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Berger S, Moseholm KF, Hegelund ER, Tesch F, Nguyen MCS, Mortensen LH, Jensen MK, Schmitt J, Mukamal KJ. Association of Tumor Necrosis Factor-α Inhibitors with Incident Dementia: Analysis Based on Population-Based Cohort Studies. Drugs Aging 2024:10.1007/s40266-024-01112-1. [PMID: 38609734 DOI: 10.1007/s40266-024-01112-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND AND OBJECTIVE Preliminary evidence suggests a possible preventive effect of tumor necrosis factor-α inhibitors (TNFi) on incident dementia. The objective of the analysis was to investigate the association between TNFi and the risk of incident dementia in a population undergoing treatment for rheumatological disorders. METHODS We followed patients aged ≥ 65 years with dementia and rheumatological conditions in two cohort studies, DANBIO (N = 21,538), a Danish clinical database, and AOK PLUS (N = 7112), a German health insurance database. We defined incident dementia using diagnostic codes and/or medication use and used Cox regression to compare the associations of TNFi with other rheumatological therapies on the risk of dementia. To ensure that the patients were receiving long-term medication, we included patients with rheumatic diseases and systemic therapies. RESULTS We observed similar trends towards a lower risk of dementia associated with TNFi versus other anti-inflammatory agents in both cohorts (hazard ratios were 0.92 [95% confidence interval 0.76, 1.10] in DANBIO and 0.89 [95% confidence interval 0.63, 1.24] in AOK PLUS, respectively). CONCLUSIONS Tumor necrosis factor-α inhibitors may decrease the risk of incident dementia although the association did not reach statistical significance in this analysis. Further research, ideally with randomization, is needed to gauge the potential of repurposing TNFi for dementia prevention and/or treatment.
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Affiliation(s)
- Saskia Berger
- Center for Evidence-Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
- Hospital Pharmacy, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Kristine F Moseholm
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Emilie R Hegelund
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Falko Tesch
- Center for Evidence-Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Minh Chau S Nguyen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Majken K Jensen
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Kenneth J Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Amini H, Bergmann ML, Taghavi Shahri SM, Tayebi S, Cole-Hunter T, Kerckhoffs J, Khan J, Meliefste K, Lim YH, Mortensen LH, Hertel O, Reeh R, Gaarde Nielsen C, Loft S, Vermeulen R, Andersen ZJ, Schwartz J. Harnessing AI to unmask Copenhagen's invisible air pollutants: A study on three ultrafine particle metrics. Environ Pollut 2024; 346:123664. [PMID: 38431246 DOI: 10.1016/j.envpol.2024.123664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/08/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
Ultrafine particles (UFPs) are airborne particles with a diameter of less than 100 nm. They are emitted from various sources, such as traffic, combustion, and industrial processes, and can have adverse effects on human health. Long-term mean ambient average particle size (APS) in the UFP range varies over space within cities, with locations near UFP sources having typically smaller APS. Spatial models for lung deposited surface area (LDSA) within urban areas are limited and currently there is no model for APS in any European city. We collected particle number concentration (PNC), LDSA, and APS data over one-year monitoring campaign from May 2021 to May 2022 across 27 locations and estimated annual mean in Copenhagen, Denmark, and obtained additionally annual mean PNC data from 6 state-owned continuous monitors. We developed 94 predictor variables, and machine learning models (random forest and bagged tree) were developed for PNC, LDSA, and APS. The annual mean PNC, LDSA, and APS were, respectively, 5523 pt/cm3, 12.0 μm2/cm3, and 46.1 nm. The final R2 values by random forest (RF) model were 0.93 for PNC, 0.88 for LDSA, and 0.85 for APS. The 10-fold, repeated 10-times cross-validation R2 values were 0.65, 0.67, and 0.60 for PNC, LDSA, and APS, respectively. The root mean square error for final RF models were 296 pt/cm3, 0.48 μm2/cm3, and 1.60 nm for PNC, LDSA, and APS, respectively. Traffic-related variables, such as length of major roads within buffers 100-150 m and distance to streets with various speed limits were amongst the highly-ranked predictors for our models. Overall, our ML models achieved high R2 values and low errors, providing insights into UFP exposure in a European city where average PNC is quite low. These hyperlocal predictions can be used to study health effects of UFPs in the Danish Capital.
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Affiliation(s)
- Heresh Amini
- Department of Environmental Medicine and Public Health, Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York, United States; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States.
| | - Marie L Bergmann
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Shali Tayebi
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Cole-Hunter
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jules Kerckhoffs
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, the Netherlands
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Kees Meliefste
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, the Netherlands
| | - Youn-Hee Lim
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Ole Hertel
- Faculty of Technical Sciences, Aarhus University, Denmark
| | | | | | - Steffen Loft
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, the Netherlands
| | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Joel Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
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Zhang J, Lim YH, So R, Mortensen LH, Napolitano GM, Cole-Hunter T, Tuffier S, Bergmann M, Maric M, Taghavi Shahri SM, Brandt J, Ketzel M, Loft S, Andersen ZJ. Long-Term Exposure to Air Pollution and Risk of Acute Lower Respiratory Infections in the Danish Nurse Cohort. Ann Am Thorac Soc 2024. [PMID: 38513223 DOI: 10.1513/annalsats.202401-074oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/21/2024] [Indexed: 03/23/2024] Open
Abstract
RATIONALE Air pollution is a major risk factor for chronic cardiorespiratory diseases, affecting both the immune and respiratory systems' functionality, while the epidemiological evidence on respiratory infections remains sparse. OBJECTIVE We aimed to assess the association of long-term exposure to ambient air pollution with risk of developing new and recurrent ALRIs that characterized by persistently severe symptoms necessitating hospital contact, and identify the potential susceptible populations by socio-economic status (SES), smoking, physical activity status, overweight, and co-morbidity with chronic lung disease. METHODS We followed 23,912 female nurses from the Danish Nurse Cohort (> 44 years) from baseline (1993 or 1999) until 2018 for the incident and recurrent ALRIs defined by hospital contact (in-, outpatient, and emergency room) data from the National Patient Register. Residential annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) were modelled using Danish DEHM/UBM/AirGIS system. We used marginal Cox models with time-varying exposures to assess the association of 3-year running-mean air pollution with incident and recurrent ALRIs and examine effect modification by age, socio-economic status (SES), smoking, physical activity, body mass index, and comorbidity with asthma or chronic obstructive pulmonary disease (COPD). RESULTS During a 21.3 years mean follow-up, 4,746 ALRIs were observed, of which 2,553 were incident. We observed strong positive associations of all three pollutants with incident ALRIs, with hazard ratios and 95% confidence intervals of 1.19 (1.08-1.31) per 2.5 µg/m3 for PM2.5, 1.17 (1.11-1.24) per 8.0 µg/m3 for NO2, and 1.09 (1.05-1.12) per 0.3 µg/m3 for BC, and slightly stronger associations with recurrent ALRIs. Associations were strongest in COPD patients and nurses with low physical activity. CONCLUSION Long-term exposure to air pollution at low levels was associated with risk of new and recurrent ALRIs, with COPD patients and physically inactive subjects most vulnerable. Primary Source of Funding: This study was supported by the Novo Nordisk Foundation Challenge Programme (NNF17OC0027812).
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Affiliation(s)
- Jiawei Zhang
- University of Copenhagen Section of Environmental Health, 86986, Department of Public Health, Kobenhavn, Denmark
| | - Youn-Hee Lim
- University of Copenhagen, Section of Environmental Health, Department of Public Health, Copenhagen, Denmark
| | - Rina So
- University of Copenhagen, Section of Environmental Health, Department of Public Health, Copenhagen, Denmark
| | - Laust H Mortensen
- University of Copenhagen, Section of Epidemiology, Department of Public Health, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - George Maria Napolitano
- University of Copenhagen Section of Environmental Health, 86986, Department of Public Health, Kobenhavn, Denmark
| | - Thomas Cole-Hunter
- University of Copenhagen, Section of Environmental Health, Department of Public Health, Copenhagen, Denmark
- University of Sydney, Centre for Air pollution, energy and health Research (CAR), Sydney, Denmark
| | - Stéphane Tuffier
- University of Copenhagen Section of Environmental Health, 86986, Kobenhavn, Denmark
| | | | - Matija Maric
- University of Copenhagen Section of Environmental Health, 86986, Kobenhavn, Denmark
| | | | - Jørgen Brandt
- Department of Environmental Science, Roskilde, Djibouti
| | - Matthias Ketzel
- Aarhus University, 1006, Department of Environmental Science, Roskilde, Denmark
- University of Surrey, 3660, Global Centre for Clean Air Research, Guildford, Surrey, United Kingdom of Great Britain and Northern Ireland
| | - Steffen Loft
- University of Copenhagen, Public Health, Copenhagen K, Denmark
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O'Halloran AM, Cremers J, Vrangbæk K, Roe L, Bourke R, Mortensen LH, Westendorp RGJ, Kenny RA. Cardiovascular disease and the risk of incident falls and mortality among adults aged ≥ 65 years presenting to the emergency department: a cohort study from national registry data in Denmark. BMC Geriatr 2024; 24:93. [PMID: 38267873 PMCID: PMC10809657 DOI: 10.1186/s12877-023-04618-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Falls cause 58% of injury-related Emergency Department (ED) attendances. Previous research has highlighted the potential role of cardiovascular risk factors for falls. This study investigated the impact of cardiovascular disease (CVD) risk on three-year incident falls, with presentation to the ED, and mortality. METHODS A matched cohort study design was employed using national registry data from 82,292 adults (33% male) aged ≥ 65 years living in Denmark who attended the ED in 2013. We compared age and gender matched ED attendees presenting with a fall versus another reason. The cohort was followed for three-year incident falls, with presentation to the ED, and mortality. The impact of falls-related CVDs was also examined. RESULTS Three-year incident falls was twofold higher among age and gender matched ED attendees aged ≥ 65 years presenting with a fall versus another reason at baseline. A presentation of falls with hip fracture had the highest percentage of incident falls in the 65-74 age group (22%) and the highest percentage mortality in all age groups (27-62%). CVD was not a significant factor in presenting with a fall at the ED, nor did it contribute significantly to the prediction of three-year incident falls. CVD was strongly associated with mortality risk among the ED fall group (RR = 1.81, 95% CI: 1.67-1.97) and showed interactions with both age and fall history. CONCLUSION In this large study of adults aged ≥ 65 years attending the ED utilising data from national administrative registers in Denmark, we confirm that older adults attending the ED with a fall, including those with hip fracture, were at greatest risk for future falls. While CVD did not predict incident falls, it increased the risk of mortality in the three-year follow up with advancing age. This may be informative for the provision of care pathways for older adults attending the ED due to a fall.
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Affiliation(s)
- Aisling M O'Halloran
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland.
| | - Jolien Cremers
- Data Science Lab, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Centre for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark
- Department of Political Science, University of Copenhagen, Copenhagen, Denmark
| | - Lorna Roe
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Robert Bourke
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Laust H Mortensen
- Data Science Lab, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rose Anne Kenny
- Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Central, 152-160 Pearse Street, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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Andersen ZJ, Zhang J, Lim YH, So R, Jørgensen JT, Mortensen LH, Napolitano GM, Cole-Hunter T, Loft S, Bhatt S, Hoek G, Brunekreef B, Westendorp R, Ketzel M, Brandt J, Lange T, Kølsen-Fisher T. Long-Term Exposure to AIR Pollution and COVID-19 Mortality and Morbidity in DENmark: Who Is Most Susceptible? (AIRCODEN). Res Rep Health Eff Inst 2023:1-41. [PMID: 38286761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Early ecological studies have suggested a link between air pollution and Coronavirus Diseases 2019 (COVID-19); however, the evidence from individual-level prospective cohort studies is still sparse. Here, we have examined, in a general population, whether long-term exposure to air pollution is associated with the risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and developing severe COVID-19, resulting in hospitalization or death and who is most susceptible. We also examined whether long-term exposure to air pollution is associated with hospitalization or death due to COVID-19 in those who have tested positive for SARS-CoV-2. METHODS We included all Danish residents 30 years or older who resided in Denmark on March 1, 2020. and followed them in the National COVID-19 Surveillance System until first positive test (incidence), COVID-19 hospitalization, or death until April 26, 2021. We estimated mean levels of nitrogen dioxide (NO2), particulate matter with an aerodynamic diameter <2.5 μm (PM2.5), black carbon (BC), and ozone (O3) at cohort participants' residence in 2019 by the Danish Eulerian Hemispheric Model/Urban Background Model. We used Cox proportional hazard models to estimate the associations of air pollutants with COVID-19 incidence, hospitalization, and mortality adjusting for age, sex, and socioeconomic status (SES) at the individual and area levels. We examined effect modification by age, sex, SES (education, income, wealth, employment), and comorbidities with cardiovascular disease, respiratory disease, acute lower respiratory infections, diabetes, lung cancer, and dementia. We used logistic regression to examine association of air pollutants with COVID-19-related hospitalization or death among SARS-CoV-2 positive patients, adjusting for age, sex, individual- and area-level SES. RESULTS Of 3,721,810 people, 138,742 were infected, 11,270 hospitalized, and 2,557 died from COVID-19 during 14 months of follow-up. We detected strong positive associations with COVID-19 incidence, with hazard ratio (HR) and 95% confidence interval (CI) of 1.10 (CI: 1.05-1.14) per 0.5-μg/m3 increase in PM2.5 and 1.18 (CI: 1.14-1.23) per 3.6-μg/m3 increase in NO2. For COVID-19 hospitalizations and for COVID-19 deaths, corresponding HRs and 95% CIs were 1.09 (CI: 1.01-1.17) and 1.19 (CI: 1.12-1.27), respectively for PM2.5, and 1.23 (CI: 1.04-1.44) and 1.18 (CI: 1.03-1.34), respectively for NO2. We also found strong positive and statistically significant associations with BC and negative associations with O3. Associations were strongest in those aged 65 years old or older, participants with the lowest SES, and patients with chronic cardiovascular, respiratory, metabolic, lung cancer, and neurodegenerative disease. Among 138,742 individuals who have tested positive for SARS-Cov-2, we detected positive association with COVID-19 hospitalizations (N = 11,270) with odds ratio and 95% CI of 1.04 (CI: 1.01- 1.08) per 0.5-μg/m3 increase in PM2.5 and 1.06 (CI: 1.01-1.12) per 3.6-μg/m3 increase in NO2, but no association with PM with an aerodynamic diameter <10 μm (PM10), BC, or O3, and no association between any of the pollutants and COVID-19 mortality (N = 2,557). CONCLUSIONS This large nationwide study provides strong new evidence in support of association between long-term exposure to air pollution and COVID-19.
