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Abril J, Trabert B, Troisi R, Grotmol T, Ekbom A, Engeland A, Gissler M, Glimelius I, Madanat-Harjuoja L, Gulbech Ording A, Sørensen HT, Tretli S, Bjørge T. Associations between pregnancy-related factors and birth characteristics with risk of rare uterine cancer subtypes: a Nordic population-based case-control study. Cancer Causes Control 2024; 35:741-747. [PMID: 38129544 DOI: 10.1007/s10552-023-01832-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Uterine sarcomas are a rare group of uterine malignancies. Due to the low incidence and changes in uterine sarcoma classification, risk factors are not well characterized. Our objective was to evaluate risk factors for uterine sarcoma and compare risk factors between uterine sarcoma, malignant mixed Mullerian tumors (MMMTs), and type I endometrial carcinomas. METHODS This nested case-control study utilized linked data from population-based medical birth and cancer registries in Denmark, Finland, Norway, and Sweden. Up to 10 controls were matched on country and birth year for each uterine cancer case. Using multivariable adjusted multinomial logistic regression, estimates of the associations between pregnancy-related factors and risk of uterine sarcoma, MMMTs, and type I endometrial carcinomas were determined. RESULTS Having a very-low-birth-weight infant (< 1500 vs. 2500-3999 g: OR [95% CI] 2.83 [1.61-4.96]) was associated with an increased risk of uterine sarcoma. Whereas, having a more recent pregnancy was associated with reduced risks of MMMT (< 10 vs. ≥ 30 years: 0.66 [0.20-2.23]) and type 1 endometrial carcinomas (0.35 [0.30-0.41]) but not uterine sarcomas (1.33 [0.90-1.98], p-heterogeneity < 0.01). CONCLUSION Our study provides evidence that risk factors for uterine sarcoma and MMMT, previously grouped with uterine sarcomas, vary substantially. Additionally, MMMT and type I endometrial carcinomas are more similar than uterine sarcoma in that pregnancy complications like gestational hypertension and preeclampsia were associated with reduced risks of both but not uterine sarcoma, suggesting different etiologies.
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Affiliation(s)
- Jazmine Abril
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, Huntsman Cancer Institute at the University of Utah, University of Utah, 2000 Circle of Hope Dr. Research South #4719, Salt Lake City, UT, 84112, USA.
| | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Anders Ekbom
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anders Engeland
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Glimelius
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | | | - Tone Bjørge
- Cancer Registry of Norway, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Sharifian MJ, Igland J, Klungsøyr K, Engeland A, Zhou A, Bjørge T. Incidence trends of adult glioma in Norway and its association with occupation and education: A registry-based cohort study. Cancer Epidemiol 2024; 89:102524. [PMID: 38367313 DOI: 10.1016/j.canep.2024.102524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Gliomas constitute 75 % of all malignant primary adult brain tumors. Being the most frequent histologic subtype, glioblastomas (GBMs) cause substantial morbidity and mortality worldwide and the Nordic countries have some of the highest incidence rates in the world. Therefore, we investigated the incidence of gliomas in Norway including time trends and associations with education and occupation. METHODS We retrieved individual-level data from databases at Statistics Norway containing information on education and occupation and linked them to data on adult glioma patients diagnosed during 2004-21 from the Cancer Registry of Norway. Age-standardized incidence rates (ASIRs) (World Standard Population) were calculated and analyzed with regards to sex and morphology. Poisson regression was used to test for time-trends, and to analyze the associations between education, occupation and glioma incidence, adjusted for age, sex, and calendar year. Estimates were reported as incidence rate ratios (IRRs) with 95 % confidence intervals (CIs). RESULTS The overall ASIR of gliomas (per 100,000 person-years) was 7.1 (95 % CI 6.9-7.3), with no specific time trend during the study period. The incidence increased with age. Compared to the other subtypes, GBMs were diagnosed at older ages. The risks of developing glioma overall and GBM were associated with occupation but not with educational level. The relative risk of glioma and GBM were respectively 1.17 (95 % CI 1.05-1.31) and 1.17 (95 % CI 1.02-1.35) among high-skilled white-collar workers compared to blue-collar workers. CONCLUSIONS The overall and sex-specific ASIRs of gliomas and GBMs did not show any noticeable time trends. The higher risk of developing glioma overall and GBM in high-skilled white-collar workers compared to blue-collar workers calls for further investigations.
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Affiliation(s)
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ange Zhou
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Statistics and Biostatistics, Cal State East Bay, Hayward, CA, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Cancer Registry of Norway, Oslo, Norway
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Fritz J, Jochems SHJ, Bjørge T, Wood AM, Häggström C, Ulmer H, Nagel G, Zitt E, Engeland A, Harlid S, Drake I, Stattin P, Stocks T. Body mass index, triglyceride-glucose index, and prostate cancer death: a mediation analysis in eight European cohorts. Br J Cancer 2024; 130:308-316. [PMID: 38087039 PMCID: PMC10803806 DOI: 10.1038/s41416-023-02526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Insulin resistance is a hypothesised biological mechanism linking obesity with prostate cancer (PCa) death. Data in support of this hypothesis is limited. METHODS We included 259,884 men from eight European cohorts, with 11,760 incident PCa's and 1784 PCa deaths during follow-up. We used the triglyceride-glucose (TyG) index as indicator of insulin resistance. We analysed PCa cases with follow-up from PCa diagnosis, and the full cohort with follow-up from the baseline cancer-free state, thus incorporating both PCa incidence and death. We calculated hazard ratios (HR) and the proportion of the total effect of body mass index (BMI) on PCa death mediated through TyG index. RESULTS In the PCa-case-only analysis, baseline TyG index was positively associated with PCa death (HR per 1-standard deviation: 1.11, 95% confidence interval (CI); 1.01-1.22), and mediated a substantial proportion of the baseline BMI effect on PCa death (HRtotal effect per 5-kg/m2 BMI: 1.24; 1.14-1.35, of which 28%; 4%-52%, mediated). In contrast, in the full cohort, the TyG index was not associated with PCa death (HR: 1.03; 0.94-1.13), hence did not substantially mediate the effect of BMI on PCa death. CONCLUSIONS Insulin resistance could be an important pathway through which obesity accelerates PCa progression to death.
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Affiliation(s)
- Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden.
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria.
| | | | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christel Häggström
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
- Department of Internal Medicine 3, LKH Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Isabel Drake
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Brikell I, Yao H, Li L, Astrup A, Gao L, Gillies MB, Xie T, Zhang-James Y, Dalsgaard S, Engeland A, Faraone SV, Haavik J, Hartman C, Ip P, Jakobsdóttir Smári U, Larsson H, Man KK, de Oliveira Costa J, Pearson SA, Hostrup Nielsen NP, Snieder H, Wimberley T, Wong IC, Zhang L, Zoega H, Klungsøyr K, Chang Z. ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. Lancet Psychiatry 2024; 11:16-26. [PMID: 38035876 DOI: 10.1016/s2215-0366(23)00332-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Although often intended for long-term treatment, discontinuation of medication for ADHD is common. However, cross-national estimates of discontinuation are missing due to the absence of standardised measures. The aim of this study was to determine the rate of ADHD treatment discontinuation across the lifespan and to describe similarities and differences across countries to guide clinical practice. METHODS We did a retrospective, observational study using population-based databases from eight countries and one Special Administrative Region (Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the USA). We used a common analytical protocol approach and extracted prescription data to identify new users of ADHD medication. Eligible individuals were aged 3 years or older who had initiated ADHD medication between 2010 and 2020. We estimated treatment discontinuation and persistence in the 5 years after treatment initiation, stratified by age at initiation (children [age 4-11 years], adolescents [age 12-17 years], young adults [age 18-24 years], and adults [age ≥25 years]) and sex. Ethnicity data were not available. FINDINGS 1 229 972 individuals (735 503 [60%] males, 494 469 females [40%]; median age 8-21 years) were included in the study. Across countries, treatment discontinuation 1-5 years after initiation was lowest in children, and highest in young adults and adolescents. Within 1 year of initiation, 65% (95% CI 60-70) of children, 47% (43-51) of adolescents, 39% (36-42) of young adults, and 48% (44-52) of adults remained on treatment. The proportion of patients discontinuing was highest between age 18 and 19 years. Treatment persistence for up to 5 years was higher across countries when accounting for reinitiation of medication; at 5 years of follow-up, 50-60% of children and 30-40% of adolescents and adults were covered by treatment in most countries. Patterns were similar across sex. INTERPRETATION Early medication discontinuation is prevalent in ADHD treatment, particularly among young adults. Although reinitiation of medication is common, treatment persistence in adolescents and young adults is lower than expected based on previous estimates of ADHD symptom persistence in these age groups. This study highlights the scope of medication treatment discontinuation and persistence in ADHD across the lifespan and provides new knowledge about long-term ADHD medication use. FUNDING European Union Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- Isabell Brikell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Honghui Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Aske Astrup
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Le Gao
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Malcolm B Gillies
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tian Xie
- Department of Psychiatry, Interdisciplinary Center of Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Yanli Zhang-James
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark; Institute of Clinical Medicine, University of Copenhagen, København, Denmark
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stephen V Faraone
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina Hartman
- Department of Psychiatry, Interdisciplinary Center of Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Unnur Jakobsdóttir Smári
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kenneth Kc Man
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China
| | - Juliana de Oliveira Costa
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Nina Pil Hostrup Nielsen
- Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Theresa Wimberley
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Ian Ck Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Daltveit DS, Klungsøyr K, Engeland A, Ekbom A, Gissler M, Glimelius I, Grotmol T, Madanat-Harjuoja L, Ording AG, Sørensen HT, Troisi R, Bjørge T. Cancer risk in the siblings of individuals with major birth defects: a large Nordic population-based case-control study. Int J Epidemiol 2023; 52:1826-1835. [PMID: 37608599 PMCID: PMC10749741 DOI: 10.1093/ije/dyad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Individuals with major birth defects are at increased risk of developing cancer, indicating a common aetiology. However, whether the siblings of individuals with birth defects are also at an increased risk of cancer is unclear. METHODS We used nationwide health registries in four Nordic countries and conducted a nested case-control study. We included 40 538 cancer cases (aged 0-46 years) and 481 945 population controls (matched by birth year and country), born between 1967 and 2014. The relative risk of cancer among individuals whose siblings had birth defects was computed with odds ratios (OR) and 95% confidence intervals (CIs), using logistic regression models. RESULTS In the total study population (aged 0-46 years), we observed no overall difference in cancer risk between individuals whose siblings had birth defects and those who had unaffected siblings (OR 1.02; 95% CI 0.97-1.08); however, the risk of lymphoid and haematopoietic malignancies was elevated (1.16; 1.05-1.28). The overall risk of childhood cancer (0-19 years) was increased for siblings of individuals who had birth defects (1.09; 1.00-1.19), which was mainly driven by lymphoma (1.35; 1.09-1.66), neuroblastoma (1.51; 1.11-2.05) and renal carcinoma (5.03; 1.73-14.6). The risk of cancer also increased with the number of siblings with birth defects (Ptrend = 0.008). CONCLUSION Overall risk of cancer among individuals (aged 0-46 years) whose siblings had birth defects was not elevated, but the risk of childhood cancer (ages 0-19 years) was increased. Our novel findings are consistent with the common aetiologies of birth defects and cancer, such as shared genetic predisposition and environmental factors.
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Affiliation(s)
- Dagrun Slettebø Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Quality Registry of Cleft Lip and Palate, Surgical Clinic, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Ekbom
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Glimelius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | | | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland
- Dana Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Centre, Boston, MA, USA
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Rebecca Troisi
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
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6
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Paramsothy A, Hegvik TA, Engeland A, Bjørge T, Egeland GM, Klungsøyr K. Fetal Exposure to Preeclampsia and Later Risk of Cardiometabolic Disorders: A Population-Based Cohort Study. Hypertension 2023; 80:e158-e166. [PMID: 37737002 DOI: 10.1161/hypertensionaha.122.20682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Fetal preeclampsia exposure has been associated with later cardiometabolic disease. However, this association has been investigated in few large population-wide studies, and it is unknown whether the association represents a causal relationship or is the result of shared etiological factors. METHODS To further investigate the relationship between preeclampsia exposure and later cardiometabolic disease, we identified 1 692 944 singleton infants born in Norway during 1967 to 1997, where 44 299 were exposed to preeclampsia in utero. The individuals were followed for hypertension, diabetes, and dyslipidemia as defined by dispensed medication. We used Cox regression models to calculate the association between preeclampsia exposure and cardiometabolic outcomes adjusting for measured confounders. We also used full sibling comparisons and stratified Cox regression to control for unmeasured familial confounders. RESULTS On the population level, exposed individuals had increased risk of hypertension (adjusted hazard ratio [aHR] 1.51 [95% CI, 1.41-1.63]), diabetes (aHR 1.33 [95% CI, 1.24-1.43], and dyslipidemia (aHR 1.28 [95% CI, 1.13-1.45]) compared with unexposed individuals. In sibling data, individuals not exposed to preeclampsia, but with an exposed sibling, had higher risk of hypertension and diabetes than individuals where no siblings were exposed to preeclampsia. Moreover, when comparing siblings discordant on preeclampsia exposure, there were no associations between preeclampsia and hypertension (aHR 1.05 [95% CI, 0.88-1.26]), diabetes (aHR 0.96 [95% CI, 0.80-1.14]), and dyslipidemia (aHR 0.86 [95% CI, 0.62-1.20]). CONCLUSIONS Fetal preeclampsia exposure was associated with adult life hypertension, diabetes, and dyslipidemia, but these associations were likely due to shared etiological factors, rather than exposure to the preeclamptic condition itself.
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Affiliation(s)
- Abira Paramsothy
- Department of Global Public Health and Primary Care, University of Bergen, Norway (A.P., T.-A.H., A.E., T.B., G.M.E., K.K.)
| | - Tor-Arne Hegvik
- Department of Global Public Health and Primary Care, University of Bergen, Norway (A.P., T.-A.H., A.E., T.B., G.M.E., K.K.)
- Department of Obstetrics and Gynecology, Levanger Hospital, Norway (T.-A.H.)
