1. |
- Andersson, Eva, 1955, et al.
(author)
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Cancer incidence among Swedish pulp and paper mill workers: a cohort study of sulphate and sulphite mills.
- 2013
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In: International archives of occupational and environmental health. - : Springer Science and Business Media LLC. - 1432-1246 .- 0340-0131. ; 86:5, s. 529-40
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Journal article (peer-reviewed)abstract
- Associations between various malignancies and work in the pulp and paper industry have been reported but mostly in analyses of mortality rather than incidence. We aimed to study cancer incidence by main mill pulping process, department and gender in a Swedish cohort of pulp and paper mill workers.The cohort (18,113 males and 2,292 females, enrolled from 1939 to 1999 with >1year of employment) was followed up for cancer incidence from 1958 to 2001. Information on the workers' department and employment was obtained from the mills' personnel files, and standardized incidence ratios (SIRs) were calculated using the Swedish population as reference.Overall cancer incidence, in total 2,488 cases, was not increased by work in any department. However, risks of pleural mesothelioma were increased among males employed in sulphate pulping (SIR, 8.38; 95% CI, 3.37-17) and maintenance (SIR, 6.35; 95% CI, 3.47-11), with no corresponding increase of lung cancer. Testicular cancer risks were increased among males employed in sulphate pulping (SIR, 4.14; 95% CI, 1.99-7.61) and sulphite pulping (SIR, 2.59; 95% CI, 0.95-5.64). Female paper production workers showed increased risk of skin tumours other than malignant melanoma (SIR, 2.92; 95% CI, 1.18-6.02).Incidence of pleural mesothelioma was increased in the cohort, showing that asbestos exposure still has severe health consequences, and highlighting the exigency of strict asbestos regulations and elimination. Testicular cancer was increased among pulping department workers. Shift work and endocrine disruptors could be of interest in this context.
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2. |
- Andersson, Eva, 1955, et al.
(author)
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Cancer mortality in a Swedish cohort of pulp and paper mill workers.
- 2010
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In: International archives of occupational and environmental health. - : Springer Science and Business Media LLC. - 1432-1246 .- 0340-0131. ; 83:2, s. 123-32
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Journal article (peer-reviewed)abstract
- PURPOSE: To study cancer mortality among Swedish pulp and paper mill workers by main mill pulping process and department, and to present the Swedish part of an international exposure measurements database. METHODS: A cohort of 18,163 male and 2,290 female workers at four sulfate and four sulfite mills, enrolled from 1939 to 1999, was followed up for mortality during 1952-2001. Standardized mortality ratios (SMRs) relative to the general Swedish population were calculated. RESULTS: There were 1,340 malignant cases out of 5,898 deaths. Total cancer mortality was not increased in either sulfate or sulfite mill workers, or by gender. Lung cancer mortality was increased among female workers (SMR 1.70, 95% CI 1.04-2.63), especially in paper production, but not among male workers (SMR 0.91, 95% CI 0.79-1.04). Exposure to wood dust and sulfur dioxide frequently exceeded occupational exposure limits. CONCLUSIONS: Female paper production workers had an increased mortality from lung cancer.
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3. |
- Andersson, Eva, 1955, et al.
(author)
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Cohort mortality study of Swedish pulp and paper mill workers-nonmalignant diseases
- 2007
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In: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 33:6, s. 470-478
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Journal article (peer-reviewed)abstract
- Objectives The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems.Methods The cohort of 18 163 men and 2 291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented.Results There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98–1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90–0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12–1.32) and SMR 1.11 (95% CI 1.02–1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07–1.54), paper production (SMR 1.26, 95% CI 1.06–1.49), and maintenance (SMR 1.16, 95% CI 1.02–1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased.Conclusions Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).
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4. |
- Andersson, Lennart, et al.
(author)
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Cancerframkallande ämnen i tätortsluft Lindesberg 2005/2006
- 2006
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Reports (other academic/artistic)abstract
- Den allmänna befolkningens exponering för bensen, butadien, formaldehyd,kvävedioxid samt partiklar PM 2,5 i Lindesberg har studerats från oktober 2005till och med januari 2006. Totalt ingick 40 personer och 60 personburna mätningar(exponeringsmätningar) av olika cancerframkallande ämnen genomfördes isjudygnsperioder. Ökat intresse för de partikulära luftföroreningarnas betydelsevid bland annat hjärt-kärlsjuklighet innebar att mätningar av partiklar PM 2,5genomfördes stationärt i hemmen under 2 dygn. Parallellt med exponeringsmätningarnagenomfördes även bakgrundsmätningar av samtliga ämnen vidbyggnaden där Bergslagens Miljö- och Byggförvaltning är inhysta (Kungsgatan)och vid trafikerad gata på Räddningstjänstens tak (Kristinavägen) av samtligaämnen med mätperiod totalt uppgående till fem veckor. Liknande studier i störretätorter har tidigare genomförts i Göteborg, Umeå, Stockholm och Malmö.Resultaten från undersökningarna i Lindesberg kan sammanfattas i följande tabell:Lufthalter för olika ämnen i Lindesbergs kommun hösten 2005Ämne Personburna mätningar Bakgrundsmätningarμg/m³Kristinavägenμg/m³Kungsgatanμg/m³Bensen1,6 0,4 0,4Butadien0,5 0,04 0,05Formaldehyd27 3 2Kvävedioxid6 10 7Partiklar PM 2,59,3 9 9,7Vi har inte kunnat konstatera någon säkerställd påverkan på lufthalter av enskildamiljöfaktorer eller levnadsmönster. För enskilda individer sågs god korrelationmellan lufthalter vid olika mätomgångar. Skillnader i exponering kunde intekonstateras då rökvanor eller boendeform jämfördes, för pendlare sågs dockskillnader i bensen-, butadien- och kvävedioxidexponering.Korrelationen mellan exponeringsmätningar och bakgrundsmätningar var låg församtliga ämnen utom för bensen, motsvarande samvariation mellan olika ämnen ienskilt prov erhölls endast för bensen och butadien.De uppmätta lufthalterna av olika ämnen i Lindesbergs kommun är väl i nivå medde olika nationella och internationella rikt- och gränsvärden som finns antagna.
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5. |
- Andersson, Lennart, et al.
(author)
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Cancerframkallande ämnen i tätortsluft Lindesberg 2010/2011
- 2010
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Reports (other academic/artistic)abstract
- Inom Naturvårdsverkets programområdeHälsorelaterad miljöövervakning(HÄMI), delprogramLuftförorening – exponeringsstudier ingår personburenmätning av vissa cancerframkallande och luftvägsirriterande ämnen i tätortsluft.De övriga orter som ingår i projektet är Göteborg, Umeå, Stockholm och Malmö.Lindesberg får här representera enmindre inlands kommun.Mätningarna genomförs för att försöka skatta allmänbefolkningens exponering förhälsoskadliga ämnen och samtliga orter har nu genomfört två mätomgångar frånstarten år 2000. De ämnen som ska mätas är bensen, butadien, formaldehyd,kvävedioxid, pratiklar PM 2,5 och benso(a)pyren.Lindesberg genomför inga egna mätningar av bakgrundshalter och vi har därföräven vid denna mätomgång valt ut samma två platser som vid föregående mätning.Räddningstjänstens tak (Kristinavägen) som representerar en trafikerad centralgata och Bergslagens Miljö- och Byggförvaltning (Kungsgatan). De uppmättalufthalterna är på samma låga nivåer som vid mätningen år 2005.Bakgrundhalterna i Lindesberg är i jämförelse med övriga orter lägre, vilket kännstroligt då det rör sig om en mindre tätort.För de personburna mätningarna är nivåerna lika med eller i vissa fall något högrejämfört med de övriga orterna. Det uppmättes några höga bensen- ochbutadienhalter med det beror på en yrkesmässig exponering.
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6. |
- Andersson, Lena, et al.
