COVID-19: incidence and mortality in Sweden comparing all foreign-born to all Swedish-born individuals in different occupations in an unvaccinated cohort of year 2020

OBJECTIVES

The aim was to analyse the incidence and mortality of COVID-19 in immigrants compared with Swedish born in inpatients and outpatient registers, respectively.

METHODS

The study population included all persons 20-88 years of age living in Sweden, 31 December 2019, including 1 676 516 foreign-born persons and 6 037 151 Swedish-born persons. The outcome was clinical cases of COVID-19 with a positive PCR test (ICD-10 U07.01) or without a positive PCR test (U07.2) from 1 January to 31 December 2020. Persons 20-64 years of age were classified with occupational titles according to the Swedish Standard Classification of Occupations. Residing municipality of each individual was coded according to the Swedish Association of Local Authorities. Relative risks (RR) were calculated by sex in 5 years age bands using Swedish born as reference. Age-adjusted RRs (adj RR) with 95% CIs were calculated in a Poisson regression model. Rural municipalities were used as the reference category.

RESULTS

Foreign born had consistently higher RRs in COVID-19, regardless of sex, with a peak in 50-69 years of age. Foreign born had a higher RR of death in COVID-19 above 50 years and 40 years of age in women and men, respectively. Among occupations, male drivers had the highest adj RR 4.37 (95% CI 3.45 to 5.54) and 5.09 (4.26 to 6.07) in outpatients and inpatients, respectively (U07.1). Persons living in commuting municipalities did not show any consistent increased risk for COVID-19.

CONCLUSION

Foreign born have a higher risk of COVID-19 compared with Swedish-born individuals at any age and occupation before vaccination began in 2021.

Sustainable Earnings among Immigrants, and the Role of Health Status for Self-Sufficiency: A 10-Year Follow-Up Study of Labour Immigrants and Refugees to Sweden 2000-2006

This study aimed to investigate economic self-sufficiency for immigrants, and how health status affected self-sufficiency. The proportion of self-sufficiency during years 1-10 after receiving a residence permit is presented for all non-European labour immigrants (n = 1259) and refugees (n = 23,859), aged 18-54, who immigrated to Sweden 2000-2006, and compared to a control group of Swedish-born (n = 144,745). The risk of not being self-sufficient in year 10 was analysed with Cox regression models, and the results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Moreover, the impact on the self-sufficiency of having a diagnosis from specialised health care during the first five years in Sweden was analysed. The results showed that half of the refugees and three-quarters of the labour immigrants were self-sufficient 10 years after residency. The adjusted risk of not being self-sufficient at year 10 was 80% higher among labour immigrants (HR = 1.8; CI = 1.6-2.0) and more than two-fold among refugees (HR = 2.7; CI = 2.6-2.8) compared to the Swedish-born. Having a diagnosis from specialised health care during the first five years in Sweden had an impact on self-sufficiency in all groups; however, the impact of having a diagnosis did not differ between refugees and Swedish-born. Measures must be taken to increase immigrants' work participation.

Cancer incidence in a male adult population in relation to estimated protracted colon dose - A nested case control study in Northern Sweden after the Chernobyl Nuclear Power Plant accident

INTRODUCTION

Uncertainty in the dose-response of low dose radiation raised concern of an increased cancer incidence in Sweden after the Chernobyl Nuclear Power Plant (NPP) accident.

MATERIAL AND METHODS

A closed cohort was created of all males ≥18 years of age living in the Northern Sweden in 1986. In total 826,400 individuals were enrolled including 40,874 hunters. A nested case-control design was used with five controls randomly selected for each cancer case matched on year of diagnosis and year of birth. Individual absorbed colon dose was calculated 1986 to 2015. Allowing for a 5-year latency period Hazard Ratios (HR) per mGy with 95% Confidence Intervals (95% CI) were calculated in a conditional logistic regression adjusted by rural/non-rural living, length of education and pre-Chernobyl cancer incidence 1980 to 1985. A total of 127,109 cancer cases occurred from 1 January 1991 to 31 December 2015. Cancer was classified in: 1) Organ-specific (stomach, colon, liver, lung, prostate, urinary bladder, thyroid and leukaemia), 2) Other and 3) Not previously associated to ionizing radiation.

