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Ibsen H, Ahrenfeldt LJ, Lykkegaard J, Søndergaard J, Švab I, Kjaer NK. Barriers for continuous medical education: cross-sectional questionnaire study among danish general practitioners. BJGP Open 2024:BJGPO.2023.0228. [PMID: 38490677 DOI: 10.3399/bjgpo.2023.0228] [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: 11/09/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND General practitioners' (GPs') participation in continuous medical education (CME) is essential for patientcare, wellbeing of the GPs, and healthcare expenditures. A quarter of the Danish GPs did not use their reimbursement for CME in 2022. Knowledge of barriers for participating in CME is limited. AIM To analyse GPs' barriers for participation in CME and patterns in perceived barriers. DESIGN & SETTING The study population comprised all 3257 GPs in Denmark, who in May 2023 were registered as entitled to reimbursement for CME. METHOD The response rate was 1303/3257 (40%). Based on a question about use of CME, the respondents were divided into frequent, partial, and seldom users. Partial and seldom users answered questions about barriers related to CME (n=726). The presence of barriers was quantified, and a Latent class analysis (LCA) was used to stratify GPs according to their barrier patterns. RESULTS Most frequent barriers were: Too busy (68%), fully booked courses (47%), and no substitute (41%). Based on the LCA, we found three distinctive patterns, clustering around: GPs from clinics with no tradition for CME (17%), GPs who used time on professional work outside clinic (teaching, organisational work) (43%), and GPs who were personally or professionally affected (40%). Singled-handed and male GPs were slightly overrepresented among seldom-users. CONCLUSIONS We have identified barriers for CME. We found three different profiles of GPs who perceived different patterns of barriers. Identified patters in barriers should be considered in future CME initiatives.
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Affiliation(s)
- Helle Ibsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Linda Juel Ahrenfeldt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of public Health, University of Southern Denmark, Odense M, Denmark
| | - Igor Švab
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Niels Kristian Kjaer
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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Ahrenfeldt LJ, Stripp TA, Möller S, Viftrup DT, Nissen RD, Hvidt NC. Cognitive function among religious and non-religious Europeans: a cross-national cohort study. Aging Ment Health 2024; 28:502-510. [PMID: 37771160 DOI: 10.1080/13607863.2023.2260766] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES To examine the associations between several measures and categories of religiosity and cognitive function across sex and European regions. METHODS We conducted a longitudinal study including 17,756 Europeans aged 50 and older who participated in the Survey of Health, Ageing and Retirement in Europe wave 1. Participants were followed for up to 15 years. Associations were analyzed using linear mixed effects models adjusted for several potential confounders. RESULTS Religious service attendance was consistently associated with better cognitive function (coefficient: 1.04, 95% CI 0.71; 1.37) across sex and European regions. Praying was also associated with better cognitive function but only among men (coefficient: 0.55, 95% CI 0.15; 0.96). However, individuals who received religious education from their parents had poorer cognitive function (coefficient: -0.59, 95% CI -0.93; -0.25). The association persisted in women and among both sexes in Western Europe. Comparing different religious categories to the non-religious, participants who were religious in childhood showed an inverse association with cognitive function, while persistently religious men exhibited better cognitive function. CONCLUSIONS Our findings indicate that religious service attendance and, to a certain extent, prayer is associated with better cognitive function. However, receiving religious education in childhood may be linked to lower cognitive function.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tobias Anker Stripp
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Human Flourishing Program, Institute for Quantitative Social Sciences, Harvard University, Cambridge, MA, USA
| | - Sören Möller
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorte Toudal Viftrup
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ricko Damberg Nissen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (Age Care), Odense University Hospital, Odense, Denmark
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Stripp TA, Cowden RG, Wehberg S, Ahrenfeldt LJ, Hvidt NC, Lee MT. Salutogenic health measures: Psychometric properties of the Danish versions of the Flourish Index and the Secure Flourish Index. Scand J Psychol 2024. [PMID: 38425084 DOI: 10.1111/sjop.13011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
Measurement of human flourishing represents a salutogenic approach to epidemiological and behavioral research emphasizing factors contributing to "good lives" rather than pathology. The objective of this study was to translate and psychometrically test the 10-item Flourish Index (FI) and 12-item Secure Flourish Index (SFI) in a convenience sample of Danish adults. A total of 325 participants completed a cross-sectional survey, with 148 of those participants completing the survey a second time (retest). Confirmatory factor analysis in a structural equation modelling framework was used to establish structural validity by comparing four different pre-specified models of the indexes. Additionally, internal consistency, convergent and incremental validity, and retest reliability were examined. The FI models exhibited superior structural validity compared with similar models of the SFI, although all models had good fits. Internal consistencies with McDonald's omega were 0.89 and 0.87 for the FI and SFI, respectively. The five (FI) or six (SFI) domains were happiness & life satisfaction, mental & physical health, meaning & purpose, character & virtue, close social relationships, and financial & material stability (λ4 = 0.51-0.91). Convergent and incremental validity tests supported predefined hypotheses. Retest analyses with the FI and SFI showed a high degree of retest reliability. Based on the psychometric evidence reported in this study, the Danish Flourish Index and Secure Flourish Index seem suitable for use with healthy adult Danes. The authors hope that this psychometric evaluation of the FI and SFI will stimulate research on patterns, health and economic outcomes, and predictors of human flourishing in Denmark.
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Affiliation(s)
- Tobias Anker Stripp
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
- Center for Science and Faith, Faculty of Theology, University of Copenhagen, Copenhagen, Denmark
| | - Richard G Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Academy for Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Matthew T Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
- Institute for Studies of Religion, Baylor University, Waco, Texas, USA
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Kjaergaard-Andersen G, Bauer EH, Bhavsar RP, Jensen HI, Ahrenfeldt LJ, Hvidt NC, Stroem T. Assessment of quality of life for frail, elderly patients post-ICU discharge: a protocol for a scoping review. BMJ Open 2024; 14:e076494. [PMID: 38171634 PMCID: PMC10773388 DOI: 10.1136/bmjopen-2023-076494] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group. METHODS AND ANALYSIS The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature. ETHICS AND DISSEMINATION Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal.