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Norway (A.P., T.-A.H., A.E., T.B., G.M.E., K.K.)
- Division of Mental and Physical Health (A.E., K.K.), Norwegian Institute of Public Health, Bergen
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Norway (A.P., T.-A.H., A.E., T.B., G.M.E., K.K.)
- Cancer Registry of Norway, Oslo (T.B.)
| | - Grace M Egeland
- Department of Global Public Health and Primary Care, University of Bergen, Norway (A.P., T.-A.H., A.E., T.B., G.M.E., K.K.)
- Division of Health Data and Digitalisation (G.M.E.), Norwegian Institute of Public Health, Bergen
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway (A.P., T.-A.H., A.E., T.B., G.M.E., K.K.)
- Division of Mental and Physical Health (A.E., K.K.), Norwegian Institute of Public Health, Bergen
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7
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Kjerpeseth LJ, Cesta CE, Furu K, Engeland A, Gissler M, Gulseth HL, Karlstad Ø, Leinonen MK, Pazzagli L, Zoega H, Cohen JM. Metformin Versus Insulin and Risk of Major Congenital Malformations in Pregnancies With Type 2 Diabetes: A Nordic Register-Based Cohort Study. Diabetes Care 2023:dc230256. [PMID: 37343541 DOI: 10.2337/dc23-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/27/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE To assess the risk of major congenital malformations with metformin versus insulin in pregnancies with type 2 diabetes. RESEARCH DESIGN AND METHODS This cohort study used four Nordic countries' nationwide registers of live and stillborn infants exposed to metformin or insulin during first trimester organogenesis. Main exclusion criteria were type 1 diabetes, polycystic ovary syndrome, fertility treatment, and exposure to other diabetes drugs. Adjusted risk ratios (RRs) and 95% CIs were estimated for any and cardiac malformations. RESULTS Of 3,734,125 infants in the source population, 25,956 were exposed to metformin or insulin in the first trimester, and 4,023 singleton infants were included. A malformation was diagnosed in 147 (4.7%) of 3,145 infants with exposure to any metformin (alone or in addition to insulin) and 50 (5.7%) of 878 infants with exposure to insulin alone (RR 0.84, 95% CI 0.46-1.54). Among 2,852 infants exposed to metformin alone and 293 infants exposed to metformin in addition to insulin 127 (4.4%) and 20 (6.8%), respectively, had a malformation. The adjusted risk was not increased for either metformin alone (0.83, 0.44-1.58) or both metformin and insulin (0.98, 0.56-1.69) versus insulin alone. Corresponding RRs for cardiac malformations were 1.01 (0.55-1.84) for any metformin, 0.92 (0.47-1.81) for metformin alone, and 1.72 (0.76-3.91) for both metformin and insulin. CONCLUSIONS No evidence of an increased malformation risk with metformin versus insulin in the first trimester was found. Results should be interpreted with caution since information on glycemic control was missing.
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Affiliation(s)
- Lars J Kjerpeseth
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Carolyn E Cesta
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anders Engeland
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Hanne L Gulseth
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Maarit K Leinonen
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Pazzagli
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Jacqueline M Cohen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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8
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Cohen JM, Alvestad S, Cesta CE, Bjørk MH, Leinonen MK, Nørgaard M, Einarsdóttir K, Engeland A, Gissler M, Karlstad Ø, Klungsøyr K, Odsbu I, Reutfors J, Selmer RM, Tomson T, Ulrichsen SP, Zoega H, Furu K. Comparative Safety of Antiseizure Medication Monotherapy for Major Malformations. Ann Neurol 2023; 93:551-562. [PMID: 36433783 DOI: 10.1002/ana.26561] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was undertaken to examine the comparative safety of antiseizure medication (ASM) monotherapy in pregnancy with respect to risk of major congenital malformations (MCMs), overall and by MCM subtype. METHODS We conducted a population-based cohort study using national health register data from Denmark, Finland, Iceland, Norway, and Sweden (1996-2020). We compared pregnancies with first trimester exposure to lamotrigine monotherapy to ASM-unexposed, carbamazepine, valproate, oxcarbazepine, levetiracetam, and topiramate to lamotrigine monotherapy, and stratified monotherapy groups by dose. The outcome was nongenetic MCM and specific subtypes. We estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) with log-binomial regression and propensity score weights. RESULTS There was a higher crude risk of any MCM in pregnancies exposed to lamotrigine monotherapy (n = 8,339) compared to ASM-unexposed pregnancies (n = 4,866,362), but not after confounder adjustment (aRR = 0.97, 95% CI = 0.87-1.08). Compared to lamotrigine, there was an increased risk of malformations associated with valproate (n = 2,031, aRR = 2.05, 95% CI = 1.70-2.46) and topiramate (n = 509, aRR = 1.81, 95% CI = 1.26-2.60), which increased in a dose-dependent manner. We found no differences in malformation risk for carbamazepine (n = 2,674, aRR = 0.91, 95% CI = 0.72-1.15), oxcarbazepine (n = 1,313, aRR = 1.09, 95% CI = 0.83-1.44), or levetiracetam (n = 1,040, aRR = 0.78, 95% CI = 0.53-1.13). Valproate was associated with several malformation subtypes, including nervous system, cardiac, oral clefts, clubfoot, and hypospadias, whereas lamotrigine and carbamazepine were not. INTERPRETATION Topiramate is associated with an increased risk of MCM similar to that associated with valproate, but lower doses may mitigate the risks for both drugs. Conversely, we found no increased risks for lamotrigine, carbamazepine, oxcarbazepine, or levetiracetam, which is reassuring. ANN NEUROL 2023;93:551-562.
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Affiliation(s)
- Jacqueline M Cohen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Silje Alvestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Carolyn E Cesta
- Center for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Marte-Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Maarit K Leinonen
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Kristjana Einarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Engeland
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Center for Child Psychiatry, University of Turku, Turku, Finland.,Region Stockholm, Academic Primary Health Care Center & Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Ingvild Odsbu
- Center for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Johan Reutfors
- Center for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Randi M Selmer
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Sinna Pilgaard Ulrichsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Helga Zoega
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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9
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Hegvik TA, Klungsøyr K, Kuja-Halkola R, Remes H, Haavik J, D'Onofrio BM, Metsä-Simola N, Engeland A, Fazel S, Lichtenstein P, Martikainen P, Larsson H, Sariaslan A. Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings. Am J Obstet Gynecol 2023; 228:233.e1-233.e12. [PMID: 35973476 DOI: 10.1016/j.ajog.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND A recent study has suggested that labor epidural analgesia may be associated with increased rates of offspring autism spectrum disorder. Subsequent replication attempts have lacked sufficient power to confidently exclude the possibility of a small effect, and the causal nature of this association remains unknown. OBJECTIVE This study aimed to investigate the extent to which exposure to labor epidural analgesia is associated with offspring autism spectrum disorder and attention-deficit/hyperactivity disorder following adjustments for unmeasured familial confounding. STUDY DESIGN We identified 4,498,462 singletons and their parents using the Medical Birth Registers in Finland (cohorts born from 1987-2005), Norway (1999-2015), and Sweden (1987-2011) linked with population and patient registries. These cohorts were followed from birth until they either had the outcomes of interest, emigrated, died, or reached the end of the follow-up (at mean ages 13.6-16.8 years), whichever occurred first. Cox regression models were used to estimate country-specific associations between labor epidural analgesia recorded at birth and outcomes (eg, at least 1 secondary care diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder or at least 1 dispensed prescription of medication used for the treatment of attention-deficit/hyperactivity disorder). The models were adjusted for sex, birth year, birth order, and unmeasured familial confounders via sibling comparisons. Pooled estimates across all the 3 countries were estimated using inverse variance weighted fixed-effects meta-analysis models. RESULTS A total of 4,498,462 individuals (48.7% female) were included, 1,091,846 (24.3%) of which were exposed to labor epidural analgesia. Of these, 1.2% were diagnosed with autism spectrum disorder and 4.0% with attention-deficit/hyperactivity disorder. On the population level, pooled estimates showed that labor epidural analgesia was associated with increased risk of offspring autism spectrum disorder (adjusted hazard ratio, 1.12; 95% confidence interval, 1.10-1.14, absolute risks, 1.20% vs 1.07%) and attention-deficit/hyperactivity disorder (adjusted hazard ratio, 1.20; 95% confidence interval, 1.19-1.21; absolute risks, 3.95% vs 3.32%). However, when comparing full siblings who were differentially exposed to labor epidural analgesia, the associations were fully attenuated for both conditions with narrow confidence intervals (adjusted hazard ratio [autism spectrum disorder], 0.98; 95% confidence interval, 0.93-1.03; adjusted hazard ratio attention-deficit/hyperactivity disorder, 0.99; 95% confidence interval, 0.96-1.02). CONCLUSION In this large cross-national study, we found no support for the hypothesis that exposure to labor epidural analgesia causes either offspring autism spectrum disorder or attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Tor-Arne Hegvik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jan Haavik
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IA
| | - Niina Metsä-Simola
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden; Max Planck Institute for Demographic Research, Rostock, Germany
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
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10
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Bjørge T, Hjellvik V, Bjørge L, Dos-Santos-Silva I, Furu K, Kvåle R, Engeland A. Incidence and prevalence of drugs used for chronic diseases in survivors of adult-onset gynaecological cancer - A nationwide cohort study. BJOG 2023; 130:770-778. [PMID: 36700296 DOI: 10.1111/1471-0528.17410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/12/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate both incidence and prevalence of drugs used for chronic diseases in survivors of adult-onset gynaecological cancer. DESIGN A prospective study. SETTING Population-based registries. POPULATION 1.76 million women, including 17 500 women with gynaecological cancers. METHODS Data from the Cancer Registry of Norway was linked to the Norwegian Prescription Database and other national databases. MAIN OUTCOME MEASURES Prevalence ratios (PRs) and hazard ratios (HRs), with 95% confidence intervals (CIs), of dispensed drugs in gynaecological cancer patients (up to 15 years after diagnosis) were estimated by log-binomial and Cox regression, respectively, with cancer-free women as reference. RESULTS For gynaecological cancer patients, the incidence of drugs used for pain control was higher than in cancer-free women, especially the first 5 years after diagnosis, and the prevalence was high at least 10 years after. The prevalence of sex hormones was high in women with gynaecological cancer at least 10 years after diagnosis (cervical and ovarian cancer PR = 23, 95% CI 18-30 and PR = 29, 95% CI 15-38, respectively), but low in cancer-free women (0.3%). Patients with uterine corpus cancer had a higher prevalence of antidiabetics before and at least 10 years after diagnosis, most pronounced in women diagnosed before age 50 (PR = 10, 95% CI 5.0-21). The prevalence of antidepressants was moderately elevated in women with gynaecological cancers. CONCLUSIONS Gynaecological cancer survivors, particularly cervical and ovarian cancer survivors, had an increased long-term use of drugs for pain control and sex hormones. Survivors of uterine corpus cancer used antidiabetics more often, both before and after diagnosis.
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Affiliation(s)
- Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Vidar Hjellvik
- Norwegian Institute of Public Health, Bergen/Oslo, Norway
| | - Line Bjørge
- Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Isabel Dos-Santos-Silva
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kari Furu
- Norwegian Institute of Public Health, Bergen/Oslo, Norway
| | - Rune Kvåle
- Norwegian Institute of Public Health, Bergen/Oslo, Norway.,Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Bergen/Oslo, Norway
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11
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Sun M, Fritz J, Häggström C, Bjørge T, Nagel G, Manjer J, Engeland A, Zitt E, van Guelpen B, Stattin P, Ulmer H, Stocks T. Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study. J Natl Cancer Inst 2023; 115:456-467. [PMID: 36647199 PMCID: PMC10086630 DOI: 10.1093/jnci/djad008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Studies of obesity with or without metabolic aberrations, commonly termed metabolically unhealthy or healthy obesity, in relation to cancer risk are scarce. METHODS We investigated body mass index (BMI, normal weight/overweight/obesity) jointly and in interaction with metabolic health status in relation to obesity-related cancer risk (n = 23,630) among 797,193 European individuals. A metabolic score comprising mid-blood pressure, plasma glucose and triglycerides was used to define metabolically healthy and unhealthy status. Hazard ratios (HRs) and multiplicative interactions were assessed using Cox regression, and additive interactions were assessed using the relative excess risk for interaction. All statistical tests were two-sided. RESULTS Metabolically unhealthy obesity, with a baseline prevalence of 7%, was, compared to metabolically healthy normal weight, associated with an increased relative risk of any obesity-related cancer and of colon, rectal, pancreas, endometrial, liver, gallbladder, and renal cell cancer (p < 0.05), with the highest risk estimates for endometrial, liver, and renal cell cancer (HRs, 2.55 to 3.00). Metabolically healthy obesity showed a higher relative risk for any obesity-related cancer and colon (in men), endometrial, renal cell, liver, and gallbladder cancer, though the risk relationships were weaker. There were no multiplicative interactions, but there were additive, positive interactions between BMI and metabolic health status on obesity-related and rectal cancer among men, and on endometrial cancer (p < 0.05). CONCLUSIONS This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk. In general, metabolic aberrations further increased the obesity-induced cancer risk, suggesting that both obesity and metabolic aberrations are useful targets for prevention.