(author)
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Estimating trends in quartz exposure in Swedish iron foundries : predicting past and present exposures
- 2012
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In: Annals of Occupational Hygiene. - Oxford, United Kingdom : Oxford University Press. - 0003-4878 .- 1475-3162. ; 56:3, s. 362-372
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Journal article (peer-reviewed)abstract
- Background: Swedish foundries have a long tradition of legally required surveys in the work place that, from the late 1960s onwards, included measurements of quartz. The availability of exposure data spanning almost 40 years presents a unique opportunity to study trends over that time and to evaluate the validity of exposure models based on data from shorter time spans. The aims of this study were (i) to investigate long term trends in quartz exposure over time, (ii) using routinely collected quartz exposure measurements to develop a mathematical model that could predict both historical and current exposure patterns, and (iii) to validate this exposure model with up-to-date measurements from a targeted survey of the industry.Methods: Eleven foundries, representative of the Swedish iron foundry industry, were divided into three groups based on the size of the companies, i.e. the number of employees. A database containing 2333 quartz exposure measurements for 11 different job descriptionswas used to create three models that covered time periods which reflected different work conditions and production processes: a historical model (1968– 1989), a development model (1990–2004), and a validation model (2005–2006). A linear mixed model for repeated measurements was used to investigate trends over time. In all mixed models, time period, company size, and job title were included as fixed (categorical) determinants of exposure. The within- and between-worker variances were considered to be random effects. A linear regression analysis was erformed to investigate agreement between the models. The average exposure was estimated for each combination of job title and company size.Results: A large reduction in exposure (51%) was seen between 1968 and 1974 and between 1975 and 1979 (28%). In later periods, quartz exposure was reduced by 8% per 5 years at best. In the first period, employees at smaller companies experienced ~50%higher exposure levels than those at large companies, but these differences became much smaller in later years. The furnace and ladle repair job were associated with the highest exposure, with 3.9–8.0 times the average exposure compared to the lowest exposed group. Without adjusting for this autonomous trend over time, predicting early historical exposures using our development model resulted in a statistically significant regression coefficient of 2.42 (R2 5 0.81), indicating an underestimation of historical exposure levels. Similar patterns were seen for other historical time periods. Comparing our development model with our validation model resulted in a statistically significant regression coefficient of 0.31, indicating an overestimation of current exposure levels.Conclusion: To investigate long-term trends in quartz exposure over time, overall linear trends can be determined by using mixed model analysis. To create individual exposure measures to predict historical exposures, it is necessary to consider factors such as the time period, type of job, type of company, and company size. The mixed model analysis showed systematic changes in concentration levels, implying that extrapolation of exposure estimates outside the range of years covered by measurements may result in underestimation or overestimation of exposure.
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7. |
- Andersson, Lena, et al.
(author)
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Exposure assessment and modeling of quartz in Swedish iron foundries for a nested case-control study on lung cancer
- 2012
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In: Journal of Occupational and Environmental Hygiene. - Philadelphia : Taylor & Francis. - 1545-9624 .- 1545-9632. ; 9:2, s. 110-119
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Journal article (peer-reviewed)abstract
- Exposure assessment of quartz in Swedish iron foundries was performed based on historical and present measurement data. To evaluate the exposure response relationship between quartz exposure and lung cancer, we modeled quartz exposure from our database of measurements using determinants job title, time period and company. Based on these modeled exposure data, we conducted a nested case– control evaluation.In our database, the overall individual daily time-weighted average (TWA) quartz concentrations of current and historical data varied between 0.0018 and 4.9 mg/m3, averaging 0.083 mg/m3. The job titles with mean TWAs for the whole study period exceeding the European Union recommended occupational exposure limit of 0.05 mg/m3 were fettlers (0.087 mg/m3), furnace and ladle repair (0.42 mg/m3) and maintenance (0.054 mg/m3) workers.The mixed model analysis demonstrated significant determinants on the job level for furnace and ladle repair (β=4.06; 95% CI 2.78-5.93). For all jobs significantly higher exposure levels occurred only during the first time period, 1968-1979 (β=2.08; 95% CI 1.75-2.47), and a decreasing but not significant trend was noted for the three following 10 year time periods up to 2006 (β=1.0, 0.96 and 1, respectively). Two iron foundries had significantly higher quartz concentration levels than the others (β=1.31; 95% CI 1.00-1.71 and β=1.63; 95% CI 1.00-2.65, respectively). The individual cumulative quartz exposure measures were categorized in low, medium and high exposure (0.5-<1, 1-1.9 and ≥2 mg/m3 *years, respectively).In the nested case-control analysis, we found the highest odds ratios of lung cancer (OR 1.17; 95% CI 0.53-2.55) for the medium exposure group. No dose– response trend or significantly increased risk was determined for our high exposed group (≥2 mg/m3), representing 40 years of exposure at >0.05 mg/m3 of quartz. To conclude, certain foundry workers are still exposed to high levels of quartz, but an increased risk of lung cancer caused by quartz exposure in these Swedish iron foundries could not be confirmed at our exposure levels.
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8. |
- Andersson, Lena, 1965-, et al.
(author)
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Inflammatory and coagulatory markers and exposure to different size fractions of particle mass, number and surface area air concentrations in the Swedish hard metal industry, in particular to cobalt
- 2021
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In: Biomarkers. - : Taylor & Francis. - 1354-750X .- 1366-5804. ; 26:6, s. 557-569
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Journal article (peer-reviewed)abstract
- Purpose: To study the relationship between inhalation of airborne particles and cobalt in the Swedish hard metal industry and markers of inflammation and coagulation in blood.Methods: Personal sampling of inhalable cobalt and dust were performed for subjects in two Swedish hard metal plants. Stationary measurements were used to study concentrations of inhalable, respirable, and total dust and cobalt, PM10 and PM2.5, the particle surface area and the particle number concentrations. The inflammatory markers CC16, TNF, IL-6, IL-8, IL-10, SAA and CRP, and the coagulatory markers FVIII, vWF, fibrinogen, PAI-1 and D-dimer were measured. A complete sampling was performed on the second or third day of a working week following a work-free weekend, and additional sampling was taken on the fourth or fifth day. The mixed model analysis was used, including covariates.Results: The average air concentration of inhalable dust and cobalt were 0.11 mg/m3 and 0.003 mg/m3, respectively. For some mass-based exposure measures of cobalt and total dust, statistically significant increased levels of FVIII, vWF and CC16 were found.Conclusions: The observed relationships between particle exposure and coagulatory biomarkers may indicate an increased risk of cardiovascular disease.
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9. |
- Andersson, Lena, et al.
(author)
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Quartz and dust exposure in Swedish iron foundries
- 2009
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In: Journal of Occupational and Environmental Hygiene. - Philadelphia, PA : Taylor & Francis. - 1545-9624 .- 1545-9632. ; 6:1, s. 9-18
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Journal article (peer-reviewed)abstract
- Exposure to respirable quartz continues to be a major concern in the Swedish iron foundry industry. Recommendations for reducing the European occupational exposure limit (EU-OEL) to 0.05 mg/m3 and the corresponding ACGIH® threshold limit value (ACGIH-TLV) to 0.025 mg/m3 prompted this exposure survey. Occupational exposure to respirable dust and respirable quartz were determined in 11 Swedish iron foundries, representing different sizes of industrial operation and different manufacturing techniques. In total, 436 respirable dust and 435 respirable quartz exposure measurements associated with all job titles were carried out and are presented as time-weighted averages. Our sampling strategy enabled us to evaluate the use of respirators in certain jobs, thus determining actual exposure. In addition, measurements using real-time dust monitors were made for high exposure jobs. For respirable quartz, 23% of all the measurements exceeded the EU-OEL, and 56% exceeded the ACGIH-TLV. The overall geometric mean (GM) for the quartz levels was 0.028 mg/m3, ranging from 0.003 to 2.1 mg/m3. Fettler and furnace and ladle repair operatives were exposed to the highest levels of both respirable dust (GM = 0.69 and 1.2 mg/m3; range 0.076-31 and 0.25-9.3 mg/m3 and respirable quartz (GM = 0.041 and 0.052 mg/m3; range 0.004-2.1 and 0.0098-0.83 mg/m3. Fettlers often used respirators and their actual quartz exposure was lower (range 0.003-0.21 mg/m3, but in some cases it still exceeded the Swedish OEL (0.1 mg/m3. For furnace and ladle repair operatives, the actual quartz exposure did not exceed the OEL (range 0.003-0.08 mg/m3, but most respirators provided insufficient protection, i.e., factors less than 200. In summary, measurements in Swedish iron foundries revealed high exposures to respirable quartz, in particular for fettlers and furnace and ladle repair workers. The suggested EU-OEL and the ACGIH-TLV were exceeded in, respectively, 23% and 56% of all measurements regardless of the type of foundry. Further work on elimination techniques to reduce quartz concentrations, along with control of personal protection equipment, is essential.
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10. |
- Andersson, Lena, 1965-, et al.
(author)
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Respiratory health and inflammatory markers : Exposure to respirable dust and quartz and chemical binders in Swedish iron foundries
- 2019
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In: PLOS ONE. - : PLOS. - 1932-6203. ; 14:11
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Journal article (peer-reviewed)abstract
- PURPOSE: To study the relationship between respirable dust, quartz and chemical binders in Swedish iron foundries and respiratory symptoms, lung function (as forced expiratory volume FEV1 and vital capacity FVC), fraction of exhaled nitric oxide (FENO) and levels of club cell secretory protein 16 (CC16) and CRP.METHODS: Personal sampling of respirable dust and quartz was performed for 85 subjects in three Swedish iron foundries. Full shift sampling and examination were performed on the second or third day of a working week after a work free weekend, with additional sampling on the fourth or fifth day. Logistic, linear and mixed model analyses were performed including, gender, age, smoking, infections, sampling day, body mass index (BMI) and chemical binders as covariates.RESULTS: The adjusted average respirable quartz and dust concentrations were 0.038 and 0.66 mg/m3, respectively. Statistically significant increases in levels of CC16 were associated with exposure to chemical binders (p = 0.05; p = 0.01) in the regression analysis of quartz and respirable dust, respectively. Non-significant exposure-responses were identified for cumulative quartz and the symptoms asthma and breathlessness. For cumulative chemical years, non-significant exposure-response were observed for all but two symptoms. FENO also exhibited a non significant exposure-response for both quartz and respirable dust. No exposure-response was determined for FEV1 or FVC, CRP and respirable dust and quartz.CONCLUSIONS: Our findings suggest that early markers of pulmonary effect, such as increased levels of CC16 and FENO, are more strongly associated with chemical binder exposure than respirable quartz and dust in foundry environments.