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Affiliation(s)
- Gunhild Kjaergaard-Andersen
- Anaesthesiology and Intensive Care Research Unit, University Hospital of Southern Denmark, Soenderjylland, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Eithne Hayes Bauer
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Internal Medicine Research Unit, University Hospital of Southern Denmark, Soenderjylland, Soenderborg, Denmark
| | - Rajesh Prabhakar Bhavsar
- Anaesthesiology and Intensive Care Research Unit, University Hospital of Southern Denmark, Soenderjylland, Aabenraa, Denmark
- Internal Medicine Research Unit, University Hospital of Southern Denmark, Soenderjylland, Soenderborg, Denmark
| | - Hanne Irene Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospita, University Hospital of Southern Denmark, Kolding, Syddanmark, Denmark
| | | | | | - Thomas Stroem
- Anaesthesiology and Intensive Care Research Unit, University Hospital of Southern Denmark, Soenderjylland, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
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Hansen RS, Scheel-Hincke LL, Jeune B, Ahrenfeldt LJ. Sex differences in vision and hearing impairments across age and European regions : Findings from SHARE. Wien Klin Wochenschr 2024; 136:55-63. [PMID: 37280394 DOI: 10.1007/s00508-023-02223-2] [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: 01/23/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
AIM Although sensory impairments are common conditions among older people, research often fails to consider the role of sex. We examined sex differences in vision impairment and hearing impairment across age and European regions. METHODS We conducted a cross-sectional study based on a pooled sample of 65,656 females and 54,881 males aged 50 years and older participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2004-2020. Logistic regression models with robust standard errors providing odds ratios (OR) and 95% confidence intervals (CI) were used to examine associations. RESULTS European females had generally higher odds of vision impairment (OR 1.16, 95% CI 1.12-1.21) but lower odds of hearing impairment than European males (OR 0.70, 95% CI 0.67-0.73). The female disadvantage in vision increased with advancing age, whereas the female advantage in hearing decreased. No overall sex difference in vision was found in northern Europe, but females had more vision impairments than males in southern (OR 1.23, 95% CI 1.14-1.32), western (OR 1.14, 95% CI 1.08-1.21) and eastern (OR 1.10, 95% CI 1.02-1.20) Europe. Females were healthier than males in terms of hearing in all regions, with the largest female advantage in northern Europe (OR 0.58, 95% CI 0.53-0.64). CONCLUSION Our findings demonstrate an overall consistent pattern of sex differences in sensory impairments across Europe showing an increasing female disadvantage in vision and a decreasing female advantage in hearing with advancing age.
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Affiliation(s)
- Rikke Syrak Hansen
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Lasse Lybecker Scheel-Hincke
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Bernard Jeune
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
| | - Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark.
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Herttua K, Thapa S, Ahrenfeldt LJ, Paljarvi T. The role of modifiable risk factors in incident cancer in transport, rescue, and security industries. Ann Epidemiol 2023; 83:71-77.e1. [PMID: 37100100 DOI: 10.1016/j.annepidem.2023.04.013] [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: 01/04/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries. METHODS This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature. RESULTS During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer. CONCLUSIONS Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes.
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Affiliation(s)
- Kimmo Herttua
- Center of Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark.
| | - Subash Thapa
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Ahrenfeldt LJ, Möller S, Hvidt NC, VanderWeele TJ, Stripp TA. Effect of religious service attendance on mortality and hospitalisations among Danish men and women: longitudinal findings from REGLINK-SHAREDK. Eur J Epidemiol 2023; 38:281-289. [PMID: 36646924 DOI: 10.1007/s10654-023-00964-y] [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: 07/05/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Research suggests a protective effect of religious service attendance on various health outcomes. However, most research has been done in religious societies, raising the question of whether these associations are also prominent in secular cultures. Here we examine mortality and hospitalisations by religious service attendance among men and women in a secular society. We performed a cohort study including 2987 Danes aged 40+ interviewed in SHARE from 2004 to 2007 and followed up in the Danish registries until 2018. We used Cox regressions and negative binomial regressions to examine associations, including interactions with sex and adjusting for age, wave, socioeconomic factors, lifestyle factors, body mass index, and history of diseases. Overall, 5.0% of men and 6.6% of women reported that they had taken part in a religious organisation within the last month. Among 848 deaths, we found lower mortality for people who attended religious services (hazard ratio (HR) 0.70; 95% CI 0.50-0.99). There was evidence for an association among women (HR 0.56; 95% CI 0.35-0.89), but not among men (HR 0.95; 95% CI 0.59-1.53). In contrast, regarding hospital admissions (n = 12,010), we found lower hospitalisation rates among men who attended religious services (incidence rate ratio (IRR) 0.67; 95% CI 0.45-0.98), whereas no association was found among women (IRR 0.95; 95% CI 0.70-1.29). Sensitivity analyses with E-values were moderately robust. Our results contribute to the limited literature on possible health benefits of religious service attendance in secular societies, demonstrating lower mortality among women and fewer hospitalisations among men.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark.
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, 5000, Odense, Denmark
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000, Odense, Denmark
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Tobias Anker Stripp
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
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Olsen CDH, Möller S, Ahrenfeldt LJ. Sex differences in quality of life and depressive symptoms among middle-aged and elderly Europeans: results from the SHARE survey. Aging Ment Health 2023; 27:35-42. [PMID: 34915773 DOI: 10.1080/13607863.2021.2013434] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES We examine sex differences in quality of life (QoL) and depressive symptoms across age and European regions. METHODS We performed a large cross-sectional study based on 64,552 women and 53,647 men aged 50+ who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2004-2020. Linear and logistic regression models were used to examine associations with QoL (CASP-12) and depressive symptoms (EURO-D). RESULTS Women reported slightly lower QoL (coefficient -0.78, 95% CI -0.92; -0.65) and more depressive symptoms (odds ratio (OR) 2.23, 95% CI 2.13; 2.34) than men. Sex differences in QoL increased with advancing age, whereas sex differences in depressive symptoms were stable across age groups. No overall sex difference in QoL was found in Northern Europe, but women had lower QoL than men in Western (coefficient -0.49, 95% CI -0.69; -0.29), Southern (coefficient -1.35, 95% CI -1.61; -1.09) and Eastern (coefficient -0.72, 95% CI -1.05; -0.39) Europe. However, sex differences varied within the specific CASP-12 items, with women having overall lower control and autonomy, but more self-realisation, than men. Women reported more depressive symptoms than men in all regions, with the largest overall sex difference in Southern Europe (OR 2.62, 95% CI 2.40; 2.86). A female disadvantage was found for most of the EURO-D items, with the largest sex differences for 'tearfulness', 'depression' and 'sleep'. CONCLUSION Middle-aged and elderly European women report lower QoL and more depressive symptoms than European men, lending support for the male-female health survival paradox.
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Affiliation(s)
- Camilla Dahl Haislund Olsen
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,The OPEN Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Tolstrup Wester C, Lybecker Scheel-Hincke L, Bovil T, Andersen-Ranberg K, Juel Ahrenfeldt L, Christian Hvidt N. Prayer frequency and COVID-19 vaccine hesitancy among older adults in Europe. Vaccine 2022; 40:6383-6390. [PMID: 36182618 PMCID: PMC9510066 DOI: 10.1016/j.vaccine.2022.09.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/03/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023]
Abstract
AIM Differences in levels of vaccine uptake have emerged across Europe, and this may partly be explained by religious beliefs. Our aim is to study the association between religiosity, measured by prayer frequency, and vaccine hesitancy, and to examine how this association varies across European countries and regions. METHODS This study was based on 42,583 adults aged 50 years and above from 27 European countries in the Survey of Health, Ageing and Retirement in Europe (SHARE), waves 1-8, and the 2nd SHARE COVID-19 Survey. Logistic regression models were used to investigate the associations. RESULTS Participants were more likely to be vaccine-hesitant when praying 'weekly or less' (odds ratio (OR) 1.32 95 % confidence interval (CI) 1.23-1.42) or daily (OR 1.78 95 % CI 1.65-1.92). Praying 'weekly or less' was associated with increased vaccine hesitancy in Southern Europe (OR 1.48 95 % CI 1.17-1.87) and Central and Eastern (OR 1.35 95 % CI 1.24-1.47) Europe, while daily praying was associated with vaccine hesitancy in Western (OR 1.77 95 % CI 1.51-2.08), Southern (OR 1.30 95 % CI 1.03-1.64), Central and Eastern (OR 1.89 95 % CI 1.73-2.06) and Northern (OR 2.75 95 % CI 1.54-4.89) Europe. CONCLUSIONS These findings provide support for an association between daily prayer frequency and COVID-19 vaccine hesitancy, with a consistent pattern across European regions.