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Affiliation(s)
- Ming Sun
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Chronic Diseases, Norwegian Institute of Public Health, Bergen, Norway
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria.,Department of Internal Medicine III (Nephrology and Dialysis), Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hanno Ulmer
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
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12
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Bröms G, Hernandez-Diaz S, Huybrechts KF, Bateman BT, Kristiansen EB, Einarsdóttir K, Engeland A, Furu K, Gissler M, Karlsson P, Klungsøyr K, Lahesmaa-Korpinen AM, Mogun H, Nørgaard M, Reutfors J, Sørensen HT, Zoega H, Kieler H. Atomoxetine in Early Pregnancy and the Prevalence of Major Congenital Malformations: A Multinational Study. J Clin Psychiatry 2023; 84. [PMID: 36652686 DOI: 10.4088/jcp.22m14430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: Most research on safety of attention-deficit/hyperactivity disorder (ADHD) medications during pregnancy concerns central nervous system stimulants, while little is known about the safety of atomoxetine, a primary treatment alternative. We assessed the prevalence of major congenital malformations overall, and cardiac malformations and limb malformations specifically, after first-trimester exposure. Methods: In this cohort study, we included all approximately 2.4 million pregnancies ending in live births recorded in the population-based nationwide health registers of Denmark, Iceland, Norway, and Sweden (2003-2017) and approximately 1.8 million publicly insured pregnancies ending in live births recorded in the US Medicaid Analytic eXtract (MAX, 2001-2013) health care claims database. We compared the prevalence of major congenital malformations in the newborn among pregnancies exposed and unexposed to atomoxetine. For each country, we calculated prevalence ratios (PRs), crude and stratified by propensity scores (PSs). We pooled the country-specific PS strata to obtain a PR adjusted for potential confounding factors. Results: We identified 368 pregnancies exposed to atomoxetine during the first trimester in the 4 Nordic countries and 622 in the US. The pooled crude PR for any major congenital malformation was 1.18 (95% CI, 0.88-1.60), and the adjusted PR was 0.99 (95% CI, 0.74-1.34). For cardiac malformations, the adjusted PR was 1.34 (95% CI, 0.86-2.09). For limb malformations, the adjusted PR was 0.90 (95% CI, 0.38-2.16). Conclusions: After atomoxetine exposure in early pregnancy, we observed no increase in major congenital malformations overall and, although with some uncertainty due to sample size, no statistically increased risk estimates for cardiac malformations and limb malformations.
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Affiliation(s)
- Gabriella Bröms
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Internal Medicine, Danderyd Hospital, Stockholm, Sweden.,Corresponding author: Gabriella Bröms, MD, PhD, Centre for Pharmacoepidemiology, Department of Medicine Solna
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Eskild Bendix Kristiansen
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Centre for Big Data Research in Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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13
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Kitahara CM, Slettebø Daltveit D, Ekbom A, Engeland A, Gissler M, Glimelius I, Grotmol T, Trolle Lagerros Y, Madanat-Harjuoja L, Männistö T, Sørensen HT, Troisi R, Bjørge T. Maternal Health, Pregnancy and Offspring Factors, and Maternal Thyroid Cancer Risk: A Nordic Population-Based Registry Study. Am J Epidemiol 2023; 192:70-83. [PMID: 36130211 PMCID: PMC10144719 DOI: 10.1093/aje/kwac163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023] Open
Abstract
Thyroid cancer incidence is higher in women than men, especially during the reproductive years, for reasons that remain poorly understood. Using population-based registry data from 4 Nordic countries through 2015, we examined associations of perinatal characteristics with risk of maternal thyroid cancer. Cases were women diagnosed with thyroid cancer ≥2 years after last birth (n = 7,425, 83% papillary). Cases were matched to controls (n = 67,903) by mother's birth year, country, and county of residence. Odds ratios (ORs) were estimated using conditional logistic regression models adjusting for parity. Older age at first pregnancy, postpartum hemorrhage (OR = 1.18, 95% (confidence interval) CI: 1.08, 1.29), and benign thyroid conditions (ORs ranging from 1.64 for hypothyroidism to 10.35 for thyroid neoplasms) were associated with increased thyroid cancer risk, as were higher offspring birth weight (per 1-kg increase, OR = 1.17, 95% CI: 1.12, 1.22) and higher likelihood of offspring being large for gestational age (OR = 1.26, 95% CI: 1.11, 1.43). Unmarried/noncohabiting status (OR = 0.91, 95% CI: 0.84, 0.98), maternal smoking (OR = 0.75, 95% CI: 0.67, 0.84), and preterm birth (OR = 0.90, 95% CI: 0.83, 0.98) were associated with reduced risk. Several factors (e.g., older age at first pregnancy, maternal smoking, goiter, benign neoplasms, postpartum hemorrhage, hyperemesis gravidarum, and neonatal jaundice) were associated with advanced thyroid cancer. These findings suggest that some perinatal exposures may influence maternal thyroid cancer risk.
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Affiliation(s)
- Cari M Kitahara
- Correspondence to Dr. Cari M. Kitahara, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rm 7E-456, Bethesda, MD 20892 (e-mail: )
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14
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Engeland A, Nystad W, Selmer R. The Cancer Registry of Norway – “a ground for scientific harvesting”. Nor J Epidemiol 2022. [DOI: 10.5324/nje.v30i1-2.4985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Cancer Registry of Norway (CRN) has been important in registry-based research in Norway for decades. The use of CRN in combination with other population-based registries and health surveys have been the basis for numerous research projects, which has contributed to fill important knowledge gaps. Researchers at the Norwegian Institute of Public Health and CRN have a long tradition of using these data sources to address research questions of common interests such as e.g. the effect of life style and diet on cancer risk. CRN and the Medical Birth Registry of Norway have co-existed for a long period, making it possible to study cancer incidence and birth characteristics over generations. During the last decades, several new registries such as the Norwegian Prescription Database and the Norwegian Patient Registry have been established, providing opportunities for studying for example drug use and cancer risk and the influence of comorbidities on the development of cancer. In the future, the CRN will be an even more valuable data source when also other population-based registries and health surveys have existed for longer time periods.
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15
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Daltveit DS, Klungsøyr K, Engeland A, Ekbom A, Gissler M, Glimelius I, Grotmol T, Madanat-Harjuoja L, Ording AG, Sørensen HT, Troisi R, Bjørge T. Sex differences in childhood cancer risk among children with major birth defects: a Nordic population-based nested case-control study. Int J Epidemiol 2022; 52:450-465. [PMID: 36179253 PMCID: PMC10114053 DOI: 10.1093/ije/dyac192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/19/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Childhood cancer is more common among children with birth defects, suggesting a common aetiology. Whether this association differs by sex is unclear. METHODS We performed a population-based nested case-control study using nationwide health registries in four Nordic countries. We included 21 898 cancer cases (0-19 years) and 218 980 matched population controls, born 1967-2014. Associations between childhood cancer and major birth defects were calculated as odds ratios (ORs) with 95% confidence intervals (CIs) using logistic regression models. Effect modification was evaluated using a counterfactual framework to estimate confidence intervals and P-values for the natural indirect effects. RESULTS Birth defects were present for 5.1% (1117/21 898) of childhood cancer cases and 2.2% (4873/218 980) of controls; OR of cancer was higher for chromosomal (OR = 10, 95% CI = 8.6-12) than for non-chromosomal defects (OR = 1.9, 95% CI = 1.8-2.1), strongest between genetic syndromes/microdeletion and renal tumours, Down syndrome and leukaemia, and nervous system defects and central nervous system tumours. The association between birth defects and cancer was stronger among females (OR = 2.8, 95% CI = 2.6-3.1) than males (OR = 2.1, 95% CI = 1.9-2.2, Pinteraction <0.001). Male sex was an independent risk factor for childhood cancer, but very little of the overall association between sex and childhood cancer was mediated through birth defects (4.8%, PNIE <0.001), although more at younger ages (10% below years and 28% below 1 year). CONCLUSIONS The birth defect-cancer associations were generally stronger among females than males. Birth defects did not act as a strong mediator for the modest differences in childhood cancer risk by sex, suggesting that other biological pathways are involved.
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Affiliation(s)
- Dagrun Slettebø Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Quality Registry of Cleft Lip and Palate, Surgical Clinic, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Ekbom
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland.,Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Glimelius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland.,Dana Farber Cancer Institute, Boston Children's Cancer and Blood Disorders Centre, Boston, MA, USA
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Rebecca Troisi
- Trans-divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
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16
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Forster RB, Engeland A, Kvåle R, Hjellvik V, Bjørge T. Association between medical androgen deprivation therapy and long-term cardiovascular disease and all-cause mortality in non-metastatic prostate cancer. Int J Cancer 2022; 151:1109-1119. [PMID: 35489025 PMCID: PMC9544783 DOI: 10.1002/ijc.34058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022]
Abstract
Studies have suggested that prostate cancer (PCa) patients receiving androgen deprivation therapy (ADT) are at increased risk of developing or exacerbating cardiovascular disease (CVD). We aimed to explore the association between ADT for PCa and subsequent CVD and all‐cause mortality in this nationwide, longitudinal study. We also evaluated the role of cardiovascular risk and ADT duration to determine effect modification. Norwegian registry data were used to identify patients with PCa from 2008‐18 and who received primary ADT in the first year after diagnosis. The associations between ADT and composite cardiovascular events, and the individual components of myocardial infarction, stroke and heart failure, in addition to atrial fibrillation and all‐cause mortality, were explored using time‐varying Cox regression models. We included 30 923 PCa patients, of whom 8449 (27%) received primary ADT. Mean follow‐up was 2.9 and 3.8 years for CVD events and mortality, respectively. We found an association between ADT and composite CVD (adjusted HR 1.13: 95% CI 1.05‐1.21), myocardial infarction (1.18: 1.05‐1.32), stroke (1.21: 1.06‐1.38), heart failure (1.23: 1.13‐1.35) and all‐cause mortality (1.49: 1.39‐1.61). These associations persisted in those with low and moderate CVD risk and ADT longer than 7 months. A relationship between ADT and composite CVD and all‐cause mortality was observed, especially in those with moderate CVD risk and longer treatment duration. Future studies with more detailed cancer data are needed to verify the clinical relevance of these results, especially when considering all‐cause mortality within the context of treatment guidelines and benefits of ADT.
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Affiliation(s)
- R B Forster
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - A Engeland
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Kvåle
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway.,Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - V Hjellvik
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - T Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
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17
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Sun M, Bjørge T, Teleka S, Engeland A, Wennberg P, Häggström C, Stocks T. Interaction of leisure-time physical activity with body mass index on the risk of obesity-related cancers: a pooled study. Int J Cancer 2022; 151:859-868. [PMID: 35362551 PMCID: PMC9546504 DOI: 10.1002/ijc.34011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
Physical activity (PA) has been associated with a lower risk of some obesity-related cancers, but the combined association and interaction of PA and body weight on obesity-related cancer risk is less clear. We examined the association of leisure-time PA (high/low) and its combination with body mass index (BMI, <25 [low]/≥25 [high] kg/m2 ) on obesity-related cancer risk in 570 021 individuals, aged 43 years on average at baseline, in five Scandinavian cohorts. We used Cox regression to calculate hazard ratios of obesity-related cancers (n = 19 074) and assessed multiplicative and additive interactions between PA and BMI on risk. High leisure-time PA, recorded in 19% of the individuals, was associated with a 7% (95% confidence interval [CI] 4-10%) lower risk of any obesity-related cancer compared to low PA, with similar associations amongst individuals with a low and a high BMI (6% [1-11%] and 7% [2-11%]). High PA was also associated with decreased risks of renal cell (11% [9-31%]) and colon cancer (9% [2-16%]). When high PA and low BMI were combined, the relative risk reduction for all obesity-related cancers was 24% (95% CI 20-28%); endometrial cancer, 47% (35-57%); renal cell cancer, 39% (27-51%); colon cancer, 27% (19-35%); multiple myeloma, 23% (2-40%); and pancreatic cancer, 21% (4-35%), compared to low PA-high BMI. There were no additive or multiplicative interactions between PA and BMI on risk. The result of this study suggests a reduced risk of obesity-related cancer by leisure-time PA in both normal weight and overweight individuals, which further decreased for PA and normal weight combined.
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Affiliation(s)
- Ming Sun
- Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Stanley Teleka
- Department of Clinical Sciences in Lund, Lund University, Lund, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences in Lund, Lund University, Lund, Sweden
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18
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Posserud MB, Skretting Solberg B, Engeland A, Haavik J, Klungsøyr K. Male to female ratios in autism spectrum disorders by age, intellectual disability and attention-deficit/hyperactivity disorder. Acta Psychiatr Scand 2021; 144:635-646. [PMID: 34494265 DOI: 10.1111/acps.13368] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the gender distribution in ASD in adults compared with children and the impact of comorbid intellectual disability (ID) and attention-deficit/hyperactivity disorder (ADHD) on the male to female ratio (MFR). METHODS We estimated the MFR and the male prevalence ratio (PR) for ASD in adults and children using the Medical Birth Registry of Norway, including all individuals born during 1967-2011. We examined variation with age, comorbid ID and ADHD as defined by diagnoses in the Norwegian Patient Registry during 2008-2015 and/or a dispensed prescription for ADHD medication. RESULTS The sample included 1,701,206 adults and 804,146 children, including 8,995 (0.5%) adults and 8,056 (1.0%) children with ASD, 53,822 (3.2%) adults and 26,967 (3.4%) children with ADHD and 9,178 (0.5%) adults and 5,038 (0.6%) children with ID. The MFR for ASD was 3.67 in children and 2.57 in adults, corresponding to a male PR in ASD of 1.54 (95% CI 1.53-1.56) and 1.41 (1.39-1.24), respectively. Comorbid ID decreased the MFR and the male PR in both adults and children, whereas comorbid ADHD significantly increased the male PR in children. The MFR and the population prevalence of ASD, ADHD and ID decreased from children to younger adults and yet further to older adults. CONCLUSION We found a lower MFR and male PR in adults than in children. Findings suggest the strong male predominance seen in childhood/clinical studies of ASD diminishes in adult samples, possibly reflecting the influence of non-aetiological factors such as later diagnosis in females, diagnostic biases and diagnostic trends.