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11. |
- Andersson, Lena, 1965-, et al.
(author)
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Respiratory Health and Inflammatory Markers : Exposure to Cobalt in the Swedish Hard Metal Industry
- 2020
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In: Journal of Occupational and Environmental Medicine. - : Lippincott Williams & Wilkins. - 1076-2752 .- 1536-5948. ; 62:10, s. 820-829
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To study the relationship between inhalable dust and cobalt and respiratory symptoms, lung function, exhaled nitric oxide in expired air and CC16 in the Swedish hard metal industry.METHODS: Personal sampling of inhalable dust and cobalt, medical examination including blood sampling was performed for 72 workers. Exposure-response relationships was determined using logistic, linear and mixed model analysis.RESULTS: The average inhalable dust and cobalt concentrations were 0.079 and 0.0017 mg/m, respectively. Statistically significant increased serum levels of CC16 were determined when the high and low cumulative exposures for cobalt were compared. Non-significant exposure-response relationships was observed between cross-shift inhalable dust or cobalt exposures and asthma, nose dripping and bronchitis.CONCLUSIONS: Our findings suggest an exposure-response relationship between inhalable cumulative cobalt exposure and CC16 levels in blood, which may reflect an injury or a reparation process in the lungs.
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12. |
- Andersson, Lena, 1965-, et al.
(author)
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Silica Exposure and Cardiovascular, Cerebrovascular, and Respiratory Morbidity in a Cohort of Male Swedish Iron Foundry Workers
- 2023
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In: Journal of Occupational and Environmental Medicine. - : Lippincott Williams & Wilkins. - 1076-2752 .- 1536-5948. ; 65:9, s. 731-739
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Journal article (peer-reviewed)abstract
- In this study, we present quantitative exposure-response data on silica exposure in male Swedish iron foundry workers receiving inpatient care for cardiovascular, cerebrovascular, and respiratory morbidity. The study show a significantly increased COPD risk at cumulative silica exposures that correspond to TWA silica below the Swedish OEL of 0.1 mg/m3. ObjectiveWe present quantitative exposure-response data on silica exposure in male Swedish iron foundry workers for cardiovascular, cerebrovascular, and respiratory morbidity.MethodsThis research is a cohort study of 2063 male Swedish iron foundry workers. From the Swedish National Patient Registers, data on morbidity incidence were retrieved. A historical measurement database of 1667 respirable silica exposure measurements from 10 Swedish iron foundries was used to calculate the cumulative exposure dose for each worker.ResultsIncreased morbidity risk for the whole group of foundry workers was determined for ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), bronchitis, and pneumonia. In addition, an increased risk for COPD at cumulative silica exposures ranging from 0.11 to 0.84 mg/m3 year is presented.ConclusionsThe study presents a significantly increased COPD risk at cumulative silica exposures below the Swedish occupational exposure limit.
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13. |
- Andersson, Tommy, 1970-, et al.
(author)
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All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008 : a Swedish nationwide long-term case-control study
- 2013
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In: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 34:14, s. 1061-1067
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Journal article (peer-reviewed)abstract
- Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) <= 85 years at the time of hospitalization with incidental AF 1995-2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories <= 65, 65-74, and 75-85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.
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14. |
- Andersson, Tommy, 1970-, et al.
(author)
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Patients without comorbidities at the time of diagnosis of atrial fibrillation : causes of death during long-term follow-up compared to matched controls
- 2017
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In: Clinical Cardiology. - : John Wiley & Sons. - 0160-9289 .- 1932-8737. ; 40:11, s. 1076-1082
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Journal article (peer-reviewed)abstract
- BACKGROUND: Little is known about the long-term, cause-specific mortality risk in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).METHODS: From a nation-wide registry of patients hospitalized with incident AF between 1995 and 2008 we identified 9 519 patients with a first diagnosed AF and no comorbidities at the time of AF diagnosis. They were matched with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.RESULTS: During follow-up, 11.1% of patients with AF and 8.3% of controls died. Cardiovascular diseases were the most common causes of death and the only diagnoses which showed significantly higher relative risk in patients with AF than controls (HR 2.0, 95% CI 1.8-2.3), and the relative risk was significantly higher in women than in men. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8-4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6-1.5). The time from AF diagnosis to death was 6.0 ± 3.1 years.CONCLUSIONS: In patients with incident AF and no known comorbidities at the time of AF diagnosis, only cardiovascular diseases were more often causes of death as compared to controls. Women carried a significantly higher relative risk than men.
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16. |
- Björk-Eriksson, Thomas, 1960, et al.
(author)
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Mortality Among Pediatric Patients With Acute Lymphoblastic Leukemia in Sweden From 1988 to 2017
- 2022
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In: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 5:11
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Journal article (peer-reviewed)abstract
- Importance: Acute lymphoblastic leukemia (ALL) constitutes 20% to 30% of all pediatric cancers. The 5-year overall survival among pediatric patients with ALL in high-income countries such as Sweden is currently more than 90%, but long-term unselected nationwide mortality data and mortality data in relation to the general population are lacking. Objective: To compare mortality between pediatric patients with ALL and the general population during a 30-year period in Sweden and to assess the incidence of ALL in Sweden. Design, Setting, and Participants: This cohort study included pediatric patients (aged <18 years) with a morphologically verified ALL diagnosis in the Swedish Cancer Register and/or at least 2 ALL diagnoses in the Swedish National Patient Register between January 1, 1988, and December 31, 2017. Data were cross-linked to the Swedish Cause of Death Register. Data were analyzed from May 2019 to January 2022. Main Outcomes and Measures: The main outcomes were mortality among patients with ALL compared with that in the general population and mortality in different subgroups within the cohort. Standardized mortality ratios (SMRs) were calculated using the general Swedish population as a reference. Within-cohort survival analyses were performed. Results: A total of 2397 patients (1354 [56%] male; mean [SD] age at diagnosis, 6.1 [4.7] years) were included in the study. The mean (SD) incidence of pediatric ALL during the study period was 4.11 (0.60) cases per 100 000 persons per year (females, 3.68 [0.65] cases per 100 000 persons per year; males, 4.52 [0.81] cases per 100 000 persons per year; P<.001). The observed number of deaths among pediatric patients with ALL was 409 vs the 9.5 deaths expected in the general population, resulting in an overall SMR of 43.1 (95% CI, 39.0-47.5); females had a higher SMR than males (57.8 [95% CI, 49.5-67.2] vs 34.5 [95% CI, 32.0-41.4]; P<.001). Analysis within the cohort showed a continued decrease in survival throughout the 30-year follow-up. The association between calendar year of ALL diagnosis, corresponding with different ALL treatment protocols, and mortality showed the lowest survival for the 1988-1991 group and the highest for the 2008-2017 group (χ2=20.3; P<.001). Conclusions and Relevance: In this cohort study, a consistently high SMR was seen among pediatric patients with ALL. Within the ALL cohort, survival evolved to a similar extent as in the young general population of Sweden. Furthermore, survival among patients with ALL decreased throughout the whole follow-up period without any trend difference after the 5-year follow-up time point. The changes in ALL treatment protocols were associated with overall improved absolute survival over time.
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17. |
- Edman, Katja, et al.
(author)
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Exposure assessment to alpha- and beta-pinene, delta(3)-carene and wood dust in industrial production of wood pellets
- 2003
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In: Annals of Occupational Hygiene. - : Oxford University Press (OUP). - 0003-4878 .- 1475-3162. ; 47:3, s. 219-226
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Journal article (peer-reviewed)abstract
- The main aim of the study was to measure the exposure to monoterpenes (alpha- and beta-pinene and Delta(3)-carene) and wood dust during industrial production of wood pellets and briquettes. Additional aims were to compare the results from wood dust sampled on a filter with real time measurements using a direct reading instrument and to identify peak exposures to dust. Twenty-four men working at six companies involved in industrial production of wood pellets and briquettes participated in the study. Monoterpenes were measured by diffusive sampling and wood dust was measured as total dust. A data logger (DataRAM) was used for continuous monitoring of dust concentration for 18 of the participants. The sampling time was approximately 8 h. The personal exposure to monoterpenes ranged from 0.64 to 28 mg/m(3) and a statistically significant (Kruskal-Wallis test, P = 0.0002) difference in levels of monoterpenes for workers at different companies was seen. In the companies the personal exposure to wood dust varied between 0.16 and 19 mg/m(3) and for 10 participants the levels exceeded the present Swedish occupational exposure limit (OEL) of 2 mg/m(3). The levels of wood dust during the morning shift were significantly (Mann-Whitney test, P = 0.04) higher compared with the afternoon shift. Continuous registration of dust concentration showed peak values for several working operations, especially cleaning of truck engines with compressed air. For 24 workers in six companies involved in industrial production of wood pellets the personal exposure to monoterpenes was low and to wood dust high compared with the present Swedish OEL and previous studies in Swedish wood industries. Since the DataRAM can identify critical working tasks with high wood dust exposure a reduction in exposure levels could probably be achieved by changes in working routines and by the use of protective equipment
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18. |
- Fan, Chenjing, et al.
