INTRODUCTION: An increasing number of women give birth by caesarean section (CS) in Denmark, some without any medical reasons for this procedure. This is called maternal request sectio (MRS). To analyse the development of MRS over a five-year period and investigate how parity, former birth complications, the weight of the child and the mother's living area and age are related to MRS. MATERIAL AND METHODS: Retrospective registry analysis of births during the period 1 January 2002 to 31 December 2006. MRS was identified by the surgical code KZYM00. RESULTS: 5,165 MRSs were recorded during the study period. Among nulliparous (P0) women there was an increase in MRS from 3.2% of all elective CS in 2002 to 19.4% in 2006. The largest share, 24.1%, was found in the age group 35+. Among multiparous (P1+) women there was an increase from 5.5% to 31.2%, and the largest share, 35.8%, was in the age group 15-24. MRS was most frequent in the Capital Region. Women who had experienced CS, third degree perineal tear, or perinatal death in their first delivery, had a 3.8, 1.3 and 2.0 times increased risk of MRS in their next delivery. The weight of the child had no influence on MRS. CONCLUSION: MRS has increased over the past five years, and now amounts to 1.3% of all births for P0 women and 3.6% for P1+ women. Previous birth complications and the age and living area of the mother are associated with MRS. Better knowledge of the reasons why some women choose MRS would provide professionals with better tools to support these women.
Københavns Universitet, Institut for Folkesundhedsvidenskab, Statens Serum Institut, Afdelingen for Epidemiologisk Forskning, Rigshospitalet, Mamma & Endokrinkirurgisk Klinik, Juliane Marie Centret, København K. email@example.com
Breast cancer is the most frequent malignant disease in Danish women, with 4,006 incident cases and 1,333 deaths in 2001. The incidence has increased since approximately 1960, while mortality has remained relatively stable. In the era before implementation of mammography screening, there was a 20% regional and a 50% socioeconomic difference in both incidence and mortality. Future trends in breast cancer incidence are determined by present risk factors, where particularly the high age at first birth and the increased prevalence of obesity are expected to push the trend upwards.
Epidemiological research has good possibilities in Denmark due to the fact that all people have a personal PIN code and due to our many National health registers. In gynaecology the National Register of Patients, the Birth Registry, IVF-registry, Cancer Registry and latest the National Prescription Database offer unique possibilities of linking exposure data with many clinical outcomes. Danish epidemiology has contributed with morbidity analyses on children concieved by in vitro fertilisation, pharmacoepidemiological studies on short and long term effects of oral contraceptives and hormone therapy and, now, with routine assessment of clinical quality.
OBJECTIVE: To assess the risk of venous thrombosis in current users of different types of hormonal contraception, focusing on regimen, oestrogen dose, type of progestogen, and route of administration. DESIGN: National cohort study. SETTING: Denmark, 1995-2005. PARTICIPANTS: Danish women aged 15-49 with no history of cardiovascular or malignant disease. MAIN OUTCOME MEASURES: Adjusted rate ratios for all first time deep venous thrombosis, portal thrombosis, thrombosis of caval vein, thrombosis of renal vein, unspecified deep vein thrombosis, and pulmonary embolism during the study period. RESULTS: 10.4 million woman years were recorded, 3.3 million woman years in receipt of oral contraceptives. In total, 4213 venous thrombotic events were observed, 2045 in current users of oral contraceptives. The overall absolute risk of venous thrombosis per 10 000 woman years in non-users of oral contraceptives was 3.01 and in current users was 6.29. Compared with non-users of combined oral contraceptives the rate ratio of venous thrombembolism in current users decreased with duration of use (4 years 2.76, 2.53 to 3.02; P
Background. Recently, the Danish National Register of Medicinal Product Statistics (NRM) was opened for research purposes, and therefore, on an individual basis, can merge with other national registers. The aim of this study was to analyse the use of hormones based on the individual data of the entire Danish female population, with the focus on a detailed evaluation of specific hormone regimens and factors associated with systemic hormone replacement therapy (HRT). Methods. All Danish female citizens, aged 15-70 years during the study period 1995-2004, were identified in the Civil Registration System, and their redeemed prescriptions for hormones and medication for diabetes, hypertension, hypercholesterolemia and heart conditions were retrieved from the NRM. Information on habitation, education, employment and gynaecological surgery was obtained from other national registers. Results. After 2002, the use of HRT was reduced by 65%. In 2002, HRT was most prevalent in women aged 55-59 years, when an average of 200 defined daily doses per 1,000 women per day was recorded. In 2002, approximately 39% of women aged 50-57 years were ever exposed to HRT. The mean duration of HRT was 5 years in an 8-year time window. During the study period, there was a significant decline in the use of systemic hormones, initially due to a decrease in cyclic combined therapy, but after 2002 continuous combined therapy decreased rapidly. HRT was positively associated with middle-term education, employment status, and living in urban areas. Women treated for diabetes used hormones less frequently than women without diabetes. Women using antiarrhythmics or antihypertensives used hormones more often than women not using this medication. HRT was positively associated with gynaecological surgery. Conclusion. One in five women, aged 50-59 years, redeemed daily HRT. Use of HRT declined from 1995 to 2002, but more than halved after 2002. HRT is associated to redemption of other medications of significance for health.