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Affiliation(s)
- Maj-Britt Posserud
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Berit Skretting Solberg
- Department of Biomedicine, University of Bergen, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Child and Adolescent Psychiatric Outpatient Unit, Hospital Betanien, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
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19
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Cesta CE, Segovia Chacón S, Engeland A, Broe A, Damkier P, Furu K, Kieler H, Karlsson P. Use of sildenafil and other phosphodiesterase type 5 inhibitors among pregnant women in Scandinavia. Acta Obstet Gynecol Scand 2021; 100:2111-2118. [PMID: 34453753 DOI: 10.1111/aogs.14251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION For phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, the only approved indication in women is for pulmonary arterial hypertension. These drugs are increasingly being proposed and tested for treatment of female infertility and complications in pregnancy. However, the extent of use of PDE5 inhibitors in the general pregnant population over the last decades is unknown. Therefore, we conducted a descriptive cohort study using data from the population health registers in the Scandinavian countries. MATERIAL AND METHODS By linking the Medical Birth Registers and the Prescribed Drug Registers in Denmark (1997-2017), Norway (2004-2017), and Sweden (2006-2016), women with filled prescriptions of PDE5 inhibitors in outpatient settings in the 90 days before the date of last menstrual period and/or during pregnancies were identified. With additional linkage to the National Patient Registers, information on maternal, pregnancy, and infant characteristics, co-morbidities, and co-medication was collected and described. RESULTS Among over 3 million singleton pregnancies, only 77 were pregnancies in women who had at least one filled prescription of a PDE5 inhibitor within the 90 days before the start of pregnancy to delivery. Prescription fills most often occurred before the last menstrual period and in the first trimester, with very few occurring later in pregnancy. Sildenafil was the most used PDE5 inhibitor. Among pregnant women using PDE5 inhibitors, 44% were 35 years of age or older, eight had a cardiovascular diagnosis, and three specifically had a diagnosis of pulmonary arterial hypertension. Among the infants born to mothers using PDE5 inhibitors, nine were born preterm, six were small-for-gestational age, five had an Apgar score at 5 minutes below 8, 18 were admitted to the Neonatal Intensive Care Unit, and eight had respiratory and cardiovascular conditions. CONCLUSIONS Few women used PDE5 inhibitors in outpatient settings before or during pregnancy in the Scandinavian countries in the last decades. Only a small proportion had a diagnosis for pulmonary arterial hypertension, suggesting off-label use in the remaining users. Use was predominantly in mothers over age 35 years. The safety of fetal exposure to sildenafil and other PDE5 inhibitors in pregnancy has not been established. As maternal age continues to increase and additional uses of PDE5 inhibitors are investigated, the safety of these drugs in pregnancy should be thoroughly evaluated.
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Affiliation(s)
- Carolyn E Cesta
- Department of Medicine Solna, Center for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Silvia Segovia Chacón
- Department of Medicine Solna, Center for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Broe
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Center for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Kieler
- Department of Medicine Solna, Center for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.,Department of Laboratory Medicine, Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Pär Karlsson
- Department of Medicine Solna, Center for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
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20
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Lupattelli A, Karlstad Ø, Engeland A, Småbrekke L, Olsen K, Øvrebust A, Waaseth M. The Norwegian Society for Pharmacoepidemiology. Nor J Epidemiol 2021. [DOI: 10.5324/nje.v29i1-2.4039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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21
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Solberg BS, Hegvik T, Halmøy A, Skjærven R, Engeland A, Haavik J, Klungsøyr K. Sex differences in parent-offspring recurrence of attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry 2021; 62:1010-1018. [PMID: 33341963 PMCID: PMC8451909 DOI: 10.1111/jcpp.13368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder sharing genetic risk factors with other common psychiatric disorders. However, intergenerational recurrence patterns of ADHD from parents to sons and daughters are not known. We aimed to examine the risk of ADHD in offspring of parents with ADHD and parents with other psychiatric disorders by parental and offspring sex, using parents without the specific disorders as comparison. METHODS In a generation study linking data from several population-based registries, all Norwegians born 1967-2011 (n = 2,486,088; Medical Birth Registry of Norway) and their parents were followed to 2015. To estimate intergenerational recurrence risk, we calculated prevalence differences (PD) and the relative risk (RR) of ADHD in offspring by parental ADHD, bipolar disorder (BD), schizophrenia spectrum disorder (SCZ), major depression (MDD), all by parental and offspring sex. RESULTS The absolute prevalence of ADHD in offspring of parents with ADHD was very high, especially in sons of two affected parents (41.5% and 25.1% in sons and daughters, respectively), and far higher than in offspring of parents with BD, SCZ or MDD. Intergenerational recurrence risks were higher for maternal than paternal ADHD (RRmaternal 8.4, 95% confidence interval (CI) 8.2-8.6 vs. RRpaternal 6.2, 6.0-6.4) and this was also true on the absolute scale (PDmaternal 21.1% (20.5-21.7) vs. PDpaternal 14.8% (14.3-15.4)). RRs were higher in daughters, while PDs higher in sons. Parental SCZ, BD and MDD were associated with an approximately doubled risk of offspring ADHD compared to parents without the respective disorders, and estimates did not differ significantly between daughters and sons. CONCLUSIONS The intergenerational recurrence risks of ADHD were high and higher from mothers with ADHD than fathers with ADHD. Other parental psychiatric disorders also conferred increased risk of offspring ADHD, but far lower, indicating a sex- and diagnosis-specific intergenerational recurrence risk in parents with ADHD.
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Affiliation(s)
- Berit S. Solberg
- Department of BiomedicineUniversity of BergenBergenNorway,Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Child and Adolescent Psychiatric Outpatient UnitHospital BetanienBergenNorway
| | | | - Anne Halmøy
- Department of PsychiatryHaukeland University HospitalBergenNorway,Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Rolv Skjærven
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Anders Engeland
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Division of Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
| | - Jan Haavik
- Department of BiomedicineUniversity of BergenBergenNorway,Bergen Center for Brain PlasticityDivision of PsychiatryHaukeland University HospitalBergenNorway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Division of Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
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22
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Wood AM, Jonsson H, Nagel G, Häggström C, Manjer J, Ulmer H, Engeland A, Zitt E, Jochems SHJ, Ghaderi S, Stattin P, Bjørge T, Stocks T. The Inverse Association of Body Mass Index with Lung Cancer: Exploring Residual Confounding, Metabolic Aberrations and Within-Person Variability in Smoking. Cancer Epidemiol Biomarkers Prev 2021; 30:1489-1497. [PMID: 34162656 DOI: 10.1158/1055-9965.epi-21-0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The inverse observational association between body mass index (BMI) and lung cancer risk remains unclear. We assessed whether the association is explained by metabolic aberrations, residual confounding, and within-person variability in smoking, and compared against other smoking-related cancers. METHODS We investigated the association between BMI, and its combination with a metabolic score (MS) of mid-blood pressure, glucose, and triglycerides, with lung cancer and other smoking-related cancers in 778,828 individuals. We used Cox regression, adjusted and corrected for within-person variability in smoking (status/pack-years), calculated from 600,201 measurements in 221,958 participants. RESULTS Over a median follow-up of 20 years, 20,242 smoking-related cancers (6,735 lung cancers) were recorded. Despite adjustment and correction for substantial within-person variability in smoking, BMI remained inversely associated with lung cancer [HR per standard deviation increase, 0.87 (95% confidence interval 0.85-0.89)]. Individuals with BMI less than 25 kg/m2 and high MS had the highest risk [HR 1.52 (1.44-1.60) vs. BMI ≥25 with low MS]. These associations were weaker and nonsignificant among nonsmokers. Similar associations were observed for head and neck cancers and esophageal squamous cell carcinoma, whereas for other smoking-related cancers, we generally observed positive associations with BMI. CONCLUSIONS The increased lung cancer risk with low BMI and high MS is unlikely due to residual confounding and within-person variability in smoking. However, similar results for other cancers strongly related to smoking suggest a remaining, unknown, effect of smoking. IMPACT Extensive smoking-adjustments may not capture all the effects of smoking on the relationship between obesity-related factors and risk of smoking-related cancers.
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Affiliation(s)
- Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
| | - Håkan Jonsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Anders Engeland
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria.,Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | | | - Sara Ghaderi
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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23
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Engeland A, Ghaderi S, Dos-Santos-Silva I, Furu K, Hjellvik V, Kvåle R, Bjørge T. Prescribed drugs in 27 000 individuals after diagnosis of colorectal cancer: A population-based cohort study. Pharmacoepidemiol Drug Saf 2021; 30:1037-1048. [PMID: 33822430 DOI: 10.1002/pds.5243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/06/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of prescribed drugs in survivors of colorectal cancer (CRC) was evaluated. METHODS Data from the Cancer Registry of Norway were linked to the Norwegian Prescription Database for a study population of 3.52 million individuals. Prevalence ratios (PRs) with 95% confidence intervals (CIs) of prescribed drugs in CRC-survivors compared to the cancer-free population, were estimated by log-binomial regression, adjusting for age and education. RESULTS Almost 27 000 individuals, aged 20 to 84, were diagnosed with CRC during 2005 to 2014. The first year after diagnosis, the prevalence of prescribed drugs was higher in CRC-survivors compared with the cancer-free population, especially drugs for anxiety and tension, and steroid-responsive conditions. PRs for several drugs, especially drugs used for mental and behavioural disorders, decreased with time since diagnosis. The prevalence of drugs used for anxiety and tension was elevated 10 years after diagnosis; PRs the first year after diagnosis were 20 (95% CI: 18-22) in males and 17 (16-18) in females. Ten years after diagnosis PRs were 5.0 (3.1-7.9) and 2.0 (1.0-3.8), respectively. In absolute numbers, the largest increase, compared to the cancer-free population, was in drugs used for gastric acid disorders and pain. The prevalence of neuromodulatory drugs was higher in CRC-survivors. CONCLUSIONS The prevalence of several drugs was higher in CRC-survivors than in the cancer-free population 10 years after diagnosis. The largest absolute excess in prevalence was for gastric acid disorder and pain medications, while the relative prevalence of drugs used for anxiety and tension was high in CRC-survivors. Long persisting neuropathia was indicated.
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Affiliation(s)
- Anders Engeland
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sara Ghaderi
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Isabel Dos-Santos-Silva
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Rune Kvåle
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health Registry Research and Development Norwegian Institute of Public Health, Bergen, Norway.,Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
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Daltveit DS, Klungsøyr K, Engeland A, Ekbom A, Gissler M, Glimelius I, Grotmol T, Madanat-Harjuoja L, Ording AG, Sæther SMM, Sørensen HT, Troisi R, Bjørge T. Cancer Risk in Individuals With Major Birth Defects: Large Nordic Population Based Case-Control Study Among Children, Adolescents, and Adults. Obstet Gynecol Surv 2021. [DOI: 10.1097/01.ogx.0000743352.84907.0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Nagel G, Bjørge T, Jaensch A, Peter RS, Häggström C, Lang A, Engeland A, Teleka S, Jirström K, Lindquist D, Stattin P, Ulmer H, Concin H, Stocks T. Metabolic factors and the risk of small intestine cancers: Pooled study of 800 000 individuals in the metabolic syndrome and cancer project. Int J Cancer 2021; 149:66-74. [PMID: 33634882 DOI: 10.1002/ijc.33530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 01/06/2023]
Abstract
To explore the largely unknown etiology of small intestine cancer, we examined metabolic factors and risk of small intestine cancer overall and by subtypes. Among 404 220 women and 403 265 men in six European cohorts, we applied Cox regression with adjustment for smoking and body mass index (BMI), to calculate sex-specific hazard ratios (HRs) of small intestine cancer by levels of BMI, mean arterial pressure (MAP) and plasma total cholesterol, triglycerides and glucose. We also calculated HRs for these factors combined (metabolic score; MetS) and used Wald test statistics to investigate pairwise interactions between metabolic factors on risk. We also performed analyses separately per subtype (neuroendocrine tumors [NETs] and adenocarcinomas). During a median follow-up of 16.9 years, 144 women and 195 men were diagnosed with small intestine cancer, including 184 NETs and 99 adenocarcinomas. Among men, no main associations or interactions between metabolic factors were observed in relation to the risk of small intestine cancer. Among women, triglycerides were positively and linearly associated with risk (HR per standard deviation [SD]: 1.23, 95% confidence interval [CI]: 1.04-1.46), and a positive association was also observed for the MetS (HR per SD: 1.25, 95% CI: 1.02-1.52). Positive interactions were observed among women between triglycerides and cholesterol (P = .0005), and between MAP and glucose (P = .009), on risk. Glucose was positively associated with adenocarcinomas among women. This large, prospective study suggests that elevated triglycerides, and metabolic factors in interaction, confer an increased risk of small intestine cancer among women, but not among men.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Alois Lang
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Stanley Teleka
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Karin Jirström
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - David Lindquist
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Hans Concin
- Agency for Preventive and Social Medicine (aks), Bregenz, Austria
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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26
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Kitahara CM, Slettebø Daltveit D, Ekbom A, Engeland A, Gissler M, Glimelius I, Grotmol T, Trolle Lagerros Y, Madanat-Harjuoja L, Männistö T, Sørensen HT, Troisi R, Bjørge T. Maternal health, in-utero, and perinatal exposures and risk of thyroid cancer in offspring: a Nordic population-based nested case-control study. Lancet Diabetes Endocrinol 2021; 9:94-105. [PMID: 33347809 PMCID: PMC7875310 DOI: 10.1016/s2213-8587(20)30399-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Thyroid cancer tends to be diagnosed at a younger age (median age 51 years) compared with most other malignancies (such as breast cancer [62 years] or lung cancer [71 years]). The incidence of thyroid cancer is higher in women than men diagnosed from early adolescence. However, few in-utero and early life risk exposures associated with increased risk of thyroid cancer have been identified. METHODS In this population-based nested case-control study we used registry data from four Nordic countries to assess thyroid cancer risk in offspring in relation to maternal medical history, pregnancy complications, and birth characteristics. Patient with thyroid cancer (cases) were individuals born and subsequently diagnosed with first primary thyroid cancer from 1973 to 2013 in Denmark, 1987 to 2014 in Finland, 1967 to 2015 in Norway, or 1973 to 2014 in Sweden. Each case was matched with up to ten individuals without thyroid cancer (controls) based on birth year, sex, country, and county of birth. Cases and matched controls with a previous diagnosis of any cancer, other than non-melanoma skin cancer, at the time of thyroid cancer diagnosis were excluded. Cases and matched controls had to reside in the country of birth at the time of thyroid cancer diagnosis. Conditional logistic regression models were used to calculate odds ratios (ORs) with 95% CIs. RESULTS Of the 2437 cases, 1967 (81·4%) had papillary carcinomas, 1880 (77·1%) were women, and 1384 (56·7%) were diagnosed before age 30 years (range 0-48). Higher birth weight (OR per kg 1·14 [95% CI 1·05-1·23]) and congenital hypothyroidism (4·55 [1·58-13·08]); maternal diabetes before pregnancy (OR 1·69 [0·98-2·93]) and postpartum haemorrhage (OR 1·28 [1·06-1·55]); and (from registry data in Denmark) maternal hypothyroidism (18·12 [10·52-31·20]), hyperthyroidism (11·91 [6·77-20·94]), goiter (67·36 [39·89-113·76]), and benign thyroid neoplasms (22·50 [6·93-73·06]) were each associated with an increased risk of thyroid cancer in offspring. INTERPRETATION In-utero exposures, particularly those related to maternal thyroid disorders, might have a long-term influence on thyroid cancer risk in offspring. FUNDING Intramural Research Program of the National Cancer Institute (National Institutes of Health).