RESULTS

The average colon dose in cases was 1.77 mGy compared to controls 1.73 mGy. Hunters average colon dose was 2.32 mGy. Organ-specific cancers showed the highest HR per mGy both in the full cohort, adj HR 1.019 (1.014-1.024) and the hunter subcohort, adj HR 1.014 (1.001-1.027) during follow-up 1991 to 2015. Other cancer and Not previously associated with ionizing radiation showed lower HR per mGy. Therefore, the adj HR per mGy for Total cancer, 1.013 (1.009-1.017) was explained by Organ-specific cancer. Increased adj HR per mGy was seen in stomach, colon and prostate cancer, respectively in the full cohort and lung cancer in hunters.

CONCLUSIONS

Some cancer sites previously associated with ionizing radiation showed a positive adjusted HR per mGy both in the full cohort and in the hunter subcohort.

Increased cancer risk in male hunters compared to the general male population in Northern Sweden after the Chernobyl Nuclear Power Plant accident?

Male hunters in Swedish counties with high fallout of ¹³⁷Cs after the Chernobyl Nuclear Power Plant (NPP) accident have higher radiation exposure due to higher consumption of game compared with the general population.

Methods

Cancer incidence in Sweden was studied in 9 counties with different ¹³⁷Cs fallout after the Chernobyl NPP accident in 1986. In total, 9,267 cancer cases occurred in hunters and 138,909 cancer cases in non-hunters to 31 December 2015. Incidence rate ratios (IRR) with 95% confidence intervals (CI) were calculated using unexposed hunters, or non-hunters, as reference to study internal radiation exposure or hunter life style, respectively.

Results

Directly age standardized total cancer incidence showed an increasing trend in non-hunters. For hunters, the total cancer incidence was significantly lower up to 2001 when the total cancer incidence crossed over the weaker non-hunter trend and remained higher for the following 15 years. IRRs for total cancer in hunters versus non-hunters for each county did not show any clear exposure response pattern. IRRs for hunters versus non-hunters were higher regardless of rural/non-rural status with slightly higher risk estimates for the rural settings. The IRR for hunters was 1.06 (95% CI 1.04-1.08) 1986-2015, representing an excess of 531 cancer cases in hunters.

Conclusion

An increased total incidence of cancer was identified for male hunters compared with male non-hunters. No obvious association between cancer and ¹³⁷Cs from the Chernobyl NPP accident could be identified, although the exposure classification was too crude to exclude such an association.

Exposure to Upper Arm Elevation During Work Compared to Leisure Among 12 Different Occupations Measured with Triaxial Accelerometers

Regarding prevention of neck and shoulder pain (NSP), unsupported arm elevation is one factor that should be taken into account when performing work risk assessment. Triaxial accelerometers can be used to measure arm elevation over several days but it is not possible to differentiate between supported and unsupported arm elevation from accelerometers only. Supported arm elevation is more likely to exist during sitting than standing. The aim of the study was to evaluate the use of whole workday measurements of arm elevation with accelerometers to assess potentially harmful work exposure of arm elevation, by comparing arm elevation at work with arm elevation during leisure, in a population with diverse work tasks, and to assess how the exposure parameters were modified when upper arm elevation during sitting time was excluded. The participants, 197 workers belonging to 12 occupational groups with diverse work tasks, wore triaxial accelerometers on the dominant arm, hip, and back for 1–4 days to measure arm elevation and periods of sitting. None of the groups were found to have higher exposure to arm elevation during work compared to leisure. Even though some occupations where known to have work tasks that forced them to work with elevated arms to a large extent. A high proportion of arm elevation derived from sitting time, especially so during leisure. When arm elevation during sitting time was excluded from the analysis, arm elevation was significantly higher at work than during leisure among construction workers, garbage collectors, manufacturing workers, and domestic cleaners. Together this illustrates that it is not suitable to use whole workday measurments of arm elevation with accelerometer as a sole information source when assessing the risk for NSP due to arm elevation. Information on body posture can provide relevant contextual information in exposure assessments when it is known that the potential harmful exposure is performed in standing or walking.