(author)
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Silica exposure increases the risk of stroke but not myocardial infarction : A retrospective cohort study
- 2018
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In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 13:2
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Work-related exposure to silica is a global health hazard that causes diseases such as silicosis. Some studies have also reported that silica exposure is linked to elevated cardiovascular disease mortality. However, these diagnoses have not been investigated in detail and there have been few studies on morbidity. The aim of this study is to examine morbidity and mortality from different cardiovascular diseases among silica-exposed Swedish foundry workers.METHODS: Historical and contemporary measurements (1968-2006) of respiratory silica exposure were matched to job categories, individual foundries, and 4 time periods (1968-1979, 1980-1989, 1990-1999, 2000-2006) using a mixed model. Morbidity and mortality data for the studied cohorts were matched against the General Population Registry. Statistical analyses were performed with SPSS and STATA, and the data were stratified by age, gender, and year.RESULTS: Mortality from cardiovascular disease (SMR 1.3; 95% CI 1.2-1.4) and stroke (SMR 1.6, 95% CI 1.2-2.1) was significantly elevated among the studied population. The cohort also exhibited significantly elevated morbidity from stroke (SIR 1.34; 95% CI 1.2-1.5) but not myocardial infarction. The mean age at the time of first morbidity from stroke was 64 years, with 36% of the cases occurring before the age of 60.CONCLUSIONS: Swedish foundry workers exposed to respirable silica exhibit elevated morbidity and mortality from stroke, but not from myocardial infarction. Our results also suggest a relationship between silica exposure and morbidity from stroke at a younger age than the general population.
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19. |
- Fardelin, Gustav, et al.
(author)
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Hand nerve function after mountain bike cycling
- 2022
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In: Journal of Science and Cycling. - : CYCLING RESEARCH CENTER. - 2254-7053. ; 11:3, s. 23-32
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Journal article (other academic/artistic)abstract
- Hand-arm vibrations can cause permanent injuries and temporary changes affecting the sensory and circulatory systems in the hands. Vibrational effects have been thoroughly studied within the occupational context concerning work with handheld vibrating tools. Less is known about vibrational exposure and risk of effects during cycling. In the present study, 10 cyclists were recruited for exposure measurements of hand-arm vibrations during mountainbike cycling on the trail, and the effects on the nerve function were examined with quantitative sensory testing (QST) before and after the ride. The intervention group was compared to a control group that consisted of men exposed to hand-arm vibrations from a polishing machine. The results of the QST did not statistically significantly differ between the intervention and study groups. The intervention group showed a lesser decrease in vibration perception in digitorum II, digitorum V, and hand grip strength than the control group. It was concluded that no acute effects on nerve function in the dominant hand were measured after mountain bike cycling on the trail, despite high vibration doses through the handlebars.
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20. |
- Graff, Pål, 1973-, et al.
(author)
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Adult onset asthma in non-allergic women working in dampness damaged buildings : A retrospective cohort study
- 2019
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In: American Journal of Industrial Medicine. - : Wiley-Liss Inc.. - 0271-3586 .- 1097-0274. ; 62:4, s. 357-363
-
Journal article (peer-reviewed)abstract
- BACKGROUND: There is still no consensus about the association between working in dampness-damaged buildings and new onset of asthma among adults. The purpose of this study was to assess asthma in the staff of two psychiatric clinics where some premises were suffering from dampness.METHODS: A 20-year retrospective cohort study was performed using questionnaires.RESULTS: Incidence rate ratios (IRR) for asthma were non-significantly elevated (IRR = 2.3) among exposed individuals. The risk was greater among females (IRR = 3.5, 95% CI 1.0-16). IRR for non-atopic women was 8.8 (95% CI 1.4-196). Adjusting for smoking habits weakened the risks marginally (IRR = 7.3, 95% CI 1.1-167). The number of male participants was too low to draw conclusion regarding the risk for men.CONCLUSION: The results suggest that working in dampness-damaged buildings might be a possible health hazard. This finding is most pronounced in non-atopic females.
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21. |
- Graff, Pål, et al.
(author)
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Sarcoidosis and silica dust exposure among men in Sweden : a case-control study
- 2020
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 10:9
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To determine whether occupational exposure to silica dust is associated with an increased risk of developing sarcoidosis.DESIGN: Case-control study of all individuals between 20 and 65 years of age diagnosed with sarcoidosis (D86) in Sweden between 2007 and 2016. Controls were matched to cases (2:1) based on age, sex and county at the time of diagnosis. A Job Exposure Matrix was used to estimate the occupational silica exposure of all cases and controls.SETTING: Medical and occupational data from the National Outpatient Register were used to implement a case-control analysis, while the two controls used for each case were selected from the National Register of the Total Population. Information about occupation and time of employment were collected from the Swedish Occupational Register.PARTICIPANTS: All men and women aged 20-65 years old who were diagnosed sarcoidosis (D86) from 2007 to 2016 were included and assigned two controls.MAIN OUTCOMES: Silica dust exposure correlates with an increased risk of developing sarcoidosis in men.RESULTS: The prevalence of silica exposure at work was statistically significantly higher among male cases than controls (OR 1.27, 95% CI 1.13 to 1.43). For men of an age of 35 years or younger the correlation seems to be stronger (OR 1.48, 95% CI 1.1 to 1.87) than in older men (OR 1.21, 95% CI 1.05 to 1.39). For men older than 35 with exposure to silica the prevalence of sarcoidosis increased with the exposure time, with an OR of 1.44 (95% CI 1.04 to 2.00) for exposure of more than 10 years.CONCLUSIONS: Occupational exposure to silica dust seems to increase the risk of sarcoidosis among men between 20 and 65 years of age. The risk is higher among exposed men 35 years or younger and older men with longer exposure (>6 years).
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22. |
- Hagström, Katja, 1975-, et al.
(author)
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Exposure to wood dust, resin acids and volatile organic compounds during production of wood pellets
- 2008
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In: Journal of Occupational and Environmental Hygiene. - Philadelphia, PA : Taylor and Francis. - 1545-9624 .- 1545-9632. ; 5:5, s. 296-304
-
Journal article (peer-reviewed)abstract
- The main aim of this study was to investigate exposure to airborne substances that are potentially harmful to health during the production of wood pellets, including wood dust, monoterpenes, and resin acids, and as an indicator of diesel exhaust nitrogen dioxide. In addition, area measurements were taken to assess background exposure levels of these substances, volatile organic compounds (VOCs), and carbon monoxide. Measurements were taken at four wood pellet production plants from May 2004 to April 2005. Forty-four workers participated in the study, and a total of 68 personal measurements were taken to determine personal exposure to wood dust (inhalable and total dust), resin acids, monoterpenes, and nitrogen dioxide. In addition, 42 measurements of nitrogen dioxide and 71 measurements of total dust, resin acids, monoterpenes, VOCs, and carbon monoxide were taken to quantify their indoor area concentrations. Personal exposure levels to wood dust were high, and a third of the measured levels of inhalable dust exceeded the Swedish occupational exposure limit (OEL) of 2 mg/m3. Parallel measurements of inhalable and total dust indicated that the former were, on average, 3.2 times higher than the latter. The data indicate that workers at the plants are exposed to significant amounts of the resin acid 7-oxodehydroabietic acid in the air, an observation that has not been recorded previously at wood processing and handling plants. The study also found evidence of exposure to dehydroabietic acid, and exposure levels for resin acids approached 74% of the British OEL for colophony, set at 50 microg/m3. Personal exposure levels to monoterpenes and nitrogen dioxide were low. Area sampling measurements indicated that aldehydes and terpenes were the most abundant VOCs, suggesting that measuring personal exposure to aldehydes might be of interest. Carbon monoxide levels were under the detection limit in all area measurements. High wood dust exposure levels are likely to have implications for worker health; therefore, it is important to reduce exposure to wood dust in this industry.
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23. |
- Hagström, Katja, 1975-, et al.
(author)
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Preschool children´s exposure to metals via measurements of hand deposition
- 2019
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In: Abstract Book, Monday.