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Affiliation(s)
- Christian Tolstrup Wester
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark.
| | - Lasse Lybecker Scheel-Hincke
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Tine Bovil
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Karen Andersen-Ranberg
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark; Geriatric Research Unit, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark; Academy of Geriatrich Cancer Research (AgeCare), Odense University Hospital, 5000 Odense, Denmark
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10
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Villumsen MD, Ahrenfeldt LJ, Christensen K, Ewertz M, Hjelmborg JB. Cancer-related reductions in survival: extent and duration evaluated using a large cohort study of twins, 1943-2011. Cancer Epidemiol Biomarkers Prev 2022; 31:1796-1803. [PMID: 35820201 DOI: 10.1158/1055-9965.epi-22-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/20/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The time during which there is an increased risk of death for cancer survivors was evaluated in a large twin study, which allows for matching on shared components such as age, genes, and socioeconomic factors in childhood. METHODS By use of data from Danish registers, time to death from initial cancer was studied prospectively in twins in two different settings. The twins were diagnosed with at least one cancer in the period 1943-2011. Setting I included 5,680 same-sex twin pairs aged six and over, while Setting II included 3,218 twin individuals from age 70 and over. The study provides comparisons within twin pairs and across birth cohorts, age at diagnoses, and time at diagnosis. RESULTS In 2001-2011, the five-year mortality risk for a twin surviving cancer after the age of 70 was twofold that of the co-twin, regardless of sex and zygosity, and it was 1.5-fold if the twin survived the initial nine months. After five to six years, the mortality risk corresponded to that of the co-twin. In previous decades, the excess hazard risk was considerably higher for both older and younger cohorts. There were no indications of change in relative survival across old birth cohorts. CONCLUSIONS This large twin study suggested that for a cancer-treatment survivor diagnosed at age 70 or later, the additional mortality risk was largely absent five years later, by which time the survival relative to the co-twin was 60%. IMPACT Elevated mortality risk after cancer is offset after five-six years.
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Affiliation(s)
- Martin Dalgaard Villumsen
- Danish Twin Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Danish Twin Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Danish Twin Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Marianne Ewertz
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Jacob B Hjelmborg
- Danish Twin Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
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11
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Wester CT, Bovil T, Scheel-Hincke LL, Ahrenfeldt LJ, Möller S, Andersen-Ranberg K. Longitudinal changes in mental health following the COVID-19 lockdown: Results from the Survey of Health, Ageing and Retirement in Europe. Ann Epidemiol 2022; 74:21-30. [PMID: 35660005 PMCID: PMC9159781 DOI: 10.1016/j.annepidem.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/04/2022] [Accepted: 05/28/2022] [Indexed: 12/30/2022]
Abstract
Background Methods Results Conclusion
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12
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Herold SC, Hvidt NC, Möller S, Christensen K, Ahrenfeldt LJ. Is Religiousness Associated with Better Lifestyle and Health Among Danes? Findings from SHARE. J Relig Health 2022; 61:1621-1640. [PMID: 32488829 DOI: 10.1007/s10943-020-01050-3] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Evidence of a possible association between religion and health in secular societies is sparse. We therefore conducted a nationwide study using data from 1596 Danes aged 50 + who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 1 (2004-2005) and were followed up between 2006 and 2015, to investigate the association between religiousness and health including a lifestyle index. Results from the longitudinal models adjusted for age and gender showed that being religiously educated by parents, taking part in a religious organization, and praying were factors associated with fewer risk factors of unhealthy lifestyle. Furthermore, being religiously educated was associated with lower odds of self-rated poor health and depressive symptoms. Results were overall consistent across the cross-sectional and longitudinal models and persisted after further adjustment for education and marital status. These findings provide support for a positive relationship between religiousness and health among Danes, particularly for those being religiously educated by their parents.
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Affiliation(s)
- Steffen Christensen Herold
- Research Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000, Odense, Denmark
| | - Sören Möller
- OPEN - Odense Patient Data Explorative Network, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Kaare Christensen
- Research Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark
- Department of Clinical Biochemistry, Odense University Hospital, 5000, Odense, Denmark
- Pharmacology and Department of Clinical Genetics, Odense University Hospital, 5000, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Research Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark.
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13
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Caputo J, Carollo A, Mussino E, Ahrenfeldt LJ, Lindahl-Jacobsen R, Drefahl S, Oksuzyan A. Spousal order of migration, gender, and hospitalization among immigrants in Denmark. Scand J Public Health 2022; 50:172-179. [PMID: 32862798 DOI: 10.1177/1403494820944724] [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] [Indexed: 11/15/2022]
Abstract
Background: Certain migration contexts that may help clarify immigrants' health needs are understudied, including the order in which married individuals migrate. Research shows that men, who are healthier than women across most populations, often migrate to a host country before women. Using Danish register data, we investigate descriptive patterns in the order that married men and women arrive in Denmark, as well as whether migration order is related to overnight hospitalizations. Methods: The study base includes married immigrants who lived in Denmark between January 1, 1980 and December 31, 2014 (N = 13,680). We use event history models to examine the influence of spousal migration order on hospitalizations. Results: The order that married individuals arrive in Denmark is indeed highly gendered, with men tending to arrive first, and varies by country of origin. Risk of hospitalization after age 50 does not depend on whether an individual migrated before, after, or at the same time as their spouse among either men or women. However, among those aged 18+, men migrating before their wives are more likely to experience hospitalizations within the first 5 years of arrival. Conclusions: These findings provide the first key insights about gendered migration patterns in Denmark. Although spousal order of migration is not related to overnight hospitalization among women, our findings provide preliminary evidence that men age 18+ who are first to arrive experience more hospitalization events in the following 5 years. Future research should explore additional outcomes and whether other gendered migration contexts are related to immigrants' health.
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Affiliation(s)
- Jennifer Caputo
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Angela Carollo
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Eleonora Mussino
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sven Drefahl
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany
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14
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Herttua K, Ahrenfeldt LJ, Paljarvi T. Risk of major chronic diseases in transport, rescue and security industries: a longitudinal register-based study. Occup Environ Med 2021; 79:162-168. [PMID: 34462305 DOI: 10.1136/oemed-2021-107764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/21/2021] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the risk of hospitalisation for major chronic diseases across representative transport, rescue and security industries. METHODS We performed a register-based study of 624 571 workers from six industries in Denmark between 2000 and 2005, followed up hospitalisation for chronic diseases up to 17 years, and compared with a 20% random sample of the economically active population. RESULTS HR from the Cox regression models showed that seafarers had higher risk of lung cancer (men: 1.54, 95% CI 1.31 to 1.81; women: 1.63, 95% CI 1.13 to 2.36), and male seafarers had higher risk of diabetes (1.32, 95% CI 1.21 to 1.43) and oral cancer (1.51, 95% CI 1.21 to 1.88). Men and women in land transport had increased risk of diabetes (men: 1.68, 95% CI 1.63 to 1.73; women 1.55, 95% CI 1.40 to 1.71) and chronic respiratory disease (men: 1.21, 95% CI 1.16 to 1.25; women 1.42, 95% CI 1.32 to 1.53). Among women, a higher risk of gastrointestinal cancer was observed in aviation (1.53, 95% CI 1.23 to 1.89) and police force (1.29, 95% CI 1.01 to 1.65), oral cancer in defence forces (1.83, 95% CI 1.20 to 2.79), and chronic respiratory disease in rescue service (1.47, 95% CI 1.21 to 1.77), while men in defence forces, police force and rescue service had mainly lower risk of these chronic diseases. CONCLUSIONS We observed considerable health disparities from chronic diseases across transport, rescue and security industries, with workers in seafaring and land transport generally bearing the greatest relative burden.