Healthy migrant effect in the Swedish context: a register-based, longitudinal cohort study

OBJECTIVES

Studies have found a 'healthy-migrant effect' (HME) among arriving migrants, that is, a better health status compared with others in the home country, but also in comparison with the population in the host country. The aims were to investigate whether the HME hypothesis is applicable to the Swedish context, that is, if health outcomes differed between a group of mainly labour migrants (Western migrants) and a group of mainly refugee/family reunion migrants (non-Western migrants) compared with the native Swedish population, and if there were any correlations between labour market attachment (LMA) and these health outcomes.

DESIGN

Register-based, longitudinal cohort study.

PARTICIPANTS

The cohort was defined on 31 December 1990 and consisted of all migrants aged 18-47 years who arrived in Sweden in 1985-1990 (n=74 954) and a reference population of native Swedes (n=1 405 047) in the same age span. They were followed for three consecutive 6-year periods (1991-1996, 1997-2002 and 2003-2008) and were assessed for five measures of health: hospitalisation for cardiovascular and psychiatric disorders, mortality, disability pension, and sick leave.

RESULTS

Western migrants had, compared with native Swedes, lower or equal HRs for all health measures during all time periods, while non-Western migrants displayed higher or equal HRs for all health measures, except for mortality, during all time periods. Age, educational level, occupation and LMA explained part of the difference between migrants and native Swedes. High LMA was associated with higher HRs for cardiovascular disorders among Western migrants, higher HRs of psychiatric disorders among non-Western migrants and higher HRs of mortality among both migrant groups compared with native Swedes.

CONCLUSIONS

There were indications of a HME among Western migrants, while less proof of a HME among non-Western migrants. Stratification for LMA and different migrant categories showed some interesting differences, and measurements of the HME may be inconclusive if not stratified by migrant category or other relevant variables.

Personal and demographic factors and change of subjective indoor air quality reported by school children in relation to exposure at Swedish schools: a 2-year longitudinal study

This paper studies changes in subjective indoor air quality (SIAQ) among school children and relates these data to repeated exposure measurements during a two-year follow-up period. Data on SIAQ and demographic information were gathered by a questionnaire sent to 1476 primary and secondary school pupils in 39 randomly selected schools at baseline and after two years (follow-up). Exposure measurements were applied after questionnaire data were collected at baseline and follow-up in approximately 100 classrooms. The arithmetic mean values for baseline and follow-up were: for indoor air temperature 23.6°C and 21.8°C and for outdoor air flow rate 5.4 L/s and 7.9L/s. Older children, those with atopy at baseline, and those in larger schools reported impaired SIAQ during follow-up. Installation of new ventilation systems, higher personal air flow rate and air exchange rate, and better illumination were associated with improved SIAQ. Higher CO2 levels were associated with impaired SIAQ. In conclusion, sufficient ventilation and illumination in classrooms are essential for the perception of good indoor air quality.

Acute effects of exposure to vapors of 3-methyl-1-butanol in humans

The secondary alcohol 3-methyl-1-butanol (3MB, isoamyl alcohol) is used, for example, as a solvent in a variety of applications and as a fragrance ingredient. It is also one of the microbial volatile organic compounds (MVOCs) found in indoor air. There are little data on acute effects. The aim of the study was to assess the acute effects of 3MB in humans. Thirty healthy volunteers (16 men and 14 women) were exposed in random order to 1 mg/m(3) 3MB or clean air for 2 h at controlled conditions. Ratings with visual analogue scales revealed slightly increased perceptions of eye irritation (P = 0.048, Wilcoxon) and smell (P < 0.0001) compared with control exposure. The other ratings were not significantly affected (irritation in nose and throat, dyspnea, headache, fatigue, dizziness, nausea, and intoxication). No significant exposure-related effects were found in blinking frequency, tear film break-up time, vital staining of the eye, nasal lavage biomarkers, lung function, and nasal swelling. In conclusion, this study suggests that 3MB is not a causative factor for health effects in damp and moldy buildings.