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Affiliation(s)
- Z J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - J Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - Y-H Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - R So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - J T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - L H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - G M Napolitano
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - T Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - S Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Denmark
| | - S Bhatt
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - G Hoek
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - B Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Rgj Westendorp
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
| | - M Ketzel
- Department of Environmental Science, Aarhus University, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - J Brandt
- Climate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - T Lange
- Department of Public Health, University of Copenhagen, Denmark
| | - T Kølsen-Fisher
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
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Zhang J, Lim YH, So R, Jørgensen JT, Mortensen LH, Napolitano GM, Cole-Hunter T, Loft S, Bhatt S, Hoek G, Brunekreef B, Westendorp R, Ketzel M, Brandt J, Lange T, Kølsen-Fisher T, Andersen ZJ. Long-term exposure to air pollution and risk of SARS-CoV-2 infection and COVID-19 hospitalisation or death: Danish nationwide cohort study. Eur Respir J 2023; 62:2300280. [PMID: 37343976 PMCID: PMC10288813 DOI: 10.1183/13993003.00280-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Early ecological studies have suggested links between air pollution and risk of coronavirus disease 2019 (COVID-19), but evidence from individual-level cohort studies is still sparse. We examined whether long-term exposure to air pollution is associated with risk of COVID-19 and who is most susceptible. METHODS We followed 3 721 810 Danish residents aged ≥30 years on 1 March 2020 in the National COVID-19 Surveillance System until the date of first positive test (incidence), COVID-19 hospitalisation or death until 26 April 2021. We estimated residential annual mean particulate matter with diameter ≤2.5 μm (PM2.5), nitrogen dioxide (NO2), black carbon (BC) and ozone (O3) in 2019 by the Danish DEHM/UBM model, and used Cox proportional hazards regression models to estimate the associations of air pollutants with COVID-19 outcomes, adjusting for age, sex, individual- and area-level socioeconomic status, and population density. RESULTS 138 742 individuals were infected, 11 270 were hospitalised and 2557 died from COVID-19 during 14 months. We detected associations of PM2.5 (per 0.53 μg·m-3) and NO2 (per 3.59 μg·m-3) with COVID-19 incidence (hazard ratio (HR) 1.10 (95% CI 1.05-1.14) and HR 1.18 (95% CI 1.14-1.23), respectively), hospitalisations (HR 1.09 (95% CI 1.01-1.17) and HR 1.19 (95% CI 1.12-1.27), respectively) and death (HR 1.23 (95% CI 1.04-1.44) and HR 1.18 (95% CI 1.03-1.34), respectively), which were strongest in the lowest socioeconomic groups and among patients with chronic respiratory, cardiometabolic and neurodegenerative diseases. We found positive associations with BC and negative associations with O3. CONCLUSION Long-term exposure to air pollution may contribute to increased risk of contracting severe acute respiratory syndrome coronavirus 2 infection as well as developing severe COVID-19 disease requiring hospitalisation or resulting in death.
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Affiliation(s)
- Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
| | - George M Napolitano
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Samir Bhatt
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iCLIMATE, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thea Kølsen-Fisher
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Amegbor PM, Sabel CE, Mortensen LH, Mehta AJ, Rosenberg MW. Early-life air pollution and green space exposures as determinants of stunting among children under age five in Sub-Saharan Africa. J Expo Sci Environ Epidemiol 2023:10.1038/s41370-023-00572-8. [PMID: 37386059 DOI: 10.1038/s41370-023-00572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children. OBJECTIVE Explore the effect of early-life environmental exposures on stunting among children under the age of five years. METHODS In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA's GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods - in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling. RESULTS The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002-1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence. IMPACT STATEMENT This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows - pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa.
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Affiliation(s)
- Prince M Amegbor
- School of Gobal Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
- Denmark Statistics, Sejrøgade 11, DK-2100, Copenhagen, Denmark.
| | - Clive E Sabel
- Department of Public Health, Bartholins Allé 2, 8000, Aarhus C, Denmark
- The Big Data Centre for Environment and Health (BERTHA), Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Laust H Mortensen
- Denmark Statistics, Sejrøgade 11, DK-2100, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark
| | - Mark W Rosenberg
- Department of Geography & Planning, Queen's University, Kingston, ON, Canada
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8
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So R, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, Vienneau D, Samoli E, Rodopoulou S, Loft S, Lim YH, Westendorp RGJ, Amini H, Cole-Hunter T, Bergmann M, Shahri SMT, Zhang J, Maric M, Mortensen LH, Bauwelinck M, Klompmaker JO, Atkinson RW, Janssen NAH, Oftedal B, Renzi M, Forastiere F, Strak M, Brunekreef B, Hoek G, Andersen ZJ. Long-term exposure to elemental components of fine particulate matter and all-natural and cause-specific mortality in a Danish nationwide administrative cohort study. Environ Res 2023; 224:115552. [PMID: 36822536 DOI: 10.1016/j.envres.2023.115552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Fine particulate matter (PM2.5) is a well-recognized risk factor for premature death. However, evidence on which PM2.5 components are most relevant is unclear. METHODS We evaluated the associations between mortality and long-term exposure to eight PM2.5 elemental components [copper (Cu), iron (Fe), zinc (Zn), sulfur (S), nickel (Ni), vanadium (V), silicon (Si), and potassium (K)]. Studied outcomes included death from diabetes, chronic kidney disease (CKD), dementia, and psychiatric disorders as well as all-natural causes, cardiovascular disease (CVD), respiratory diseases (RD), and lung cancer. We followed all residents in Denmark (aged ≥30 years) from January 1, 2000 to December 31, 2017. We used European-wide land-use regression models at a 100 × 100 m scale to estimate the residential annual mean levels of exposure to PM2.5 components. The models were developed with supervised linear regression (SLR) and random forest (RF). The associations were evaluated by Cox proportional hazard models adjusting for individual- and area-level socioeconomic factors and total PM2.5 mass. RESULTS Of 3,081,244 individuals, we observed 803,373 death from natural causes during follow-up. We found significant positive associations between all-natural mortality with Si and K from both exposure modeling approaches (hazard ratios; 95% confidence intervals per interquartile range increase): SLR-Si (1.04; 1.03-1.05), RF-Si (1.01; 1.00-1.02), SLR-K (1.03; 1.02-1.04), and RF-K (1.06; 1.05-1.07). Strong associations of K and Si were detected with most causes of mortality except CKD and K, and diabetes and Si (the strongest associations for psychiatric disorders mortality). In addition, Fe was relevant for mortality from RD, lung cancer, CKD, and psychiatric disorders; Zn with mortality from CKD, RD, and lung cancer, and; Ni and V with lung cancer mortality. CONCLUSIONS We present novel results of the relevance of different PM2.5 components for different causes of death, with K and Si seeming to be most consistently associated with mortality in Denmark.
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Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Matija Maric
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard W Atkinson
- Population Health Research Institute, St George's University of London, London, UK
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bente Oftedal
- Department of air quality and noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Cole-Hunter T, Zhang J, Lim YH, Samoli E, Chen J, Strak M, Wolf K, Weinmayr G, Zitt E, Hoffmann B, Jöckel KH, Mortensen LH, Ketzel M, Méndez DY, Ljungman P, Nagel G, Pershagen G, Rizzuto D, Schramm S, Brunekreef B, Hoek G, Andersen ZJ. Reply to Rumrich and colleagues (What does "Parkinson's disease mortality" mean?). Environ Int 2023; 173:107853. [PMID: 36931779 DOI: 10.1016/j.envint.2023.107853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | | | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Damsted Rasmussen T, Fredsted Villadsen S, Hansen AV, Mortensen LH, Ekstrøm CT, Jervelund SS, Nybo Andersen AM. Effectiveness evaluation of an antenatal care intervention addressing disparities to improve perinatal outcomes in Denmark: A nationwide register-based analysis of a cluster randomised controlled trial (MAMAACT). BJOG 2023; 130:759-769. [PMID: 36655509 DOI: 10.1111/1471-0528.17404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate whether MAMAACT, an antenatal care (ANC) intervention, aimed at reducing ethnic and social disparities in perinatal mortality, affected perinatal health outcomes. DESIGN Cluster randomised controlled trial. SETTING Nineteen of 20 maternity wards in Denmark. POPULATION All newborn children within a pre-implementation period (2014-2017) or an implementation period (2018-2019) (n = 188 658). INTERVENTION A 6-h training session for midwives in intercultural communication and cultural competence, two follow-up dialogue meetings, and health education materials for pregnant women on warning signs of pregnancy complications in six languages. METHODS Nationwide register-based analysis of the MAMAACT cluster randomised controlled trial. Mixed-effects logistic regression models were used to estimate the change in outcomes from pre- to post-implementation in the intervention group relative to the control group. Results were obtained for the overall study population and for children born to immigrants from low- to middle-income countries, separately. Models were adjusted for confounders selected a priori. MAIN OUTCOME MEASURES A composite perinatal mortality and morbidity outcome, including stillbirths, neonatal deaths, Apgar score <7, umbilical arterial pH < 7.0, admissions to a neonatal intensive care unit (NICU) >48 h, and NICU admissions for mechanical ventilation. Additional outcomes were the individual measures. RESULTS The intervention increased the risk of the composite outcome (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 0.99-1.34), mainly driven by differences in NICU admission risk (composite outcome excluding NICU, aOR 0.98, 95% CI 0.84-1.14). The intervention slightly increased the risk of low Apgar score and decreased the risk of low arterial pH, reflecting, however, small differences in absolute numbers. Other outcomes were unchanged. CONCLUSIONS Overall, the MAMAACT intervention did not improve the composite perinatal mortality and morbidity outcome (when excluding NICU admissions). The lack of effects may be due to contextual factors including organisational barriers in ANC hindering the midwives from changing practices.
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Affiliation(s)
- Trine Damsted Rasmussen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Sarah Fredsted Villadsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.,Data Science Lab, Statistics Denmark, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Signe Smith Jervelund
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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11
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Cole-Hunter T, Zhang J, So R, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Jöckel KH, Mortensen LH, Ketzel M, Yacamán Méndez D, Leander K, Ljungman P, Faure E, Lee PC, Elbaz A, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, Vermeulen RCH, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH, Andersen ZJ. Long-term air pollution exposure and Parkinson's disease mortality in a large pooled European cohort: An ELAPSE study. Environ Int 2023; 171:107667. [PMID: 36516478 DOI: 10.1016/j.envint.2022.107667] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The link between exposure to ambient air pollution and mortality from cardiorespiratory diseases is well established, while evidence on neurodegenerative disorders including Parkinson's Disease (PD) remains limited. OBJECTIVE We examined the association between long-term exposure to ambient air pollution and PD mortality in seven European cohorts. METHODS Within the project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven cohorts among six European countries. Annual mean residential concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (O3), as well as 8 PM2.5 components (copper, iron, potassium, nickel, sulphur, silicon, vanadium, zinc), for 2010 were estimated using Europe-wide hybrid land use regression models. PD mortality was defined as underlying cause of death being either PD, secondary Parkinsonism, or dementia in PD. We applied Cox proportional hazard models to investigate the associations between air pollution and PD mortality, adjusting for potential confounders. RESULTS Of 271,720 cohort participants, 381 died from PD during 19.7 years of follow-up. In single-pollutant analyses, we observed positive associations between PD mortality and PM2.5 (hazard ratio per 5 µg/m3: 1.25; 95% confidence interval: 1.01-1.55), NO2 (1.13; 0.95-1.34 per 10 µg/m3), and BC (1.12; 0.94-1.34 per 0.5 × 10-5m-1), and a negative association with O3 (0.74; 0.58-0.94 per 10 µg/m3). Associations of PM2.5, NO2, and BC with PD mortality were linear without apparent lower thresholds. In two-pollutant models, associations with PM2.5 remained robust when adjusted for NO2 (1.24; 0.95-1.62) or BC (1.28; 0.96-1.71), whereas associations with NO2 or BC attenuated to null. O3 associations remained negative, but no longer statistically significant in models with PM2.5. We detected suggestive positive associations with the potassium component of PM2.5. CONCLUSION Long-term exposure to PM2.5, at levels well below current EU air pollution limit values, may contribute to PD mortality.
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Affiliation(s)
- Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Diego Yacamán Méndez
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Elodie Faure
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Pei-Chen Lee
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France; Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Alexis Elbaz
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; MRC Centre for Environment and Health, Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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12
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Andersen ZJ, Zhang J, Jørgensen JT, Samoli E, Liu S, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, Remfry E, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hoffmann B, Hvidtfeldt UA, Monique Verschuren WM, Jöckel KH, So R, Cole-Hunter T, Mehta AJ, Mortensen LH, Ketzel M, Lager A, Leander K, Ljungman P, Severi G, Boutron-Ruault MC, Magnusson PKE, Nagel G, Pershagen G, Peters A, Rizzuto D, van der Schouw YT, Schramm S, Stafoggia M, Katsouyanni K, Brunekreef B, Hoek G, Lim YH. Long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in a large pooled European cohort: ELAPSE study. Environ Int 2022; 170:107581. [PMID: 36244228 DOI: 10.1016/j.envint.2022.107581] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Ambient air pollution is an established risk factor for premature mortality from chronic cardiovascular, respiratory and metabolic diseases, while evidence on neurodegenerative diseases and psychiatric disorders remains limited. We examined the association between long-term exposure to air pollution and mortality from dementia, psychiatric disorders, and suicide in seven European cohorts. Within the multicenter project 'Effects of Low-Level Air Pollution: A Study in Europe' (ELAPSE), we pooled data from seven European cohorts from six countries. Based on the residential addresses, annual mean levels of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), ozone (O3), and 8 PM2.5 components were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and mortality from dementia, psychiatric disorders, and suicide. Of 271,720 participants, 900 died from dementia, 241 from psychiatric disorders, and 164 from suicide, during a mean follow-up of 19.7 years. In fully adjusted models, we observed positive associations of NO2 (hazard ratio [HR] = 1.38; 95 % confidence interval [CI]: 1.13, 1.70 per 10 µg/m3), PM2.5 (HR = 1.29; 95 % CI: 0.98, 1.71 per 5 µg/m3), and BC (HR = 1.37; 95 % CI: 1.11, 1.69 per 0.5 × 10-5/m) with psychiatric disorders mortality, as well as with suicide (NO2: HR = 1.13 [95 % CI: 0.92, 1.38]; PM2.5: HR = 1.19 [95 % CI: 0.76, 1.87]; BC: HR = 1.08 [95 % CI: 0.87, 1.35]), and no association with dementia mortality. We did not detect any positive associations of O3 and 8 PM2.5 components with any of the three mortality outcomes. Long-term exposure to NO2, PM2.5, and BC may lead to premature mortality from psychiatric disorders and suicide.
