Valid mortality statistics are important for healthcare planning and research. Suicides and accidents often present a challenge in the classification of the manner of death. The aim of this study was to analyse the reliability of the national suicide statistics by comparing the classification of suicide in the Scandinavian cause of death registers with a reclassification by 8 persons with different medical expertise (psychiatry, forensic pathology and public health) from each of the 3 Scandinavian countries.
The cause of death registers in Norway, Sweden and Denmark retrieved available information on a sample of 600 deaths in 2008 from each country. 200 were classified in the registers as suicides, 200 as accidents or undetermined and 200 as natural deaths. The reclassification comprised an assessment of the manner and cause of death as well as the level of certainty.
In total, 81%, 88% and 90% of deaths registered as suicide in the official mortality statistics were confirmed by experts using the Swedish, Norwegian and Danish data sets, respectively. About 3% of deaths classified as accidents or natural deaths in the cause of death registers were reclassified as suicides. However, after a second reclassification based on additional information, 9% of the natural deaths and accidents were reclassified as suicides in the Norwegian data set, and 21% of the undetermined deaths were reclassified as suicides in the Swedish data set. In total, the levels of certainty of the experts were 87% of suicides in the Norwegian data set, 77% in the Swedish data set and 92% in Danish data set; the uncertainty was highest in poisoning suicides.
A high percentage of reported suicides were confirmed as being suicides. Few accidents and natural deaths were reclassified as suicides. Hence, reclassification did not increase the overall official suicide statistics of the 3 Scandinavian countries.
Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort). The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84) after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of symptomatic meniscal lesions.
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OBJECTIVE: To describe different data sources that may illuminate the incidence and character of child sexual abuse (CSA) in Denmark in the late 1990s. METHOD: Data concerning alleged sexual abuse of children below 15 years of age in the 1990s were retrieved from the Danish National Patient Register and the Danish National Criminal Register. In addition, all police files concerning reported CSA in 1 year (1998), were reviewed. RESULTS: The average annual incidence of CSA was .06 per 1,000 children, based on data in the National Patient Register; however, it was .5 per 1,000 based on data in the Criminal Register. In the Criminal Register, significant annual differences were found in cases of sexual offence against children below 12 years. The police reports comprised very comprehensive information about the victims and the character of CSA. Based on this information the incidence of police reported CSA in 1998 was 1.0 per 1,000 children, and .6 per 1,000 excluding reported cases of indecent exposure. Half of intra-familial CSA resulted in a conviction compared to 40% of extra-familial CSA and 16% of indecent exposure. CONCLUSIONS: In Denmark, criminal statistics contain the most systematic collection of data on CSA. However, data reflect the reporting behavior by parents or other closely related adults, which may be influenced by changes in public awareness of the problem. Consequently, register data should be supplemented by data obtained from self-reported surveys on CSA.
Occupational workload has been associated with an increased risk of osteoarthritis (OA), but only little research has been conducted among female workers. The objective of this study was to analyse if men and women in farming, construction or healthcare work have increased risk of developing OA of the hip or knee.
A follow-up study based on register data of the whole Danish working population in the period 1981 to 2006 followed up for hip or knee OA during 1996 to 2006. Cumulative years in occupation were calculated for assessment of dose-response relationship. Gender-specific analyses were carried out with Cox regression models using age as timescale and adjusting for calendar period, income, unemployment and previous knee injury, and done separately for hip and knee OA.
Male floor layers and bricklayers and male and female healthcare assistants had the highest risks of knee OA, and farmers had the highest risk of hip OA. Male farmers had increased risk of hip OA already after 1-5 years in occupation (HR, 1.63) and a dose-response-related risk of hip OA (HR up to 4.22). Generally, the risk of OA increased with cumulative years in the occupation in both men and women.
Occupations with heavy physical workload present a strong risk for hip and knee OA in both men and women, and the risks increase with cumulative years in occupation and noticeable hip OA among male farmers.
The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986-2005, to the national Danish registers on health and welfare. It facilitates studies of self-reported health behaviour and utilisation of healthcare services by subgroups and analysis of non-response bias.