PRACTICAL IMPLICATIONS

3-Methyl-1-butanol (3MB) is one of the most commonly reported MVOCs in damp and moldy buildings and in occupational settings related to agriculture and composting. Our study revealed no irritation effects at 1 mg/m3, a concentration higher than typically found in damp and moldy buildings. Our study thus suggests that 3MB is not a causative factor for health effects in damp and moldy buildings.

Work and health among immigrants and native Swedes 1990-2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality

Background

There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration.

Methods

This study included migrants to Sweden since 1960 who were 28–47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately.

Results

Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results.

Conclusions

Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

The prevalence and incidence of sick building syndrome in Chinese pupils in relation to the school environment: a two-year follow-up study

There are few incidence studies on sick building syndrome (SBS). We studied two-year change of SBS in Chinese pupils in relation to parental asthma/allergy (heredity), own atopy, classroom temperature, relative humidity (RH), absolute humidity (AH), crowdedness, CO₂, NO₂, and SO₂. A total of 1993 participated at baseline, and 1143 stayed in the same classrooms after two years. The prevalence of mucosal and general symptoms was 33% and 28% at baseline and increased during follow-up (P < 0.001). Twenty-seven percent reported at least one symptom improved when away from school. Heredity and own atopy were predictors of SBS at baseline and incidence of SBS. At baseline, SO₂ was associated with general symptoms (OR=1.10 per 100 μg/m³), mucosal symptoms (OR=1.12 per 100 μg/m³), and skin symptoms (OR=1.16 per 100 μg/m³). NO₂ was associated with mucosal symptoms (OR=1.13 per 10 μg/m³), and symptoms improved when away from school (OR=1.13 per 10 μg/m³). Temperature, RH, AH, and CO₂ were negatively associated with prevalence of SBS. Incidence or remission of SBS was not related to any exposure, except a negative association between SO₂ and new skin symptoms. In conclusion, heredity and atopy are related to incidence and prevalence of SBS, but the role of the measured exposures for SBS is more unclear.

PRACTICAL IMPLICATIONS

We found high levels of CO₂ indicating inadequate ventilation and high levels of SO₂ and NO₂, both indoors and outdoors. All schools had natural ventilation, only. Relying on window opening as a tool for ventilation in China is difficult because increased ventilation will decrease the level of CO₂ but increase the level of NO₂ and SO₂ indoors. Prevalence studies of sick building syndrome (SBS) might not be conclusive for causal relationships, and more longitudinal studies on SBS are needed both in China and other parts of the world. The concept of mechanical ventilation and air filtration should be introduced in the schools, and when planning new schools, locations close to heavily trafficked roads should be avoided.

A longitudinal study of sick building syndrome among pupils in relation to microbial components in dust in schools in China

There are few longitudinal studies on sick building syndrome (SBS), which include ocular, nasal, throat, and dermal symptoms, headache, and fatigue. We studied the associations between selected microbial components, fungal DNA, furry pet allergens, and incidence and remission of SBS symptoms in schools in Taiyuan, China. The study was based on a two-year prospective analysis in pupils (N=1143) in a random sample of schools in China. Settled dust in the classrooms was collected by vacuum cleaning and analyzed for lipopolysaccharide (LPS), muramic acid (MuA), and ergosterol (Erg). Airborne dust was collected in Petri dishes and analyzed for cat and dog allergens and fungal DNA. The relationship between the concentration of allergens and microbial compounds and new onset of SBS was analyzed by multi-level logistic regression. The prevalence of mucosal and general symptoms was 33% and 28%, respectively, at baseline, and increased during follow-up. At baseline, 27% reported at least one symptom that improved when away from school (school-related symptoms). New onset of mucosal symptoms was negatively associated with concentration of MuA, total LPS, and shorter lengths of 3-hydroxy fatty acids from LPS, C14, C16, and C18. Onset of general symptoms was negatively associated with C18 LPS. Onset of school-related symptoms was negatively associated with C16 LPS, but positively associated with total fungal DNA. In general, bacterial compounds (LPS and MuA) seem to protect against the development of mucosal and general symptoms, but fungal exposure measured as fungal DNA could increase the incidence of school-related symptoms.

