PURPOSE: Elderly patients with colorectal cancer undergo surgery with curative intent less frequently than younger patients, and survival declines with increasing age. We compared relative survival of colorectal cancer among patients older than 75 years with that of younger patients in Denmark during the period 1977 to 1999. We also examined trends in choice of initial treatment. METHODS: From the files of the nationwide population-based Danish Cancer Registry, we identified all cases of colorectal cancer diagnosed between 1977 and 1999. We then linked this data to information on survival obtained from the Danish Register of Causes of Death and from the Central Population Register. RESULTS: During the entire study period, short-term and long-term relative survival improved for patients of all ages, but the improvement was more pronounced among elderly patients (>75 years). Radical resection was increasingly chosen as the initial treatment for elderly patients; during the 1995 to 1999 period it was performed on approximately 50 percent of such patients, almost as frequently as among younger patients. CONCLUSIONS: Relative survival of elderly colorectal cancer patients (>75 years) improved in Denmark between 1977 and 1999. In the most recent period studied, 1995 to 1997, only minor differences in five-year relative survival were observed among younger, middle-aged, and elderly patients. A simultaneous increase in the rate of radical resection among elderly patients, reflecting more effective treatment, may underlie this finding.
There is increasing evidence that inflammation plays an important role in atherosclerosis. Such inflammation is likely related to the presence of infectious organisms. Hence, we examined whether the use of antibiotic drugs decreases the risk of first-time myocardial infarction (MI). We identified 6737 cases of first-time hospitalization for MI, and 67,364 age- and gender-matched, population-based controls during 1991-2002, using data from the County Hospital Discharge Registry and the Civil Registration System of North Jutland County, Denmark. All prescriptions for antibiotics prior to the hospitalization for MI were identified through a prescription database. Conditional logistic regression was used to estimate odds ratios (OR) associated with antibiotic use, adjusted for potential confounding factors including previous discharge diagnoses of hypertension, chronic bronchitis and emphysema, alcoholism, liver cirrhosis, or diabetes mellitus and prescriptions for anti-hypertensive drugs, antidiabetic drugs, lipid-lowering agents, high-dose aspirin, platelet inhibitors, oral anticoagulants, or hormone replacement therapy. The use of any one type of antibiotic in the 3 years before hospitalization was not associated with a decreased risk of MI; the adjusted ORs with corresponding 95% confidence intervals were 1.07, 1.00-1.14 for penicillins; 1.15, 1.00-1.33 for macrolides; 0.95, 0.65-1.39 for tetracyclines; 1.25, 0.84-1.87 for quinolones; and 0.95, 0.80-1.12 for sulfonamides. A slight increase in the risk of MI was seen with the use of more than one type of antibiotic in the preceding 3 years (OR = 1.17, 95% CI = 1.09-1.27). Our findings do not support the hypothesis that the use of antibiotics is associated with a lower risk of first-time MI.
PURPOSE: Several studies have found an increased risk of myocardial infarction among depressed patients. Selective serotonin reuptake inhibitors (SSRIs) appear to lack the arrhythmic adverse effects of tricyclic antidepressants, and are thought to inhibit platelet aggregation. We examined whether use of different antidepressant classes is associated with a lower risk of first-time hospitalization for myocardial infarction, as compared with nonuse. METHODS: We identified 8887 cases of first-time hospitalization for myocardial infarction and 88,862 age- and sex-matched population-based controls during 1994-2002, using data from North Jutland County, Denmark. Cases and controls were stratified according to history of cardiovascular disease. All prescriptions for antidepressants before hospitalization for myocardial infarction were identified using a prescription database. Conditional logistic regression was used to estimate odds ratios of myocardial infarction associated with antidepressant use, adjusted for possible confounding factors. RESULTS: In patients with a history of cardiovascular disease, we found indications of a lower risk of myocardial infarction among those who used SSRIs (adjusted odds ratio [OR] = 0.85; 95% confidence interval [CI]: 0.62 to 1.16), nonselective serotonin reuptake inhibitors (adjusted OR = 0.83; 95% CI: 0.50 to 1.38), and other antidepressants (adjusted OR = 0.55; 95% CI: 0.31 to 0.97). There were no such associations among persons without a history of cardiovascular disease. CONCLUSION: Antidepressant use may be associated with a decreased risk of hospitalization for myocardial infarction among persons with a history of cardiovascular disease, although it remains uncertain whether there are differences by class of antidepressant.