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Affiliation(s)
- Kimmo Herttua
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Tapio Paljarvi
- Department of Psychiatry, University of Oxford, Oxford, UK
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15
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Ahrenfeldt LJ, Möller S, Wensink MJ, Eisenberg ML, Christensen K, Jensen TK, Lindahl-Jacobsen R. Impaired fecundity as a marker of health and survival: a Danish twin cohort study. Hum Reprod 2021; 36:2309-2320. [PMID: 34009293 PMCID: PMC8496092 DOI: 10.1093/humrep/deab077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/05/2021] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Is fecundity, measured as self-reported time to first pregnancy (TTP), a marker for subsequent health and survival? SUMMARY ANSWER Long TTP was a marker for increased mortality among women and higher hospitalization rates for both women and men. WHAT IS KNOWN ALREADY Poor semen quality has been linked to increased mortality and morbidity from a wide range of diseases. Associations among fecundity, health and survival among women are still uncertain and studies on actual measures of fecundity and health outcomes are rare. STUDY DESIGN, SIZE, DURATION We performed a prospective cohort study of 7825 women and 6279 men, aged 18 and above with measures on first TTP, who participated in one of the Danish nation-wide twin surveys in 1994 (twins born 1953-1976) and 1998 (twins born 1931-1952). They were followed-up for mortality and hospital admissions from the interview until 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS Twins were identified in the Danish Twin Registry and linked to Danish registers. TTP was restricted to the first pregnancy as a categorical outcome with cut-off points at 2, 10 and 18 months. We analysed the association between TTP and survival using a Cox proportional hazards model estimating hazards ratios (HRs) with 95% confidence intervals (CIs). Fine-Gray survival models were used to estimate sub-hazard ratios for specific causes of death allowing for competing risks. Using negative binomial regression, we estimated incidence rate ratios (IRRs) with 95% CIs for all-cause and cause-specific hospitalizations. All analyses were stratified by sex and adjusted for age at interview, birth cohorts, age at first attempt to become pregnant, smoking, years in school and BMI. MAIN RESULTS AND THE ROLE OF CHANCE In the total study population, 49.9% of women and 52.7% of men reported a TTP of less than 2 months, 30.8% of women and 29.6% of men reported a TTP of 2-9 months, 6.6% of women and 5.7% of men reported a TTP of 10-17 months, and 13.3% of women and 12.0% of men reported a TTP of 18 months or more. Among 1305 deaths, we found a higher mortality for women (HR = 1.46; 95% CI 1.15, 1.87) with a TTP of ≥18 months relative to those with a TTP of <2 months, while the highest mortality was indicated for men with a TTP of 10-17 months (HR = 1.31; 95% CI 0.98, 1.74). Among 53 799 hospitalizations, we found an increased hospitalization rate among women (HR = 1.21; 95% CI 1.0-1.41) and men (HR = 1.16; 95% CI 1.00-1.35) with a TTP of ≥18 months, and for men with a TTP of 2-9 months (HR = 1.14; 95% CI 1.01-1.30). A dose-response relationship was found for women regarding both mortality (P = 0.022) and hospitalizations (P = 0.018). Impaired fecundity was associated with a wide range of diseases and some causes of death, indicating a multi-factorial causal influence on fecundity, especially among women. LIMITATIONS, REASONS FOR CAUTION A major limitation was that fecundity depends on both partners, which was not considered in this study. Moreover, we could not obtain information on a number of potential confounders. WIDER IMPLICATIONS OF THE FINDINGS Fecundity seems positively correlated with overall health and may be a universal marker of future health and survival. These results add knowledge to the limited findings showing that reduced fecundity in women and poor semen quality in men may reflect worse health and a shorter life, particularly among women. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by NIH grant HD096468 (M.L.E., T.K.J. and R.L.J.). The authors declare that they have no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L J Ahrenfeldt
- Unit of Epidemiology, Biostatistics and
Biodemography, Department of Public Health, University of Southern
Denmark, Odense, Denmark
- The Danish Twin Registry, Department of Public
Health, University of Southern Denmark, Odense, Denmark
| | - S Möller
- OPEN—Open Patient data Explorative Network,
Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of
Southern Denmark, Odense, Denmark
| | - M J Wensink
- Unit of Epidemiology, Biostatistics and
Biodemography, Department of Public Health, University of Southern
Denmark, Odense, Denmark
- Interdisciplinary Centre on Population Dynamics
(CPop), University of Southern Denmark, Odense, Denmark
| | - M L Eisenberg
- Male Reproductive Medicine and Surgery, Department
of Urology and Obstetrics & Gynecology, Stanford University School of
Medicine, Stanford, CA, USA
| | - K Christensen
- Unit of Epidemiology, Biostatistics and
Biodemography, Department of Public Health, University of Southern
Denmark, Odense, Denmark
- The Danish Twin Registry, Department of Public
Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and
Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Genetics, Odense University
Hospital, Odense, Denmark
| | - T K Jensen
- Department of Clinical Pharmacology, Farmacy and
Environmental Medicine, University of Southern Denmark, Odense,
Denmark
| | - R Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and
Biodemography, Department of Public Health, University of Southern
Denmark, Odense, Denmark
- Interdisciplinary Centre on Population Dynamics
(CPop), University of Southern Denmark, Odense, Denmark
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16
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Nielsen CR, Ahrenfeldt LJ, Jeune B, Christensen K, Lindahl-Jacobsen R. Healthy life expectancy by frailty state in Europe from 2004 to 2015: findings from SHARE. Eur J Public Health 2021; 31:554-560. [PMID: 33615329 PMCID: PMC8485734 DOI: 10.1093/eurpub/ckab012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As populations age, the possible consequences of increased frailty are a major concern for the health sector. Here, we investigate how life expectancy with and without frailty has changed during a 10-11-year-period across Europe. METHODS The Sullivan method was used to investigate changes in life expectancy with and without frailty in 10 European countries. Frailty status (non-frail, pre-frail and frail) was determined by use of the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI). Data on frailty prevalence was obtained from 21 698 individuals in wave 1 (2004-05) and 38 859 individuals in wave 6 (2015) of the SHARE. Information on mortality was obtained from the Eurostat Database. RESULTS In 2015, women aged 70 spent 25.0% (95% CI: 24.0-26.1) of their remaining life expectancy in a frail state, and the number for men was 11.5% (95% CI: 10.7-12.3). Southern Europeans spent 24.2% (95% CI: 22.9-25.4) of their remaining life expectancy in a frail state and the numbers for Central Europeans and Northern Europeans were 17.0% (95% CI: 16.0-17.9) and 12.2% (95% CI: 10.9-13.5), respectively. From 2004-05 to 2015, life expectancy increased by 1.1 years (from 15.3 to 16.4 years) for 70-year-old Europeans. Similarly, non-frail life expectancy increased by 1.1 years (95% CI: 0.8-1.4), whereas no significant changes in life expectancy in frail states were observed. CONCLUSIONS This study suggests that Europeans today spend more years in a non-frail state than Europeans did 10-11 years ago. Our findings reflect a considerable inequality by gender and region.