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Affiliation(s)
- Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | | | - Anders Ekbom
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Ylva Trolle Lagerros
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland; Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuija Männistö
- Northern Finland Laboratory Center NordLab, Oulu, Finland
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Cancer Registry of Norway, Oslo, Norway
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27
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Daltveit DS, Klungsøyr K, Engeland A, Ekbom A, Gissler M, Glimelius I, Grotmol T, Madanat-Harjuoja L, Ording AG, Sæther SMM, Sørensen HT, Troisi R, Bjørge T. Cancer risk in individuals with major birth defects: large Nordic population based case-control study among children, adolescents, and adults. BMJ 2020; 371:m4060. [PMID: 33268348 PMCID: PMC7708828 DOI: 10.1136/bmj.m4060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine associations between birth defects and cancer from birth into adulthood. DESIGN Population based nested case-control study. SETTING Nationwide health registries in Denmark, Finland, Norway, and Sweden. PARTICIPANTS 62 295 cancer cases (0-46 years) and 724 542 frequency matched controls (matched on country and birth year), born between 1967 and 2014. MAIN OUTCOME MEASURES Relative risk of cancer in relation to major birth defects, estimated as odds ratios with 99% confidence intervals from logistic regression models. RESULTS Altogether, 3.5% (2160/62 295) of cases and 2.2% (15 826/724 542) of controls were born with major birth defects. The odds ratio of cancer for people with major birth defects compared with those without was 1.74 (99% confidence interval 1.63 to 1.84). For individuals with non-chromosomal birth defects, the odds ratio of cancer was 1.54 (1.44 to 1.64); for those with chromosomal anomalies, the odds ratio was 5.53 (4.67 to 6.54). Many structural birth defects were associated with later cancer in the same organ system or anatomical location, such as defects of the eye, nervous system, and urinary organs. The odds ratio of cancer increased with number of defects and decreased with age, for both non-chromosomal and chromosomal anomalies. The odds ratio of cancer in people with any non-chromosomal birth defect was lower in adults (≥20 years: 1.21, 1.09 to 1.33) than in adolescents (15-19 years: 1.58, 1.31 to 1.90) and children (0-14 years: 2.03, 1.85 to 2.23). The relative overall cancer risk among adults with chromosomal anomalies was markedly reduced from 11.3 (9.35 to 13.8) in children to 1.50 (1.01 to 2.24). Among adults, skeletal dysplasia (odds ratio 3.54, 1.54 to 8.15), nervous system defects (1.76, 1.16 to 2.65), chromosomal anomalies (1.50, 1.01 to 2.24), genital organs defects (1.43, 1.14 to 1.78), and congenital heart defects (1.28, 1.02 to 1.59) were associated with overall cancer risk. CONCLUSIONS The increased risk of cancer in individuals with birth defects persisted into adulthood, both for non-chromosomal and chromosomal anomalies. Further studies on the molecular mechanisms involved are warranted.
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Affiliation(s)
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Ekbom
- Unit of Clinical Epidemiology, Department of Medicine/Solna, Karolinska Institute, Stockholm, Sweden
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rebecca Troisi
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
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28
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Felde G, Engeland A, Hunskaar S. Urinary incontinence associated with anxiety and depression: the impact of psychotropic drugs in a cross-sectional study from the Norwegian HUNT study. BMC Psychiatry 2020; 20:521. [PMID: 33138789 PMCID: PMC7607697 DOI: 10.1186/s12888-020-02922-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anxiety and depression are in both cross-sectional and longitudinal studies associated with urinary incontinence (UI) in women, strongest for the urgency component of UI. The role of psychotropic drugs in this association, especially antidepressants, has been questioned, but not clarified. The present study aimed to explore the associations between UI and anxiety/depression and the possible impact of psychotropic drugs on these associations. METHODS We conducted a cross-sectional, population-based study with questionnaire data from 21,803 women ≥20 years in the Norwegian Nord-Trøndelag Health Study merged with the Norwegian Prescription Database, which contains information on all dispensed prescriptions. We used multivariate logistic regression to investigate the association between UI (any UI, and by type and severity) and anxiety/depression (by different score on Hospital anxiety and depression scale), and the influence of psychotropic drugs on this association (by different volume of drug use). RESULTS Compared with normal anxiety- and depression score, having moderate/severe anxiety or depression (HADS≥11) increased the prevalence of UI from 27.6 to 37.8% (OR 1.59 (1.40-1.81), p < 0.001) for anxiety and from 28.0 to 43.7% (OR 1.79 (1.46-2.21), p < 0.001) for depression. According to type of UI, mixed UI was most strongly associated with a high HADS-score with an odds ratio 1.84 (1.65-2.05) for anxiety and 1.85 (1.61-2.13) for depression. Compared to no UI, severe UI was associated with depression with odds ratios of 2.04 (1.74-2.40), compared with no UI. Psychotropic drug use did not influence the associations between UI and anxiety/depression. We found high prevalence of UI among users of various psychotropic drugs. After adjustments, only antidepressants were associated with UI, with OR 1.36 (1.08-1.71) for high defined daily dose of the drug. Anxiolytics were associated with less UI with OR 0.64 (0.45-0.91) after adjustments for anxiety. CONCLUSION This study showed that anxiety, depression and use of antidepressants are associated factors with UI, strongest for urgency and mixed type of UI, with increasing ORs by increasing severity of the conditions and increased daily dose of the medication. Use of antidepressants did not influence the associations between UI and anxiety/depression.
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Affiliation(s)
- Gunhild Felde
- Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, 5020, Bergen, Norway.
| | - Anders Engeland
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, 5020 Bergen, Norway ,grid.418193.60000 0001 1541 4204Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Steinar Hunskaar
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Postboks 7804, 5020 Bergen, Norway
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29
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Abstract
This pharmacoepidemiology study uses Scandinavian birth registry data to estimate the association between modafinil use during early pregnancy and major congenital malformations among infants born in Norway and Sweden between 2005-2006 and 2016-2017.
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Affiliation(s)
- Carolyn E. Cesta
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Engeland
- Department of Chronic Diseases and Aging, Norwegian Institute of Public Health, Bergen, Norway
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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30
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Fritz J, Bjørge T, Nagel G, Manjer J, Engeland A, Häggström C, Concin H, Teleka S, Tretli S, Gylling B, Lang A, Stattin P, Stocks T, Ulmer H. The triglyceride-glucose index as a measure of insulin resistance and risk of obesity-related cancers. Int J Epidemiol 2020; 49:193-204. [PMID: 30945727 DOI: 10.1093/ije/dyz053] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The role of insulin resistance as a mediator in the association of body mass index (BMI) with site-specific cancer risk has, to our knowledge, never been systematically quantified. METHODS Altogether 510 471 individuals from six European cohorts, with a mean age of 43.1 years, were included. We used the triglyceride glucose product (TyG index) as a surrogate measure for insulin resistance. We fitted Cox models, adjusted for relevant confounders, to investigate associations of TyG index with 10 common obesity-related cancers, and quantified the proportion of the effect of BMI mediated through TyG index on the log-transformed hazard ratio (HR) scale. RESULTS During a median follow-up of 17.2 years, 16 052 individuals developed obesity-related cancers. TyG index was associated with the risk of cancers of the kidney HR per one standard deviation increase 1.13, 95% confidence interval: 1.07 to 1.20], liver (1.13, 1.04 to 1.23), pancreas (1.12, 1.06 to 1.19), colon (1.07, 1.03 to 1.10) and rectum (1.09, 1.04 to 1.14). Substantial proportions of the effect of BMI were mediated by TyG index for cancers of the pancreas (42%), rectum (34%) and colon (20%); smaller proportions for kidney (15%) and liver (11%). Little or no mediation was observed for breast (postmenopausal), endometrial and ovarian cancer. Results were similar for males and females, except for pancreatic cancer where the proportions mediated were 20% and 91%, respectively. CONCLUSIONS The TyG index was associated with increased risk of cancers of the digestive system and substantially mediated the effect of BMI, suggesting that insulin resistance plays a promoting role in the pathogenesis of gastrointestinal cancers.
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Affiliation(s)
- Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Stanley Teleka
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Björn Gylling
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Alois Lang
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
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31
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Reutfors J, Cesta CE, Cohen JM, Bateman BT, Brauer R, Einarsdóttir K, Engeland A, Furu K, Gissler M, Havard A, Hernandez-Diaz S, Huybrechts KF, Karlstad Ø, Leinonen MK, Li J, Man KKC, Pazzagli L, Schaffer A, Schink T, Wang Z, Yu Y, Zoega H, Bröms G. Antipsychotic drug use in pregnancy: A multinational study from ten countries. Schizophr Res 2020; 220:106-115. [PMID: 32295750 PMCID: PMC7306443 DOI: 10.1016/j.schres.2020.03.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
AIM To compare the prevalence and trends of antipsychotic drug use during pregnancy between countries across four continents. METHODS Individually linked health data in Denmark (2000-2012), Finland (2005-2014), Iceland (2004-2017), Norway (2005-2015), Sweden (2006-2015), Germany (2006-2015), Australia (New South Wales, 2004-2012), Hong Kong (2001-2015), UK (2006-2016), and the US (Medicaid, 2000-2013, and IBM MarketScan, 2012-2015) were used. Using a uniformed approach, we estimated the prevalence of antipsychotic use as the proportion of pregnancies where a woman filled at least one antipsychotic prescription within three months before pregnancy until birth. For the Nordic countries, data were meta-analyzed to investigate maternal characteristics associated with the use of antipsychotics. RESULTS We included 8,394,343 pregnancies. Typical antipsychotic use was highest in the UK (4.4%) whereas atypical antipsychotic use was highest in the US Medicaid (1.5%). Atypical antipsychotic use increased over time in most populations, reaching 2% in Australia (2012) and US Medicaid (2013). In most countries, prochlorperazine was the most commonly used typical antipsychotic and quetiapine the most commonly used atypical antipsychotic. Use of antipsychotics decreased across the trimesters of pregnancy in all populations except Finland. Antipsychotic use was elevated among smokers and those with parity ≥4 in the Nordic countries. CONCLUSION Antipsychotic use during pregnancy varied considerably between populations, partly explained by varying use of the typical antipsychotic prochlorperazine, which is often used for nausea and vomiting in early pregnancy. Increasing usage of atypical antipsychotics among pregnant women reflects the pattern that was previously reported for the general population.
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Affiliation(s)
- Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Carolyn E Cesta
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jacqueline M Cohen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America; Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's, Harvard Medical School, Boston, MA, United States of America
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Engeland
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia
| | | | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Øystein Karlstad
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Jiong Li
- Aarhus University, Aarhus, Denmark
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Laura Pazzagli
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Schaffer
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Zixuan Wang
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | | | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Centre for Big Data Research in Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Gabriella Bröms
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Internal Medicine, Danderyd Hospital, Stockholm, Sweden
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32
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Sköld C, Bjørge T, Ekbom A, Engeland A, Gissler M, Grotmol T, Madanat-Harjuoja L, Ording AG, Trabert B, Tretli S, Troisi R, Sørensen HT, Glimelius I. Pregnancy-related risk factors for sex cord-stromal tumours and germ cell tumours in parous women: a registry-based study. Br J Cancer 2020; 123:161-166. [PMID: 32336755 PMCID: PMC7340776 DOI: 10.1038/s41416-020-0849-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/20/2020] [Accepted: 04/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Non-epithelial ovarian cancers are divided into sex cord-stromal tumours (SCSTs) and germ cell tumours (GCTs). Whereas parity and other pregnancy-related factors are protective for epithelial ovarian cancer, their associations with SCSTs and GCTs remains unclear. METHODS Using data from the medical birth registries from Denmark, Finland, Norway and Sweden, we compared all parous women with a diagnosis of SCSTs (n = 420) or GCTs (n = 345) 1970-2013 with up to 10 parous controls (SCSTs n = 4041; GCTs n = 2942) matched on the cases' birth year and country. We used conditional logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs) of associations between pregnancy-related factors and SCSTs and GCTs. RESULTS The risk of SCSTs, but not GCTs, decreased with higher age at last birth [≥40 versus <25 years: OR 0.48 (95% CI 0.23-0.98)]. The risk of SCSTs (but not GCTs) also decreased with shorter time since last birth. Number of births, preterm birth, preeclampsia, and offspring size were not associated with risk of SCSTs or GCTs. CONCLUSIONS We found a decreased risk of SCSTs with higher age at last birth and shorter time since last birth. The risk of SCSTs (but not GCTs) may be influenced by the woman's reproductive history.