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Affiliation(s)
- Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elizabeth Remfry
- Wolfson Institute of Population Health, Queen Mary University of London, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria; Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - John Gulliver
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom; Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford GU2 7XH, United Kingdom
| | - Anton Lager
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France; Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Italy
| | - Marie-Christine Boutron-Ruault
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" Team, CESP UMR1018, 94805 Villejuif, France
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany; Ludwig Maximilians Universität München, München, Germany
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, Rome, Italy
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Science Policy & Epidemiology Environmental Research Group, King's College London, London, United Kingdom
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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13
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Gailey S, Mortensen LH, Bruckner TA. Job loss and fetal growth restriction: identification of critical trimesters of exposure. Ann Epidemiol 2022; 76:174-180. [PMID: 35605768 PMCID: PMC10194830 DOI: 10.1016/j.annepidem.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Previous research suggests that job loss in a household during pregnancy may perturb fetal growth. However, this work often cannot rule out unmeasured confounding due to selection into job loss. Recent work using data on exogenous job loss (due to a plant closure) finds that a father's unexpected job loss during his spouse's pregnancy increases the risk of a low weight birth. Using a unique set of linked registries in Denmark, we build on this work and examine whether associations between a father's unexpected job loss and low birthweight differ by trimester of in utero exposure. We additionally examine trimester-specific associations of job loss with small-for-gestational-age, a proxy for restricted fetal growth, which may cause low birthweight. METHODS We apply a sibling control design to over 1.4 million live births in Denmark, 1980 to 2017, to examine whether this plausibly exogenous form of job loss corresponds with increased risk of low weight or small-for-gestational-age births, depending on the timing of displacement in the first, second, or third trimester. RESULTS Results indicate an elevated risk of low birthweight (OR = 1.80, 95% CI: 1.24, 2.62) and small-for-gestational-age (OR = 1.40, 95% CI: 1.02, 1.93) among gestations exposed to job loss in the second trimester of pregnancy. Sensitivity analyses using continuous outcome measures (e.g., birthweight in grams, birthweight for gestational age percentile) and maternal fixed effects analyses produce substantively similar inference. CONCLUSIONS Findings support the notion that unexpected job loss may affect fetal growth and that the second trimester in particular appears sensitive to this external stressor.
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Affiliation(s)
- Samantha Gailey
- Minnesota Population Center, University of Minnesota, Twin Cities, Minnesota, USA.
| | - Laust H Mortensen
- Statistics Denmark, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tim A Bruckner
- University of California Irvine, Center for Population, Inequality and Policy and Program in Public Health, Irvine, California, USA
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14
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Magnus MC, Oakley LL, Hansen AV, Örtqvist AK, Petersen TG, Mortensen LH, Bliddal M, Andersen AMN, Stephansson O, Håberg SE. Fetal death after the introduction of COVID-19 mitigation measures in Sweden, Denmark and Norway: a registry-based study. Sci Rep 2022; 12:20625. [PMID: 36450919 PMCID: PMC9709372 DOI: 10.1038/s41598-022-25036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
It remains unclear whether the rate of fetal death has changed during the COVID-19 pandemic. We assessed the impact of COVID-19 mitigation measures on fetal death in Sweden (449,347 births), Denmark (290,857 pregnancies) and Norway (261,057 pregnancies) using robust population-based registry data. We used Cox regression to assess the impact of the implementation of pandemic mitigation measures on March 12th, 2020, on miscarriage (fetal loss before gestational week 22) and stillbirth (fetal loss after gestational week 22). A total of 11% of 551,914 pregnancies in Denmark and Norway ended in miscarriage, while the proportion of stillbirths among 937,174 births across the three countries was 0.3%. There was no difference in the risk of fetal death during the year following pandemic mitigation measures. For miscarriage, the combined hazard ratio (HR) for Norway and Denmark was 1.01 (95% CI 0.98, 1.03), and for stillbirth, the combined HR for all three countries was 0.99 (95% CI 0.89, 1.09). We observed a slightly decreased risk of miscarriage during the first 4 months, with an HR of 0.94 (95% CI 0.90, 0.99) after lockdown. In conclusion, the risk of fetal death did not change after the implementation of COVID-19 pandemic mitigation measures in the three Scandinavian countries.
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Affiliation(s)
- Maria C. Magnus
- grid.418193.60000 0001 1541 4204Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
| | - Laura L. Oakley
- grid.418193.60000 0001 1541 4204Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway ,grid.8991.90000 0004 0425 469XDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne V. Hansen
- grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark ,grid.437930.a0000 0001 2248 6353Statistics Denmark, Copenhagen, Denmark
| | - Anne K. Örtqvist
- grid.4714.60000 0004 1937 0626Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,Department of Obstetrics and Gynaecology, Visby County Hospital, Visby, Sweden
| | - Tanja G. Petersen
- grid.7143.10000 0004 0512 5013Open, Odense University Hospital, Odense, Denmark
| | - Laust H. Mortensen
- grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark ,grid.437930.a0000 0001 2248 6353Statistics Denmark, Copenhagen, Denmark
| | - Mette Bliddal
- grid.10825.3e0000 0001 0728 0170OPEN, University of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne-Marie Nybo Andersen
- grid.5254.60000 0001 0674 042XDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Olof Stephansson
- grid.4714.60000 0004 1937 0626Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Women’s Health, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Siri E. Håberg
- grid.418193.60000 0001 1541 4204Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213 Oslo, Norway
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15
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Hegelund ER, Kjerpeseth LJ, Mortensen LH, Igland J, Berge T, Anjum M, Tell GS, Ariansen I. Prevalence and Incidence Rates of Atrial Fibrillation in Denmark 2004–2018. Clin Epidemiol 2022; 14:1193-1204. [PMCID: PMC9618383 DOI: 10.2147/clep.s374468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the prevalence and incidence of atrial fibrillation (AF) in Denmark during 2004–2018 and to investigate whether methodological choices influence these estimates. Patients and Methods A register-based cohort study was conducted of all individuals aged ≥18 years in Denmark 2004–2018. The cumulative prevalence of AF at the end of the study period was calculated as the number of AF cases alive with at least one inpatient or two outpatient diagnoses during 1994–2018 divided by the number of Danish residents in 2018. Incidence rates were calculated as the number of annual AF cases with no previous diagnosis in the past 10 years (ie, a 10-year washout period) divided by the person-time contributed by the population free of AF on 1 January in the same calendar year. Furthermore, the influence of varying case definitions was investigated. Results The cumulative prevalence of AF was 3.0% in 2018. The incidence rate increased from 391 to 481 per 100,000 person-years (PYs) from 2004 to 2015 (1.7% average annual increase) after which it declined to 367 per 100,000 PYs in 2018 (8.5% average annual decrease). This pattern was observed in both sexes irrespective of age. Methodological choices, particularly the case definition’s strictness and the length of the washout period, had a substantial influence on the reported estimates. Conclusion The cumulative prevalence of AF is currently around 3.0% in the Danish population, but the incidence has declined since 2015. As these estimates are influenced by methodological choices, future studies should strive for precise reporting of study methodology. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/ov6Ab_Q65eU
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Affiliation(s)
- Emilie R Hegelund
- Methodology and Analysis, Statistics Denmark, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars J Kjerpeseth
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Laust H Mortensen
- Methodology and Analysis, Statistics Denmark, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Mariam Anjum
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway,Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Inger Ariansen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway,Inger Ariansen, Department of Chronic Diseases, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, N-0213, Norway, Tel +47 21 07 70 00, Fax +47 22 35 36 05, Email
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16
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Zhang J, Lim YH, Andersen ZJ, Napolitano G, Taghavi Shahri SM, So R, Plucker M, Danesh-Yazdi M, Cole-Hunter T, Therming Jørgensen J, Liu S, Bergmann M, Jayant Mehta A, H. Mortensen L, Requia W, Lange T, Loft S, Kuenzli N, Schwartz J, Amini H. Stringency of COVID-19 Containment Response Policies and Air Quality Changes: A Global Analysis across 1851 Cities. Environ Sci Technol 2022; 56:12086-12096. [PMID: 35968717 PMCID: PMC9454244 DOI: 10.1021/acs.est.2c04303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 containment response policies (CRPs) had a major impact on air quality (AQ). These CRPs have been time-varying and location-specific. So far, despite having numerous studies on the effect of COVID-19 lockdown on AQ, a knowledge gap remains on the association between stringency of CRPs and AQ changes across the world, regions, nations, and cities. Here, we show that globally across 1851 cities (each more than 300 000 people) in 149 countries, after controlling for the impacts of relevant covariates (e.g., meteorology), Sentinel-5P satellite-observed nitrogen dioxide (NO2) levels decreased by 4.9% (95% CI: 2.2, 7.6%) during lockdowns following stringent CRPs compared to pre-CRPs. The NO2 levels did not change significantly during moderate CRPs and even increased during mild CRPs by 2.3% (95% CI: 0.7, 4.0%), which was 6.8% (95% CI: 2.0, 12.0%) across Europe and Central Asia, possibly due to population avoidance of public transportation in favor of private transportation. Among 1768 cities implementing stringent CRPs, we observed the most NO2 reduction in more populated and polluted cities. Our results demonstrate that AQ improved when and where stringent COVID-19 CRPs were implemented, changed less under moderate CRPs, and even deteriorated under mild CRPs. These changes were location-, region-, and CRP-specific.
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Affiliation(s)
- Jiawei Zhang
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Youn-Hee Lim
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | | | - George Napolitano
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | | | - Rina So
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Maude Plucker
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Mahdieh Danesh-Yazdi
- Department
of Environmental Health, Harvard TH Chan
School of Public Health, Boston, Massachusetts 02115, United States
- Program
in Public Health, Department of Family, Population & Preventive
Medicine, Stony Brook University School
of Medicine, Stony Brook, New York 11794-8434, United States
| | - Thomas Cole-Hunter
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | | | - Shuo Liu
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Marie Bergmann
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Amar Jayant Mehta
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Laust H. Mortensen
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
- Methods
and Analysis, Statistics Denmark, 2100 Copenhagen, Denmark
| | - Weeberb Requia
- School
of Public Policy and Government, Fundação
Getúlio Vargas, Brasilia, Distrito Federal 72125590, Brazil
| | - Theis Lange
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Steffen Loft
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | - Nino Kuenzli
- Swiss Tropical
and Public Health Institute (Swiss TPH), Basel 4051, Switzerland
- University
of Basel, Basel 4001, Switzerland
| | - Joel Schwartz
- Department
of Environmental Health, Harvard TH Chan
School of Public Health, Boston, Massachusetts 02115, United States
| | - Heresh Amini
- Department
of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
- Department
of Environmental Health, Harvard TH Chan
School of Public Health, Boston, Massachusetts 02115, United States
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17
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Liu S, Lim YH, Chen J, Strak M, Wolf K, Weinmayr G, Rodopolou S, de Hoogh K, Bellander T, Brandt J, Concin H, Zitt E, Fecht D, Forastiere F, Gulliver J, Hertel O, Hoffmann B, Hvidtfeldt UA, Verschuren WMM, Jöckel KH, Jørgensen JT, So R, Amini H, Cole-Hunter T, Mehta AJ, Mortensen LH, Ketzel M, Lager A, Leander K, Ljungman P, Severi G, Boutron-Ruault MC, Magnusson PKE, Nagel G, Pershagen G, Peters A, Raaschou-Nielsen O, Rizzuto D, van der Schouw YT, Schramm S, Sørensen M, Stafoggia M, Tjønneland A, Katsouyanni K, Huang W, Samoli E, Brunekreef B, Hoek G, Andersen ZJ. Long-term Air Pollution Exposure and Pneumonia-related Mortality in a Large Pooled European Cohort. Am J Respir Crit Care Med 2022; 205:1429-1439. [PMID: 35258439 DOI: 10.1164/rccm.202106-1484oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Ambient air pollution exposure has been linked to mortality from chronic cardiorespiratory diseases, while evidence on respiratory infections remains more limited. Objectives: We examined the association between long-term exposure to air pollution and pneumonia-related mortality in adults in a pool of eight European cohorts. Methods: Within the multicenter project ELAPSE (Effects of Low-Level Air Pollution: A Study in Europe), we pooled data from eight cohorts among six European countries. Annual mean residential concentrations in 2010 for fine particulate matter, nitrogen dioxide (NO2), black carbon (BC), and ozone were estimated using Europe-wide hybrid land-use regression models. We applied stratified Cox proportional hazard models to investigate the associations between air pollution and pneumonia, influenza, and acute lower respiratory infections (ALRI) mortality. Measurements and Main Results: Of 325,367 participants, 712 died from pneumonia and influenza combined, 682 from pneumonia, and 695 from ALRI during a mean follow-up of 19.5 years. NO2 and BC were associated with 10-12% increases in pneumonia and influenza combined mortality, but 95% confidence intervals included unity (hazard ratios, 1.12 [0.99-1.26] per 10 μg/m3 for NO2; 1.10 [0.97-1.24] per 0.5 10-5m-1 for BC). Associations with pneumonia and ALRI mortality were almost identical. We detected effect modification suggesting stronger associations with NO2 or BC in overweight, employed, or currently smoking participants compared with normal weight, unemployed, or nonsmoking participants. Conclusions: Long-term exposure to combustion-related air pollutants NO2 and BC may be associated with mortality from lower respiratory infections, but larger studies are needed to estimate these associations more precisely.