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Affiliation(s)
- Camilla Riis Nielsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Interdisiciplinary Center on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Bernard Jeune
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Interdisiciplinary Center on Population Dynamics, University of Southern Denmark, Odense, Denmark
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17
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Möller S, Ahrenfeldt LJ. Estimating Relative Risk When Observing Zero Events-Frequentist Inference and Bayesian Credibility Intervals. Int J Environ Res Public Health 2021; 18:ijerph18115527. [PMID: 34064019 PMCID: PMC8196730 DOI: 10.3390/ijerph18115527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022]
Abstract
Relative risk (RR) is a preferred measure for investigating associations in clinical and epidemiological studies with dichotomous outcomes. However, if the outcome of interest is rare, it frequently occurs that no events are observed in one of the comparison groups. In this case, many of the standard methods used to obtain confidence intervals (CIs) for the RRs are not feasible, even in studies with strong statistical evidence of an association. Different strategies for solving this challenge have been suggested in the literature. This paper, which uses both mathematical arguments and statistical simulations, aims to present, compare, and discuss the different statistical approaches to obtain CIs for RRs in the case of no events in one of the comparison groups. Moreover, we compare these frequentist methods with Bayesian approaches to determine credibility intervals (CrIs) for the RRs. Our results indicate that most of the suggested approaches can be used to obtain CIs (or CrIs) for RRs in the case of no events, although one-sided intervals obtained by methods based on deliberate, probabilistic considerations should be preferred over ad hoc methods. In addition, we demonstrate that Bayesian approaches can be used to obtain CrIs in these situations. Thus, it is possible to obtain statistical inference for the RR, even in studies with no events in one of the comparison groups, and CIs for the RRs should always be provided. However, it is important to note that the obtained intervals are sensitive to the method chosen in the case of small sample sizes.
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Affiliation(s)
- Sören Möller
- Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense C, Denmark
- Correspondence:
| | - Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark;
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Ahrenfeldt LJ, Möller S. The Reciprocal Relationship between Socioeconomic Status and Health and the Influence of Sex: A European SHARE-Analysis Based on Structural Equation Modeling. Int J Environ Res Public Health 2021; 18:ijerph18095045. [PMID: 34068750 PMCID: PMC8126237 DOI: 10.3390/ijerph18095045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 01/19/2023]
Abstract
It is well recognized that socioeconomic status (SES) is an important determinant of health, but many studies fail to address the possibility of reverse causation. We aim to investigate the reciprocal relationship between trajectories of SES and health, and how these associations differ by sex. We performed a longitudinal study including 29,824 men and 37,263 women aged 50+ participating in at least two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using structural equation modeling, we found that baseline household income and wealth led to improvements in cognitive function, grip strength, quality of life and depressive symptoms, and a better initial health led to higher income and wealth for both sexes. However, the results indicated that the relative effect of cognitive function and grip strength on SES trajectories was overall greater than the corresponding effect of SES on health changes, particularly regarding income among women, but for quality of life and depressive symptoms, the reverse was indicated, though most pronounced for the associations with wealth. The reciprocal associations between SES and physical function were stronger for men than for women, whereas most associations with cognitive function and mental health were similar between sexes. This study demonstrates that both social causation and health selection contribute to social inequalities in health, but the influence of each direction and the importance of sex differences may vary according to the health outcomes investigated.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence: ; Tel.: +45-6550-3844
| | - Sören Möller
- OPEN–Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Abstract
Much of science, including public health research, focuses on means (averages). The purpose of the present paper is to reinforce the idea that variability matters just as well. At the hand of four examples, we highlight four classes of situations where the conclusion drawn on the basis of the mean alone is qualitatively altered when variability is also considered. We suggest that some of the more serendipitous results have their origin in variability.
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Affiliation(s)
- Maarten Jan Wensink
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Winsløwsvej 9B, 5000 Odense, Denmark;
| | - Linda Juel Ahrenfeldt
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Winsløwsvej 9B, 5000 Odense, Denmark;
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Winsløwsvej 9B, 5000 Odense, Denmark;
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20
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Ahrenfeldt LJ, Otavova M, Christensen K, Lindahl-Jacobsen R. Sex and age differences in COVID-19 mortality in Europe. Wien Klin Wochenschr 2020; 133:393-398. [PMID: 33351155 PMCID: PMC7755064 DOI: 10.1007/s00508-020-01793-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 07/20/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
Aim To examine the magnitude of sex differences in survival from the coronavirus disease 2019 (COVID-19) in Europe across age groups and regions. We hypothesized that men have a higher mortality than women at any given age but that sex differences will decrease with age as only the healthiest men survive to older ages. Methods We used population data from the Institut National D’Études Démographiques on cumulative deaths due to COVID-19 from February to June 2020 in 10 European regions: Denmark, Norway, Sweden, The Netherlands, England and Wales, France, Germany, Italy, Spain and Portugal. For each region, we calculated cumulative mortality rates stratified by age and sex and corresponding relative risks for men vs. women. Results The relative risk of dying from COVID-19 was higher for men than for women in almost all age groups in all regions. The overall relative risk ranged from 1.11 (95% confidence interval, CI 1.01–1.23) in Portugal to 1.54 (95% CI 1.49–1.58) in France. In most regions, sex differences increased until the ages of 60–69 years, but decreased thereafter with the smallest sex difference at age 80+ years. Conclusion Despite variability in data collection and time coverage among regions, the study showed an overall similar pattern of sex differences in COVID-19 mortality in Europe. Supplementary Information The online version of this article (10.1007/s00508-020-01793-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark.
