We examined the severity of airway obstruction and the occurrence of respiratory symptoms in a large, nationally representative population sample and in a subgroup of subjects with chronic bronchitis and/or emphysema to obtain information for developing national prevention and treatment strategies for these diseases. The study population comprised of 7217 randomly selected subjects (aged 30 years and older) who participated in a comprehensive health examination survey. The 'cases' were subjects diagnosed as having chronic bronchitis and/or emphysema. The survey methods comprised of questionnaires, interviews, physical measurements, including spirometry, and clinical examinations. In the whole study population, the age-adjusted prevalence of chronic bronchitis and/or emphysema was 22% among men and 7% among women, whilst clinically relevant airways obstruction (FEV1/FVC%
In a population sample health survey, body mass, previous trauma and physical stress were studied for associations with coxarthrosis. A sample of 8,000 persons representative of the Finnish population aged 30 or over was invited for examination, and 90 percent participated. On the basis of a standardized clinical examination, a physician diagnosed coxarthrosis in 6 percent of the women and 4 percent of the men. The prevalence rose with age. In persons with a past traumatic lower-limb injury, the odds ratio of unilateral coxarthrosis was 2.1 and of bilateral coxarthrosis 1.5, as adjusted for sex, age and other determinants using logistic regression. The sum index reflecting self-reported features of physical stress in present or previous occupations was directly proportional to the prevalence of coxarthrosis. Body mass index (kg/m2) was closely associated with bilateral coxarthrosis; the adjusted odds ratio (95 percent confidence intervals) for indices > 35, compared to those
The risk of cancer was evaluated among 77,952 asthma patients with bronchial asthma. The series was obtained through linkage of two registers: the Finnish Social Insurance Institution's file of asthma patients and the Finnish Cancer Registry. There was a significant excess risk of lung cancer in both sexes, the standardized incidence ratio (SIR) being 1.32 among men and 1.66 among women. In women, the risk of cancer of the rectum was significantly increased (SIR 1.42), whereas the risks of cancer of the corpus uteri and multiple myeloma were lower than expected (SIR 0.76 and 0.53, respectively). In men, the incidence of cancer of the larynx was significantly reduced (SIR 0.63) and that of the bladder increased (SIR 1.25). When both sexes were combined, cancers of the colon (SIR 1.17) and rectum (SIR 1.28) also showed a significantly elevated risk. A reduction in risk was seen in stomach cancer (SIR 0.88) and lymphatic leukaemia (SIR 0.55). The increased lung cancer risk may be due to local inflammatory changes. It is possible that differences in the immune system, e.g. natural killer cell activity, explain some of the reduced cancer risks.
Prevalence and incidence of known diabetes mellitus in Finnish subjects aged 30 years or over in 1970-1987 were investigated using a nationwide register of drug recipients and four population surveys. On the basis of the drug-register data, the prevalence of drug-treated diabetes in men increased from 1.5% in 1970 to 2.8% in 1987. In women, the prevalence increased from 2.1% in 1970 to 3.0% in 1979 and declined thereafter slightly to 2.7% in 1987. The increase in the prevalence of drug-treated diabetes was mainly due to the increase of diabetes in the age groups 60 years and older. The prevalence of all known diabetic subjects in the population studies increased from 2.1% in the health examination survey of 1966-1972 (n = 38,676) to 3.5% in the interview survey of 1976 (n = 10,657) and to 4.5% in the health examination survey of 1979-1980 (n = 7,217) but decreased to 3.3% in the interview survey in 1987 (n = 9,522). The increased prevalence of obesity in men and better survival may be important factors contributing to the increasing prevalence rates of diabetes in Finnish subjects aged 30 years and over.
Helicobacter pylori infection has been suggested to be associated with an increased risk of gastric cancer, and low levels of serum pepsinogen I (PG I) have been linked to atrophic gastritis, which is a risk factor for gastric cancer. In Finland, 39,268 persons from 25 cohorts participated during 1968-1972 in a health examination survey and were followed for up to 13 years. A nested case-control study was performed on 84 stomach cancer patients identified from the Finnish Cancer Registry and 146 controls matched for age, sex, and municipality. Serum samples drawn at the baseline study were analyzed. An elevated level of serum anti-H. pylori immunoglobulin A (IgA) antibodies (a titer > or = 70) and a low serum PG I level ( or = 700), the odds ratio was only 1.50 (95% CI 0.70-3.22). When both high IgA and low PG I were present, the odds ratio was 5.96 (95% CI 2.02-17.57). The association of H. pylori infection with cancer became stronger with longer follow-up times, whereas that of low PG I was strongest at shorter follow-up times. Our findings support the hypothesis that H. pylori infection is a prevalent and potentially preventable cause of gastric cancer. They stress the value of IgA antibody determinations and provide new evidence for a pathogenesis leading from prolonged infection through atrophic gastritis to gastric cancer.