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Affiliation(s)
| | | | - Jie Chen
- Institute for Risk Assessment Sciences and
| | - Maciek Strak
- Institute for Risk Assessment Sciences and.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sophia Rodopolou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tom Bellander
- Institute of Environmental Medicine.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jørgen Brandt
- Department of Environmental Science.,iClimate, Interdisciplinary Centre for Climate Change, and
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria.,Department of Internal Medicine 3, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Daniela Fecht
- Medical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/Azienda Sanitaria Locale Roma 1, Rome, Italy.,Science Policy & Epidemiology Environmental Research Group King's College London, London, United Kingdom
| | - John Gulliver
- Medical Research Council Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Ole Hertel
- Department of Ecoscience, Aarhus University, Roskilde, Denmark, Aarhus University, Roskilde, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | | | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | | | - Rina So
- Section of Environmental Health
| | | | | | - Amar J Mehta
- Section of Epidemiology, and.,Statistics Denmark, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, and.,Statistics Denmark, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | | | | | - Petter Ljungman
- Institute of Environmental Medicine.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gianluca Severi
- University Paris-Saclay, University of Versailles Saint-Quentin, Inserm, Gustave Roussy, "Exposome and Heredity" team, The Centre de Recherche en Epidémiologie et Santé des Populations UMR1018, Villejuif, France.,Department of Statistics, Computer Science and Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Marie-Christine Boutron-Ruault
- University Paris-Saclay, University of Versailles Saint-Quentin, Inserm, Gustave Roussy, "Exposome and Heredity" team, The Centre de Recherche en Epidémiologie et Santé des Populations UMR1018, Villejuif, France
| | | | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Göran Pershagen
- Institute of Environmental Medicine.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.,Chair of Epidemiology, Ludwig Maximilians Universität München, Germany
| | - Ole Raaschou-Nielsen
- Department of Environmental Science.,Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Debora Rizzuto
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Massimo Stafoggia
- Institute of Environmental Medicine.,Department of Epidemiology, Lazio Region Health Service/Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Diet, Genes and Environment (DGE), Copenhagen, Denmark; and
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Science Policy & Epidemiology Environmental Research Group King's College London, London, United Kingdom
| | - Wei Huang
- Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Zorana J Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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18
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So R, Andersen ZJ, Chen J, Stafoggia M, de Hoogh K, Katsouyanni K, Vienneau D, Rodopoulou S, Samoli E, Lim YH, Jørgensen JT, Amini H, Cole-Hunter T, Mahmood Taghavi Shahri S, Maric M, Bergmann M, Liu S, Azam S, Loft S, Westendorp RGJ, Mortensen LH, Bauwelinck M, Klompmaker JO, Atkinson R, Janssen NAH, Oftedal B, Renzi M, Forastiere F, Strak M, Thygesen LC, Brunekreef B, Hoek G, Mehta AJ. Long-term exposure to air pollution and mortality in a Danish nationwide administrative cohort study: Beyond mortality from cardiopulmonary disease and lung cancer. Environ Int 2022; 164:107241. [PMID: 35544998 DOI: 10.1016/j.envint.2022.107241] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association between long-term exposure to air pollution and mortality from cardiorespiratory diseases is well established, yet the evidence for other diseases remains limited. OBJECTIVES To examine the associations of long-term exposure to air pollution with mortality from diabetes, dementia, psychiatric disorders, chronic kidney disease (CKD), asthma, acute lower respiratory infection (ALRI), as well as mortality from all-natural and cardiorespiratory causes in the Danish nationwide administrative cohort. METHODS We followed all residents aged ≥ 30 years (3,083,227) in Denmark from 1 January 2000 until 31 December 2017. Annual mean concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), and ozone (warm season) were estimated using European-wide hybrid land-use regression models (100 m × 100 m) and assigned to baseline residential addresses. We used Cox proportional hazard models to evaluate the association between air pollution and mortality, accounting for demographic and socioeconomic factors. We additionally applied indirect adjustment for smoking and body mass index (BMI). RESULTS During 47,023,454 person-years of follow-up, 803,881 people died from natural causes. Long-term exposure to PM2.5 (mean: 12.4 µg/m3), NO2 (20.3 µg/m3), and/or BC (1.0 × 10-5/m) was statistically significantly associated with all studied mortality outcomes except CKD. A 5 µg/m3 increase in PM2.5 was associated with higher mortality from all-natural causes (hazard ratio 1.11; 95% confidence interval 1.09-1.13), cardiovascular disease (1.09; 1.07-1.12), respiratory disease (1.11; 1.07-1.15), lung cancer (1.19; 1.15-1.24), diabetes (1.10; 1.04-1.16), dementia (1.05; 1.00-1.10), psychiatric disorders (1.38; 1.27-1.50), asthma (1.13; 0.94-1.36), and ALRI (1.14; 1.09-1.20). Associations with long-term exposure to ozone (mean: 80.2 µg/m3) were generally negative but became significantly positive for several endpoints in two-pollutant models. Generally, associations were attenuated but remained significant after indirect adjustment for smoking and BMI. CONCLUSION Long-term exposure to PM2.5, NO2, and/or BC in Denmark were associated with mortality beyond cardiorespiratory diseases, including diabetes, dementia, psychiatric disorders, asthma, and ALRI.
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Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jie Chen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Matija Maric
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Bergmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Shadi Azam
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
| | - Mariska Bauwelinck
- Interface Demography - Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jochem O Klompmaker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Richard Atkinson
- Population Health Research Institute, St George's University of London, London, UK
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Bente Oftedal
- Department of Air Quality and Noise, Norwegian Institute of Public Health, Oslo, Norway
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 1, Rome, Italy; Science Policy & Epidemiology Environmental Research Group King's College London, London, UK
| | - Maciek Strak
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Denmark Statistics, Copenhagen, Denmark
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19
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Cole-Hunter T, So R, Amini H, Backalarz C, Brandt J, Bräuner EV, Hertel O, Jensen SS, Jørgensen JT, Ketzel M, Laursen JE, Lim YH, Loft S, Mehta A, Mortensen LH, Simonsen MK, Sisgaard T, Westendorp R, Andersen ZJ. Long-term exposure to road traffic noise and all-cause and cause-specific mortality: a Danish Nurse Cohort study. Sci Total Environ 2022; 820:153057. [PMID: 35031374 DOI: 10.1016/j.scitotenv.2022.153057] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Long-term road traffic noise exposure is linked to cardio-metabolic disease morbidity, whereas evidence on mortality remains limited. OBJECTIVES We investigated association of long-term exposure to road traffic noise with all-cause and cause-specific mortality. METHODS We linked 22,858 females from the Danish Nurse Cohort (DNC), recruited into the Danish Register of Causes of Death up to 2014. Road traffic noise levels since 1970 were modelled by Nord2000 as the annual mean of a weighted 24 h average (Lden). Cox regression models examined the associations between Lden (5-year and 23-year means) and all-cause and cause-specific mortalities, adjusting for lifestyle and exposure to PM2.5 (particulate matter with diameter < 2.5 μm) and NO2 (nitrogen dioxide). RESULTS During follow-up (mean 17.4 years), 3902 nurses died: 1622 from cancer, 922 from CVDs (289 from stroke), 338 from respiratory diseases (186 from chronic obstructive pulmonary disease, 114 from lower respiratory tract infections [ALRIs]), 234 from dementia, 95 from psychiatric disorders, and 79 from diabetes. Hazard ratios (95% confidence intervals) for all-cause mortality from fully-adjusted models were 1.06 (1.01, 1.11) and 1.09 (1.03, 1.15) per 10 dB of 5-year and 23-year mean Lden, respectively, which attenuated slightly in our main model (fully-adjusted plus PM2.5: 1.04 [1.00, 1.10]; 1.08 [1.02, 1.13]). Main model estimates suggested the strongest associations between 5-year mean Lden and diabetes (1.14: 0.81, 1.61), ALRIs (1.13: 0.84, 1.54), dementia (1.12: 0.90, 1.38), and stroke (1.10: 0.91, 1.31), whereas associations with 23-year mean Lden were suggested for respiratory diseases (1.15: 0.95, 1.39), psychiatric disorders (1.11: 0.78, 1.59), and all cancers (1.08: 0.99, 1.17). DISCUSSION Among the female nurses from the DNC, we observed that long-term exposure to road traffic noise led to premature mortality, independently of air pollution, and its adverse effects may extend well beyond those on the cardio-metabolic system to include respiratory diseases, cancer, neurodegenerative and psychiatric disorders.
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Affiliation(s)
- Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate - interdisciplinary Centre for Climate Change, Aarhus University, Roskilde, Denmark
| | - Elvira Vaclavik Bräuner
- Juliane Marie Center, Department of Growth and Reproduction, Capital Region of Denmark, Rigshospitalet, Copenhagen, Denmark
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Denmark
| | | | | | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Mette Kildevæld Simonsen
- Diakonissestiftelsen, Peter Bangsvej 1, 2000 Frederiksberg, Denmark; Research Unit for Dietary Studies, The Parker Institute Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torben Sisgaard
- Section of Environment, Occupation & Health Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Rudi Westendorp
- Section of Epidemiology and Center for Healthy Ageing, Department of Public Health, University of Copenhagen
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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20
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Cole-Hunter T, Dehlendorff C, Amini H, Mehta A, Lim YH, Jørgensen JT, Li S, So R, Mortensen LH, Westendorp R, Hoffmann B, Bräuner EV, Ketzel M, Hertel O, Brandt J, Jensen SS, Christensen JH, Geels C, Frohn LM, Backalarz C, Simonsen MK, Loft S, Andersen ZJ. Long-term exposure to road traffic noise and stroke incidence: a Danish Nurse Cohort study. Environ Health 2021; 20:115. [PMID: 34740347 PMCID: PMC8571835 DOI: 10.1186/s12940-021-00802-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/26/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Road traffic noise has been linked to increased risk of ischemic heart disease, yet evidence on stroke shows mixed results. We examine the association between long-term exposure to road traffic noise and incidence of stroke, overall and by subtype (ischemic or hemorrhagic), after adjustment for air pollution. METHODS Twenty-five thousand six hundred and sixty female nurses from the Danish Nurse Cohort recruited in 1993 or 1999 were followed for stroke-related first-ever hospital contact until December 31st, 2014. Full residential address histories since 1970 were obtained and annual means of road traffic noise (Lden [dB]) and air pollutants (particulate matter with diameter < 2.5 μm and < 10 μm [PM2.5 and PM10], nitrogen dioxide [NO2], nitrogen oxides [NOx]) were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals [CI]) for the associations of one-, three-, and 23-year running means of Lden preceding stroke (all, ischemic or hemorrhagic), adjusting for stroke risk factors and air pollutants. The World Health Organization and the Danish government's maximum exposure recommendations of 53 and 58 dB, respectively, were explored as potential Lden thresholds. RESULTS Of 25,660 nurses, 1237 developed their first stroke (1089 ischemic, 148 hemorrhagic) during 16 years mean follow-up. For associations between a 1-year mean of Lden and overall stroke incidence, the estimated HR (95% CI) in the fully adjusted model was 1.06 (0.98-1.14) per 10 dB, which attenuated to 1.01 (0.93-1.09) and 1.00 (0.91-1.09) in models further adjusted for PM2.5 or NO2, respectively. Associations for other exposure periods or separately for ischemic or hemorrhagic stroke were similar. There was no evidence of a threshold association between Lden and stroke. CONCLUSIONS Long-term exposure to road traffic noise was suggestively positively associated with the risk of overall stroke, although not after adjusting for air pollution.
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Affiliation(s)
- Tom Cole-Hunter
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, NSW Australia
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Heresh Amini
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar Mehta
- Denmark Statistics, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T. Jørgensen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Li
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laust H. Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Elvira V. Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, UK
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M. Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Mette K. Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Steffen Loft
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zorana J. Andersen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Lim YH, Jørgensen JT, So R, Cole-Hunter T, Mehta AJ, Amini H, Bräuner EV, Westendorp RGJ, Liu S, Mortensen LH, Hoffmann B, Loft S, Ketzel M, Hertel O, Brandt J, Jensen SS, Backalarz C, Simonsen MK, Tasic N, Maric M, Andersen ZJ. Long-Term Exposure to Air Pollution, Road Traffic Noise, and Heart Failure Incidence: The Danish Nurse Cohort. J Am Heart Assoc 2021; 10:e021436. [PMID: 34612059 PMCID: PMC8751865 DOI: 10.1161/jaha.121.021436] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background We examined the association of long-term exposure to air pollution and road traffic noise with incident heart failure (HF). Methods And Results Using data on female nurses from the Danish Nurse Cohort (aged >44 years), we investigated associations between 3-year mean exposures to air pollution and road traffic noise and incident HF using Cox regression models, adjusting for relevant confounders. Incidence of HF was defined as the first hospital contact (inpatient, outpatient, or emergency) between cohort baseline (1993 or 1999) and December 31, 2014, based on the Danish National Patient Register. Annual mean levels of particulate matter with a diameter <2.5 µm since 1990 and NO2 and road traffic noise since 1970 were estimated at participants' residences. Of the 22 189 nurses, 484 developed HF. We detected associations with all 3 pollutants, with hazard ratios (HRs) of 1.17 (95% CI, 1.01-1.36), 1.10 (95% CI, 0.99-1.22), and 1.12 (95% CI, 0.99-1.26) per increase of 5.1 µg/m3 in particulate matter with a diameter <2.5 µm, 8.6 µg/m3 in NO2, and 9.3 dB in road traffic noise, respectively. We observed an enhanced risk of HF incidence for those exposed to high levels of the 3 pollutants; however, the effect modification of coexposure was not statistically significant. Former smokers and nurses with hypertension showed the strongest associations with particulate matter with a diameter <2.5 µm (Peffect modification<0.05). Conclusions We found that long-term exposures to air pollution and road traffic noise were independently associated with HF.
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Affiliation(s)
- Youn-Hee Lim
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark.,Seoul National University Medical Research Center Seoul Republic of Korea
| | - Jeanette T Jørgensen
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Rina So
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark.,Centre for Air Pollution, Energy and Health Research University of Sydney Australia
| | - Amar J Mehta
- Statistics Denmark Copenhagen Denmark.,Section of Epidemiology Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Heresh Amini
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark.,Department of Environmental Health Harvard T.H. Chan School of Public Health Boston MA
| | - Elvira V Bräuner
- Department of Growth and Reproduction Copenhagen University Hospital-RigshospitaletUniversity of Copenhagen Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Center for Healthy Aging University of Copenhagen Denmark
| | - Shuo Liu
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Laust H Mortensen
- Statistics Denmark Copenhagen Denmark.,Section of Epidemiology Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine Centre for Health and SocietyMedical FacultyHeinrich-Heine-University of Düsseldorf Germany
| | - Steffen Loft
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark
| | - Matthias Ketzel
- Department of Environmental Science Aarhus University Roskilde Denmark.,Global Centre for Clean Air Research University of Surrey United Kingdom
| | - Ole Hertel
- Department of Environmental Science Aarhus University Roskilde Denmark
| | - Jørgen Brandt
- Department of Environmental Science Aarhus University Roskilde Denmark.,iClimate-Aarhus University Interdisciplinary Center for Climate Change Aarhus University Roskilde Denmark
| | | | | | - Mette K Simonsen
- Diakonissestiftelsen Frederiksberg Denmark.,The Parker InstituteCopenhagen University HospitalBispebjerg and Frederiksberg Frederiksberg Denmark
| | - Nebojsa Tasic
- Institute of Cardiovascular Diseases "Dedinje" Belgrade Serbia
| | - Matija Maric
- Institute of Cardiovascular Diseases "Dedinje" Belgrade Serbia
| | - Zorana J Andersen
- Section of Environmental Health Department of Public Health Faculty of Health and Medical Sciences University of Copenhagen Denmark
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22
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Hegelund ER, Mehta AJ, Mortensen LH, Westendorp RGJ. The plasticity of late-onset dementia: A nationwide cohort study in Denmark. Alzheimers Dement 2021; 18:1287-1295. [PMID: 34569688 DOI: 10.1002/alz.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The determinants of the secular decline in the incidence of dementia are not clear. The aim of this study was to investigate the influences of four factors-education, wealth, cerebrovascular health, and general health-on the secular decline. METHODS A cohort study was conducted of all individuals aged ≥65 years in Denmark from 2005 through 2018 (N = 1,757,168). Annual incidence rates of dementia and population attributable risks of the four factors were calculated and birth cohort trends were examined. RESULTS The incidence of dementia declined by 22.5% in men and 34.2% in women from 2005 through 2018. Population attributable risks of lower education, lower wealth, and stroke likewise declined. Independent of these improvements, the incidence of dementia fell across successive birth cohorts. DISCUSSION Most of the observed plasticity in late-onset dementia is associated with a risk decline across successive birth cohorts that is independent of improvements in traditional risk factors.