| | - Martina Otavova
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark.,Interdisciplinary Center on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark.,Danish Aging Research Center, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, 5000, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, 5000, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark.,Interdisciplinary Center on Population Dynamics, University of Southern Denmark, 5000, Odense, Denmark
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21
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Ahrenfeldt LJ, Scheel-Hincke LL, Kjærgaard S, Möller S, Christensen K, Lindahl-Jacobsen R. Gender differences in cognitive function and grip strength: a cross-national comparison of four European regions. Eur J Public Health 2020; 29:667-674. [PMID: 30590595 DOI: 10.1093/eurpub/cky266] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cross-national comparison studies on gender differences have mainly focussed on life expectancy, while less research has examined differences in health across countries. We aimed to investigate gender differences in cognitive function and grip strength over age and time across European regions. METHODS We performed a cross-sectional study including 51 292 men and 62 007 women aged 50 + participating in the Survey of Health, Ageing and Retirement in Europe between 2004-05 and 2015. Linear regression models were used to examine associations. RESULTS In general, women had better cognitive function than men, whereas men had higher grip strength measures. Sex differences were consistent over time, but decreased with age. Compared with men, women had higher cognitive scores at ages 50-59, corresponding to 0.17 SD (95% CI 0.14, 0.20) but slightly lower scores at ages 80-89 (0.08 SD, 95% CI 0.14, 0.00). For grip strength, the sex difference decreased from 18.8 kg (95% CI 18.5, 19.1) at ages 50-59 to 8.5 kg (95% CI 7.1, 9.9) at age 90 + . Northern Europeans had higher cognitive scores (19.6%) and grip strength measures (13.8%) than Southern Europeans. Gender differences in grip strength were similar across regions, whereas for cognitive function they varied considerably, with Southern Europe having a male advantage from ages 60-89. CONCLUSION Our results illustrate that gender differences in health depend on the selected health dimension and the age group studied, and emphasize the importance of considering regional differences in research on cognitive gender differences.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lasse Lybecker Scheel-Hincke
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren Kjærgaard
- Interdisciplinary Center on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN - Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Ahrenfeldt LJ, Nielsen CR, Möller S, Christensen K, Lindahl-Jacobsen R. Burden and prevalence of risk factors for severe COVID-19 disease in the ageing European population - A SHARE-based analysis. Res Sq 2020:rs.3.rs-73657. [PMID: 32935092 PMCID: PMC7491580 DOI: 10.21203/rs.3.rs-73657/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aim: International health authorities suggest that individuals aged 65 years and above and people with underlying comorbidities such as hypertension, chronic lung disease, cardiovascular disease, cancer, diabetes, and obesity are at increased risk of severe Coronavirus Disease 2019 (COVID-19); however, the prevalence of risk factors is unknown in many countries. Therefore, we aim to describe the distribution of these risk factors across Europe. Subject and Methods: Prevalence of risk factors for severe COVID-19 was identified based on interview for 73,274 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2017. Burden of disease was estimated using population data from Eurostat. Results: A total of 75.3% of the study population (corresponding to app. 60 million European men and 71 million women) had at least one risk factor for severe COVID-19, 45.9% (app. 36 million men and 43 million women) had at least two factors and 21.2% (app. 17 million men and 20 million women) had at least three risk factors. The prevalences of underlying medical conditions ranged from 4.5% for cancer to 41.4% for hypertension, and the region-specific prevalence of having at least three risk factors ranged from 18.9% in Northern Europe to 24.6% in Eastern Europe. Conclusions: Information about the prevalences of risk factors might help authorities to identify the most vulnerable subpopulations with multiple risk factors of severe COVID-19 disease and thus to decide appropriate strategies to mitigate the pandemic.
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Ahrenfeldt LJ, Möller S, Wensink M, Jensen TK, Christensen K, Lindahl-Jacobsen R. Heritability of subfertility among Danish twins. Fertil Steril 2020; 114:618-627. [DOI: 10.1016/j.fertnstert.2020.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 12/18/2022]
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Abstract
Aim: To examine the magnitude of sex differences in survival from the Coronavirus Disease 2019 (COVID-19) in Europe across age and countries. We hypothesise that men have higher mortality than women at any given age, but that sex differences will decrease with age as only the strongest men survive to older ages. Methods: We used population data from Institut National D’Études Demographiques on cumulative deaths due to COVID-19 from February to June 2020 in 10 European countries: Denmark, Norway, Sweden, The Netherlands, England & Wales, France, Germany, Italy, Spain and Portugal. For each country, we calculated cumulative mortality rates stratified by age and sex and corresponding relative risks for men vs. women. Results: The relative risk of dying from COVID-19 was higher for men than for women in almost all age groups in all countries. The overall relative risk ranged from 1.11 (95% CI 1.01–1.23) in Portugal to 1.54 (95% CI 1.49–1.58) in France. In most countries, sex differences increased until ages 60–69 years, but decreased thereafter with the smallest sex difference at ages 80+. Conclusions: Despite variability in data collection and time coverage among countries, we illustrate an overall similar pattern of sex differences in COVID-19 mortality in Europe.
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Ahrenfeldt LJ, Hvidt NC, Opsahl T, Möller S. Re: .Letter to the Editor of Public Health in response to 'Religiousness and depressive symptoms in Europeans: findings from the Survey of Health, Ageing, and Retirement in Europe'. Public Health 2020; 185:37-38. [PMID: 32531532 DOI: 10.1016/j.puhe.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Affiliation(s)
- L J Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark.
| | - N C Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000 Odense, Denmark
| | - T Opsahl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense, Denmark
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Rizzi S, Wensink M, Ahrenfeldt LJ, Christensen K, Lindahl-Jacobsen R. Age-specific cancer rates: a bird's-eye view on progress. Ann Epidemiol 2020; 48:51-54.e1. [PMID: 32430230 DOI: 10.1016/j.annepidem.2020.04.007] [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: 11/03/2019] [Revised: 03/31/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We aim to shed light on progress in cancer medicine through studying time trends in age-specific rates of cancer incidence and mortality over the last quarter century. METHODS We analyzed age-specific incidence and mortality rates of all cancer sites combined using the high-quality population-based databases of Denmark, Finland, Norway, Sweden, and the Netherlands for the period 1990-2016. RESULTS Over these 26 years, cancer incidence rates increased in all investigated countries irrespective of age by about 22%. By contrast, cancer mortality rates decreased across all ages, also by about 22%, except ages 80+ years in Denmark, Norway, and Sweden, where they remained unchanged. This pattern is consistent with earlier diagnoses and more effective treatments of cancer. CONCLUSIONS This bird's-eye view on cancer reveals substantive progress in cancer medicine.
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Affiliation(s)
- Silvia Rizzi
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark; Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.