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Affiliation(s)
- Camilla Sköld
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Anders Ekbom
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Bergen, Norway
| | - Mika Gissler
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Laura Madanat-Harjuoja
- Finnish Cancer Registry, Helsinki, Finland.,Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | | | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
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33
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Handal M, Nechanská B, Skurtveit S, Lund IO, Gabrhelík R, Engeland A, Mravčík V. Prenatal exposure to opioid maintenance treatment and neonatal outcomes: Nationwide registry studies from the Czech Republic and Norway. Pharmacol Res Perspect 2019; 7:e00501. [PMID: 31428431 PMCID: PMC6694203 DOI: 10.1002/prp2.501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 12/03/2022] Open
Abstract
There is lack of knowledge about the safety of treatment with methadone and buprenorphine as part of opioid maintenance treatment (OMT) during pregnancy. The purpose of this study was to examine neonatal outcomes concerning the use of OMT during pregnancy. We used nationwide registry linkages from the Czech Republic (2000-2014) and Norway (2004-2013). We compared prenatally OMT-exposed newborns with (a) newborns of women hospitalized with opioid use disorder during pregnancy in the Czech sample and (b) newborns with neonatal abstinence syndrome (NAS) in Norway. We performed multivariate linear and binary logistic regression exploring the associations between OMT and neonatal outcomes (growth parameters, gestational age, fetal death, small for gestational age, Apgar score, and NAS). Regression coefficients (b) and odds ratios (ORs) were estimated. The cohorts consisted of 333 Czech, and 235 Norwegian OMT-exposed newborns, and 106 and 294 newborns in the comparison groups, respectively. In both countries, the neonatal growth parameters were similar in the OMT and the comparison groups. In Norway, OMT exposure prolonged gestational age (adjusted b = 0.96 weeks, 95% confidence interval [CI] =0.39-1.53) while the odds of preterm birth and Apgar score at 5 minutes were lower than in the comparison group (adjusted OR = 0.35, 0.16-0.75 and aOR = 0.21, 0.06-0.78, respectively). Newborns of women in OMT had similar growth parameters as newborns of women with opioid use disorders who were not in OMT during pregnancy. Overall, our findings do not suggest that OMT results in worse neonatal outcomes.
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Affiliation(s)
- Marte Handal
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
| | - Blanka Nechanská
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
- Institute of Health Information and Statistics of the Czech RepublicPragueCzech Republic
| | - Svetlana Skurtveit
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
- Norwegian Centre for Addiction Research at the University of OsloOsloNorway
| | - Ingunn Olea Lund
- Department of Mental DisordersNorwegian Institute of Public HealthOsloNorway
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Anders Engeland
- Department of Chronic Diseases and AgeingNorwegian Institute of Public HealthOsloNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Viktor Mravčík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
- National Monitoring Centre for Drugs and AddictionOffice of the Government of the Czech RepublicPragueCzech Republic
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Bjørge T, Häggström C, Ghaderi S, Nagel G, Manjer J, Tretli S, Ulmer H, Harlid S, Rosendahl AH, Lang A, Stattin P, Stocks T, Engeland A. BMI and weight changes and risk of obesity-related cancers: a pooled European cohort study. Int J Epidemiol 2019; 48:1872-1885. [DOI: 10.1093/ije/dyz188] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 01/21/2023] Open
Abstract
Abstract
Background
Obesity is an established risk factor for several cancers. Adult weight gain has been associated with increased cancer risk, but studies on timing and duration of adult weight gain are relatively scarce. We examined the impact of BMI (body mass index) and weight changes over time, as well as the timing and duration of excess weight, on obesity- and non-obesity-related cancers.
Methods
We pooled health data from six European cohorts and included 221 274 individuals with two or more height and weight measurements during 1972–2014. Several BMI and weight measures were constructed. Cancer cases were identified through linkage with national cancer registries. Hazard ratios (HRs) of cancer with 95% confidence intervals (CIs) were derived from time-dependent Cox-regression models.
Results
During follow-up, 27 881 cancer cases were diagnosed; 9761 were obesity-related. The HR of all obesity-related cancers increased with increasing BMI at first and last measurement, maximum BMI and longer duration of overweight (men only) and obesity. Participants who were overweight before age 40 years had an HR of obesity-related cancers of 1.16 (95% CI 1.02, 1.32) and 1.15 (95% CI 1.04, 1.27) in men and women, respectively, compared with those who were not overweight. The risk increase was particularly high for endometrial (70%), male renal-cell (58%) and male colon cancer (29%). No positive associations were seen for cancers not regarded as obesity-related.
Conclusions
Adult weight gain was associated with increased risk of several major cancers. The degree, timing and duration of overweight and obesity also seemed to be important. Preventing weight gain may reduce the cancer risk.
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Affiliation(s)
- Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Christel Häggström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Sara Ghaderi
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ann H Rosendahl
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alois Lang
- Agency for Preventive and Social Medicine, Bregenz (aks), Austria
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
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35
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Trabert B, Troisi R, Grotmol T, Ekbom A, Engeland A, Gissler M, Glimelius I, Madanat-Harjuoja L, Sørensen HT, Tretli S, Gulbech Ording A, Bjørge T. Associations of pregnancy-related factors and birth characteristics with risk of endometrial cancer: A Nordic population-based case-control study. Int J Cancer 2019; 146:1523-1531. [PMID: 31173648 DOI: 10.1002/ijc.32494] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/06/2019] [Accepted: 05/23/2019] [Indexed: 01/21/2023]
Abstract
Many pregnancy-related factors are associated with reduced endometrial cancer risk. However, it remains unclear whether pregnancy-related complications (e.g., hypertensive conditions) are associated with risk and whether these associations vary by endometrial cancer subtype. Thus, we evaluated the risk of endometrial cancer, overall and by subtype, in relation to pregnancy-related factors, pregnancy complications and birth characteristics. Utilizing population-based register data from four Nordic countries, we conducted a nested case-control analysis of endometrial cancer risk. We included 10,924 endometrial cancer cases and up to 10 matched controls per case. Odds ratios (ORs) with 95% confidence intervals (CIs) were derived from unconditional logistic regression models. We further evaluated associations by individual histology (i.e., endometrioid, serous, etc.) or, for rare exposures (e.g., pregnancy complications), by dualistic type (Type I [n = 10,343] and Type II [n = 581]). Preexisting and pregnancy-related hypertensive conditions were associated with increased endometrial cancer risk (OR [95% CI]: preexisting hypertension 1.88 [1.39-2.55]; gestational hypertension 1.47 [1.33-1.63]; preeclampsia 1.43 [1.30-1.58]), with consistent associations across dualistic type. Increasing number of pregnancies (≥4 vs. 1 birth: 0.64 [0.59-0.69]) and shorter time since last birth (<10 vs. ≥30 years: 0.34 [0.29-0.40]) were associated with reduced endometrial cancer risk, with consistent associations across most subtypes. Our findings support the role for both hormonal exposures and cell clearance as well as immunologic/inflammatory etiologies for endometrial cancer. This research supports studying endometrial hyperplasia, a precursor condition of endometrial cancer, in the context of pregnancy-related exposures, as this may provide insight into the mechanisms by which pregnancy affects subsequent cancer risk.
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Affiliation(s)
- Britton Trabert
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Anders Ekbom
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Engeland
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland.,Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tone Bjørge
- Cancer Registry of Norway, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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36
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Häggström C, Jonsson H, Bjørge T, Nagel G, Manjer J, Ulmer H, Drake I, Ghaderi S, Lang A, Engeland A, Stattin P, Stocks T. Linear age‐course effects on the associations between body mass index, triglycerides, and female breast and male liver cancer risk: An internal replication study of 800,000 individuals. Int J Cancer 2019; 146:58-67. [DOI: 10.1002/ijc.32240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 01/28/2019] [Accepted: 02/14/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Christel Häggström
- Department of Biobank ResearchUmeå University Umeå Sweden
- Department of Surgical SciencesUppsala University Uppsala Sweden
- Department of Public Health and Clinical Medicine, Nutritional ResearchUmeå University Umeå Sweden
| | - Håkan Jonsson
- Department of Radiation SciencesUmeå University Umeå Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary CareUniversity of Bergen Bergen Norway
- Cancer Registry of Norway Oslo Norway
| | - Gabriele Nagel
- Institute of Epidemiology and Medical BiometryUlm University Ulm Germany
- Vorarlberg Cancer RegistryAgency for Preventive and Social Medicine Bregenz (aks) Austria
| | - Jonas Manjer
- Department of SurgerySkåne University Hospital, Lund University Malmö Sweden
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health EconomicsInnsbruck Medical University Innsbruck Austria
| | - Isabel Drake
- Department of Clinical Sciences in MalmöLund University Lund Sweden
| | - Sara Ghaderi
- Department of Global Public Health and Primary CareUniversity of Bergen Bergen Norway
| | - Alois Lang
- Vorarlberg Cancer RegistryAgency for Preventive and Social Medicine Bregenz (aks) Austria
| | - Anders Engeland
- Department of Global Public Health and Primary CareUniversity of Bergen Bergen Norway
- Norwegian Institute of Public Health Bergen/Oslo Norway
| | - Pär Stattin
- Department of Surgical SciencesUppsala University Uppsala Sweden
| | - Tanja Stocks
- Department of Clinical Sciences in LundLund University Lund Sweden
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37
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Bateman BT, Heide-Jørgensen U, Einarsdóttir K, Engeland A, Furu K, Gissler M, Hernandez-Diaz S, Kieler H, Lahesmaa-Korpinen AM, Mogun H, Nørgaard M, Reutfors J, Selmer R, Huybrechts KF, Zoega H. β-Blocker Use in Pregnancy and the Risk for Congenital Malformations: An International Cohort Study. Ann Intern Med 2018; 169:665-673. [PMID: 30326014 PMCID: PMC6854680 DOI: 10.7326/m18-0338] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND β-Blockers are a class of antihypertensive medications that are commonly used in pregnancy. OBJECTIVE To estimate the risks for major congenital malformations associated with first-trimester exposure to β-blockers. DESIGN Cohort study. SETTING Health registries in the 5 Nordic countries and the U.S. Medicaid database. PATIENTS Pregnant women with a diagnosis of hypertension and their offspring. MEASUREMENTS First-trimester exposure to β-blockers was assessed. Outcomes were any major congenital malformation, cardiac malformations, cleft lip or palate, and central nervous system (CNS) malformations. Propensity score stratification was used to control for potential confounders. RESULTS Of 3577 women with hypertensive pregnancies in the Nordic cohort and 14 900 in the U.S. cohort, 682 (19.1%) and 1668 (11.2%), respectively, were exposed to β-blockers in the first trimester. The pooled adjusted relative risk (RR) and risk difference per 1000 persons exposed (RD1000) associated with β-blockers were 1.07 (95% CI, 0.89 to 1.30) and 3.0 (CI, -6.6 to 12.6), respectively, for any major malformation; 1.12 (CI, 0.83 to 1.51) and 2.1 (CI, -4.3 to 8.4) for any cardiac malformation; and 1.97 (CI, 0.74 to 5.25) and 1.0 (CI, -0.9 to 3.0) for cleft lip or palate. For CNS malformations, the adjusted RR was 1.37 (CI, 0.58 to 3.25) and the RD1000 was 1.0 (CI, -2.0 to 4.0) (based on U.S. cohort data only). LIMITATION Analysis was restricted to live births, exposure was based on dispensed medication, and cleft lip or palate and CNS malformations had few outcomes. CONCLUSION The results suggest that maternal use of β-blockers in the first trimester is not associated with a large increase in the risk for overall malformations or cardiac malformations, independent of measured confounders. PRIMARY FUNDING SOURCE The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Söderström König Foundation.
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Affiliation(s)
- Brian T Bateman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (B.T.B., K.F.H.)
| | | | | | - Anders Engeland
- Norwegian Institute of Public Health, Oslo, and University of Bergen, Bergen, Norway (A.E.)
| | - Kari Furu
- Norwegian Institute of Public Health, Oslo, Norway (K.F., R.S.)
| | - Mika Gissler
- University of Turku, Turku, Finland, and Karolinska Institutet, Stockholm, Sweden (M.G., H.K., J.R.)
| | | | - Helle Kieler
- University of Turku, Turku, Finland, and Karolinska Institutet, Stockholm, Sweden (M.G., H.K., J.R.)
| | | | - Helen Mogun
- Karolinska Institutet, Stockholm, Sweden; National Institute for Health and Welfare, Helsinki, Finland; Brigham and Women's Hospital, Boston, Massachusetts (H.M.)
| | - Mette Nørgaard
- Aarhus University Hospital, Aarhus, Denmark (U.H., M.N.)
| | - Johan Reutfors
- University of Turku, Turku, Finland, and Karolinska Institutet, Stockholm, Sweden (M.G., H.K., J.R.)
| | - Randi Selmer
- Norwegian Institute of Public Health, Oslo, Norway (K.F., R.S.)
| | - Krista F Huybrechts
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (B.T.B., K.F.H.)
| | - Helga Zoega
- University of Iceland, Reykjavik, Iceland, and University of New South Wales, Sydney, New South Wales, Australia (H.Z.)
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38
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Hjerkind KV, Gislefoss RE, Tretli S, Nystad W, Bjørge T, Engeland A, Meyer HE, Holvik K, Ursin G, Langseth H. Cohort Profile Update: The Janus Serum Bank Cohort in Norway. Int J Epidemiol 2018; 46:1101-1102f. [PMID: 28087783 DOI: 10.1093/ije/dyw302] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kirsti Vik Hjerkind
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Randi E Gislefoss
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Steinar Tretli
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
| | - Wenche Nystad
- Division of Mental and Physical Health, Norwegian Institute for Public Health, Oslo, Norway
| | - Tone Bjørge
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anders Engeland
- Division of Mental and Physical Health, Norwegian Institute for Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Haakon E Meyer
- Division of Mental and Physical Health, Norwegian Institute for Public Health, Oslo, Norway
| | - Kristin Holvik
- Division of Mental and Physical Health, Norwegian Institute for Public Health, Oslo, Norway
| | - Giske Ursin
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hilde Langseth
- Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway
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39
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Troisi R, Gulbech Ording A, Grotmol T, Glimelius I, Engeland A, Gissler M, Trabert B, Ekbom A, Madanat-Harjuoja L, Sørensen HT, Tretli S, Bjørge T. Pregnancy complications and subsequent breast cancer risk in the mother: a Nordic population-based case-control study. Int J Cancer 2018; 143:1904-1913. [PMID: 29752724 DOI: 10.1002/ijc.31600] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/17/2018] [Accepted: 04/27/2018] [Indexed: 01/30/2023]
Abstract
Certain features of pregnancy are important risk factors for breast cancer, such as protection afforded by young age at first birth. Preeclampsia, a pregnancy complication, is associated with reduced maternal breast cancer risk. However, questions remain regarding causality, biological mechanisms and the relation of other hypertensive conditions to risk. We conducted a population-based case-control study of breast cancer cases (n = 116,196) in parous women identified through linkage of birth and cancer registries in Denmark, Finland, Norway and Sweden (1967-2013), including up to 10 matched controls per case (n = 1,147,192) sampled from the birth registries (complete data were not available on all variables). Odds ratios (ORs) with 95% confidence intervals (CIs) were derived from unconditional logistic regression models including matching factors (country, maternal birth year) and parity. Hypertension diagnosed before pregnancy (OR 0.87; 95% CI 0.78-0.97), gestational hypertension (OR 0.90; 95% CI 0.86-0.93) and preeclampsia (OR 0.91; 95% CI 0.88-0.95) were associated with reduced breast cancer risk. Results remained similar after adjustment for smoking and maternal body mass index before first pregnancy, and were generally similar stratified by parity, age at breast cancer diagnosis, time since first and last birth, sex of the offspring and calendar time. Except for retained placenta (OR 1.14; 95% CI 0.98-1.32), no other pregnancy complication appeared associated with breast cancer risk. The mechanisms mediating the modest risk reductions for history of preeclampsia or hypertension preceding or arising during pregnancy, and possible increased risk with history of retained placenta are unknown and warrant further laboratory, clinical and epidemiological investigation.