DANCOS data are utilised in a variety of analyses presented here by a few examples that emphasise the impact of modifiable risk factors on public health, description of non-response bias, and the epidemiology of chronic pain and of osteoarthritis. Examples of DANCOS-based results are shown for each of the four topics. Smoking results in 24% of all deaths and, compared to other risk factors for public health, smoking accounts for the highest number of years of life lost. For non-response the mortality is higher among non-respondents than among respondents, but no significant bias on healthcare estimates can be seen. On average individuals with chronic pain had 12.8 contacts per year to the primary healthcare sector compared with 7.3 for individuals without. For osteoarthritis it is estimated that in 2020 there will be 22,600 incident cases.
DANCOS is a public health survey linked with registers with many research possibilities. With this article we hope to stimulate further interest in the survey.
This article gives an overview of a nationally representive public health research database in Denmark, the Danish National Cohort Study (DANCOS). DANCOS combines baseline data from health interview surveys with both pre- and post-baseline data from national health registries with date from a re-interview survey. As part of the national health interview survey programme, three nation-wide surveys were conducted in 1986/1987, 1991 and 1994. The samples in the three cohorts consisted of 23,096 adult Danes ages 16 years and older, and 18,296 (79.2%) were personally interviewed on socio-economic status; living conditions; health behaviour; self-rated health; morbidity; utilization of health services; and the consequences of illness and disability. Each Dane is equipped with a unique identification number that allows highly accurate linkage of data in the health surveys and in the national health and administrative registries. All respondents and non-respondents were followed through 2002, a total of 3,796 had died and 249 had emigrated. The specific cause of death for 2,485 people was recorded in the Danish Register of Causes of Death, updated through 1998. For 1978-1977, the Danish National Hospital Register contained information about 16,503 persons who had been hospitalized for any illness or related health problems, accounting for 70,925 hospital admissions. For 1970-1997, the Danish Psychiatric Central Register comprised information on 1691 persons. For 1990-1997, the Danish National Health Service Register recorded 980,043 contacts with general practitioners and specialist physicians. For 1943-1996, the Danish cancer Registry contained information about one or more cancer diseases among 1,432 people. A total of 4,334 people in the 1994 cohort were re-interview in 2000. DANCOS allows for a wide range of analysis in a historical prospective design of determinants of morbidity and mortality, of health care utilization and of the social effects of ill health. DANCOS also allows studies of methodological issues, including analyzing the characteristics of non-respondents.
Cause-specific mortality statistics is a valuable source for the identification of risk factors for poor public health.
Since 1875, the National Board of Health has maintained the register covering all deaths among citizens dying in Denmark, and since 1970 has computerised individual records.
Classification of cause(s) of deaths is done in accordance to WHO's rules, since 1994 by ICD-10 codes. A change in coding practices and a low autopsy rate might influence the continuity and validity in cause-specific mortality.
The longstanding national registration of causes of death is essential for much research. The quality of the register on causes of death relies mainly upon the correctness of the physicians' notification and the coding in the National Board of Health.
There may be various reasons for differences in suicide rates between countries and over time within a country. One reason can be different registration practices.
The purpose of this study was to describe and compare the present procedures for mortality and suicide registration in the three Scandinavian countries and to illustrate potential sources of error in the registration of suicide.
Information about registration practices and classification procedures was obtained from the cause of death registers in Norway, Sweden, and Denmark. In addition, we received information from experts in the field in each country.
Sweden uses event of undetermined intent more frequently than Denmark does, and Denmark more frequently than Norway. There seems to be somewhat more uncertainty among deaths classified as ill-defined and unknown cause of mortality in Norway, compared with the other two countries. Sweden performs more forensic autopsies than Norway, and Norway more than Denmark. In Denmark, in cases of a suspected unnatural manner of death, a thorough external examination of the deceased is performed.
Differences in the classification of causes of death and in postmortem examinations exist in Scandinavian countries. These differences might influence the suicide statistics in Scandinavia.