Installation of mechanical ventilation in a horse stable: effects on air quality and human and equine airways

OBJECTIVES

To examine the effects of installing a mechanical ventilation system at a riding-school stable on indoor air quality and human and horse airways.

METHODS

The intervention was the installation of mechanical ventilation in a riding-school stable. Carbon dioxide (CO2), ammonia, particles, horse allergen, microorganisms and endotoxins were measured in the stable. The stable-workers and riding-students completed a questionnaire and underwent the following tests: analysis of nasal lavage for inflammation biomarkers; levels of exhaled nitrogen oxide (NO); measurements of daily peak-expiratory flow (PEF). The horses were examined clinically by airway endoscopy and bronchoalveolar lavage (BAL) and were analysed for cytology and biomarkers.

RESULTS

Levels of CO2 were nearly halved and airborne horse allergen levels were markedly reduced (5-0.8 kU/m3) after the intervention. A decreased level of ultrafine particles was observed (8000-5400 particles/cm3) after the intervention, while total and respirable dust levels were mainly unchanged (200 and 130 μg/m3). Levels of microorganisms in surface samples decreased following the intervention, whereas airborne microorganisms and endotoxin increased. There was no significant change in human symptoms, PEF-variability, exhaled NO or inflammatory biomarkers in the nasal lavage. In horses, the mean score of lower airway mucus was significantly reduced together with the mean level of expression of interleukin-6 mRNA in BAL cells after the intervention.

CONCLUSIONS

The installation of a mechanical ventilation system resulted in an increased air exchange rate, as demonstrated by reduced levels of CO2, ammonia, ultrafine particles and horse allergen. There was no significant clinical effect on human airways, but there was a tendency for reduced inflammation markers. The results on the horses may indicate less impact on their airways after the intervention.

Acute effects of exposure to 1 mg/m(3) of vaporized 2-ethyl-1-hexanol in humans

The objective was to assess acute effects from controlled exposure of volunteers to 2-ethyl-1-hexanol, a volatile organic compound that is often found in indoor air. Sixteen males and fourteen females were in random order exposed to 1 mg/m(3) of vapors of 2-ethyl-1-hexanol or to clean air (control exposure) in an exposure chamber during 2 h at rest. The subjects performed symptom ratings on Visual Analog Scales. During exposure to 2-ethyl-1-hexanol subjective ratings of smell and eye discomfort were minimally but significantly increased. Ratings of nasal irritation, throat irritation, headache, dyspnoea, fatigue, dizziness, nausea, and intoxication were not significantly affected. No exposure-related effects on measurement of blinking frequency by electromyography, measurement of the eye break-up time, vital staining of the eye, nasal lavage biomarkers, transfer tests, spirometric and rhinometric measures were seen. No differences in response were seen between sexes or between atopics and non-atopics. Practical Implications It is important to assess acute effects in volatile organic compounds like 2-ethyl-1-hexanol. 2-ethyl-1-hexanol is often found in indoor air generated by degradation of plastic building materials or in new buildings. There are associations between 2-ethyl-1-hexanol in indoor air and respiratory effects, eye irritation, headache, and blurred vision. A controlled chamber exposure study in acute effects was performed. In conclusion, this study showed weak subjective symptom of irritation in the eyes.

Hearing status among cabin crew in a Swedish commercial airline company

PURPOSE

To study hearing loss in commercial airline cabin crew (CC).

METHODS

Totally 155 male and 781 female CC (n = 936) in a Swedish airline company underwent repeated audiometric tests during 1974-2005. The last test was used to study hearing loss. The mean test values at 3, 4, 6 kHz were used for the ear with worse hearing loss. Data were compared with a Swedish population (n = 603) who were not occupationally exposed to noise. Equivalent noise levels (Leq) were measured in different aircraft.