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Affiliation(s)
- Rebecca Troisi
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ingrid Glimelius
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anders Engeland
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen/Oslo, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Britton Trabert
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Anders Ekbom
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland.,Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tone Bjørge
- Cancer Registry of Norway, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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40
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Sköld C, Bjørge T, Ekbom A, Engeland A, Gissler M, Grotmol T, Madanat-Harjuoja L, Gulbech Ording A, Stephansson O, Trabert B, Tretli S, Troisi R, Sørensen HT, Glimelius I. Preterm delivery is associated with an increased risk of epithelial ovarian cancer among parous women. Int J Cancer 2018; 143:1858-1867. [PMID: 29737528 DOI: 10.1002/ijc.31581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/31/2018] [Accepted: 04/17/2018] [Indexed: 11/07/2022]
Abstract
Epithelial ovarian cancer is a fatal disease of largely unknown etiology. Higher parity is associated with reduced risk of ovarian cancer. However, among parous women, the impact of pregnancy-related factors on risk is not well understood. This population-based case-control study included all parous women with epithelial ovarian cancer in Denmark, Finland, Norway and Sweden during 1967-2013 (n = 10,957) and up to 10 matched controls (n = 107,864). We used conditional logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for pregnancy-related factors and ovarian cancer risk by histological subtype. Preterm delivery was associated with an increased risk [pregnancy length (last pregnancy) ≤30 vs. 39-41 weeks, OR 1.33 (95% CI 1.06-1.67), adjusted for number of births]; the OR increased as pregnancy length decreased (p for trend < 0.001). Older age at first and last birth was associated with a decreased risk [first birth: 30-39 vs. <25 years: adjusted OR 0.76 (95% CI 0.70-0.83); last birth 30-39 vs. <25 years: adjusted OR 0.76 (95% CI 0.71-0.82)]. Increasing number of births was protective [≥4 births vs. 1; OR 0.63 (95% CI 0.59-0.68)] for all subtypes, most pronounced for clear-cell tumors [OR 0.30, (95% CI 0.21-0.44), pheterogeneity < 0.001]. No associations were observed for multiple pregnancies, preeclampsia or offspring size. In conclusion, in addition to high parity, full-term pregnancies and pregnancies at older ages were associated with decreased risk of ovarian cancer. Our findings favor the cell clearance hypothesis, i.e. a recent pregnancy provides protection by clearing of precancerous cells from the epithelium of the ovary/fallopian tubes, mediated by placental or ovarian hormones.
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Affiliation(s)
- Camilla Sköld
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Anders Ekbom
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Bergen, Norway
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Laura Madanat-Harjuoja
- Cancer Society of Finland, Finnish Cancer Registry, Helsinki, Finland.,Department of Paediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Olof Stephansson
- Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Rebecca Troisi
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
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Nechanská B, Mravčík V, Skurtveit S, Lund IO, Gabrhelík R, Engeland A, Handal M. Neonatal outcomes after fetal exposure to methadone and buprenorphine: national registry studies from the Czech Republic and Norway. Addiction 2018; 113:1286-1294. [PMID: 29443414 PMCID: PMC6221017 DOI: 10.1111/add.14192] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/07/2017] [Accepted: 02/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Opioid maintenance treatment (OMT) is recommended to opioid-dependent females during pregnancy. However, it is not clear which medication should be preferred. We aimed to compare neonatal outcomes after prenatal exposure to methadone (M) and buprenorphine (B) in two European countries. DESIGN Nation-wide register-based cohort study using personalized IDs assigned to all citizens for data linkage. SETTING The Czech Republic (2000-14) and Norway (2004-13). [Correction added after online publication on 26 April 2018: The Czech Republic (2000-04) corrected to (2000-14).] PARTICIPANTS: Opioid-dependent pregnant Czech (n = 333) and Norwegian (n = 235) women in OMT who received either B or M during pregnancy and their newborns. MEASUREMENTS We linked data from health registries to identify the neonatal outcomes: gestational age, preterm birth, birth weight, length and head circumference, small for gestational age, miscarriages and stillbirth, neonatal abstinence syndrome (NAS) and Apgar score. We performed multivariate linear regression and binary logistic regression to explore the associations between M and B exposure and outcomes. Regression coefficient (β) and odds ratio (OR) were computed. FINDINGS Most neonatal outcomes were more favourable after exposure to B compared with M, but none of the differences was statistically significant. For instance, in the multivariate analysis, birth weight was β = 111.6 g [95% confidence interval (CI) = -10.5 to 233.6 and β = 83.1 g, 95% CI = -100.8 to 267.0] higher after B exposure in the Czech Republic and Norway, respectively. Adjusted OR of NAS for B compared with M was 0.94 (95% CI = 0.46-1.92) in the Norwegian cohort. CONCLUSIONS Two national cohorts of women receiving opioid maintenance treatment during pregnancy showed small but not statistically significant differences in neonatal outcomes in favour of buprenorphine compared with methadone.
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Affiliation(s)
- Blanka Nechanská
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Viktor Mravčík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic,National Monitoring Centre for Drugs and Addiction, Office of the Government of the Czech RepublicPragueCzech Republic
| | - Svetlana Skurtveit
- Norwegian institute of Public HealthOsloNorway,Norwegian Centre for Addiction Research at the University of OsloOsloNorway
| | | | - Roman Gabrhelík
- Department of Addictology, First Faculty of MedicineCharles UniversityPragueCzech Republic
| | - Anders Engeland
- Norwegian institute of Public HealthOsloNorway,Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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Engeland A, Bjørge T, Klungsøyr K, Hjellvik V, Skurtveit S, Furu K. Trends in prescription drug use during pregnancy and postpartum in Norway, 2005 to 2015. Pharmacoepidemiol Drug Saf 2018; 27:995-1004. [PMID: 29920833 DOI: 10.1002/pds.4577] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/30/2018] [Accepted: 05/18/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To explore trends in use of maternal medication 3 months prior to, during and 3 months after pregnancy. METHODS Data on births from the Medical Birth Registry of Norway were linked to the Norwegian Prescription Database, identifying women's use of medications around pregnancy. All women giving birth in Norway during 2005 to 2015 (638 532 singleton births to 414 567 women) were included. Proportions of pregnant women using different medications in association with pregnancy, and annual relative change in medication use during 2005 to 2015, were calculated. RESULTS In Norway, 60% of pregnant women used prescription medications during pregnancy (2005-15), increasing from 57% in 2005 to 62% in 2015. The annual relative increase was 0.9% (95% CI: 0.8-1.0). In the first trimester, approximately 17% of the women used medications regarded as potentially teratogenic during 2005 to 2015, increasing from 15% to 19%. Overall, this proportion was higher in the first than in the second (8.9%) and third (8.0%) trimesters, and higher than in the 3 months after pregnancy (14%). The annual relative increase of medications regarded as potentially teratogenic in the first trimester was 2.5% (95% CI: 2.3-2.7). CONCLUSIONS The proportion of women using potentially teratogenic medications in the first trimester of pregnancy have increased during the last decade. Clinicians need to be aware of the possibility of pregnancy when prescribing potentially teratogenic medication to women of fertile age and focus this in the consultations. The increasing trends call for the need of routine surveillance of adverse birth outcomes linked to medication use in pregnancy.
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Affiliation(s)
- Anders Engeland
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Cancer Registry of Norway, Oslo, Norway
| | - Kari Klungsøyr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vidar Hjellvik
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Addictive Research, University of Oslo, Oslo, Norway
| | - Kari Furu
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Abstract
This pharmacoepidemiology study uses Swedish and Norwegian registry data to investigate associations between fluconazole use during pregnancy and subsequent stillbirth and neonatal death.
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Affiliation(s)
- Björn Pasternak
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Wintzell
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anders Engeland
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Martin Neovius
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Olof Stephansson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Hegvik TA, Instanes JT, Haavik J, Klungsøyr K, Engeland A. Associations between attention-deficit/hyperactivity disorder and autoimmune diseases are modified by sex: a population-based cross-sectional study. Eur Child Adolesc Psychiatry 2018; 27:663-675. [PMID: 28983730 PMCID: PMC5945751 DOI: 10.1007/s00787-017-1056-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/21/2017] [Indexed: 12/18/2022]
Abstract
Several studies have demonstrated associations between neuropsychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD), and the immune system, including autoimmune diseases. Since ADHD and many autoimmune diseases show sex-specific properties, such associations may also differ by sex. Using Norwegian national registries, we performed a cross-sectional study based on a cohort of 2,500,118 individuals to investigate whether ADHD is associated with common autoimmune diseases. Associations between ADHD and autoimmune diseases in females and males were investigated with logistic regression and effect modification by sex was evaluated. Several subanalyses were performed. The strongest association was found between ADHD and psoriasis in females, adjusted odds ratio (adjOR) = 1.57 (95% confidence interval: 1.46-1.68) and males, adjOR = 1.31 (1.23-1.40); p value for interaction < 0.0001. Furthermore, among females, ADHD was associated with Crohn's disease, adjOR = 1.44 (1.16-1.79) and ulcerative colitis, adjOR = 1.28 (1.06-1.54). In contrast, males with ADHD had lower odds of Crohn's disease, adjOR = 0.71 (0.54-0.92), in addition to a trend for lower odds of ulcerative colitis, adjOR = 0.86 (0.71-1.03); p values for interaction < 0.0001 and 0.0023, respectively. In a group of females where information on smoking and body mass index was available, adjustment for these potential mediators did not substantially alter the associations. Our findings support previously reported associations between ADHD and diseases of the immune system. The associations differ by sex, suggesting that sex-specific immune-mediated neurodevelopmental processes may be involved in the etiology of ADHD.
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Affiliation(s)
- Tor-Arne Hegvik
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway.
- K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway.
| | - Johanne Telnes Instanes
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N-5009, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Domain for Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Bergen/Oslo, Norway
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45
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Solberg BS, Halmøy A, Engeland A, Igland J, Haavik J, Klungsøyr K. Gender differences in psychiatric comorbidity: a population-based study of 40 000 adults with attention deficit hyperactivity disorder. Acta Psychiatr Scand 2018; 137:176-186. [PMID: 29266167 PMCID: PMC5838558 DOI: 10.1111/acps.12845] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aimed at determining whether gender modified associations between ADHD and psychiatric comorbidities in adults. METHOD We identified adults with ADHD by linking Norwegian national registries and compared them with the remaining adult population (born 1967-1997, ADHD and bipolar during 2004-2015, other psychiatric disorders 2008-2015). Prevalence differences (PDs) and prevalence ratios (PRs) of psychiatric disorders were determined by Poisson regression. Interaction by gender was evaluated on additive (PDs) and multiplicative (PRs) scales. Proportions of psychiatric disorders attributable to ADHD were calculated. RESULTS We identified 40 103 adults with ADHD (44% women) and 1 661 103 adults (49% women) in the remaining population. PDs associated with ADHD were significantly larger in women than in men for anxiety, depression, bipolar and personality disorders, for example depression in women: 24.4 (95% CI, 23.8-24.9) vs. in men: 13.1 (12.8-13.4). PDs were significantly larger in men for schizophrenia and substance use disorder (SUD), for example SUD in men: 23.0 (22.5-23.5) vs. in women: 13.7 (13.3-14.0). Between 5.6 and 16.5% of psychiatric disorders in the population were attributable to ADHD. CONCLUSION The association between ADHD and psychiatric comorbidities differed significantly among men and women. Clinicians treating adults with ADHD should be aware of these frequent and gender-specific comorbidities, such that early treatment can be offered.
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Affiliation(s)
- B. S. Solberg
- Department of BiomedicineUniversity of BergenBergenNorway,Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,K.G. Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway
| | - A. Halmøy
- Department of BiomedicineUniversity of BergenBergenNorway,K.G. Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway,Department of PsychiatryHaukeland University HospitalBergenNorway
| | - A. Engeland
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,Division of Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
| | - J. Igland
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - J. Haavik
- Department of BiomedicineUniversity of BergenBergenNorway,K.G. Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway,Department of PsychiatryHaukeland University HospitalBergenNorway
| | - K. Klungsøyr
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway,K.G. Jebsen Center for Neuropsychiatric DisordersUniversity of BergenBergenNorway,Division of Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
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46
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Mittal S, Bjørnevik K, Im DS, Flierl A, Dong X, Locascio JJ, Abo KM, Long E, Jin M, Xu B, Xiang YK, Rochet JC, Engeland A, Rizzu P, Heutink P, Bartels T, Selkoe DJ, Caldarone BJ, Glicksman MA, Khurana V, Schüle B, Park DS, Riise T, Scherzer CR. β2-Adrenoreceptor is a regulator of the α-synuclein gene driving risk of Parkinson's disease. Science 2018; 357:891-898. [PMID: 28860381 DOI: 10.1126/science.aaf3934] [Citation(s) in RCA: 289] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 02/13/2017] [Accepted: 06/23/2017] [Indexed: 12/21/2022]
Abstract
Copy number mutations implicate excess production of α-synuclein as a possibly causative factor in Parkinson's disease (PD). Using an unbiased screen targeting endogenous gene expression, we discovered that the β2-adrenoreceptor (β2AR) is a regulator of the α-synuclein gene (SNCA). β2AR ligands modulate SNCA transcription through histone 3 lysine 27 acetylation of its promoter and enhancers. Over 11 years of follow-up in 4 million Norwegians, the β2AR agonist salbutamol, a brain-penetrant asthma medication, was associated with reduced risk of developing PD (rate ratio, 0.66; 95% confidence interval, 0.58 to 0.76). Conversely, a β2AR antagonist correlated with increased risk. β2AR activation protected model mice and patient-derived cells. Thus, β2AR is linked to transcription of α-synuclein and risk of PD in a ligand-specific fashion and constitutes a potential target for therapies.
