Familial risks for hospitalization with endocrine diseases

Determination of age-specific and sex-specific familial risks for the different manifestations of venous thromboembolism: A nationwide family study in Sweden

This nationwide study aimed to determine whether differences exist in age-specific and sex-specific familial risks for pulmonary embolism (PE), venous thrombosis of the lower limbs (VT) and other forms of venous thromboembolism (OVTE) among offspring, siblings and spouses of affected individuals. The Swedish Multi-Generation Register was linked to the Hospital Discharge Register data for the period 1987–2007. Standardised incidence ratios (SIRs) were calculated for individuals whose relatives were hospitalised for venous thromboembolism (VTE), as determined by the International Classification of Diseases (ICD), and those whose relatives were unaffected by VTE. The total number of hospitalised VTE patients was 45,362. All VTE patients were categorised as PE, VT or OVTE according to ICD at first hospitalisation. For example, the parental SIRs for PE, VT and OVTE in offspring at age 10–19 years were 2.89 (95% CI 1.48–5.06), 4.99 (95% CI 3.22–6.10) and 3.89 (95% CI 2.51–5.75), respectively. The low spousal risks of PE (1.08; 95% CI 1.02–1.13), VT (1.06; 95% CI 1.011.12) and OVTE (1.07; 95% CI 1.00–1.15) suggest the familial risks to be largely genetic. In both men and women, familial relative risks were increased for all the different manifestations of VTE with the exception of those older than 70 years. Familial history is a risk indicator in both sexes, and is potentially useful for clinical risk assessment for the different manifestations of VTE.

Venous thromboembolism does not share strong familial susceptibility with ischemic stroke: a nationwide family study in Sweden

BACKGROUND

Coagulation allelic variants associated with venous thromboembolism (VTE) have been suggested to be involved in the pathogenesis of ischemic stroke. This nationwide study aimed at determining whether VTE shares familial susceptibility with ischemic stroke.

METHOD AND RESULTS

The Swedish Multigeneration Register of 0- to 75-year-old subjects was linked to the Swedish Hospital Discharge Register and the Cause of Death Register for the period 1987 to 2007. Odds ratios (ORs) for VTE and ischemic stroke were determined in 2 ways: odds of ischemic stroke in offspring whose parents had been diagnosed with VTE, and odds of VTE in offspring whose parents had been diagnosed with ischemic stroke. The analyses were repeated for siblings and spouses. Offspring of parents with VTE (n=25,929) were at increased risk for ischemic stroke (n=5595): OR, 1.10 (95% confidence interval [CI], 1.06-1.14). Siblings of probands with VTE (n=45,132) had no increased risk of ischemic stroke (n=1716): OR, 1.05 (95% CI, 1.00-1.11). Spouses of probands with VTE (n=24,106) were at increased risk for ischemic stroke (n=940): OR, 1.18 (95% CI, 1.10-1.27). The risks for VTE in relatives of probands with ischemic stroke were OR, 1.15; 95% CI, 1.10-1.21 (offspring); OR, 1.07; 95% CI, 1.02-1.12 (siblings); and OR, 1.21; 95% CI, 1.11-1.32 (spouses).

CONCLUSIONS

VTE does not share strong familial susceptibility with ischemic stroke in the Swedish population. Moreover, familial nongenetic factors contribute to the observed weak familial associations. The present study suggests that it is unlikely that strong shared disease-causing mutations exist to a large extent in the Swedish population.

Familial risks of unusual forms of venous thrombosis: a nationwide epidemiological study in Sweden

OBJECTIVE

This is the first nationwide study to determine familial risks of unusual forms of venous thrombosis amongst offspring of affected parents and amongst siblings.

DESIGN AND SETTINGS

The Swedish Multigeneration Register of 0- to 75-year-old subjects was linked to the Hospital Discharge Register for the period 1987-2007. Standardized incidence ratios (SIRs) were calculated for individuals whose relatives were hospitalized for venous thromboembolism (VTE), as determined by the International Classification of Diseases, compared to those whose relatives were not affected by VTE.

RESULTS

The total number of hospitalized patients with VTE was 45 362, of which 1824 (4.0%) were affected by a rare thrombotic condition. The familial SIRs in cases with a history of VTE in parents or siblings were significantly increased for migrating thrombophlebitis (1.81; 95% confidence interval (CI) 1.40-2.31), portal vein thrombosis (2.35; 95% CI 1.77-3.06), vena cava thrombosis (1.96; 95% CI 1.42-2.64) and cerebral venous thrombosis (1.74; 95% CI 1.30-2.28). Budd-Chiari syndrome (SIR, 0.92; 95% CI 0.24-2.38) and renal vein thrombosis (SIR, 1.72; 95% CI 0.62-3.77) were not significantly associated with parental or sibling history of VTE; however, these two conditions were very rare, and therefore, we cannot draw any definite conclusions from this finding.