Time trends and geographical variation of Helicobacter pylori antibodies in Finland were investigated by enzyme immunoassay in 20- to 34-year-old randomly selected females from six localities during 1969-73 (n = 375), and 15- to 45-year-old females representing nine communities and four geographical areas in 1983 (n = 882) and 1995 (n = 842). In the six communities investigated at three different time points, the overall prevalence declined from 38 to 12%, with an emphasis on the latter 12 years. The regionally varying rate of decrease in helicobacter prevalence changed the pre-existing geographical variation, leaving northern Finland with the highest rate. A 10%-units higher local helicobacter prevalence seemed to predict a 23% (95% CI 3-44%) higher gastric cancer incidence 20 years later. The overall decline in helicobacter seropositivity is consistent with earlier reports from Finland and other developed countries, and supports the cohort theory as an explanation for the age-related increase in H. pylori seroprevalence.
We first review the associations between depression and cardiovascular diseases (CVDs). Then we examine them in the nationally representative Mini-Finland Health Survey, which covers 8,000 persons. Chronic somatic diseases and mental disorders were diagnosed using standardized methods. Cross-sectionally, CVDs and neurotic depression were associated both before and after adjustment for covariates. The strongest associations were observed in the case of severe CVDs. During a 6.6 year follow-up, the risk of CVD death and coronary death was elevated in depressed persons both with and without CVDs at entry. Much of the cross-sectional association is probably due to depression caused by CVDs. The outcome of CVD may be poorer in depressed persons. The hypothesis that depression is a cause of CVDs requires further study.
A population sample of 27,000 Finnish women and 30,000 men was studied for the presence of a thoracic vertebral fracture. In both sexes, the prevalence of such fractures increased with age: after 40 years of age in the men and after 55 years of age in the women. The interaction of sex and age was significant, and even when the other determinants were adjusted for. In the women aged 35-44, 55-64, and 75 years or more, the prevalence per 1,000 was respectively 2.4, 5.1, and 29, and in the men in the corresponding age groups 5.2, 15, and 28. A previous history of trauma was a fracture determinant in both sexes. In the men, but not in the women, there was an increased risk of fracture when there was a history of tuberculosis and/or peptic ulcer, and in current smokers. Thus, contrary to observations on extremity fractures, the men had an increased risk of sustaining a thoracic vertebral fracture compared with the women. This may reflect differences in the development of osteoporosis in the axial skeleton versus the appendicular skeleton.
The associations between DISH (diffuse skeletal Hyperostosis) and spondylosis deformans on the one hand and cardiovascular disease and cancer on the other were studied in a follow-up investigation of 6 167 persons in Finland. Mean duration of follow-up investigation of 6 167 persons in Finland. Mean duration of follow-up was 6.3 years. Similar methods were employed in the baseline and follow-up examination. A finding of DISH or of spondylosis was based on a reading of lateral X-ray films. Age-adjusted incidence of hypertension, ECG findings suggesting coronary heart disease (CHD), CHD history, enlargement of the heart determined by interpretation of photofluorograms, digitalis medication, cerebrovascular incidents and a history of cancer were compared in persons with and without DISH/spondylosis and free of these conditions at baseline. A further analysis, in which the data were analysed separately for DISH and spondylosis present at baseline and cases which developed during follow-up, was also carried out. A slight association between DISH and spondylosis, and hypertension probably due to obesity was observed. According to several criteria degenerative heart disease (CHD, heart enlargement, digitalis use) was associated with DISH and spondylosis, particularly in men. An association with heart enlargement was observed with DISH but not with spondylosis. No associations with cerebrovascular accidents or cancer were observed, but the paucity of cases prevents definite conclusions. Thus, there were some difference between spondylosis and DISH with regard to risk of future cardiovascular disease.
Low lignan status has been reported to be related to an elevated risk of breast cancer. Since lignan status is reduced by antibacterial medications, it is plausible to hypothesize that repeated use of antibiotics may also be a risk factor for breast cancer. History of treatment for urinary tract infection was studied for its prediction of breast cancer among 9,461 Finnish women 19-89 years of age and initially cancer-free. During a follow-up in 1973-1991, a total of 157 breast cancer cases were diagnosed. Women reporting previous or present medication for urinary tract infection at baseline showed an elevated breast cancer risk in comparison with other women. The age-adjusted relative risk was 1.34 (95% confidence interval (CI) = 0.98-1.83). The association was concentrated to women under 50 years of age. The relative risk for these women was 1.74 (95% CI 1.13-2.68), whereas it was 0.97 (95% CI 0.59-1.58) for older women. The relative risk in the younger age-group was 1.47 (95% CI 0.73-2.97) during the first 10 years of follow-up, and 1.93 (95% CI 1.11-3.37) for follow-up times longer than 10 years. These data suggest that premenopausal women using long-term medication for urinary tract infections show a possible elevated risk of future breast cancer. The results are, however, still inconclusive and the hypothesis needs to be tested by other studies.