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Affiliation(s)
- Emilie R Hegelund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Amar J Mehta
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Laust H Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Statistics Denmark, Copenhagen, Denmark
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23
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Gailey S, Knudsen ES, Mortensen LH, Bruckner TA. Birth outcomes following unexpected job loss: a matched-sibling design. Int J Epidemiol 2021; 51:858-869. [PMID: 34508593 DOI: 10.1093/ije/dyab180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth outcomes, however, lacks high-quality individual data on, and variation in, plausibly exogenous job loss during pregnancy and therefore cannot rule out strong confounding. METHODS We analysed unique linked registries in Denmark, from 1980 to 2017, to examine whether a father's involuntary job loss during his spouse's pregnancy increases the risk of a low-weight (i.e. <2500 grams) and/or preterm (i.e. <37 weeks of gestational age) birth. We applied a matched-sibling design to 743 574 sibling pairs. RESULTS Results indicate an increased risk of a low-weight birth among infants exposed in utero to fathers' unexpected job loss [odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.07, 1.75]. Sex-specific analyses show that this result holds for males (OR = 1.70, 95% CI: 1.14, 2.53) but not females (OR = 1.24, 95% CI: 0.80, 1.91). We find no relation with preterm birth. CONCLUSIONS Findings support the inference that a father's unexpected job loss adversely affects the course of pregnancy, especially among males exposed in utero.
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Affiliation(s)
- Samantha Gailey
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Elias Stapput Knudsen
- Department of Technology, Management, and Economics, Technical University of Denmark, Copenhagen, Denmark
| | - Laust H Mortensen
- Denmark Statistics, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tim A Bruckner
- Program in Public Health, University of California Irvine, Irvine, CA, USA.,Center for Population, Inequality, and Policy, University of California Irvine, Irvine, CA, USA
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24
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Andersen ZJ, Cramer J, Jørgensen JT, Dehlendorff C, Amini H, Mehta A, Cole-Hunter T, Mortensen LH, Westendorp R, So R, Li S, Hoffmann B, Loft S, Bräuner EV, Ketzel M, Hertel O, Brandt J, Jensen SS, Christensen JH, Geels C, Frohn LM, Backalarz C, Simonsen MK, Lim YH. Long-Term Exposure to Road Traffic Noise and Air Pollution, and Incident Atrial Fibrillation in the Danish Nurse Cohort. Environ Health Perspect 2021; 129:87002. [PMID: 34338552 PMCID: PMC8327770 DOI: 10.1289/ehp8090] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Associations between long-term exposure to air pollution and road traffic noise have been established for ischemic heart disease, but findings have been mixed for atrial fibrillation (AF). OBJECTIVES The goal of the study was to examine associations of long-term exposure to road traffic noise and air pollution with AF. METHODS Time-varying Cox regression models were used to estimate associations of 1-, 3-, and 23-y mean road traffic noise and air pollution exposures with AF incidence in 23,528 women enrolled in the Danish Nurse Cohort (age >44y at baseline in 1993 or 1999). AF diagnoses were ascertained via the Danish National Patient Register. Annual mean weighted 24-h average road traffic noise levels (Lden) at the nurses' residences, since 1970, were estimated using the Nord2000 model, and annual mean levels of particulate matter with a diameter <2.5μm (PM2.5) and nitrogen dioxide (NO2) were estimated using the DEHM/UBM/AirGIS model. RESULTS Of 23,528 nurses with no prior AF diagnosis at the cohort baseline, 1,522 developed AF during follow-up. In a fully adjusted model (including PM2.5), the estimated risk of AF was 18% higher [hazard ratio (HR); 95% confidence interval (CI): 1.18; 1.02, 1.36] in nurses with residential 3-y mean Lden levels >58 dB vs. <48 dB, with similar findings for 1-y mean exposures. A 3.9-μg/m3 increase in 3-y mean PM2.5 was associated with incident AF before and after adjustment for concurrent exposure to road traffic noise (HR 1.09; 95% CI: 1.00, 1.20 and 1.08; 95% CI: 0.97, 1.19, respectively). Associations with 1-y mean PM2.5 exposures were positive but closer to the null and not significant. Associations with NO2 were null for all time periods before and after adjustment for road traffic noise and inverse when adjusted for concurrent PM2.5. CONCLUSION Our analysis of prospective data from a cohort of Danish female nurses followed for up to 14 y provided suggestive evidence of independent associations between incident AF and 1- and 3-y exposures to road traffic noise and PM2.5. https://doi.org/10.1289/EHP8090.
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Affiliation(s)
- Zorana J. Andersen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johannah Cramer
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T. Jørgensen
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Heresh Amini
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar Mehta
- Denmark Statistics, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, New South Wales, Australia
- International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laust H. Mortensen
- Denmark Statistics, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rina So
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Shuo Li
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine; Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Steffen Loft
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elvira V. Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate, Aarhus University, Roskilde, Denmark
| | | | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M. Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Mette K. Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Youn-Hee Lim
- Environmental Epidemiology Group, Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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25
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Liu S, Lim YH, Pedersen M, Jørgensen JT, Amini H, Cole-Hunter T, Mehta AJ, So R, Mortensen LH, Westendorp RGJ, Loft S, Bräuner EV, Ketzel M, Hertel O, Brandt J, Jensen SS, Christensen JH, Sigsgaard T, Geels C, Frohn LM, Brborić M, Radonić J, Sekulic MT, Bønnelykke K, Backalarz C, Simonsen MK, Andersen ZJ. Long-term exposure to ambient air pollution and road traffic noise and asthma incidence in adults: The Danish Nurse cohort. Environ Int 2021; 152:106464. [PMID: 33684733 DOI: 10.1016/j.envint.2021.106464] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Ambient air pollution is likely a risk factor for asthma, and recent evidence suggests the possible relevance of road traffic noise. OBJECTIVES We examined the associations of long-term exposure to air pollution and road traffic noise with adult-asthma incidence. METHODS We followed 28,731 female nurses (age > 44 years) from the Danish Nurse Cohort, recruited in 1993 and 1999, for first hospital contact for asthma from 1977 until 2015. We estimated residential annual mean concentrations of particulate matter with diameter < 2.5 µm (PM2.5) since 1990 and nitrogen dioxide (NO2) since 1970 with the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (Lden) since 1970 with the Nord2000 model. Time-varying Cox regression models were used to associate air pollution and road traffic noise exposure with asthma incidence. RESULTS During 18.6 years' mean follow-up, 528 out of 23,093 participants had hospital contact for asthma. The hazard ratios (HR) and 95% confidence intervals for asthma incidence associated with 3-year moving average exposures were 1.29 (1.03, 1.61) per 6.3 µg/m3 for PM2.5, 1.16 (1.07, 1.27) per 8.2 µg/m3 for NO2, and 1.12 (1.00, 1.25) per 10 dB for Lden. The HR for NO2 remained unchanged after adjustment for either PM2.5 or Lden, while the HRs for PM2.5 and Lden attenuated to unity after adjustment for NO2. CONCLUSIONS Long-term exposure to air pollution was associated with adult-asthma incidence independently of road traffic noise, with NO2 most relevant. Road traffic noise was not independently associated with adult-asthma incidence.
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Affiliation(s)
- Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Pedersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Air pollution, energy and health Research (CAR), University of Sydney, Sydney, Australia
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; iClimate, Aarhus University, Roskilde, Denmark
| | - Steen S Jensen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Maja Brborić
- University of Novi Sad, Faculty of Technical Sciences, Department of Environmental Engineering and Occupational Safety and Health, Novi Sad, Serbia
| | - Jelena Radonić
- University of Novi Sad, Faculty of Technical Sciences, Department of Environmental Engineering and Occupational Safety and Health, Novi Sad, Serbia
| | - Maja Turk Sekulic
- University of Novi Sad, Faculty of Technical Sciences, Department of Environmental Engineering and Occupational Safety and Health, Novi Sad, Serbia
| | - Klaus Bønnelykke
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Mette K Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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26
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Liu S, Lim YH, Pedersen M, Jørgensen JT, Amini H, Cole-Hunter T, Mehta AJ, So R, Mortensen LH, Westendorp RGJ, Loft S, Bräuner EV, Ketzel M, Hertel O, Brandt J, Jensen SS, Christensen JH, Sigsgaard T, Geels C, Frohn LM, Brborić M, Radonić J, Sekulic MT, Bønnelykke K, Backalarz C, Simonsen MK, Andersen ZJ. Long-term air pollution and road traffic noise exposure and COPD: the Danish Nurse Cohort. Eur Respir J 2021; 58:13993003.04594-2020. [PMID: 33986028 DOI: 10.1183/13993003.04594-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/17/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND While air pollution has been linked to the development of chronic obstructive pulmonary disease (COPD), evidence on the role of environmental noise is just emerging. We examined the associations of long-term exposure to air pollution and road traffic noise with COPD incidence. METHODS We defined COPD incidence for 24 538 female nurses from the Danish Nurse Cohort (age>44 years) as the first hospital contact between baseline (1993 or 1999) and 2015. We estimated residential annual mean concentrations of particulate matter with diameter<2.5 µm (PM2.5) since 1990 and nitrogen dioxide (NO2) since 1970 by the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (Lden) since 1970 by the Nord2000 model. Time-varying Cox regression models were applied to assess the associations of air pollution and road traffic noise with COPD incidence. RESULTS 977 nurses developed COPD during 18.6 years' mean follow-up. We observed associations with COPD for all three exposures with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.19 (1.01, 1.41) per 6.26 µg·m-3 for PM2.5, 1.13 (1.05, 1.20) per 8.19 µg·m-3 for NO2, and 1.15 (1.06, 1.25) per 10 dB for Lden. Associations with NO2 and Lden attenuated slightly after mutual adjustment, but were robust to adjustment for PM2.5. Associations with PM2.5 were attenuated to null after adjustment for either NO2 or Lden. No potential interaction effect was observed between air pollutants and noise. CONCLUSIONS Long-term exposure to air pollution, especially traffic-related NO2, and road traffic noise were independently associated with COPD.
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Affiliation(s)
- Shuo Liu
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Pedersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Centre for Air pollution, energy and health Research (CAR), University of Sydney, Sydney, Australia
| | - Amar J Mehta
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Statistics Denmark, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Ole Hertel
- Department of Bioscience, Aarhus University, Roskilde, Denmark.,Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark.,iClimate, Aarhus University, Roskilde, Denmark
| | - Steen S Jensen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Torben Sigsgaard
- Department of Public Health, Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Maja Brborić
- Faculty of Technical Sciences, Department of Environmental Engineering and Occupational Safety and Health, University of Novi Sad, Novi Sad, Serbia
| | - Jelena Radonić
- Faculty of Technical Sciences, Department of Environmental Engineering and Occupational Safety and Health, University of Novi Sad, Novi Sad, Serbia
| | - Maja Turk Sekulic
- Faculty of Technical Sciences, Department of Environmental Engineering and Occupational Safety and Health, University of Novi Sad, Novi Sad, Serbia
| | - Klaus Bønnelykke
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Mette K Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark.,The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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27
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Clarke RB, Amini H, James P, von Euler-Chelpin M, Jørgensen JT, Mehta A, Cole-Hunter T, Westendorp R, Mortensen LH, Loft S, Brandt J, Hertel O, Ketzel M, Backalarz C, Andersen ZJ, Lim YH. Outdoor light at night and breast cancer incidence in the Danish Nurse Cohort. Environ Res 2021; 194:110631. [PMID: 33345898 DOI: 10.1016/j.envres.2020.110631] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Knowledge of the role of melatonin, xenograft experiments, and epidemiological studies suggests that exposure to light at night (LAN) may disturb circadian rhythms, possibly increasing the risk of developing breast cancer. OBJECTIVES We examined the association between residential outdoor LAN and the incidence of breast cancer: overall and subtypes classified by estrogen (ER) and progesterone (PR) receptor status. METHODS We used data on 16,941 nurses from the Danish Nurse Cohort who were followed-up from the cohort baseline in 1993 or 1999 through 2012 in the Danish Cancer Registry for breast cancer incidence and the Danish Breast Cancer Cooperative Group for breast cancer ER and PR status. LAN exposure data were obtained from the U.S. Defense Meteorological Satellite Program (DMSP) available for 1996, 1999, 2000, 2003, 2004, 2006, and 2010 in nW/cm2/sr unit, and assigned to the study participants' residence addresses during the follow-up. Time-varying Cox regression models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between LAN and breast cancer, adjusting for individual characteristics, road traffic noise, and air pollution. RESULTS Of 16,941 nurses, 745 developed breast cancer in total during 320,289 person-years of follow-up. We found no association between exposure to LAN and overall breast cancer. In the fully adjusted models, HRs for the highest (65.8-446.4 nW/cm2/sr) and medium (22.0-65.7 nW/cm2/sr) LAN tertiles were 0.97 (95% CI: 0.77, 1.23) and 1.09 (95% CI: 0.90, 1.31), respectively, compared to the lowest tertile of LAN exposure (0-21.9 nW/cm2/sr). We found a suggestive association between LAN and ER-breast cancer. CONCLUSION This large cohort study of Danish female nurses suggests weak evidence of the association between LAN and breast cancer incidence.
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Affiliation(s)
- Rebecca B Clarke
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States.
| | - Peter James
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - My von Euler-Chelpin
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar Mehta
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Air pollution, energy and health Research, University of Sydney, Sydney, Australia; International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Statistics Denmark, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | | | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Seoul National University Medical Research Center, Seoul, Republic of Korea.