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Conference paper (other academic/artistic)abstract
- Background: Since we spend most of our time indoors the indoor environment can lead to exposure to substances like metals. Small children are often more exposed than adults, for instance due to their hand-to-mouth behaviour. Since some metals can have adverse health effects in children the aim of this study was to investigate indoor exposure to metals on children’s hands in preschools.Method: In the study, 60 children at 8 preschools in two cities in Sweden participated. Metals on the hands were sampled at two different periods (winter and spring) giving a total of 109 samples. During sampling, both hands were wiped using hand-wipes soaked in 1 % HNO3, and sampling was done after two hours of indoor activities. The following metals were analyzed using ICP-MS; beryllium, magnesium, aluminium, vanadium, chromium, manganese, iron, cobalt, nickel, copper, zinc, arsenic, molybdenum, silver, cadmium, antimony, barium, thallium and lead. Results All samples were above limit of quantification (LOQ) except for beryllium and molybdenum (4 %Conclusion: Metals linked to severe health effects like cadmium, arsenic and lead as well as a range of other metals could be detected on children’s hands. These findings indicate an exposure to metals for children both via dermal uptake and oral intake due to hand-to-mouth transfer, but potential contributions to the body burden are unknown. Higher levels were seen during spring and in one of the cities, possible explanations to these observations needs to be looked into more closely.
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24. |
- Hedbrant, Alexander, 1987-, et al.
(author)
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Effects on white blood cell counts and the NLRP3 inflammasome due to dust and cobalt exposure in the hard metal industry
- 2022
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In: Biomarkers. - : Taylor & Francis. - 1354-750X .- 1366-5804. ; , s. 60-70
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Journal article (peer-reviewed)abstract
- INTRODUCTION: In light of potential negative health effects of cobalt exposure, a characterization of inflammatory mechanisms in exposed individuals is warranted. The current study investigated cobalt exposure in the Swedish hard metal industry and its relationship to inflammatory markers, including NLRP3 inflammasome activation and white blood cell (WBC) counts.MATERIAL AND METHODS: Inhalable cobalt and dust exposures, and systemic cobalt levels, were determined for 72 workers in the hard metal industry and linear regression models were applied to correlate exposure to markers of inflammasome activation and WBC counts.RESULTS: Mean exposures to inhalable dust (0.11 mg/m3) and cobalt (0.0034 mg/m3) were below the Swedish occupational exposure limits, and these low exposures did not correlate with any investigated outcomes. Instead, cobalt blood levels significantly correlated with a ca 10% decrease in IL-18 plasma levels per 10 nM cobalt increase. Furthermore, pre-shift cobalt blood and/or urine levels significantly correlated with some WBC measures, including decreased neutrophil-to-lymphocyte ratio, increased lymphocyte-to-monocyte ratio, and lymphocyte counts.CONCLUSION: The low inhalable particle exposures had no impact on WBC counts and inflammasome activation. Instead, systemic cobalt levels, which also include skin exposure, demonstrated possible suppressive effects on inflammatory responses in cobalt-exposed individuals in the hard metal industry.
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25. |
- Hedbrant, Alexander, 1987-, et al.
(author)
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Quartz Dust Exposure Affects NLRP3 Inflammasome Activation and Plasma Levels of IL-18 and IL-1Ra in Iron Foundry Workers
- 2020
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In: Mediators of Inflammation. - : Hindawi Publishing Corporation. - 0962-9351 .- 1466-1861.
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Journal article (peer-reviewed)abstract
- Purpose: To study the association between inhalation of particulate matter or quartz in Swedish iron foundries and the effects on NLRP3 inflammasome activation. Methods: Particle exposure measurements were performed during an eight-hour work day for 85 foundry workers at three Swedish iron foundries. Personal sampling was used for measurement of respirable quartz and dust and stationary measurements to obtain exposure measurements for inhalable dust and PM10. The NLRP3 inflammasome markers, interleukin- (IL-) 1β and IL-18, and inhibitors IL-1 receptor antagonist (IL-1Ra) and IL-18 binding protein (IL-18BP) were measured in plasma. Inflammasome activation was measured by caspase-1 enzymatic activity in monocytes in whole blood by flow cytometry, and expression of inflammasome-related genes was quantified using real-time PCR. Multiple linear regression analysis was used to investigate associations between PM exposures and inflammatory markers. Sex, age, smoking, current infection, BMI, and single nucleotide polymorphism in the inflammasome regulating genes CARD8 (C10X) and NLRP3 (Q705K) were included as covariates. Results: The average exposure levels of respirable dust and quartz were 0.85 and 0.052 mg/m3, respectively. A significant exposure-response was found for respirable dust and IL-18 and for inhalable dust and IL-1Ra. Whole blood, drawn from study participants, was stimulated ex vivo with inflammasome priming stimuli LPS or Pam3CSK4, resulting in a 47% and 49% increase in caspase-1 enzymatic activity in monocytes. This increase in caspase-1 activity was significantly attenuated in the higher exposure groups for most PM exposure measures. Conclusions: The results indicate that exposure levels of PM in the iron foundry environment can affect the NLRP3 inflammasome and systemic inflammation.
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26. |
- Johansson, Niclas, et al.
(author)
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Effects on blood parameters from hand-arm vibrations exposure
- 2023
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In: Toxicology and industrial health. - : Sage Publications. - 0748-2337 .- 1477-0393. ; 39:6, s. 291-297
-
Journal article (peer-reviewed)abstract
- Vibration exposure from handheld tools can affect the hands with neurological symptoms and vibration-induced Raynaud's phenomenon (VRP). The underlying pathophysiological mechanisms are not fully known, however, changes in the composition of blood parameters may contribute to VRP with an increase in blood viscosity and inflammatory response. The aim of this study was to examine the effect on blood parameters in capillary blood from fingers that had been exposed to a vibrating hand-held tool. This study involved nine healthy participants who had been exposed to vibration and an unexposed control group of six participants. Capillary blood samples were collected before and after vibration exposure for the exposed group, and repeated samples also from the control group. The exposed groups were exposed to vibration for a 15-min period or until they reached a 5.0 m/s2 vibration dose. Analysis of blood status and differential counting of leucocytes was performed on the capillary blood samples. The results of the blood samples showed an increase in mean value for erythrocyte volume fraction (EVF), hemoglobin, red blood cell count, white blood cell count and neutrophils, as well as a decrease of mean cell volume, mean cell hemoglobin, and mean cell hemoglobin concentration. The increase of EVF and neutrophils was statistically significant for samples taken from the index finger but not the little finger. Even though the study was small it showed that an acute vibration exposure to the hands might increase EVF and neutrophilic granulocytes levels in the capillary blood taken from index fingers.
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27. |
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28. |
- Klasson, Maria, 1977-, et al.
(author)
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Biological monitoring of dermal and air exposure to cobalt at a Swedish hard metal production plant : does dermal exposure contribute to uptake?
- 2017
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In: Contact Dermatitis. - : John Wiley & Sons. - 0105-1873 .- 1600-0536. ; 77:4, s. 201-207
-
Journal article (peer-reviewed)abstract
- Background: Occupational exposure to cobalt is well established in hard metal manufacture. Cobalt is known to cause contact allergy, asthma, hard metal lung disease, and lung cancer. The relationship between skin exposure and uptake determined in blood has not been extensively investigated.Objective: To examine whether skin and inhalable air exposure to cobalt contributes to uptake, determined as cobalt in blood, in a hard metal manufacturing factory.Methods: The amount of cobalt on the skin found with an acid wash technique, the air concentrations of inhalable cobalt and cobalt blood concentrations were determined and correlated in exposed workers.Results: We found a significant rank correlation for cobalt concentrations on the skin, in inhalable air, and in blood (0.376-0.498). Multiple linear regression showed significant regression coefficients for cobalt skin exposure and blood (B = 0.01, p < 0.05) and for inhalable cobalt in air and blood (B = 49.1, p < 0.001). According to our model based on data from the regression analyses, a twofold increase in skin exposure levels at different air concentrations caused a 3 - 14% increase in blood levels.Conclusions: Our data suggest that skin exposure to cobalt in the hard metal industry could affect the total uptake at the same order of magnitude as air exposure.
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29. |
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30. |
- Klasson, Maria, 1977-, et al.
(author)
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Dermal exposure to cobalt studied in vitro in keratinocytes : effects of cobalt exposure on inflammasome activated cytokines, and mRNA response
- 2021
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In: Biomarkers. - : Taylor & Francis. - 1354-750X .- 1366-5804. ; 26:8, s. 674-684
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Cobalt is a dermal sensitizer, and keratinocytes respond to cobalt exposure by releasing proinflammatory mediators, regulating the immune response.OBJECTIVE: To determine the effect of cobalt on the inflammasome associated cytokine- and gene expression in cultured human keratinocytes (HaCaT). Cultivation in low- or high calcium conditions model separate differentiation states of keratinocytes in the skin.METHOD: HaCaT cells in two different states of differentiation were exposed to cobalt chloride and caspase-1 activity as well as the production of IL-1 beta, IL-18 and gene expression of IL1B, IL18, NLRP3, CASP1, and PYCARD was quantified. RESULTS: High cobalt chloride exposure mediated significant increase in caspase-1 activity, cytokine levels, and IL1B and NLRP3 expression with a corresponding regulatory decrease for CASP1 and PYCARD expression. No difference between high- and low calcium culturing conditions modelling differentiation states was detected.CONCLUSIONS: Our data suggest that HaCaT cells respond with inflammmasome associated activity upon cobalt exposure in a concentration-dependent manner. These mechanisms could be of importance for the understanding of the pathophysiology behind allergic sensitization to dermal cobalt exposure.