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Affiliation(s)
- Shuchi Mittal
- Neurogenomics Laboratory and Parkinson Personalized Medicine Program, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.,Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway
| | - Doo Soon Im
- Brain and Mind Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Adrian Flierl
- The Parkinson's Institute and Clinical Center, Sunnyvale, CA 94085, USA
| | - Xianjun Dong
- Neurogenomics Laboratory and Parkinson Personalized Medicine Program, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.,Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Joseph J Locascio
- Neurogenomics Laboratory and Parkinson Personalized Medicine Program, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kristine M Abo
- Neurogenomics Laboratory and Parkinson Personalized Medicine Program, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Elizabeth Long
- Neurogenomics Laboratory and Parkinson Personalized Medicine Program, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Ming Jin
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Bing Xu
- Department of Pharmacology, University of California at Davis, Davis, CA 95616, USA
| | - Yang K Xiang
- Department of Pharmacology, University of California at Davis, Davis, CA 95616, USA
| | - Jean-Christophe Rochet
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN 47907, USA
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Patrizia Rizzu
- German Center for Neurodegenerative Diseases (DZNE), Tübingen 72076, Germany
| | - Peter Heutink
- German Center for Neurodegenerative Diseases (DZNE), Tübingen 72076, Germany
| | - Tim Bartels
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Dennis J Selkoe
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Barbara J Caldarone
- Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.,Harvard NeuroDiscovery Center, Harvard Medical School, Boston, MA 02115, USA
| | - Marcie A Glicksman
- Harvard NeuroDiscovery Center, Harvard Medical School, Boston, MA 02115, USA
| | - Vikram Khurana
- Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.,Harvard Stem Cell Institute, Cambridge, MA 02138, USA
| | - Birgitt Schüle
- The Parkinson's Institute and Clinical Center, Sunnyvale, CA 94085, USA
| | - David S Park
- Brain and Mind Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada
| | - Trond Riise
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway
| | - Clemens R Scherzer
- Neurogenomics Laboratory and Parkinson Personalized Medicine Program, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA. .,Ann Romney Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA
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47
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Huybrechts KF, Bröms G, Christensen LB, Einarsdóttir K, Engeland A, Furu K, Gissler M, Hernandez-Diaz S, Karlsson P, Karlstad Ø, Kieler H, Lahesmaa-Korpinen AM, Mogun H, Nørgaard M, Reutfors J, Sørensen HT, Zoega H, Bateman BT. Association Between Methylphenidate and Amphetamine Use in Pregnancy and Risk of Congenital Malformations: A Cohort Study From the International Pregnancy Safety Study Consortium. JAMA Psychiatry 2018; 75:167-175. [PMID: 29238795 PMCID: PMC5838573 DOI: 10.1001/jamapsychiatry.2017.3644] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Given the rapidly increasing use of stimulant medications during pregnancy and among women of reproductive age who may become pregnant inadvertently, there is a need to better understand their safety. OBJECTIVE To examine the risk of congenital malformations associated with intrauterine exposure to stimulants. DESIGN, SETTING, AND PARTICIPANTS Cohort study of the Medicaid-insured population in the United States nested in the 2000-2013 US Medicaid Analytic eXtract, with follow-up of safety signals detected in the Medicaid Analytic eXtract data using the Nordic Health registries (2003-2013) (Denmark, Finland, Iceland, Norway, and Sweden). A total of 1 813 894 publicly insured pregnancies in the United States and 2 560 069 singleton pregnancies in the 5 Nordic countries ending in live births were included. Relative risks were estimated accounting for underlying psychiatric disorders and other potential confounders. Relative risk estimates for the US and Nordic data were pooled using a fixed-effects meta-analytic approach. The study was conducted from July 1, 2015, to March 31, 2017. EXPOSURES Methylphenidate and amphetamines dispensed during the first trimester. MAIN OUTCOMES AND MEASURES Major congenital malformations and subgroup of cardiac malformations. RESULTS In the US data, of the 1 813 894 pregnancies evaluated, 35.0 per 1000 infants not exposed to stimulants were diagnosed as having congenital malformations, compared with 45.9 per 1000 infants for methylphenidate and 45.4 for amphetamines. For cardiac malformations, the risks were 12.7 (95% CI, 12.6-12.9), 18.8 (95% CI, 13.8-25.6), and 15.4 (95% CI, 12.5-19.0) per 1000 infants, respectively. The adjusted relative risks for methylphenidate were 1.11 (95% CI, 0.91-1.35) for any malformation and 1.28 (95% CI, 0.94-1.74) for cardiac malformations. No increased risks were observed for amphetamines: 1.05 (95% CI, 0.93-1.19) for any malformations and 0.96 (95% CI, 0.78-1.19) for cardiac malformations. Findings were confirmed in sensitivity analyses accounting for proxies of unmeasured confounders and increasing the specificity of the exposure and outcome definitions. Replication of the analyses for methylphenidate using the Nordic data including 2 560 069 pregnancies yielded a relative risk of 1.28 (95% CI, 0.83-1.97) for cardiac malformations, resulting in a pooled estimate of 1.28 (95% CI, 1.00-1.64). CONCLUSIONS AND RELEVANCE These findings suggest a small increase in the risk of cardiac malformations associated with intrauterine exposure to methylphenidate but not to amphetamines. This information is important when weighing the risks and benefits of alternative treatment strategies for attention-deficit/hyperactivity disorder in women of reproductive age and during early pregnancy.
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Affiliation(s)
- Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gabriella Bröms
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kristjana Einarsdóttir
- Unit for Nutrition Research, Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anders Engeland
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kari Furu
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland,Research Centre for Child Psychiatry, University of Turku, Turku, Finland,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Øystein Karlstad
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Hegvik TA, Instanes JT, Haavik J, Klungsøyr K, Engeland A. Correction to: Associations between attention-deficit/hyperactivity disorder and autoimmune diseases are modified by sex: a population-based cross-sectional study. Eur Child Adolesc Psychiatry 2018; 27:677. [PMID: 29196875 PMCID: PMC5945736 DOI: 10.1007/s00787-017-1087-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The article "Associations between attention-deficit/hyperactivity disorder and autoimmune diseases are modified by sex: a population-based cross-sectional study", written by Tor-Arne Hegvik, Johanne Telnes Instanes, Jan Haavik, Kari Klungsøyr and Anders Engeland, was originally published electronically on the publisher's internet portal (currently SpringerLink) on October 5, 2017 without open access due to an error by the Springer editorial office in the processing of this article. The authors had originally opted for open access.
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Affiliation(s)
- Tor-Arne Hegvik
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, N‑5009, Bergen, Norway. .,K.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N‑5009, Bergen, Norway.
| | - Johanne Telnes Instanes
- 0000 0004 1936 7443grid.7914.bDepartment of Biomedicine, University of Bergen, Jonas Lies vei 91, N‑5009 Bergen, Norway ,0000 0004 1936 7443grid.7914.bK.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N‑5009 Bergen, Norway ,0000 0004 1936 7443grid.7914.bDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan Haavik
- 0000 0004 1936 7443grid.7914.bDepartment of Biomedicine, University of Bergen, Jonas Lies vei 91, N‑5009 Bergen, Norway ,0000 0004 1936 7443grid.7914.bK.G. Jebsen Centre for Neuropsychiatric Disorders, University of Bergen, Jonas Lies vei 91, N‑5009 Bergen, Norway ,0000 0000 9753 1393grid.412008.fDivision of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- 0000 0004 1936 7443grid.7914.bDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ,0000 0001 1541 4204grid.418193.6Domain for Health Data and Digitalization, Norwegian Institute of Public Health, Bergen, Norway
| | - Anders Engeland
- 0000 0004 1936 7443grid.7914.bDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ,0000 0001 1541 4204grid.418193.6Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Bergen/Oslo, Norway
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Antonazzo IC, Riise T, Cortese M, Berge LI, Engeland A, Bernt Fasmer O, Lund A, Joachim Ødegaard K, Poluzzi E, Bjornevik K. Diabetes is associated with decreased migraine risk: A nationwide cohort study. Cephalalgia 2017; 38:1759-1764. [PMID: 29249165 DOI: 10.1177/0333102417748573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background Results from studies on diabetes and migraine risk are conflicting, which may be due to methodological limitations. Prospective studies with long follow-up could increase our understanding of the relationship between the two diseases. Method We performed a cohort study including the whole Norwegian population alive on 01.01.2004, using prescriptions registered in the Norwegian prescription database to identify individuals developing type 1 diabetes, type 2 diabetes and migraine during follow-up (10 years). We used Cox proportional hazards regression to estimate rate ratios with corresponding 95% confidence intervals for the effect of diabetes on migraine risk, adjusting for age, sex, and educational level. Result We identified 7,883 type 1 diabetes patients and 93,600 type 2 patients during the study period. Type 1 diabetes was significantly associated with a subsequent decreased migraine risk during follow-up in the age- and sex-adjusted analyses (0.74; 0.61-0.89). Type 2 diabetes was also associated with a significantly lower migraine risk (0.89; 0.83-0.95). Further adjustment for educational level yielded similar results for both diabetes. Conclusion Both type 1 and type 2 diabetes were significantly associated with a decreased risk of migraine. This suggests that diabetes or diabetes treatment may have a protective effect on the development of migraine.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- 1 Department of Global Public Health and Primary Care, University of Bergen, Norway.,2 Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Italy
| | - Trond Riise
- 1 Department of Global Public Health and Primary Care, University of Bergen, Norway.,3 The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway
| | - Marianna Cortese
- 1 Department of Global Public Health and Primary Care, University of Bergen, Norway.,3 The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway.,4 Department of Clinical Medicine, University of Bergen, Norway
| | - Line Iden Berge
- 5 Kronstad DPS, Division of Psychiatry, Haukeland University Hospital, Norway
| | - Anders Engeland
- 1 Department of Global Public Health and Primary Care, University of Bergen, Norway.,6 Division of Mental and Physical Health, Norwegian Institute of Public Health, Norway
| | - Ole Bernt Fasmer
- 5 Kronstad DPS, Division of Psychiatry, Haukeland University Hospital, Norway.,7 Section for Psychiatry, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Anders Lund
- 5 Kronstad DPS, Division of Psychiatry, Haukeland University Hospital, Norway.,7 Section for Psychiatry, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Ketil Joachim Ødegaard
- 5 Kronstad DPS, Division of Psychiatry, Haukeland University Hospital, Norway.,7 Section for Psychiatry, Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Elisabetta Poluzzi
- 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Italy
| | - Kjetil Bjornevik
- 1 Department of Global Public Health and Primary Care, University of Bergen, Norway.,3 The Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Norway
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Instanes JT, Halmøy A, Engeland A, Haavik J, Furu K, Klungsøyr K. Attention-Deficit/Hyperactivity Disorder in Offspring of Mothers With Inflammatory and Immune System Diseases. Biol Psychiatry 2017; 81:452-459. [PMID: 26809250 DOI: 10.1016/j.biopsych.2015.11.024] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prenatal inflammatory mechanisms may play a role in the pathogenesis of psychiatric disorders and could be relevant for attention-deficit/hyperactivity disorder (ADHD). We investigated maternal chronic somatic diseases with immune components as possible risk factors for ADHD in offspring. METHODS We performed a population-based nested case-control study by linking data from longitudinal Norwegian registers. We included all individuals born during the period 1967-2008 and alive at record linkage (2012). Individuals receiving ADHD medication during the years 2004-2012 were defined as patients with ADHD (N = 47,944), and all remaining individuals (N = 2,274,713) were defined as control subjects. The associations between maternal diseases and ADHD in offspring were analyzed using logistic regression models. RESULTS The following chronic diseases with immune components were related to ADHD in offspring: multiple sclerosis (adjusted odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.2-2.5), rheumatoid arthritis (adjusted OR = 1.7; 95% CI = 1.5-1.9), type 1 diabetes (adjusted OR = 1.6; 95% CI = 1.3-2.0), asthma (adjusted OR = 1.5; 95% CI = 1.4-1.6), and hypothyroidism (adjusted OR = 1.2; 95% CI = 1.1-1.4). In contrast, chronic hypertension and type 2 diabetes showed no significant associations. Estimates were almost unchanged with additional adjustment for parental ADHD, infant birth weight, and gestational age. Although point estimates for male and female offspring were different for some diseases (e.g., maternal asthma [adjusted OR = 1.7; 95% CI = 1.5-1.8 for female offspring and adjusted OR = 1.5; 95% CI = 1.4-1.6 for male offspring]), none of the associations differed significantly by offspring sex. CONCLUSIONS Several maternal somatic diseases with immune components were found to increase the risk of ADHD in offspring. The associations could involve several causal pathways, including common genetic predisposition and environmental factors, and increased insight into the mechanisms behind these relationships could enhance our understanding of the etiology of ADHD.
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Affiliation(s)
- Johanne T Instanes
- Department of Biomedicine, Bergen; Department of Global Public Health and Primary Care, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen.
| | - Anne Halmøy
- Department of Biomedicine, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen; Haukeland University Hospital;Bergen
| | - Anders Engeland
- Department of Global Public Health and Primary Care, Bergen; Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Haavik
- Department of Biomedicine, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen; Haukeland University Hospital;Bergen
| | - Kari Furu
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, Bergen; K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen;Bergen; Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen
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