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28
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Olesen SS, Mortensen LH, Zinck E, Becker U, Drewes AM, Nøjgaard C, Novovic S, Yadav D, Tolstrup JS. Time trends in incidence and prevalence of chronic pancreatitis: A 25-year population-based nationwide study. United European Gastroenterol J 2021; 9:82-90. [PMID: 33176616 PMCID: PMC8259237 DOI: 10.1177/2050640620966513] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/17/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Updated population-based estimates on incidence and prevalence of chronic pancreatitis are scarce. METHODS We used nationwide healthcare registries to identify all Danish patients diagnosed with chronic pancreatitis and computed crude and standardised incidence rates and prevalence estimates in 1994-2018. Incidence and prevalence were evaluated in relation to patients age and gender, aetiology (alcoholic vs. non-alcoholic) and smoking and alcohol consumption in the general Danish population. RESULTS The mean incidence rate of chronic pancreatitis during the study period was 12.6 per 100,000 person years for the total population, for women it was 8.6 per 100,000 person years and for men it was 16.7 per 100,000 person years. The standardised incidence rate was stable from 1994 to 2018, remaining at 12.5 per 100,000 person years in the last observation period (2014-2018). The point prevalence of chronic pancreatitis in 2016 was 153.9 per 100,000 persons. A gradual increase in standardised prevalence estimates was observed during the study period from 126.6 in 1996 to 153.9 in 2016. The mean age at chronic pancreatitis diagnosis increased from 52.1 to 60.0 years during the study period. CONCLUSION The prevalence of chronic pancreatitis is increasing in the Danish population despite a stable incidence level. Improved management strategies and changes in the underlying patient population may explain these observations.
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Affiliation(s)
- Søren S Olesen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Laust H Mortensen
- Data Science Lab, Methods and Analysis, Statistics Denmark, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Zinck
- Data Science Lab, Methods and Analysis, Statistics Denmark, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Asbjørn M Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Srdan Novovic
- Gastro Unit, Hvidovre University Hospital, Hvidovre, Denmark
| | - Dhiraj Yadav
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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29
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Chen S, Pawelec G, Trompet S, Goldeck D, Mortensen LH, Slagboom PE, Christensen K, Gussekloo J, Kearney P, Buckley BM, Ford I, Jukema JW, Westendorp RGJ, Maier AB. Associations of Cytomegalovirus Infection With All-Cause and Cardiovascular Mortality in Multiple Observational Cohort Studies of Older Adults. J Infect Dis 2021; 223:238-246. [PMID: 32909605 PMCID: PMC7857154 DOI: 10.1093/infdis/jiaa480] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Whether latent cytomegalovirus (CMV) infection in older adults has any substantial health consequences is unclear. Here, we sought associations between CMV-seropositivity and IgG titer with all-cause and cardiovascular mortality in 5 longitudinal cohorts. METHODS Leiden Longevity Study, Prospective Study of Pravastatin in the Elderly at Risk, Longitudinal Study of Aging Danish Twins, and Leiden 85-plus Study were assessed at median (2.8-11.4 years) follow-up . Cox regression and random effects meta-analysis were used to estimate mortality risk dependent on CMV serostatus and/or IgG antibody titer, in quartiles after adjusting for confounders. RESULTS CMV-seropositivity was seen in 47%-79% of 10 122 white community-dwelling adults aged 59-93 years. Of these, 3519 had died on follow-up (579 from cardiovascular disease). CMV seropositivity was not associated with all-cause (hazard ratio [HR], 1.05; 95% confidence interval [CI], .97-1.14) or cardiovascular mortality (HR, 0.97; 95% CI, .83-1.13). Subjects in the highest CMV IgG quartile group had increased all-cause mortality relative to CMV-seronegatives (HR, 1.16; 95% CI, 1.04-1.29) but this association lost significance after adjustment for confounders (HR, 1.13; 95% CI, .99-1.29). The lack of increased mortality risk was confirmed in subanalyses. CONCLUSIONS CMV infection is not associated with all-cause or cardiovascular mortality in white community-dwelling older adults.
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Affiliation(s)
- Sijia Chen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Experimental Immunology, Academic Medical Center, Amsterdam, the Netherlands
| | - Graham Pawelec
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - David Goldeck
- Department of Immunology, University of Tübingen, Tübingen, Germany
- Fairfax Centre, Kidlington, United Kingdom
| | | | - P Eline Slagboom
- Section of Molecular Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Patricia Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Brendan M Buckley
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rudi G J Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
- Leyden Academy on Vitality and Ageing, Leiden, the Netherlands
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije University, Amsterdam, the Netherlands
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30
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So R, Jørgensen JT, Lim YH, Mehta AJ, Amini H, Mortensen LH, Westendorp R, Ketzel M, Hertel O, Brandt J, Christensen JH, Geels C, Frohn LM, Sisgaard T, Bräuner EV, Jensen SS, Backalarz C, Simonsen MK, Loft S, Cole-Hunter T, Andersen ZJ. Long-term exposure to low levels of air pollution and mortality adjusting for road traffic noise: A Danish Nurse Cohort study. Environ Int 2020; 143:105983. [PMID: 32736159 DOI: 10.1016/j.envint.2020.105983] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The association between air pollution and mortality is well established, yet some uncertainties remain: there are few studies that account for road traffic noise exposure or that consider in detail the shape of the exposure-response function for cause-specific mortality outcomes, especially at low-levels of exposure. OBJECTIVES We examined the association between long-term exposure to particulate matter [(PM) with a diameter of <2.5 µm (PM2.5), <10 µm (PM10)], and nitrogen dioxide (NO2) and total and cause-specific mortality, accounting for road traffic noise. METHODS We used data on 24,541 females (age > 44 years) from the Danish Nurse Cohort, who were recruited in 1993 or 1999, and linked to the Danish Causes of Death Register for follow-up on date of death and its cause, until the end of 2013. Annual mean concentrations of PM2.5, PM10, and NO2 at the participants' residences since 1990 were estimated using the Danish DEHM/UBM/AirGIS dispersion model, and annual mean road traffic noise levels (Lden) were estimated using the Nord2000 model. We examined associations between the three-year running mean of PM2.5, PM10, and NO2 with total and cause-specific mortality by using time-varying Cox Regression models, adjusting for individual characteristics and residential road traffic noise. RESULTS During the study period, 3,708 nurses died: 843 from cardiovascular disease (CVD), 310 from respiratory disease (RD), and 64 from diabetes. In the fully adjusted models, including road traffic noise, we detected associations of three-year running mean of PM2.5 with total (hazard ratio; 95% confidence interval: 1.06; 1.01-1.11), CVD (1.14; 1.03-1.26), and diabetes mortality (1.41; 1.05-1.90), per interquartile range of 4.39 μg/m3. In a subset of the cohort exposed to PM2.5 < 20 µg/m3, we found even stronger association with total (1.19; 1.11-1.27), CVD (1.27; 1.01-1.46), RD (1.27; 1.00-1.60), and diabetes mortality (1.44; 0.83-2.48). We found similar associations with PM10 and none with NO2. All associations were robust to adjustment for road traffic noise. DISCUSSION Long-term exposure to low-levels of PM2.5 and PM10 is associated with total mortality, and mortality from CVD, RD, and diabetes. Associations were even stronger at the PM2.5 levels below EU limit values and were independent of road traffic noise.
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Affiliation(s)
- Rina So
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark
| | | | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amar J Mehta
- Denmark Statistics, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Heresh Amini
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Laust H Mortensen
- Denmark Statistics, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Torben Sisgaard
- Institute of Environmental and Occupational Medicine, Department of Public Health, Aarhus University, Denmark
| | | | | | | | - Mette Kildevæld Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark; Research Unit for Dietary Studies, The Parker Institute Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Air Pollution, Energy and Health Research (CAR), University of Sydney, Sydney, Australia
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark.
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Amini H, Dehlendorff C, Lim YH, Mehta A, Jørgensen JT, Mortensen LH, Westendorp R, Hoffmann B, Loft S, Cole-Hunter T, Bräuner EV, Ketzel M, Hertel O, Brandt J, Solvang Jensen S, Christensen JH, Geels C, Frohn LM, Backalarz C, Simonsen MK, Andersen ZJ. Long-term exposure to air pollution and stroke incidence: A Danish Nurse cohort study. Environ Int 2020; 142:105891. [PMID: 32593048 DOI: 10.1016/j.envint.2020.105891] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 05/23/2023]
Abstract
Ambient air pollution has been linked to stroke, but few studies have examined in detail stroke subtypes and confounding by road traffic noise, which was recently associated with stroke. Here we examined the association between long-term exposure to air pollution and incidence of stroke (overall, ischemic, hemorrhagic), adjusting for road traffic noise. In a nationwide Danish Nurse Cohort consisting of 23,423 nurses, recruited in 1993 or 1999, we identified 1,078 incident cases of stroke (944 ischemic and 134 hemorrhagic) up to December 31, 2014, defined as first-ever hospital contact. The full residential address histories since 1970 were obtained for each participant and the annual means of air pollutants (particulate matter with diameter < 2.5 µm and < 10 µm (PM2.5 and PM10), nitrogen dioxide (NO2), nitrogen oxides (NOx)) and road traffic noise were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals (CI)) for the associations of one-, three, and 23-year running mean of air pollutants with stroke adjusting for potential confounders and noise. In fully adjusted models, the HRs (95% CI) per interquartile range increase in one-year running mean of PM2.5 and overall, ischemic, and hemorrhagic stroke were 1.12 (1.01-1.25), 1.13 (1.01-1.26), and 1.07 (0.80-1.44), respectively, and remained unchanged after adjustment for noise. Long-term exposure to ambient PM2.5 was associated with the risk of stroke independent of road traffic noise.
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Affiliation(s)
- Heresh Amini
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amar Mehta
- Statistics Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Statistics Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Westendorp
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine; Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Steffen Loft
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tom Cole-Hunter
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Air Pollution, Energy, and Health Research, University of New South Wales, Sydney, NSW, Australia; International Laboratory for Air Quality and Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Aarhus, Denmark; Global Centre for Clean Air Research (GCARE), University of Surrey, United Kingdom
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | | | | | - Camilla Geels
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Lise M Frohn
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | | | - Mette K Simonsen
- Diakonissestiftelsen, Frederiksberg, Denmark; The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sengupta K, Ersbøll AK, Christensen LB, Mortensen LH, Andersen I. Inequality, Familial Aggregation, and Risk Prediction of Caries in Siblings. JDR Clin Trans Res 2020; 6:448-457. [PMID: 32816616 DOI: 10.1177/2380084420951147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Social and family conditions are likely of great importance to dental health; however, limited evidence of familial aggregation of caries among adolescent siblings exists. Moreover, social and family-level factors have never been evaluated as isolated caries predictors at the individual level. OBJECTIVES The objectives were to evaluate socioeconomic patterning of caries among siblings, assess sibling-specific aggregation of caries within families, and examine if such aggregation differed by parental socioeconomic position (SEP). We also evaluated the discriminant ability of sibling caries, SEP, and other social and familial factors in predicting caries in cosiblings. METHODS This nationwide register-based study included all 15-y-olds in Denmark in 2003 (index siblings) and their biological siblings born within ±3 y (cosiblings). Clinical and sociodemographic data for each subject were compiled from Danish national dental, social, and population registers. Caries was measured by the decayed, missing, and filled tooth surfaces (DMFS) index. Predictors included SEP (parental education, income, and occupational social class), gender, birth order, immigration status, and household type. Adjusted SEP-caries associations were estimated using negative binomial regression. Familial aggregation was evaluated using adjusted pairwise odds ratios from alternating logistic regressions. Caries prediction was based on classification and regression tree (CART) analyses. RESULTS The study included 23,847 sibling pairs (n = 47,694). Socioeconomic patterning of caries was similar among the index and cosiblings with significant graded SEP-caries associations. Significant sibling-specific aggregation of caries was observed; cosiblings of caries-affected index siblings had odds of having caries 3.9 times (95% confidence interval: 3.65-4.18) as high as that of cosiblings with caries-free index siblings. This sibling similarity was stronger in socioeconomically disadvantaged families (adjusted pairwise odds ratios: 3.08-5.47). CART revealed index sibling caries as the single most important caries predictor, with caries predicted in ≥84% of cosiblings of adolescents with ≥3 carious tooth surfaces. CONCLUSIONS Caries in a sibling should prompt preventive family-based approaches targeting cosiblings. KNOWLEDGE TRANSFER STATEMENT This study revealed significant socioeconomic patterning of caries in adolescent siblings. Prediction modeling indicated that the single most important caries predictor among cosiblings was index sibling caries. Information on sibling caries level should be routinely combined with clinical evaluation to identify children at risk. Moreover, information on social and family conditions should be used to target prevention and health promotion at the school or municipal level. These approaches could possibly contribute to reducing the existing caries inequalities.
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Affiliation(s)
- K Sengupta
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A K Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L B Christensen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L H Mortensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - I Andersen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Mortensen LH, Cnattingius S, Gissler M, Klungsøyr K, Skjaerven R, Nybo Andersen AM, Nielsen HS. Sex of the first-born and obstetric complications in the subsequent birth. A study of 2.3 million second births from Denmark, Finland, Norway, and Sweden. Acta Obstet Gynecol Scand 2020; 99:1381-1386. [PMID: 32304226 DOI: 10.1111/aogs.13872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Studies have shown associations between a first-born boy and increased risks of pregnancy loss, stillbirth, decreased birthweight, and preterm birth in subsequent pregnancies, but with limited precision. MATERIAL AND METHODS We examined associations between sex of the first-born and obstetric complications in second births. We calculated the relative risks (RR)s of preeclampsia/eclampsia, placental abruption, stillbirth, and preterm birth in approximately 2.3 million second births comparing women with a preceding first-born boy to those with a first-born girl using the Medical Birth Registries of Denmark, Finland, Norway, and Sweden 1980-2008. RESULTS In second births following a first-born boy rather than a girl, the RR was 4% higher for preeclampsia/eclampsia (RR = 1.04, 95% CI 1.02-1.06), 9% higher for placental abruption (RR = 1.09, 95% CI 1.05-1.13), 9% higher for stillbirth (RR = 1.09, 95% CI 1.04-1.14), and 8% higher for preterm birth (RR = 1.08, 95% CI 1.07-1.09). The population attributable risks ranged from 2% to 4.5%. CONCLUSIONS Male sex of the first-born is associated with small increases in risks of obstetric complications in the second birth. Exploration of the underlying mechanisms is needed to increase our knowledge and treatment options for these serious obstetric complications.
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Affiliation(s)
- Laust H Mortensen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Rolv Skjaerven
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henriette S Nielsen
- Department of Obstetric and Gynecology, Hvidovre Hospital, University Hospital Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bruckner TA, Lebreton É, Perrone N, Mortensen LH, Blondel B. Preterm birth and selection in utero among males following the November 2015 Paris attacks. Int J Epidemiol 2019; 48:1614-1622. [DOI: 10.1093/ije/dyz089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Background
On 13 November 2015, coordinated terrorist attacks swept through Paris. This large stressor, like earlier terrorist attacks in the USA, may have perturbed the health of pregnant women. We test whether the attacks preceded an increase in the risk of preterm parturition among live-born males as well as excess male loss in utero. We focused on males on the basis of previous findings of elevated male frailty following population stressors.