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31. |
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32. |
- Klasson, Maria, 1977-, et al.
(author)
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Dose- and time-dependent changes in viability and IL-6, CXCL8 and CCL2 production by HaCaT-cells exposed to cobalt : Effects of high and low calcium growth conditions
- 2021
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In: PLOS ONE. - : PLOS. - 1932-6203. ; 16:6
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Journal article (peer-reviewed)abstract
- BACKGROUND: Sensitization requires exposure to an allergen with subsequent production of a "danger "signal. In the skin, keratinocytes are the main producers of these signals.OBJECTIVE: To compare dose- and time-effects of cobalt on the viability of and cytokine release from HaCaT cells cultured at low or high calcium.METHOD: To model two separate states of differentiation of keratinocytes, HaCaT cells were cultured under low or high calcium conditions. HaCaT were exposed to different concentrations of cobalt chloride (10 μm to 5 mM) over time (30 minutes- 48 hours). Cell viability was measured with the Cell-Titer Blue Viability assay. Cytokine production was measured using a bead-based immunoassay and flow cytometry. Gene expression was quantified using qPCR. Data was analyzed by ANOVA and linear mixed model.RESULTS: Viability of the cells was dose- and time-dependent. A linear mixed statistical model showed that cobalt exposure induces increase in IL-6, CXCL8 and CCL2 production over time and whereas increase of IL-6 and a decrease of CCL2 was associated with increasing cobalt chloride concentrations. When comparing the cells incubated under high and low calcium conditions, the more differentiated cells in the high concentration were found to exert a stronger response in terms of IL-6 release.CONCLUSIONS: Our data suggest that cobalt chloride triggered an alarm system in HaCaT cells, and proinflammatory cytokines/chemokines were secreted in a dose- and time-dependent manner. When high and low calcium incubations were compared, the difference was seen only for IL-6. These findings indicate that the effect of cobalt chloride on cell toxicity occurs throughout the living epidermis.
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33. |
- Klasson, Maria, 1977-, et al.
(author)
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Occupational Exposure to Cobalt and Tungsten in the Swedish Hard Metal Industry : Air Concentrations of Particle Mass, Number, and Surface Area
- 2016
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In: Annals of Occupational Hygiene. - Oxford, United Kingdom : Oxford University Press. - 0003-4878 .- 1475-3162. ; 60:6, s. 684-699
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Journal article (peer-reviewed)abstract
- Exposure to cobalt in the hard metal industry entails severe adverse health effects, including lung cancer and hard metal fibrosis. The main aim of this study was to determine exposure air concentration levels of cobalt and tungsten for risk assessment and dose-response analysis in our medical investigations in a Swedish hard metal plant. We also present mass-based, particle surface area, and particle number air concentrations from stationary sampling and investigate the possibility of using these data as proxies for exposure measures in our study. Personal exposure full-shift measurements were performed for inhalable and total dust, cobalt, and tungsten, including personal real-time continuous monitoring of dust. Stationary measurements of inhalable and total dust, PM2.5, and PM10 was also performed and cobalt and tungsten levels were determined, as were air concentration of particle number and particle surface area of fine particles. The personal exposure levels of inhalable dust were consistently low (AM 0.15mg m(-3), range <0.023-3.0mg m(-3)) and below the present Swedish occupational exposure limit (OEL) of 10mg m(-3) The cobalt levels were low as well (AM 0.0030mg m(-3), range 0.000028-0.056mg m(-3)) and only 6% of the samples exceeded the Swedish OEL of 0.02mg m(-3) For continuous personal monitoring of dust exposure, the peaks ranged from 0.001 to 83mg m(-3) by work task. Stationary measurements showed lower average levels both for inhalable and total dust and cobalt. The particle number concentration of fine particles (AM 3000 p·cm(-3)) showed the highest levels at the departments of powder production, pressing and storage, and for the particle surface area concentrations (AM 7.6 µm(2)·cm(-3)) similar results were found. Correlating cobalt mass-based exposure measurements to cobalt stationary mass-based, particle area, and particle number concentrations by rank and department showed significant correlations for all measures except for particle number. Linear regression analysis of the same data showed statistically significant regression coefficients only for the mass-based aerosol measures. Similar results were seen for rank correlation in the stationary rig, and linear regression analysis implied significant correlation for mass-based and particle surface area measures. The mass-based air concentration levels of cobalt and tungsten in the hard metal plant in our study were low compared to Swedish OELs. Particle number and particle surface area concentrations were in the same order of magnitude as for other industrial settings. Regression analysis implied the use of stationary determined mass-based and particle surface area aerosol concentration as proxies for various exposure measures in our study.
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34. |
- Larsson, Johanna, et al.
(author)
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Sarcoidosis and increased risk of comorbidities and mortality in Sweden
- 2020
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In: Sarcoidosis Vasculitis and Diffuse Lung Diseases. - : MATTIOLI 1885. - 1124-0490. ; 37:2, s. 104-135
-
Journal article (peer-reviewed)abstract
- Introduction: Sarcoidosis is a systemic inflammatory disorder, with an unclear etiology, involving granuloma formation that in most cases affects the lungs and intrathoracic lymph nodes. Sarcoidosis occurs in an acute or chronic form, each with different clinical presentation and prognosis.Methods: Case-control study of comorbidity and mortality in people diagnosed with sarcoidosis (ICD10 code D86) from 2007 through 2016 in Sweden. Controls were matched to cases (2:1) based on age, sex and county at the time of diagnosis. Data was collected from the Swedish National Patient Register and The Cause of Death Register. All men and women aged 20-65 years old who were diagnosed with sarcoidosis (D86, ICD10) during the years of study were included, resulting 7828 cases and 15656 controls.Results: Patients with sarcoidosis had increased mortality compared to matched controls (hazard ratio 1.88; 95% CI 1.56 - 2.26) and the Swedish general population (standardized mortality ratios1.75; 95% CI 1.52 - 2.00). The sarcoid cases, compared to controls, also had a significantly greater number of inpatient visits within several different chapters of ICD10 e.g. cardiomyopathy, heart failure, pulmonary embolism and malignant neoplasm.Conclusion: Individuals with sarcoidosis are at higher risk of comorbidities and mortality than matched controls as well as the general population of Sweden. These findings are important knowledge for healthcare professionals who meet sarcoid patients, to encourage identification and treatment of comorbidities to reduce the risk of impaired quality of life and, eventually, premature death.
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35. |
- Lenander-Ramirez, Alexander, et al.
(author)
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Respirable Dust and Silica - Respiratory Diseases Among Swedish Iron Foundry Workers
- 2022
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In: Journal of Occupational and Environmental Medicine. - : Lippincott Williams & Wilkins. - 1076-2752 .- 1536-5948. ; 64:7, s. 593-598
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: The mortality and morbidity pattern for respiratory diseases was determined in a cohort of 1,752 Swedish foundry workers, particularly for respirable silica dust exposure.METHODS: The morbidity follow-up in the Swedish National Non-primary Outpatient Register covered 2001 to 2017 (NPR; specialist not in care patients), the mortality from the National Causes of Death Register covered 2001 to 2017. Cumulative exposures to silica and dust were determined.RESULTS: The morbidity in COPD showed significantly increased risk for all exposure groups, as did silicosis in the high exposure group, these cases corresponded to silica exposure levels below 0.05 mg/m3. The mortality of all causes and respiratory diseases was significantly increased by cumulative silica exposure in the high exposure group.CONCLUSIONS: Significantly increased morbidity for respiratory diseases and COPD was determined at silica exposure levels below the current Swedish OEL.
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36. |
- Löfgren, Anton, et al.
(author)
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Nerve Function Impairment after Acute Vibration Exposure
- 2020
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In: Journal of Occupational and Environmental Medicine. - : Lippincott Williams & Wilkins. - 1076-2752 .- 1536-5948. ; 62:2, s. 124-129
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: This study was to investigate the acute effects of hand-arm vibrations on the nerve functions of the hands, and the impact of the grip force applied to the vibrating tool during exposure.METHODS: Grip strength and perception of vibration, touch, and temperature were evaluated using QST before and after vibration exposure in 21 occupationally unexposed individuals. The procedure was performed twice, with a higher grip force being applied during exposure on the second occasion.RESULTS: Vibration perception was significantly impaired after both exposures. Grip strength, perception of touch and temperature were only significantly affected after the high grip force exposure.CONCLUSIONS: Exposure to hand-arm vibrations has acute effects on hand nerve function that are sensitive to the grip force applied during exposure.
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37. |
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38. |
- Löfstedt, Håkan, 1963-, et al.