RESULTS

Leq was 78-84 dB (A), maximum A-weighted exposure was 114 dB. Median values for all ages were close to the reference group. No association was found between years of employment and hearing loss, when adjusting for age and gender by multiple logistic regression analysis.

CONCLUSION

Cabin crew are exposed to equivalent noise levels below the current Swedish occupational standard, and have normal age-matched hearing threshold levels.

Bias in height and weight reported by Swedish adolescents and relations to body dissatisfaction: the COMPASS study

OBJECTIVE

To assess the size of biases in self-reported height, weight in a large sample of adolescents with special attention to possible effects of body dissatisfaction and to assess how such biases may influence estimates of overweight and obesity.

DESIGN

Cross-sectional study.

SETTING

Unselected population from Southwestern parts of Stockholm County, Sweden.

SUBJECTS

Two-thousand seven hundred and twenty-six boys and girls, 15 years of age.

METHODS

Data were collected by a questionnaire answered by adolescents and a physical examination made by trained study nurses. A validated physical appearance scale and body silhouettes were embedded into the questionnaire.

RESULTS

Obese boys under-reported their weight (5.2 kg) (95% confidence intervals (CI) 3.7; 6.6) more than obese girls (3.8 kg) (95% CI 1.8; 5.8). Agreement between self-reported and measured body mass index (BMI)-categories (obese, overweight and non-overweight/obese) as estimated by weighted kappa was 0.77 (95% CI 0.72; 0.82) for girls and 0.74 (95% CI 0.70; 0.79) for boys. For obese girls and boys sensitivity of self-reports were 0.65 (95% CI 0.47; 0.79) and 0.52 (95% CI 0.38; 0.66). Boys with low scores on the physical appearance scale under-reported their weight and BMI more than those with high scores. Boys and girls who wished to be leaner under-reported their weight and BMI more than subjects who were satisfied with their body size (P<0.05).

CONCLUSION

Thirty-five percent of obese girls and 48% of obese boys would remain undetected from self-reported data. Boys and girls who were dissatisfied with their physical appearance or size under-reported their weight more than satisfied subjects.

Left main coronary artery stenosis no longer a risk factor for early and late death after coronary artery bypass surgery--an experience covering three decades

OBJECTIVE

To analyse early and late mortality after coronary artery bypass grafting (CABG) in patients with and without left main coronary artery (LMCA) stenosis during the 30-year period 1970-1999.

METHODS

A total of 1888 of 10,647 patients (18%) who underwent a first isolated CABG at the Karolinska Hospital in Stockholm, Sweden, during 1970-1999 had significant left main coronary artery stenosis. The Swedish National Cause of Death Register was used to determine mortality up to five years after the operation.

RESULTS

The proportion of patients with LMCA stenosis of all CABG patients increased from 7% during the 1970s to 26% in 1999. During 1970-1984 early mortality was 5.8% in patients with LMCA stenosis compared with 1.5% in patients without LMCA stenosis (odds ratio (OR) 3.7 (95% confidence interval (CI) 1.8-7.6)). The corresponding rates during 1995-1999 were 2.0% versus 2.2% (OR 0.8 (95% CI 0.5-1.5)), respectively. The increased risk of early death in patients with LMCA stenosis was neutralised in males during 1985-1994 and in females during 1995-1999. Five-year survival in males was 88% after operations performed during 1994-1999 compared with 82% after CABG performed during 1970-1984. Five-year mortality, exclusive of early deaths, during 1970-1984 was higher in patients with LMCA stenosis (12.8%) than in those without (8.4%) (relative risk 1.7 (95% CI 1.1-2.5)). An increased risk of late mortality in patients with LMCA stenosis was neutralised in males during 1985-1994 and in females during 1995-1999.

CONCLUSIONS

During 1970-1999 there was a decrease of early and five-year mortality in patients with LMCA stenosis after CABG despite increase of patient age and risk factors. There were gender differences so that the risk of death in patients with compared with in those without LMCA stenosis was neutralised in males during 1985-1994 and in females during 1994-1999. The continuous decline of mortality during three decades most likely reflects improvement of the peri- and postoperative management of patients undergoing CABG during this period.