patients with type 2 diabetes based on real life situations. Methods: This is a cohort study on 25,476 patients with type 2 diabetes registered in the Swedish National Diabetes Register from 1997-1999 and followed until 2009. Follow-up for cancer was accomplished through register linkage. We calculated incidences of and hazard ratios (HR) for cancer in groups categorized by HbA1c <= 58 mmol/mol (7.5%) versus >58 mmol/mol, by quartiles of HbA1c, and by HbA1c continuously at Cox regression, with covariance adjustment for age, sex, diabetes duration, smoking and insulin treatment, or adjusting with a propensity score. Results: Comparing HbA1c >58 mmol/mol with <= 58 mmol/mol, adjusted HR for all cancer was 1.02 [95% CI 0.95-1.10] using baseline HbA1c, and 1.04 [95% CI 0.97-1.12] using updated mean HbA1c, and HRs were all non-significant for specific cancers of gastrointestinal, kidney and urinary organs, respiratory organs, female genital organs, breast or prostate. Similarly, no increased risks of all cancer or the specific types of cancer were found with higher quartiles of baseline or updated mean HbA1c, compared to the lowest quartile. HR for all cancer was 1.01 [0.98-1.04] per 1%-unit increase in HbA1c used as a continuous variable, with non-significant HRs also for the specific types of cancer per unit increase in HbA1c. Conclusions: In this study there were no associations between HbA1c and risks for all cancers or specific types of cancer in patients with type 2 diabetes.
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