CONTEXT: Studies have suggested an increased risk of ovarian cancer among women taking postmenopausal hormone therapy. Data are sparse on the differential effects of formulations, regimens, and routes of administration. OBJECTIVE: To assess risk of ovarian cancer in perimenopausal and postmenopausal women receiving different hormone therapies. DESIGN AND SETTING: Nationwide prospective cohort study including all Danish women aged 50 through 79 years from 1995 through 2005 through individual linkage to Danish national registers. Redeemed prescription data from the National Register of Medicinal Product Statistics provided individually updated exposure information. The National Cancer Register and Pathology Register provided ovarian cancer incidence data. Information on confounding factors and effect modifiers was from other national registers. Poisson regression analyses with 5-year age bands included hormone exposures as time-dependent covariates. PARTICIPANTS: A total of 909,946 women without hormone-sensitive cancer or bilateral oophorectomy. MAIN OUTCOME MEASURE: Ovarian cancer. RESULTS: In an average of 8.0 years of follow-up (7.3 million women-years), 3068 incident ovarian cancers, of which 2681 were epithelial cancers, were detected. Compared with women who never took hormone therapy, current users of hormones had incidence rate ratios for all ovarian cancers of 1.38 (95% confidence interval [CI], 1.26-1.51) and 1.44 (95% CI, 1.30-1.58) for epithelial ovarian cancer. The risk declined with years since last use: 0 to 2 years, 1.22 (95% CI, 1.02-1.46); more than 2 to 4 years, 0.98 (95% CI, 0.75-1.28); more than 4 to 6 years, 0.72 (95% CI, 0.50-1.05), and more than 6 years, 0.63 (95% CI, 0.41-0.96). For current users the risk of ovarian cancer did not differ significantly with different hormone therapies or duration of use. The incidence rates in current and never users of hormones were 0.52 and 0.40 per 1000 years, respectively, ie, an absolute risk increase of 0.12 (95% CI, 0.01-0.17) per 1000 years. This approximates 1 extra ovarian cancer for roughly 8300 women taking hormone therapy each year. CONCLUSION: Regardless of the duration of use, the formulation, estrogen dose, regimen, progestin type, and route of administration, hormone therapy was associated with an increased risk of ovarian cancer.
AIM: To assess the risk of myocardial infarction (MI) as a result of hormone therapy (HT), with focus on the influence of age, duration of HT, various regimens and routes, progestagen type, and oestrogen dose. METHODS AND RESULTS: All healthy Danish women (n = 698,098, aged 51-69) were followed during 1995-2001. On the basis of a central prescription registry, daily updated national capture on HT was determined. National Registers identified 4947 MI incidents. Poisson regression analyses estimated rate ratios (RRs). Overall, we found no increased risk [RR 1.03 (95% CI: 0.95-1.11)] of MI with the current HT compared with women who never used HT; age-stratified RR among women aged 51-54, 55-59, 60-64, and 65-69 years were 1.24 (1.02-1.51), 0.96 (0.82-1.12), 1.11 (0.97-1.27), and 0.92 (0.80-1.06), respectively. An increasing risk with longer duration was found for younger women, which was not observed with older age groups. In all age groups, the highest risk of MI was found with continuous HT regimen. No increased risk was found with unopposed oestrogen, cyclic combined therapy, or tibolone. Significantly lower risk was found with dermal route than oral unopposed oestrogen therapy (P = 0.04). No associations were found with progestagen type or oestrogen dose. CONCLUSION: In a National cohort study, we found that HT regimen and route of application could modify the influence of HT on the risk of MI.
Comment In: Womens Health (Lond Engl). 2009 Jan;5(1):29-3119102637
The Danish National Board of Health recommended in 2004 routine ultrasound scanning in week 12 with nuchal translucency measurement, combined with the double test to all pregnant women. Those who were found to have a risk of trisomy 21 higher than 1:300 were offered amniocentesis or chorionic villus sampling (CVS). The total number of pregnancies in Denmark with an invasive prenatal procedure decreased from 6,929 in 1996 to 3,103 in 2006, the percentage of CVS increased from 45 to 69%, and the percentage of women below 35 years among those undergoing invasive procedures increased from 38 to 52%. The mean gestational age at which the procedures were done increased--for CVS from week 11 to 13, and for amniocentesis from week 16 to 17. We thus achieved to more than double the offer of prenatal screening and at the same time reduce the number of invasive procedures by 55%.
The majority of physicians are aware of the urgency of preventing major global warming, and of the global health consequences such warming could bring. Therefore, we should perhaps be more motivated to mitigate these climate changes. The Danish Medical Association should stress the importance of preventing major global climate health disasters, and the need for ambitious international reduction agreements. In our advice and treatment of patients, focus could be on mutually shared strategies comprising mitigation of global warming and changing of life-style habits to improve our general health.
The Danish National Patient Registry (DNRP) was established in Denmark in 1976, and since then in accordance with current law, it has been collecting discharge diagnoses, surgical codes and recently also different diagnostic and treatment codes from all Danish hospitals. Besides being an administrative tool and a tool for epidemiological research through recent years, the DNPR has also supported national clinical quality databases. We report the experiences from a national quality control in Danish reproductive gynaecology based on data from the DNPR. We conclude that the NRP is a suitable tool for continuous clinical quality control, and discuss ways of improving the validity of DNPR data.