| | - Maarten Wensink
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark; Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark; Danish Aging Research Center, University of Southern Denmark, Odense, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark; Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark
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Ahrenfeldt LJ, Pedersen JK, Thinggaard M, Christensen K, Lindahl-Jacobsen R. Sex differences in health and mortality by income and income changes. J Epidemiol Community Health 2019; 74:225-231. [PMID: 31844031 DOI: 10.1136/jech-2019-213096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/17/2019] [Revised: 10/27/2019] [Accepted: 11/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The adverse association between income, health and survival is well documented, but little is known about how income trajectories influence health and survival for men and women. We aim to investigate sex differences in mortality and hospitalisations by income and income changes. METHODS We performed a population-based, nationwide study including 1 063 787 Danes born 1935-1955 and residing in Denmark during 1980-2015. Income was calculated during two age intervals: 45-49 and 55-59 years. The average income was divided into quartiles for men and women separately, which formed the basis for the income trajectories. Individuals were followed up from age 60 until 2014/2015 for hospital admission and mortality, respectively. RESULTS Men had higher mortality and were more hospitalised than women. Sex differences in mortality were most pronounced for people with stable low income (relative difference in hazard=1.93; 95% CI 1.89 to 1.98) and a downward income trajectory (1.91; 95% CI 1.85 to 1.98) with smaller sex differences for people with an upward trajectory (1.59; 95% CI 1.56 to 1.62) and stable high income (1.37; 95% CI 1.33 to 1.41). A similar pattern was found for family income. Regarding hospitalisations, similar results were found, though less pronounced. Investigation of mortality and hospitalisations by all possible trajectories demonstrated that income at ages 55-59 was an important predictor of mortality, with increasing mortality for decreasing income quartile. CONCLUSION Income trajectories as a proxy for change in social position have a larger influence on men's than women's health and mortality. Income in the late 50s is an important predictor of mortality, particularly for men.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jacob Krabbe Pedersen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mikael Thinggaard
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Abstract
Recent research in religiousness and health suggests that epidemiological forces can have opposed effects. Here we examine two forms of religiousness and their association with disease. We performed a cross-sectional study of 23,864 people aged 50+ included in wave 1 (2004-2005) of the Survey of Health, Ageing and Retirement in Europe and a longitudinal study including people from wave 1, who were followed up during 11 years. Results suggested that taking part in a religious organization was associated with lower odds of heart attack (OR 0.74, 95% CI 0.60, 0.90), stroke (OR 0.68, 95% CI 0.50, 0.95), and diabetes (OR 0.72, 95% CI 0.58, 0.90) and longitudinally associated with lower odds of cancer (OR 0.78, 95% CI 0.60, 1.00). Conversely, praying was longitudinally associated with higher odds of heart attack (OR 1.27, 95% CI 1.10, 1.48) and high cholesterol (OR 1.12, 95% CI 1.00, 1.26). The most religious people had lower odds of stroke, diabetes, and cancer than other respondents, and in the longitudinal model, people who only prayed had higher odds of heart attack than non-religious people. Our findings lend support to the hypothesis that restful religiousness (praying, taking part in a religious organization, and being religiously educated) was associated with lower odds of some diseases, whereas little evidence was present that crisis religiousness (praying only) was associated with higher odds of disease.
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Affiliation(s)
- L J Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark.
| | - N C Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Academy of Geriatric Cancer Research, Odense University Hospital, 5000, Odense, Denmark
| | - S T Kjøller
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - R Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark
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Møller JJK, Jespersen E, Lindahl-Jacobsen R, Ahrenfeldt LJ. Associations between perceived information needs and anxiety/depressive symptoms among cancer caregivers: A cross-sectional study. J Psychosoc Oncol 2019; 38:171-187. [PMID: 31535929 DOI: 10.1080/07347332.2019.1664699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Caregivers to cancer patients often experience information needs. This study investigates the associations between perceived information needs and anxiety/depressive symptoms among caregivers to cancer patients.Design: Cross-sectional study using self-completed questionnaires.Sample: A total of 128 caregivers to cancer patients who participated in a rehabilitation stay at REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care, from April 2016 to March 2017.Methods: The caregivers completed a questionnaire assessing both information needs and anxiety/depressive symptoms. We used ordinal logistic regressions to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between seven information needs and anxiety/depressive symptoms. The reference group was caregivers with no perceived information needs.Findings: The combined score of perceived information needs was associated with higher odds of anxiety (OR = 3.86 per unit increase, 95% CI 1.85-8.03) and depressive symptoms (OR = 3.83 per unit increase, 95% CI 1.15-12.75). For the individual items, our results showed higher odds of anxiety symptoms for caregivers with perceived information needs regarding (1) the disease and its course, for both little need for information (OR = 3.62, 95% CI 1.39-9.43) and substantial need for information (OR = 4.57, 95% CI 1.40-14.93); however, for substantial information needs, an interaction with gender was found showing higher odds for men (OR = 28.90, 95% CI 4.46-187.41), but no significant association for women. Also, substantial need for information regarding the disease and its course were associated with higher odds of depressive symptoms (OR = 11.43, 95% CI 1.18-111.21). Furthermore, we found higher odds of anxiety symptoms for caregivers who perceived information needs regarding (2) which symptoms and adverse effects to be aware of; (3) how to help and support a cancer patient; (4) expected mental responses in a person with cancer; (5) how to find information on the internet, and (6) where to direct caregiver questions and/or concerns after patient discharge.Conclusions: Among caregivers to cancer patients, perceived needs regarding the disease and its course were associated with higher odds of anxiety and depressive symptoms. Furthermore, several other information needs were associated with anxiety symptoms.Implications for Psychosocial Providers or Policy: To prevent unnecessary anxiety and depressive symptoms among cancer caregivers, health care professionals should be aware of the importance of informing caregivers regarding the disease and its course. Other issues to address concerning anxiety symptoms are information regarding which symptoms and adverse effects to be aware of; how to help and support a cancer patient; expected mental responses in a person with cancer; how to find information on the internet; and where to direct caregiver questions and/or concerns after patient discharge.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Institute of Clinical Research, University of Southern Denmark, Nyborg, Denmark
| | - Eva Jespersen
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Institute of Clinical Research, University of Southern Denmark, Nyborg, Denmark.,Department of Rehabilitation, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Ahrenfeldt LJ, Möller S, Thinggaard M, Christensen K, Lindahl-Jacobsen R. Sex Differences in Comorbidity and Frailty in Europe. Int J Public Health 2019; 64:1025-1036. [PMID: 31236603 PMCID: PMC7237816 DOI: 10.1007/s00038-019-01270-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To examine sex differences in prevalent comorbidity and frailty across age and European regions. METHODS This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004-2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions. RESULTS European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07-1.15) and frailty (OR 1.56, 95% CI 1.51-1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18-1.44), Southern (OR 1.23, 95% CI 1.15-1.30), and Northern (OR 1.08, 95% CI 1.01-1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72-1.96). CONCLUSIONS European women are frailer and have slightly more comorbidity than European men lending support for the male-female health survival paradox.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark.
| | - Sören Möller
- OPEN - Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikael Thinggaard
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
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Scheel-Hincke LL, Möller S, Lindahl-Jacobsen R, Jeune B, Ahrenfeldt LJ. Cross-national comparison of sex differences in ADL and IADL in Europe: findings from SHARE. Eur J Ageing 2019; 17:69-79. [PMID: 32158373 DOI: 10.1007/s10433-019-00524-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 01/26/2023] Open
Abstract
Women experience greater longevity than men, but have poorer health, although sex differences vary across health measures and geographical regions. We aim to examine sex differences in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) over age across European regions in a cross-sectional setting including 51,292 men and 62,007 women aged 50+ from a pooled sample of waves 1 (2004-2005) to 6 (2015) in the Survey of Health, Ageing and Retirement in Europe. ADL and IADL were dichotomised into no limitations and at least one limitation. Binomial regression models were used to estimate absolute and relative sex differences. Women had higher risk than men of ADL limitations (RR = 1.21, 95% CI 1.16; 1.27) and IADL limitations (RR = 1.54, 95% CI 1.48; 1.60), corresponding to risk differences of 1.3% and 5.7%, respectively. When we stratified by age groups and regions, sex differences in ADL were found in all age groups in Southern Europe, in the age groups 65-79 years and 80+ years in Western and Eastern Europe, and from the age of 80 in Northern Europe. For IADL, sex differences were found in all age groups in the four European regions, except from ages 50-64 in Eastern Europe. The absolute sex differences increased with age in all European regions. In conclusion, our results lend support for the male-female health survival paradox by showing that European women have higher risk of ADL and IADL limitations than European men and that sex differences increase with advancing age.