To study the risk of preterm birth, caesarean section, and small for gestational age after anti-tumor necrosis factor agent treatment (anti-TNF) in pregnancy.
Population-based study including women with inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, and their infants born 2006 to 2013 from the national health registers in Denmark, Finland, and Sweden. Women treated with anti-TNF were compared with women with nonbiologic systemic treatment. Adalimumab, etanercept, and infliximab were compared pairwise. Continuation of treatment in early pregnancy was compared with discontinuation. Odds ratios with 95% confidence intervals were calculated in logistic regression models adjusted for country and maternal characteristics.
Among 1 633 909 births, 1027 infants were to women treated with anti-TNF and 9399 to women with nonbiologic systemic treatment. Compared with non-biologic systemic treatment, women with anti-TNF treatment had a higher risk of preterm birth, odds ratio 1.61 (1.29-2.02) and caesarean section, 1.57 (1.35-1.82). The odds ratio for small for gestational age was 1.36 (0.96-1.92). In pairwise comparisons, infliximab was associated with a higher risk of severely small for gestational age for inflammatory joint and skin diseases but not for inflammatory bowel disease. Discontinuation of anti-TNF had opposite effects on preterm birth for inflammatory bowel disease and inflammatory joint and skin diseases.
Anti-TNF agents were associated with increased risks of preterm birth, caesarean section, and small for gestational age. However, the diverse findings across disease groups may indicate an association related to the underlying disease activity, rather than to agent-specific effects.
BACKGROUND: A depressed Apgar score at 5 minutes is a marker for perinatal insults, including neurologic damage. We examined the association between 5-minute Apgar score and the risk of epilepsy hospitalization in childhood. METHODS: Using records linked from population registries, we conducted a cohort study among singleton children born alive in the period 1978-2001 in North Jutland County, Denmark. The first hospital discharge diagnosis of epilepsy during the follow-up time was the main outcome. We followed each child for up to 12 years, calculated absolute risks and risk differences, and used a Poisson regression model to estimate risk ratios for epilepsy hospitalization. We adjusted risk ratio estimates for birth weight, gestational age, mode of delivery, birth presentation, mother's age at delivery, and birth defects. RESULTS: One percent of the 131,853 eligible newborns had a 5-minute Apgar score
Recent data suggest a reduced risk of malignant melanoma (MM) among atopic dermatitis (AD) patients, but an increased risk of other skin cancers (including basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]).
We examined the association between AD and skin cancers in a large cohort study in Denmark from 1977 through 2006.
Our cohort consisted of 31 330 AD patients recorded in the Danish National Patient Registry, including AD patients admitted to hospitals and specialized outpatient clinics. Linkage to the Danish Cancer Registry allowed ascertainment of skin cancers. We calculated standardized incidence ratios (SIRs) and associated 95% confidence intervals (CIs) by comparing the incidence rate of skin cancers among AD patients with that among the general Danish population.
The overall observed number of MM cases among AD patients was 12, with 21 expected, yielding a SIR of 0.59 (95% CI 0.30, 1.02), with the most pronounced protective effect among AD patients with more than 5 years of follow-up (SIR?=?0.46; 95% CI 0.19, 0.95). The corresponding SIRs for BCC and SCC were increased among AD patients (1.41 [95% CI 1.07, 1.83] and 2.48 [95% CI 1.00, 5.11], respectively).
Our findings support an inverse association between AD and MM, but an increased risk of BCC and SCC among AD patients.
Comparison of mortality among patients with positive and negative blood cultures may indicate the contribution of bacteremia to mortality. This study (1) compared mortality among patients with community-acquired bacteremia with mortality among patients with negative blood cultures and (2) determined the effects of bacteremia type and comorbidity level on mortality among patients with positive blood cultures.
This cohort study included 29,273 adults with blood cultures performed within the first 2 days following hospital admission to an internal medical ward in northern Denmark during 1995-2006. We computed product limit estimates and used Cox regression to compute adjusted mortality rate ratios (MRRs) within 0-2, 3-7, 8-30, and 31-180 days following admission for bacteremia patients compared to culture-negative patients.