(author)
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Respiratory and Ocular Symptoms Among Employees at Swedish Indoor Swimming Pools
- 2016
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In: Journal of Occupational and Environmental Medicine. - : Lippincott Williams & Wilkins. - 1076-2752 .- 1536-5948. ; 58:12, s. 1190-1195
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Journal article (peer-reviewed)abstract
- Background: This study investigated trichloramine exposure and prevalence of respiratory and ocular symptoms among Swedish indoor swimming pool workers.Methods: Questionnaires were distributed to pool workers and referents. Lung function and fraction of exhaled nitric oxide (FeNO) were measured before and after work. Exposure to trichloramine and trihalomethanes was measured over work shifts.Results: The mean personal trichloramine exposure was 36g/m(3). Significantly more exposed workers reported ocular and nasal symptoms. There were significant differences between groups in FeNO change following work, with exposed showing increased FeNO, which grew when analyses included only nonsmokers.Conclusions: The findings indicate that indoor swimming pool environments may have irritating effects on mucous membranes. FeNO data also indicate an inflammatory effect on central airways, but the clinical relevance is unclear. Low trichloramine levels found in this study were not associated with health effects.
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39. |
- Löfstedt, Håkan, 1963-, et al.
(author)
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Respiratory symptoms and lung function in relation to wood dust and monoterpene exposure in the wood pellet industry
- 2017
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In: Upsala Journal of Medical Sciences. - : Taylor & Francis. - 0300-9734 .- 2000-1967. ; 122:2, s. 78-84
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Wood pellets are used as a source of renewable energy for heating purposes. Common exposures are wood dust and monoterpenes, which are known to be hazardous for the airways. The purpose of this study was to study the effect of occupational exposure on respiratory health in wood pellet workers.MATERIALS AND METHODS: Thirty-nine men working with wood pellet production at six plants were investigated with a questionnaire, medical examination, allergy screening, spirometry, and nasal peak expiratory flow (nasal PEF). Exposure to wood dust and monoterpenes was measured.RESULTS: The wood pellet workers reported a higher frequency of nasal symptoms, dry cough, and asthma medication compared to controls from the general population. There were no differences in nasal PEF between work and leisure time. A lower lung function than expected (vital capacity [VC], 95%; forced vital capacity in 1 second [FEV1], 96% of predicted) was noted, but no changes were noted during shifts. There was no correlation between lung function and years working in pellet production. Personal measurements of wood dust at work showed high concentrations (0.16-19 mg/m(3)), and exposure peaks when performing certain work tasks. Levels of monoterpenes were low (0.64-28 mg/m(3)). There was no association between exposure and acute lung function effects.CONCLUSIONS: In this study of wood pellet workers, high levels of wood dust were observed, and that may have influenced the airways negatively as the study group reported upper airway symptoms and dry cough more frequently than expected. The wood pellet workers had both a lower VC and FEV1 than expected. No cross-shift changes were found.
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40. |
- Makdoumi, Karim, 1977-, et al.
(author)
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The risk for ophthalmological conditions in ulcerative colitis : A population-based case-control study. Is silica dust-exposure associated with inflammatory eye disease?
- 2024
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In: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768.
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Journal article (peer-reviewed)abstract
- PURPOSE: To study the risk for eye diseases in individuals with Ulcerative Colitis (UC), and to assess whether silica dust-exposure could contribute to the development of inflammatory eye diseases.METHODS: A case-control study was conducted using a patient register processed by the National Board of Health and Welfare (NBHW) and Statistics Sweden. Cases were diagnosed with UC between 2007 and 2016. Matching was done with two random controls having the same age, sex and county of residence, without a systemic inflammatory disease. Using a job-exposure matrix, cases and controls were assessed for work-related silica dust exposure. The risk for eye disease was estimated by Cox regression analysis with calculation of Hazard Ratio (HR).RESULTS: A total of 58 989 individuals were included, comprising 19 663 cases and 39 326 controls. The sex distribution was similar. Overall, individuals with UC had an increased risk for eye disease, specified in ICD 10 chapter VII (H00-H59) with HR 1.25 (CI 1.20-1.32). The highest HR on block-level for cases was 1.52 (CI 1.36-1.70), (H15-H22), which includes episcleritis, keratitis and anterior uveitis. The risk for ocular disease was higher in silica dust-exposed than non-exposed with a HR of 1.44 (CI 1.16-1.78) and 1.25 (CI 1.19-1.31), respectively. Among cases, the risk for iridocyclitis (H20) was further elevated by silica dust exposure, with HR of 3.84 (CI 1.64-8.97) in exposed compared to 1.94 (1.57-2.41) in non-exposed.CONCLUSION: UC is associated with an increased risk for eye diseases, including inflammatory conditions. Our findings highlight that silica dust-exposure may be of importance in the pathogenesis of uveitis.
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41. |
- Montén, Adam, et al.
(author)
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Occupational Quartz Exposure in a Population of Male Individuals-Association With Risk of Developing Atrial Fibrillation
- 2020
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In: Journal of Occupational and Environmental Medicine. - : Lippincott Williams & Wilkins. - 1076-2752 .- 1536-5948. ; 62:6, s. e267-e272
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Occupational quartz exposure is a health risk, with increased risk of developing lung, autoimmune diseases, and elevated mortality in cardiovascular diseases.METHODS: The population was obtained from the period 2005 to 2016 and consisted of 5237 cases of patients with atrial fibrillation (AF). Quartz exposure information was obtained through a Swedish job exposure matrix.RESULTS: The risk of developing AF was increased for the quartz-exposed male population who were within a year of having commenced employment OR 1.54; (95% CI 1.06-2.24); this increased in the age group 20 to 55 (OR 2.05; CI 95% 1.02-4.10).CONCLUSION: Our main conclusion is that quartz dust exposure may be related to increased risk of AF in high exposed (above 0.05 mg/m mean quartz dust) in men aged 20 to 55 years.
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42. |
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43. |
- Ohlson, Carl-Goran, et al.
(author)
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Inflammatory markers and exposure to occupational air pollutants
- 2010
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In: Inhalation Toxicology. - : Informa UK Limited. - 0895-8378 .- 1091-7691. ; 22:13, s. 1083-1090
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Journal article (peer-reviewed)abstract
- Methods: Total dust was sampled in the breathing zone of 73 subjects working with welding, cutting, grinding and in foundries such as iron, aluminium, and concrete. Stationary measurements were used to study different size fractions of particles including respirable dust, particulate matter (PM)(10) and PM2.5, the particle number concentration, the number of particles deposited in the alveoli, and total particle surface area concentration. Inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), fibrinogen, D-dimer, and urate were measured in plasma or serum before the first shift after the summer vacation and after the first, second, and fourth shift. Results: The mean level of total dust in the breathing zone was 0.93 mg/m
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44. |
- Olsson, Daniel S, 1983, et al.
(author)
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Incidence of malignant tumours in patients with a non-functioning pituitary adenoma.
- 2017
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In: Endocrine-Related Cancer. - : BioScientifica Ltd.. - 1351-0088 .- 1479-6821. ; 24:5, s. 227-235
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Journal article (peer-reviewed)abstract
- Whether patients with non-functioning pituitary adenoma (NFPA) are at increased risk of developing malignant tumours has been sparsely studied and is a matter of debate. In this study, we have investigated the incidence of malignant tumours in a large and unselected group of patients with NFPA. The study was nationwide and included all patients diagnosed with NFPA between 1987 and 2011 (n = 2795) in Sweden, identified in the National Patient Register. Malignant tumours, occurring after the NFPA diagnosis, were identified in the Swedish Cancer Register between 1987 and 2014. Standardised incidence ratios (SIRs) for malignant tumours with 95% confidence intervals (CI) were calculated using the Swedish population as reference. In total, 448 malignant tumours were detected in 386 patients with NFPA, as compared to 368 expected malignancies in the general population (SIR 1.22 (95% CI 1.11-1.33)). The incidence of neoplasms of the brain was increased (SIR 5.83 (95% CI 4.03-8.14)). When analysing the total incidence of malignancies excluding neoplasms of the brain, the overall SIR was still increased (SIR 1.14 (95% CI 1.03-1.26)). The incidence of malignant neoplasm of skin other than malignant melanoma (SIR 1.99 (95% CI 1.55-2.52)) and malignant melanoma (SIR 1.62 (95% CI 1.04-2.38)) were increased, whereas the incidence of breast cancer (SIR 0.65 (95% CI 0.42-0.97)) was decreased. The incidence of other types of malignancies did not differ significantly from the expected incidence in the general population. In conclusion, patients with NFPA have an increased overall risk of developing malignancies. To what extent these findings are due to more frequent medical surveillance, genetic predisposition or endocrine changes, remains unknown.
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45. |
- Olsson, Daniel S, 1983, et al.
(author)
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Life expectancy in patients with pituitary adenoma receiving growth hormone replacement.