Methods
We examined live births in the Paris region (n = 1 049 057) over 70 months, from January 2011 to October 2016. Interrupted time-series methods identified and removed serial correlation in the monthly risk of preterm birth; these methods employed non-linear least-squares estimation. We also repeated analyses using month of conception, and performed sensitivity tests among females as well as among male births outside Paris.
Results
Males exhibited an elevated incidence of preterm birth in November 2015 and January 2016 [risk difference for November 2015 = 0.006, 95% confidence interval (CI): 0.0002—0.012; risk difference for January 2016 = 0.010, 95% CI: 0.004—0.016], which equates to an 11% increase in the count of preterm births. Females, as well as males born outside Paris, showed no change in preterm delivery. The sex ratio also fell below expected values in December 2015, January 2016 and February 2016.
Conclusions
Among males, more preterm births, but fewer live births, occurred after the November 2015 Paris attacks. Future examinations of perinatal health responses to unexpected stressors may benefit from sex-specific analyses.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California at Irvine, Irvine, CA, USA
| | - Élodie Lebreton
- Perinat-ARS-IDF, Agence Régionale de Santé d'Île-de-France, Paris, France
| | - Natalie Perrone
- Department of Sociology, New York University, New York, NY, USA
| | - Laust H Mortensen
- Department of Social Medicine, and Statistics Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Béatrice Blondel
- INSERM U1153, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
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Bruckner TA, Singh P, Mortensen LH, Løkke A. The stillbirth sex ratio as a marker of population health among live‐born males in Denmark, 1835‐1923. Am J Hum Biol 2019; 31:e23241. [DOI: 10.1002/ajhb.23241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/17/2019] [Accepted: 03/09/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tim A. Bruckner
- Program in Public Health University of California, Irvine Irvine California
| | - Parvati Singh
- Program in Public Health University of California, Irvine Irvine California
| | | | - Anne Løkke
- Department of History/Saxo Institute University of Copenhagen Copenhagen Denmark
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Thisted DLA, Mortensen LH, Hvidman L, Krebs L. Operative technique at caesarean delivery and risk of complete uterine rupture in a subsequent trial of labour at term. A registry case-control study. PLoS One 2017; 12:e0187850. [PMID: 29136026 PMCID: PMC5685606 DOI: 10.1371/journal.pone.0187850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/29/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To estimate the relation of single-layer closure at previous caesarean delivery, and other pre-labour and intra-partum risk factors for complete uterine rupture in trial of vaginal birth after a caesarean (TOLAC) at term. Study design Population-based case-control study. We identified all women (n = 39 742) recorded in the Danish Medical Birth Registry (DMBR) during a 12-year period (1997–2008) with a singleton pregnancy at term and TOLAC. Among these, all women with a complete uterine rupture were identified (cases). Information from the registry was validated against medical records. Controls were selected in the DMBR as the following two births with TOLAC at term and no uterine rupture. Detailed information from cases and controls was collected from manual review of medical records. Main outcome measure was complete uterine rupture during TOLAC at term. Results Upon validation, 175 cases and 272 controls met the above criteria. After adjustment for possible confounding factors there was no association between single layer closure and uterine rupture (aOR 1.38, CI: 0.88–2.17). Significant risk factors were: Induction with an unfavourable cervix (aOR 2.10 CI: 1.19–3.71), epidural (aOR 2.17 CI 1.31–3.57), augmentation by oxytocin for more than one hour (aOR 2.03 CI: 1.20–3.44), and birth weight ≥ 4000g (aOR 2.65 CI 1.05–6.64). Previous vaginal delivery (aOR 0.41 CI: 0.25–0.68) and inter-delivery interval of more than 24 months (aOR 0.38 CI: 0.18–0.78) reduced the risk of uterine rupture. Conclusion Single-layer uterine closure did not remain significantly associated to uterine rupture during TOLAC at term after adjustment for confounding factors. Induction of labour with an unfavourable cervix, birth weight ≥ 4000g and indicators of prolonged labour were all major risk factors for uterine rupture.
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Affiliation(s)
- Dorthe L. A. Thisted
- Fetal Medicine Unit. Department of Gynaecology and Obstetrics, University of Copenhagen, Hvidovre Hospital, Kettegaard Alle 30, Hvidovre, Denmark
- * E-mail:
| | - Laust H. Mortensen
- Methods and Analysis, Statistics Denmark, Sejeroegade 11, Copenhagen, Denmark
- Section of Social Medicine, University of Copenhagen, Oester Farimagsgade Copenhagen, Denmark
| | - Lone Hvidman
- Department of Obstetrics and Gynaecology Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Lone Krebs
- Department of Gynaecology and Obstetrics, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark
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Pedersen ESL, Mortensen LH, Brage S, Bjerregaard AL, Aadahl M. Criterion validity of the Physical Activity Scale (PAS2) in Danish adults. Scand J Public Health 2017; 46:726-734. [PMID: 29081247 DOI: 10.1177/1403494817738470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Physical Activity Scale (PAS2) was developed to measure physical activity (PA) during work, transportation and leisure time, in the Danish adult population. The objective of this study was to assess the criterion validity of PAS2 against a combined accelerometer and heart rate monitor in Danish adults and to investigate if the criterion validity differed by socio-demographic factors and body mass index. METHOD A total of 330 Danish adults (mean age = 46.7 years, 38.5% men) participating in the Health2008 study completed the PAS2 questionnaire and wore a combined accelerometer and heart rate sensor for seven days. Average daily estimates from PAS2 were categorised into time spent in sedentary behaviour, light PA, moderate PA and vigorous PA and were compared to the objective measures. RESULTS PAS2 accounted for 19.5 hours/day on average. Time spent in sedentary behaviour, light and moderate-intensity PA was weakly correlated with objective data (polychoric correlation coefficients (PCC): 0.18-0.20), whereas vigorous intensity PA was moderately correlated (PCC: 0.54, p = 0.04). Mean bias was -2.3 hours/day (95% limits of agreement (LoA): -9.04 to 4.34) for sedentary behaviour, 1.68 hours/day (LoA: 8.02 to -4.62) for light activity, 0.55 hours/day (LoA: 3.37 to -2.26) for moderate activity and 0.12 hours/day (LoA: 0.57 to 0.33) for vigorous activity. Criterion validity was lower in women, in participants who were above 40 years, overweight, had short education and were unemployed. CONCLUSIONS PAS2 overestimated time spent on light, moderate and vigorous intensity PA and underestimated time spent on sedentary behaviour. Validity differed by key socio-demographic characteristics.
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Affiliation(s)
- E S L Pedersen
- 1 Institute of Social and Preventive Medicine, University of Bern, Switzerland.,2 Research Centre for Prevention and Health, Rigshospitalet, Glostrup, Denmark
| | - L H Mortensen
- 3 Section of Social Medicine, University of Copenhagen, Denmark.,4 Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - S Brage
- 5 MRC Epidemiology Unit, University of Cambridge, UK
| | - A L Bjerregaard
- 6 Section of General Practice, Department of Public Health, Aarhus University, Denmark
| | - M Aadahl
- 2 Research Centre for Prevention and Health, Rigshospitalet, Glostrup, Denmark.,7 Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Knudsen KB, Pressler T, Mortensen LH, Jarden M, Skov M, Quittner AL, Katzenstein T, Boisen KA. Erratum to: Associations between adherence, depressive symptoms and health-related quality of life in young adults with cystic fibrosis. Springerplus 2017; 5:2119. [PMID: 28820914 PMCID: PMC5451372 DOI: 10.1186/s40064-017-3789-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
[This corrects the article DOI: 10.1186/s40064-016-2862-5.].
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Affiliation(s)
- K B Knudsen
- The Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - T Pressler
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L H Mortensen
- The Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Jarden
- The Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The University Hospital Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Skov
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A L Quittner
- Department of Psychology, University of Miami, Coral Gables, FL USA
| | - T Katzenstein
- The Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - K A Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Kjøllesdal MKR, Ariansen I, Mortensen LH, Næss Ø. The importance of early life family factors in the association between cardiovascular risk factors and early cardiovascular mortality. Open Heart 2017; 4:e000608. [PMID: 28878947 PMCID: PMC5574457 DOI: 10.1136/openhrt-2017-000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/24/2017] [Accepted: 06/13/2017] [Indexed: 11/10/2022] Open
Abstract
Objective To explore the importance of early life factors shared by siblings, such as parental socioeconomic position, parental practices, housing and neighbourhood, for the association between cardiovascular disease (CVD) risk factors and mortality from CVD, ischaemic heart disease (IHD) and cerebrovascular disease. Methods Norwegian health surveys (1974–2003) were linked with data from the Norwegian Family Based Life Course Study and the Cause of Death Registry. Participants with at least one full sibling among survey participants (n=2 71 643) were included. Data on CVD risk factors, body mass index (BMI), height, systolic blood pressure (SBP) and total cholesterol (TC) were stratified into ‘low’, ‘medium’ and ‘high’ risk, and smoking to ‘daily smoking’ and ‘not daily smoking’. Results Mean age of participants was 41 years, mean follow-up time was 19 years and during follow-up 2512 died from CVD. For each category of increased risk factor level, the per step HR of CVD mortality was increased by 1.91 (95% CI 1.78 to 2.05) for SBP, 1.67 (1.58 to 1.76) for TC, 1.44 (1.36 to 1.53) for BMI, 1.26 (1.18 to 1.35) for height and 2.89 (2.66 to 3.14) for smoking. In analyses where each sibship (groups of full siblings) had a group-specific baseline hazard, these associations were attenuated to 1.74, 1.51, 1.29, 1.18 and 2.63, respectively. The associations between risk factors and IHD mortality followed the same pattern. Conclusion Early life family factors explained a small part of the association between risk factors and mortality from CVD and IHD in a relatively young sample.
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Affiliation(s)
- Marte K R Kjøllesdal
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Inger Ariansen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Laust H Mortensen
- Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Abstract
Increased mortality has been observed in mothers and fathers with male offspring but little is known regarding specific diseases. In a register linkage we linked women born 1925–1954 having survived to age 50 (n = 661,031) to offspring and fathers (n = 691,124). Three approaches were used: 1) number of total boy and girl offspring, 2) sex of the first and second offspring and 3) proportion of boys to total number of offspring. A sub-cohort (n = 50,736 mothers, n = 44,794 fathers) from survey data was analysed for risk factors. Mothers had increased risk of total and cardiovascular mortality that was consistent across approaches: cardiovascular mortality of 1.07 (95% CI: 1.03–1.11) per boy (approach 2), 1.04 (1.01–1.07) if the first offspring was a boy, and 1.06 (1.01–1.10) if the first two offspring were boys (approach 3). We found that sex of offspring was not associated with total or cardiovascular mortality in fathers. For other diseases or risk factors no robust associations were seen in mothers or fathers. Increased cardiovascular risk in mothers having male offspring suggests a maternal disease specific mechanism. The lack of consistent associations on measured risk factors could suggest other biological pathways than those studied play a role in generating this additional cardiovascular risk.
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Affiliation(s)
- Øyvind Næss
- Epidemiological Division, National Institute of Public Health, Oslo, Norway. .,Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Laust H Mortensen
- Department of Public Health, University of Copenhagen, København, Denmark
| | - Åse Vikanes
- Epidemiological Division, National Institute of Public Health, Oslo, Norway.,The Intervention Center, Oslo University Hospital, Oslo, Norway
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, School of Social and Community Medicine, Bristol, UK
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Bruckner TA, Mortensen LH, Catalano RA. Social and demographic drivers of trend and seasonality in elective abortions in Denmark. BMC Pregnancy Childbirth 2017; 17:214. [PMID: 28676084 PMCID: PMC5496190 DOI: 10.1186/s12884-017-1397-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elective abortions show a secular decline in high income countries. That general pattern, however, may mask meaningful differences-and a potentially rising trend-among age, income, and other racial/ethnic groups. We explore these differences in Denmark, a high-income, low-fertility country with excellent data on terminations and births. METHODS We examined monthly elective abortions (n = 225,287) from 1995 to 2009, by maternal age, parity, income level and mother's country of origin. We applied time-series methods to live births as well as spontaneous and elective abortions to approximate the denominator of pregnancies at risk of elective abortion. We used linear regression methods to identify trend and seasonal patterns. RESULTS Despite an overall declining trend, teenage women show a rising proportion of pregnancies that end in an elective termination (56% to 67%, 1995 to 2009). Non-Western immigrant women also show a slight increase in incidence. Heightened economic disadvantage among non-Western immigrant women does not account for this rise. Elective abortions also show a sustained "summer peak" in June, July and August. Low-income women show the most pronounced summer peak. CONCLUSIONS Identification of the causes of the increase over time in elective abortion among young women, and separately among non-Western immigrant women, represents key areas of further inquiry. The unexpected increase over time in elective abortions among teens and non-Western immigrants in Denmark may signal important social and cultural impediments to contraception. The summer peak in abortions among low-income women, moreover, conflicts with the conventional assumption that the social and demographic composition of mothers who electively end their pregnancy remains stable within a calendar year.
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Affiliation(s)
- Tim A Bruckner
- Public Health, University of California, Irvine, 635 E. Peltason Dr, Irvine, CA, 92697-7075, USA.
| | - Laust H Mortensen
- Department of Social Medicine, and Statistics Denmark, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, København K, Denmark
| | - Ralph A Catalano
- Public Health, University of California, Berkeley, 50 University Hall, Berkeley, CA, 94720, USA
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Mortensen LH, Torssander J. Family of origin and educational inequalities in mortality: Results from 1.7 million Swedish siblings. SSM Popul Health 2017; 3:192-200. [PMID: 29349216 PMCID: PMC5768994 DOI: 10.1016/j.ssmph.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 12/29/2022] Open
Abstract
Circumstances in the family of origin have short- and long-term consequences for people's health. Family background also influences educational achievements - achievements that are clearly linked to various health outcomes. Utilizing population register data, we compared Swedish siblings with different levels of education (1,732,119 individuals within 662,095 sibships) born between 1934 and 1959 and followed their death records until the end of 2012 (167,932 deaths). The educational gradient in all-cause mortality was lower within sibships than in the population as a whole, an attenuation that was strongest at younger ages (< 50 years of age) and for those with a working class or farmer background. There was substantial variation across different causes of death with clear reductions in educational inequalities in, e.g., lung cancer and diabetes, when introducing shared family factors, which may indicate that part of the association can be ascribed to circumstances that siblings have in common. In contrast, educational inequalities in suicide and, for women, other mental disorders increased when adjusting for factors shared by siblings. The vast variation in the role of childhood conditions for the education-mortality association may help us to further understand the interplay between family background, education, and mortality. The increase in the education gradient in suicide when siblings are compared may point towards individually oriented explanations ('non-shared environment'), perhaps particularly in mental disorders, while shared family factors primarily seem to play a more important role in diseases in which health behaviors are most significant.