CONCLUSIONS

Family history is an important risk factor for most unusual forms of VTE. Moreover, even the paraneoplastic phenomenon, migrating thrombophlebitis (Trousseau's syndrome), is associated with a family history of VTE. Thus, our data suggest that most rare forms of VTE have a familial background.

Venous thromboembolism does not share strong familial susceptibility with coronary heart disease: a nationwide family study in Sweden

AIMS

This nationwide study aimed to determine whether venous thromboembolism (VTE) shares familial susceptibility with coronary heart disease (CHD).

METHODS AND RESULTS

Data from the Swedish Multigeneration Register for subjects aged 0-76 years old for the period 1964-2008 were linked to the Hospital Discharge Register and Cause of Death Register. Familial risks of VTE and CHD were examined in two ways: risk of CHD in offspring whose parents had been diagnosed with VTE, and risk of VTE in offspring whose parents had been diagnosed with CHD. The analyses were repeated separately for siblings and spouses. In total, 174 768 offspring had CHD and 56 302 VTE. No association between VTE and CHD was observed among siblings. Among offspring, a lower risk of CHD was observed in subjects whose parents had suffered from VTE [standardized incidence ratio (SIR) 0.94 (95% confidence interval (CI) 0.92-0.95)], while offspring of parents with CHD had an increased risk of VTE [SIR 1.03 (95% CI 1.01-1.04)]. In spouses of VTE patients, an increased risk of CHD was observed [SIR 1.02 (95% CI 1.01-1.03)]. Conversely, risk of VTE was increased among spouses of CHD patients [SIR 1.03 (95% CI 1.02-1.03)]. Subanalyses of cases of myocardial infarction and pulmonary embolism/deep venous thrombosis showed similar results.

CONCLUSION

The familial background of CHD is different from that of VTE. The present study suggests that it is unlikely that shared disease-causing mutations exist to a large extent in the population.

Parental history and venous thromboembolism: a nationwide study of age-specific and sex-specific familial risks in Sweden

BACKGROUND

The value of parental history as a risk indicator for venous thromboembolism (VTE) has not been determined in a nationwide setting.

OBJECTIVES

To perform the first nationwide study of age-specific and sex-specific familial VTE risks in offspring of parents hospitalized for VTE.

PATIENTS/METHODS

The Swedish Multigeneration Register of 0-75-year-old subjects was linked to the Hospital Discharge Register for 1987-2007. Standardized incidence ratios (SIRs) were calculated for individuals whose parents were hospitalized for VTE as compared with those whose parents were unaffected.

RESULTS

Among 45,362 hospitalized offspring cases with VTE, 4865 offspring of affected parents were identified with a familial SIR of 2.00 (95% confidence interval [CI] 1.94-2.05). Familial SIR was slightly higher for male offspring than for female offspring (2.08, 95% CI 2.00-2.16 vs. 1.91, 95% CI 1.84-1.99). The risk in offspring was further increased when both parents were affected (3.97, 95% CI 3.40-4.61), with high familial risks at ages 20-29 years (10.00, 95% CI 5.91-15.84). The familial risks for VTE among offspring were increased from the age of 10 years up to 75 years, with familial SIRs of 3.96 (95% CI 3.13-4.94) at age 10-19 years and 1.48 (95% CI 1.17-1.84) at ages 70-75 years. However, the absolute incidence rate increased with age.

CONCLUSIONS

Parental history is potentially useful for risk assessments of VTE, although age needs to be considered. Our results support the use of an age-dependent multicausal model to estimate the risk of VTE.

Violent crime runs in families: a total population study of 12.5 million individuals

BACKGROUND

Etiological theory and prior research with small or selected samples suggest that interpersonal violence clusters in families. However, the strength and pattern of this aggregation remains mostly unknown.

METHOD

We investigated all convictions for violent crime in Sweden 1973-2004 among more than 12.5 million individuals in the nationwide Multi-Generation Register, and compared rates of violent convictions among relatives of violent individuals with relatives of matched, non-violent controls, using a nested case-control design.

RESULTS

We found strong familial aggregation of interpersonal violence among first-degree relatives [e.g. odds ratio (OR)sibling 4.3, 95% confidence interval (CI) 4.2-4.3], lower for more distant relatives (e.g. OR cousin 1.9, 95% CI 1.9-1.9). Risk patterns across biological and adoptive relations provided evidence for both genetic and environmental influences on the development of violent behavior. Familial risks were stronger among women, in higher socio-economic strata, and for early onset interpersonal violence. There were crime-specific effects (e.g. OR sibling for arson 22.4, 95% CI 12.2-41.2), suggesting both general and subtype-specific familial risk factors for violent behavior.

CONCLUSIONS

The observed familiality should be accounted for in criminological research, applied violence risk assessment, and prevention efforts.