- 2017
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In: European journal of endocrinology. - 1479-683X. ; 176:1, s. 67-75
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Journal article (peer-reviewed)abstract
- Hypopituitarism has been associated with increased mortality. The excess mortality may be due to untreated growth hormone (GH) deficiency but also due to various underlying disorders. We therefore analysed mortality in patients with only one underlying disorder, non-functioning pituitary adenoma (NFPA), with and without GH replacement therapy (GHRT).Patients with NFPA in the western region of Sweden, 1997-2011, were identified through the National Patient Registry and cross-referenced with several National Health Registries. All patient records were reviewed. Standardised mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated using the general population as reference. Cox-regression models were performed to identify predictors of mortality.A total of 426 NFPA patients with 4599 patient-years were included, of whom 207 had used GHRT and 219 had not received GHRT. Median (range) follow-up in patients with and without GHRT was 12.2 (0-25) and 8.2 (0-27) years, respectively. Other pituitary hormone deficiencies were more frequent in the GHRT group than those in the non-GHRT group. SMR was 0.65 (95% CI, 0.44-0.94; P=0.018) for the GHRT group and 1.16 (0.94-1.42; P=0.17) for the non-GHRT group. Direct comparison between the groups showed reduced mortality among those who were GH replaced (P=0.0063). The SMR for malignant tumours was reduced in the GHRT-group (0.29; 0.08-0.73; P=0.004) but not in untreated patients.Selection bias explaining some of the results cannot be excluded. However, NFPA patients with GHRT had reduced overall mortality compared with the general population, and death due to malignancy was not increased. This suggests that long-term GHRT is safe in adult patients selected for treatment.
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46. |
- Olsson, Daniel S, 1983, et al.
(author)
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Time trends of mortality in patients with non-functioning pituitary adenoma : a Swedish nationwide study
- 2017
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In: Pituitary. - : Springer-Verlag New York. - 1386-341X .- 1573-7403. ; 20:2, s. 218-224
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Journal article (peer-reviewed)abstract
- PURPOSE: Patients with non-functioning pituitary adenomas (NFPA), especially women, have increased mortality. The aim of this study was to investigate whether mortality in NFPA patients has changed during the last two decades.METHODS: This was a nationwide population-based study including 2795 patients (1502 men, 1293 women) diagnosed with NFPA between 1997 and 2011. Patients were identified and followed in Swedish National Health Registries. Standardized mortality ratios (SMRs) with 95 % confidence intervals were calculated for three time periods at first NFPA diagnosis using the general population as reference.RESULTS: Mean (±SD) age at NFPA diagnosis was 58.9 ± 16.8 years. Mean (range) follow-up time was 8.3 (0-18) years, resulting in 20,517 patient-years at risk. Surgical treatment and radiotherapy were used in 53 and 5 %, respectively. The prevalence of hypopituitarism was 64 % during the first time period of diagnosis and then declined gradually during the study period (P value for trend <0.0001). The use of pituitary surgery and radiotherapy remained stable. In women, mortality was increased for patients diagnosed between 1997 and 2006 but not for those diagnosed between 2007 and 2011. The SMR in men remained stable throughout the study and did not differ from the general population. During the last time period, 2007-2011, the SMR between men and women did not differ.CONCLUSIONS: While mortality in men with NFPA remains normal and stable during the last two decades, mortality in women has declined. Decreasing prevalence of pituitary insufficiency may be a plausible explanation for this positive development.
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47. |
- Papakokkinou, Eleni, et al.
(author)
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Excess Morbidity Persists in Patients With Cushing’s Disease During Long-term Remission : A Swedish Nationwide Study
- 2020
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In: Journal of Clinical Endocrinology and Metabolism. - Washington : Oxford University Press. - 0021-972X .- 1945-7197. ; 105:8, s. 2616-2624
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Journal article (peer-reviewed)abstract
- Context: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined.Objective: To investigate comorbidities in patients with CD.Design, setting, and patients: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status.Main outcomes: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission.Results: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission.Conclusion: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.
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48. |
- Pettersson, Albert, et al.
(author)
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The level of education and the risk for retinal detachments and breaks : A registry-based case-control study
- 2024
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In: Acta Ophthalmologica. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 102:4, s. 462-468
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Journal article (peer-reviewed)abstract
- PURPOSE: Myopia is the most important risk factor for developing retinal tears and retinal detachment (RD). Due to altered lifestyle factors myopia is increasing in the world. In this study, the correlation between educational level and risk for retinal detachment were analysed.METHODS: A case-control registry study was conducted including a total of 10 268 individuals. Data were collected from registries of the Swedish National Board of Health and Welfare as well as the Swedish Central Bureau of Statistics. Cases were defined as ICD-10 H33 (retinal detachments and breaks). For each case, a matched control was selected with the same age and sex, living in the same county at the time of diagnosis. The study population was divided into seven groups with regard to educational level and compared using conditional logistic regression.RESULTS: In the total population, the odds ratio (OR) increased in a proportional fashion with a higher level of education. The odds ratio for the total population at the highest education level was 1.77 and increased to 2.00 when excluding individuals with diabetes. Out of the 5134 cases, 72% were men and 28% women. A statistically significant difference between sexes was only confirmed for the second highest education level.CONCLUSION: Individuals with a longer education have a significantly higher risk for retinal complications in the form of RD and breaks. Higher education is a risk factor for retinal complications in both sexes but seemingly more strongly in men.
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49. |
- Poci, Dritan, 1969-, et al.
(author)
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Do Some Patients Younger Than 65 Years Old And With Incident Atrial Fibrillation Need Anticoagulation Treatment? : Conclusions From A Swedish Nationwide Registry Study
- 2018
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Conference paper (peer-reviewed)abstract
- Background: It is still under debate whether patients with atrial fibrillation (AF) and a low risk of cerebral infarction would benefit from anticoagulation.Objective: We aimed to assess whether younger patients with AF and lower CHA2DS2-VASc score would benefit from anticoagulation treatment.Methods: In a retrospective, nationwide cohort study, using the Swedish national registries, 59981 hospitalized patients were identified with incident AF. After exclusion of 11548 patients because of warfarin use before the AF diagnosis, or death, emigration or stroke within 30 days of AF diagnosis, the remaining 48 433 patients, among whom 27166 patients had no warfarin treatment, were, after adjustment for age, sex and year of AF diagnosis, divided according to age, sex and CHA2DS2-VASc score 0, 1, 2 and ≥3 and included in a time-varying analysis of warfarin treatment versus no treatment. Patients were followed up to 48 months after the inclusion.Results: In men <65 years and with a CHA2DS2-VASc score 2 or ≥3, the relative risk of having a stroke or cerebral infarction was lower when they received warfarin treatment, HR 0.35 (95% CI 0.18-0.69) and HR 0.37 (95% CI 0.23-0.59) respectively, as compared to HR 1.11 (95% CI 0.56-2.23) when the score was 1. Women younger than 65 years had a low relative risk when CHA2DS2-VASc score was ≥3 points, HR 0.31 (95% CI 0.16-0.59), as compared to HR 1.84 (95% CI 0.86-3.94) and HR 2.13 (95% CI 0.94-4.84) when the score was 2 and 1 respectively. The risk of intracranial bleeding was low and similar in all subgroups on anticoagulation except in the youngest men without risk factors.Conclusion: Women and men <65 years had a beneficial effect of warfarin if they had two risk factors other than age and sex, without an increased risk of bleeding. Our results support prophylactic anticoagulation treatment in patients under 65 years and a CHA2DS2-VASc score ≥2, other than age and sex.
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50. |
- Ragnarsson, Oskar, 1971, et al.
(author)
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Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study
- 2019
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In: Journal of Clinical Endocrinology and Metabolism. - : ENDOCRINE SOC. - 0021-972X .- 1945-7197. ; 104:6, s. 2375-2384
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Journal article (peer-reviewed)abstract
- Context: Whether patients with Cushing disease (CD) in remission have increased mortality is still debatable. Objective: To study overall and disease-specific mortality and predictive factors in an unselected nationwide cohort of patients with CD. Design, Patients, and Methods: A retrospective study of patients diagnosed with CD, identified in the Swedish National Patient Registry between 1987 and 2013. Medical records were systematically reviewed to verify the diagnosis. Standardized mortality ratios (SMRs) with 95% CIs were calculated and Cox regression models were used to identify predictors of mortality. Results: Of 502 identified patients with CD (n = 387 women; 77%), 419 (83%) were confirmed to be in remission. Mean age at diagnosis was 43 (SD, 16) years and median follow-up was 13 (interquartile range, 6 to 23) years. The observed number of deaths was 133 vs 54 expected, resulting in an overall SMR of 2.5 (95% CI, 2.1 to 2.9). The commonest cause of death was cardiovascular diseases (SMR, 3.3; 95% CI, 2.6 to 4.3). Excess mortality was also found associated with infections and suicide. For patients in remission, the SMR was 1.9 (95% CI, 1.5 to 2.3); bilateral adrenalectomy and glucocorticoid replacement therapy were independently associated with increased mortality, whereas GH replacement was associated with improved outcome. Conclusion: Findings from this large nationwide study indicate that patients with CD have excess mortality. The findings illustrate the importance of achieving remission and continued active surveillance, along with adequate hormone replacement and evaluation of cardiovascular risk and mental health.
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