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Affiliation(s)
- Laust H Mortensen
- Statistics Denmark and Department of Public Health, University of Copenhagen, Denmark
| | - Jenny Torssander
- Swedish Institute for Social Research, Stockholm University, Sweden
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Mortensen LH, Rehnberg J, Dahl E, Diderichsen F, Elstad JI, Martikainen P, Rehkopf D, Tarkiainen L, Fritzell J. Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003. BMJ Open 2016; 6:e010974. [PMID: 28011804 PMCID: PMC5223725 DOI: 10.1136/bmjopen-2015-010974] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Prior work has examined the shape of the income-mortality association, but work has not compared gradients between countries. In this study, we focus on changes over time in the shape of income-mortality gradients for 4 Nordic countries during a period of rising income inequality. Context and time differentials in shape imply that the relationship between income and mortality is not fixed. SETTING Population-based cohort study of Denmark, Finland, Norway and Sweden. PARTICIPANTS We collected data on individuals aged 25 or more in 1995 (n=12.98 million individuals, 0.84 million deaths) and 2003 (n=13.08 million individuals, 0.90 million deaths). We then examined the household size equivalised disposable income at the baseline year in relation to the rate of mortality in the following 5 years. RESULTS A steep income gradient in mortality in men and women across all age groups except the oldest old in Denmark, Finland, Norway and Sweden. From the 1990s to 2000s mortality dropped, but generally more so in the upper part of the income distribution than in the lower part. As a consequence, the shape of the income gradient in mortality changed. The shift in the shape of the association was similar in all 4 countries. CONCLUSIONS A non-linear gradient exists between income and mortality in most cases and because of a more rapid mortality decline among those with high income the income gradient has become steeper over time.
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Affiliation(s)
- Laust H Mortensen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Johan Rehnberg
- Centre for Health Equity Studies (CHESS), Karolinska Institutet and Stockholm University, Sweden
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Espen Dahl
- HiOA, Oslo and Akershus University College, Oslo, Norway
| | - Finn Diderichsen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Pekka Martikainen
- Centre for Health Equity Studies (CHESS), Karolinska Institutet and Stockholm University, Sweden
- Population Research Unit, University of Helsinki, Helsinki, Finland
- The Max Planck Institute for Demographic Research, Rostock, Germany
| | - David Rehkopf
- General Medical Disciplines, Stanford University, USA
| | - Lasse Tarkiainen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Nielsen HB, Ovesen LL, Mortensen LH, Lau CJ, Joensen LE. Type 1 diabetes, quality of life, occupational status and education level - A comparative population-based study. Diabetes Res Clin Pract 2016; 121:62-68. [PMID: 27662040 DOI: 10.1016/j.diabres.2016.08.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 08/17/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022]
Abstract
AIM Type 1 diabetes requires extensive self-management to avoid complications and may have negative effects on the everyday life of people with the disease. The aim of this study was to compare adults with type 1 diabetes to the general population in terms of health-related quality of life, occupational status (level of employment, working hours and sick leave) and education level. METHODS 2415 adults (aged 18-98years) with type 1 diabetes were compared to 48,511 adults (aged 18-103years) from the general population. Data were obtained from two cross-sectional surveys conducted in 2010 and 2011 of adults living or treated in the Capital Region in Denmark. Differences between adults with type 1 diabetes and the general population were standardised for age and sex and analyzed using linear probability models and negative binomial regression. Differences were further analyzed in subgroups. RESULTS Compared to the general population, adults with type 1 diabetes experienced lower health-related quality of life, were more frequently unemployed, had more sick leave per year and were slightly better educated. Differences in health-related quality of life and employment increased with age and were larger among women, as compared to men. No significant differences were found with regard to working hours. CONCLUSION Our findings suggest that type 1 diabetes is associated with lower health-related quality of life, higher unemployment and additional sick leave. The negative association with type 1 diabetes is more pronounced in women and older adults.
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Affiliation(s)
- Helena B Nielsen
- Steno Diabetes Center, Gentofte, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Louise L Ovesen
- Steno Diabetes Center, Gentofte, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Laust H Mortensen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; Analysis and Methods, Statistics Denmark, Copenhagen, Denmark
| | - Cathrine J Lau
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
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Kjøllesdal MKR, Ariansen I, Mortensen LH, Davey Smith G, Næss Ø. Educational differences in cardiovascular mortality: The role of shared family factors and cardiovascular risk factors. Scand J Public Health 2016; 44:744-750. [PMID: 27655782 DOI: 10.1177/1403494816669427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). METHODS Data from national and regional health surveys in Norway (1974-2003) were linked with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants ( n=271,310). Data were available on CVD risk factors, including weight, height, blood pressure, total cholesterol and smoking. RESULTS The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98-3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors, the HR for CVD mortality in the cohort analyses was 2.05 (CI 1.77-2.37) in the lowest educational group relative to the highest. The respective HR in the within-sibship analyses was 2.46 (CI 1.48-2.24). CONCLUSIONS Using a sibling design, we did not find that the association between education and CVD mortality was confounded by early life factors shared by siblings, but it was explained to a large extent by CVD risk factors. These results suggest that reducing levels of CVD risk factors could have the greatest effect on mortality in less well-educated people.
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Affiliation(s)
| | - I Ariansen
- 2 Norwegian Institute of Public Health, Norway
| | | | - G Davey Smith
- 4 MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Ø Næss
- 1 Institute of Health and Society, University of Oslo, Norway.,2 Norwegian Institute of Public Health, Norway
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46
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Knudsen KB, Pressler T, Mortensen LH, Jarden M, Skov M, Quittner AL, Katzenstein T, Boisen KA. Associations between adherence, depressive symptoms and health-related quality of life in young adults with cystic fibrosis. Springerplus 2016; 5:1216. [PMID: 27516954 PMCID: PMC4967055 DOI: 10.1186/s40064-016-2862-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/18/2016] [Indexed: 02/08/2023]
Abstract
Background Cystic fibrosis (CF) is a life shortening disease, however prognosis has improved and the adult population is growing. Most adults with cystic fibrosis live independent lives and balance the demands of work and family life with a significant treatment burden. The aim of this study was to examine the relationships among treatment adherence, symptoms of depression and health-related quality of life (HRQoL) in a population of young adults with CF. Methods We administered three standardized questionnaires to 67 patients with CF aged 18–30 years; Morisky Medication Adherence Scale, Major Depression Inventory, and Cystic Fibrosis Questionnaire-Revised. Results There was a response rate of 77 % and a majority of the young adults (84 %) were employed or in an education program. Most participants (74 %) reported low adherence to medications. One third (32.8 %) of the participants reported symptoms of depression. HRQoL scores were especially low on Vitality and Treatment Burden, and symptoms of depression were associated with low HRQoL scores (p < 0.01) with medium to large deficits across on all HRQoL domains (Cohen’s d 0.60–1.72) except for the domain treatment burden. High depression symptom scores were associated with low adherence (r = −0.412, p < 0.001). Conclusions Despite improved physical health, many patients with CF report poor adherence, as well as impaired mental wellbeing and HRQoL. Thus, more attention to mental health issues is needed.
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Affiliation(s)
- K B Knudsen
- The Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - T Pressler
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - L H Mortensen
- The Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M Jarden
- The Department of Public Health, University of Copenhagen, Copenhagen, Denmark ; The University Hospital Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M Skov
- Cystic Fibrosis Center Copenhagen, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A L Quittner
- Department of Psychology, University of Miami, Coral Gables, FL USA
| | - T Katzenstein
- The Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - K A Boisen
- Center of Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Bruckner TA, Mortensen LH, Catalano RA. Bruckner et al. Respond to "Preventable Pregnancy Loss Is a Public Health Problem". Am J Epidemiol 2016; 183:713-4. [PMID: 27009346 DOI: 10.1093/aje/kww005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 11/14/2022] Open
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Bruckner TA, Mortensen LH, Catalano RA. Spontaneous Pregnancy Loss in Denmark Following Economic Downturns. Am J Epidemiol 2016; 183:701-8. [PMID: 27009344 DOI: 10.1093/aje/kww003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/27/2015] [Indexed: 11/13/2022] Open
Abstract
An estimated 11%-20% of clinically recognized pregnancies result in spontaneous abortion. The literature finds elevated risk of spontaneous abortion among women who report adverse financial life events. This work suggests that, at the population level, national economic decline-an ambient and plausibly unexpected stressor-will precede an increase in spontaneous abortion. We tested this hypothesis using high-quality information on pregnancy and spontaneous loss for all women in Denmark. We applied time-series methods to monthly counts of clinically detected spontaneous abortions (n = 157,449) and the unemployment rate in Denmark beginning in January 1995 and ending in December 2009. Our statistical methods controlled for temporal patterns in spontaneous abortion (e.g., seasonality, trend) and changes in the population of pregnancies at risk of loss. Unexpected increases in the unemployment rate preceded by 1 month a rise in the number of spontaneous abortions (β = 33.19 losses/month, 95% confidence interval: 8.71, 57.67). An attendant analysis that used consumption of durable household goods as an indicator of financial insecurity supported the inference from our main test. Changes over time in elective abortions and in the cohort composition of high-risk pregnancies did not account for results. It appears that in Denmark, ambient stressors as common as increasing unemployment may precede a population-level increase in spontaneous abortion.
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Catalano R, Bruckner TA, Karasek D, Adler NE, Mortensen LH. Shared risk aversion in spontaneous and induced abortion. Hum Reprod 2016; 31:1113-9. [PMID: 26965433 DOI: 10.1093/humrep/dew031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does the incidence of spontaneous abortion correlate positively over conception cohorts with the incidence of non-clinically indicated induced abortion as predicted by shared risk aversion? SUMMARY ANSWER We find that the number of spontaneous and non-clinically indicated induced abortions correlates in conception cohorts, suggesting that risk aversion affects both the conscious and non-conscious mechanisms that control parturition. WHAT IS KNOWN ALREADY Much literature speculates that natural selection conserved risk aversion because the trait enhanced Darwinian fitness. Risk aversion, moreover, supposedly influences all decisions including those that individuals can and cannot report making. We argue that these circumstances, if real, would manifest in conscious and non-conscious decisions to invest in prospective offspring, and therefore affect incidence of induced and spontaneous abortion over time. STUDY DESIGN, SIZE, DURATION Using data from Denmark, we test the hypothesis that monthly conception cohorts yielding unexpectedly many non-clinically indicated induced abortions also yield unexpectedly many spontaneous abortions. The 180 month test period (January 1995 through December 2009), yielded 1 351 800 gestations including 156 780 spontaneous as well as 233 280 induced abortions 9100 of which were clinically indicated. PARTICIPANTS/MATERIALS, SETTING, METHODS We use Box-Jenkins transfer functions to adjust the incidence of spontaneous and non-clinically indicated induced abortions for autocorrelation (including seasonality), cohort size, and fetal as well as gestational anomalies over the 180-month test period. We use cross-correlation to test our hypothesized association. MAIN RESULTS AND THE ROLE OF CHANCE We find a positive association between spontaneous and non-clinically indicated induced abortions. This suggests, consistent with our theory, that mothers of conception cohorts that yielded more spontaneous abortions than expected opted more frequently than expected for non-clinically indicated induced abortion. LIMITATIONS, REASONS FOR CAUTION Limitations of our work include that even the world's best registration system will not capture all spontaneous abortions and that results may not generalize beyond Denmark. WIDER IMPLICATIONS OF THE FINDINGS Our findings imply that abortion, intentional or 'spontaneous,' follows from a woman's estimate, made consciously or otherwise, of the costs and benefits of extending gestation given characteristics of the prospective offspring, likely environmental circumstances at birth, and maternal resources. STUDY FUNDING/COMPETING INTERESTS The Robert Wood Johnson Health and Society Scholars Program funded the research described in this manuscript. None of the authors has any conflict of interest to declare.
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Affiliation(s)
- Ralph Catalano
- School of Public Health, University of California, Berkeley, CA 94704, USA
| | - Tim A Bruckner
- Public Health & Planning, Policy and Design, University of California, Irvine, CA 92697, USA
| | - Deborah Karasek
- School of Public Health, University of California, Berkeley, CA 94704, USA
| | - Nancy E Adler
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA 94118, USA
| | - Laust H Mortensen
- Department of Social Medicine, University of Copenhagen, 1017 Copenhagen, Denmark
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Thisted DLA, Mortensen LH, Krebs L. Uterine rupture without previous caesarean delivery: a population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2015; 195:151-155. [PMID: 26544026 DOI: 10.1016/j.ejogrb.2015.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/30/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine incidence and patient characteristics of women with uterine rupture during singleton births at term without a previous caesarean delivery. STUDY DESIGN Population based cohort study. Women with term singleton birth, no record of previous caesarean delivery and planned vaginal delivery (n=611,803) were identified in the Danish Medical Birth Registry (1997-2008). Medical records from women recorded with uterine rupture during labour were reviewed to ascertain events of complete uterine rupture. Relative Risk (RR) and adjusted Relative Risk Ratio (aRR) of complete uterine rupture with 95% confidence intervals (95% CI) were ascertained according to characteristics of the women and of the delivery. RESULTS We identified 20 cases with complete uterine rupture. The incidence of complete uterine rupture among women without previous caesarean delivery was about 3.3/100,000 deliveries. Multiparity (RR 8.99 (95% CI 1.86-43.29)), induction of labour (RR 3.26 (95% CI 1.24-8.57)), epidural analgesia (RR 10.78 (95% CI 4.25-27.39)), and augmentation by oxytocin (RR 9.50 (95% CI 3.15-28.63)) were associated with uterine rupture. Induction of labour was not significantly related to uterine rupture when adjusted for parity, epidural analgesia and augmentation by oxytocin. CONCLUSION Although uterine rupture is rare, its association with epidural analgesia and augmentation of labour with oxytocin in multipara should be considered. Thus, vigilance should be exercised when labour is obstructed and there is need for epidural analgesia and/or augmentation by oxytocin in multiparous women. Due to the rare occurrence of uterine rupture caution should be exerted when interpreting the findings of this study.
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Affiliation(s)
- Dorthe L A Thisted
- Department of Gynaecology and Obstetrics, University of Copenhagen, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark.
| | - Laust H Mortensen
- Section of Social Medicine, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Lone Krebs
- Department of Gynaecology and Obstetrics, University of Copenhagen, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark
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