Mortality in 2,648 bacteremic patients and 26,625 culture-negative patients was 4.8% vs. 2.0% 0-2 days after admission, 3.7% vs. 2.7% 3-7 days after admission, 5.6% vs. 5.1% 8-30 days after admission, and 9.7% vs. 8.7% 31-180 days after admission, corresponding to adjusted MRRs of 1.9 (95% confidence interval (CI): 1.6-2.2), 1.1 (95% CI: 0.9-1.5), 0.9 (95% CI: 0.8-1.1), and 1.0 (95% CI: 0.8-1.1), respectively. Mortality was higher among patients with Gram-positive (adjusted 0-2-day MRR 1.9, 95% CI: 1.6-2.2) and polymicrobial bacteremia (adjusted 0-2-day MRR 3.5, 95% CI: 2.2-5.5) than among patients with Gram-negative bacteremia (adjusted 0-2-day MRR 1.5, 95% CI 1.2-2.0). After the first 2 days, patients with Gram-negative bacteremia had the same risk of dying as culture-negative patients (adjusted MRR 0.8, 95% CI: 0.5-1.1). Only patients with polymicrobial bacteremia had increased mortality within 31-180 days following admission (adjusted MRR 1.3, 95% CI: 0.8-2.1) compared to culture-negative patients. The association between blood culture status and mortality did not differ substantially by level of comorbidity.
Community-acquired bacteremia was associated with an increased risk of mortality in the first week of medical ward admission. Higher mortality among patients with Gram-positive and polymicrobial bacteremia compared with patients with Gram-negative bacteremia and negative cultures emphasizes the prognostic importance of these infections.
Cites: Science. 2000 Mar 31;287(5462):2398-910766613
Cites: JAMA. 1995 Sep 13;274(10):807-127650804
Cites: Ann Intern Med. 2002 Nov 19;137(10):791-712435215
Bone metastases and skeletal-related events (SREs), including radiation therapy or surgery to bone, pathologic fracture, or spinal cord compression, among children have not been described in a population-based study. We examined the rate of bone metastasis, SREs, and survival in the Danish pediatric cancer population. We identified children below 18 years with a first-time diagnosis of cancer between January 1, 1994 and December 31, 2009 in the Danish Cancer Registry. From the Danish National Registry of Patients, we obtained bone metastasis and SRE diagnoses, and estimated incidence rates (IRs). We estimated 6-month, 1-year, and 5-year survival using Kaplan-Meier curves. Of 2652 children, 35 (1.3%) developed bone metastasis during a mean follow-up of 7.0 years (IR=1.9 per 1000 person-years [95% confidence interval (CI), 1.4-2.6]). IRs were substantially higher among children with solid tumors than those with hematologic malignancies (IR=3.2 [95% CI, 2.3-4.6] and IR=0.48 [95% CI, 0.18-1.3]). Survival was poorer for children with bone metastasis than those without bone metastasis. Among children with bone metastasis, 67% experienced an SRE during a mean follow-up of 1.1 years, yielding an IR of 590 per 1000 person-years (95% CI, 381-915). Bone metastases are rare among children with cancer, but SREs are a common consequence.
We previously reported that both leukoreduced (LR) and buffy coat-depleted (BCD) blood transfusions had a detrimental effect on long-term overall survival in patients who underwent elective surgery for colorectal disease. This analysis investigates long-term cause-specific mortality in trial participants diagnosed with colorectal cancer (CRC).
We used the Danish Civil Registration System to follow 448 trial participants with CRC, from their enrollment in 1992 to 1995 until January 2007. A total of 108 patients were transfused with BCD blood, 94 with LR blood, and 246 did not receive a transfusion (NT). We reviewed death certificates for study patients who died during follow-up. Cause-of-death data were coded according to the International Classification of Diseases (ICD-8 and -10). The Charlson Comorbidity Index was used for risk adjustment.
A total of 43% of NT, 28% of BCD, and 27% of LR transfused patients were alive after 15 years of follow-up (p = 0.001 for transfused vs. NT patients). For LR-transfused versus NT patients the adjusted mortality ratio for death from rectal cancer was 1.81 (95% confidence interval [CI], 0.97-3.38), and for death from cardiovascular disease 2.12 (95% CI, 1.23-3.62). For BCD versus NT patients the adjusted mortality ratio for death from rectal cancer was 1.19 (95% CI, 0.61-2.33) and for cardiovascular disease it was 1.68 (95% CI, 0.97-2.91).
LR transfusion is associated with decreased long-term survival due to death from cardiovascular disease. A similar but weaker tendency was observed for BCD transfusion.