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Affiliation(s)
- Lasse Lybecker Scheel-Hincke
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
| | - Sören Möller
- 2OPEN - Odense Patient data Explorative Network, Odense University Hospital, 5000 Odense, Denmark.,3Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Rune Lindahl-Jacobsen
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
| | - Bernard Jeune
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
| | - Linda Juel Ahrenfeldt
- 1Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000 Odense, Denmark
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Mao Y, Ahrenfeldt LJ, Christensen K, Wu C, Christensen J, Olsen J, Sun Y. Risk of epilepsy in opposite-sex and same-sex twins: a twin cohort study. Biol Sex Differ 2018; 9:21. [PMID: 29866174 PMCID: PMC5987428 DOI: 10.1186/s13293-018-0179-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/29/2017] [Accepted: 05/14/2018] [Indexed: 02/08/2023] Open
Abstract
Background There is a complex interaction between female and male sex hormones and the risk of epilepsy. Whether prenatal exposure to higher levels of sex hormones affects the development of epilepsy in childhood or later in life is not well known. The sex hormone environment of fetuses may be affected by the sex of the co-twin. We estimated the risk of epilepsy for twins with an opposite-sex (OS) co-twin compared with twins with a same-sex (SS) co-twin. Methods From the Danish Twin Registry, we identified OS female twins (n = 11,078), SS female twins (n = 19,186), OS male twins (n = 11,080), and SS male twins (n = 20,207) born between 1977 and 2009. The SS twins include monozygotic twins, dizygotic twins, and twins with unknown zygosity. These children were followed up from day 29 after birth until diagnosis of epilepsy, death, emigration, or end of follow-up (31 December 2011) whichever came first. Information on diagnosis of epilepsy was obtained from the Danish National Patient Registry. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for epilepsy in the OS twins using a Cox proportional hazards regression model compared with the SS twins. To account for the correlation of twins from the same mother when estimating standard errors, we used the cluster option in Stata. Results We identified 152 OS female twins, 282 SS female twins, 162 OS male twins, and 335 SS male twins diagnosed with epilepsy corresponding to an incidence rate of 9.9 and 9.7 per 10,000 person years for the OS and SS female twins, and 10.6 and 10.9 per 10,000 person years for the OS and SS male twins, respectively. We found a similar risk of epilepsy among the OS and SS female twins [HR = 1.01; 95% CI 0.83–1.24] as well as among the OS and SS male twins [HR = 0.94; 95% CI 0.78–1.14] Conclusions In this population-based study of Danish twins, we did not find difference in the risk of epilepsy between twins with an OS co-twin and twins with a SS co-twin. This applied to both female and male twins. The study therefore does not support the hypothesis that subtle hormone difference in fetal life due to co-twin may play a role in the development of epilepsy later in life.
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Affiliation(s)
- Yanyan Mao
- School of Public Health, Fudan University, Shanghai, China.,Key Lab. of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China
| | - Linda Juel Ahrenfeldt
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Chunsen Wu
- Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Jakob Christensen
- Department of Neurology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Institute for Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), California, LA, USA
| | - Yuelian Sun
- Department of Clinical Epidemiology, Institute for Clinical Medicine, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark.
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Ahrenfeldt LJ, Möller S, Andersen-Ranberg K, Vitved AR, Lindahl-Jacobsen R, Hvidt NC. Religiousness and health in Europe. Eur J Epidemiol 2017; 32:921-929. [PMID: 28840406 DOI: 10.1007/s10654-017-0296-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [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: 02/23/2017] [Accepted: 08/17/2017] [Indexed: 11/25/2022]
Abstract
Recent research suggests that epidemiological forces in religion and health can have opposed effects. Using longitudinal data of people aged 50+ included in wave 1 (2004-2005) of the Survey of Health, Ageing and Retirement in Europe (SHARE), and followed up through waves 2 (2006-2007), 4 (2011) and 5 (2013), we examined two forms of religious internalization and their association with health. Multivariate logistic regressions were used to examine all associations. Taking part in a religious organization was associated with lower odds of GALI (global activity limitation index) (OR = 0.86, 95% CI 0.75, 0.98) and depressive symptoms 0.80 (95% CI 0.69, 0.93), whereas being religiously educated lowered odds of poor self-rated health (SRH) 0.81 (95% CI 0.70, 0.93) and long-term health problems 0.84 (95% CI 0.74, 0.95). The more religious had lower odds of limitations with activities of daily living 0.76 (95% CI 0.58, 0.99) and depressive symptoms 0.77 (95% CI 0.64, 0.92) than other respondents, and compared to people who only prayed and did not have organizational involvement, they had lower odds of poor SRH 0.71 (95% CI 0.52, 0.97) and depressive symptoms 0.66 (95% CI 0.50, 0.87). Conversely, people who only prayed had higher odds of depressive symptoms than non-religious people 1.46 (95% CI 1.15, 1.86). Our findings suggest two types of religiousness: 1. Restful religiousness (praying, taking part in a religious organization and being religiously educated), which is associated with good health, and 2. Crisis religiousness (praying without other religious activities), which is associated with poor health.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, 5000, Odense, Denmark.
- Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark.
| | - Sören Möller
- OPEN - Odense Patient data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Karen Andersen-Ranberg
- Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark
| | - Astrid Roll Vitved
- Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, 5000, Odense, Denmark
- Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
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Ahrenfeldt LJ, Larsen LA, Lindahl-Jacobsen R, Skytthe A, Hjelmborg JVB, Möller S, Christensen K. Early-life mortality risks in opposite-sex and same-sex twins: a Danish cohort study of the twin testosterone transfer hypothesis. Ann Epidemiol 2016; 27:115-120.e2. [PMID: 28024904 DOI: 10.1016/j.annepidem.2016.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 05/31/2016] [Revised: 09/28/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the twin testosterone transfer (TTT) hypothesis by comparing early-life mortality risks of opposite-sex (OS) and same-sex (SS) twins during the first 15 years of life. METHODS We performed a population-based cohort study to compare mortality in OS and SS twins. We included 68,629 live-born Danish twins from 1973 to 2009 identified through the Danish Twin Registry and performed piecewise stratified Cox regression and log-binomial regression. RESULTS Among 1933 deaths, we found significantly higher mortality for twin boys than for twin girls. For both sexes, OS twins had lower mortality than SS twins; the difference persisted for the first year of life for boys and for the first week of life for girls. CONCLUSIONS Although the mortality risk for OS boys was in the expected direction according to the TTT hypothesis, the results for OS girls pointed in the opposite direction, providing no clear evidence for the TTT hypothesis.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Department of Public Health, The Danish Twin Registry, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark; Department of Public Health, Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense C, Denmark.
| | - Lisbeth Aagaard Larsen
- Department of Public Health, The Danish Twin Registry, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark
| | - Rune Lindahl-Jacobsen
- Department of Public Health, The Danish Twin Registry, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark; Department of Public Health, Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense C, Denmark
| | - Axel Skytthe
- Department of Public Health, The Danish Twin Registry, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark
| | - Jacob V B Hjelmborg
- Department of Public Health, The Danish Twin Registry, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark
| | - Sören Möller
- Department of Public Health, The Danish Twin Registry, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark
| | - Kaare Christensen
- Department of Public Health, The Danish Twin Registry, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense C, Denmark
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