Publications by authors named "Ida Kim Wium-Andersen"

16 Publications

  • Page 1 of 1

Body mass index and height in young adult men in relation to subsequent risk of mood disorder.

Eur J Epidemiol 2021 Jul 10. Epub 2021 Jul 10.

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.

Adolescence represents an important period in brain and mental development, which raises the question of whether measures of body size at entry into adult life influence the risk of developing mood disorders. We examined the association of BMI and height in a cohort of young men with risk of mood disorders throughout life. The study included 630,807 Danish men born 1939-1959 and 1983-1997 with measures of height and weight at conscription board examinations. Psychiatrist's diagnosis of mood disorders was obtained from national patient registries from 1969 to 2016. The associations of BMI and height with mood disorders were estimated by Cox proportional hazard regression analyses adjusting for education, cognitive ability, migration status drug and alcohol misuse. During a mean follow-up of 26.3 years, 2,608 (0.6%) and 19,690 (3.1%) men were diagnosed with bipolar disorder and depression, respectively. We found an inverse linear association of BMI with risk of bipolar disorder, whereas the association of BMI with depression was curve-linear with a decline in risk until BMI around 25 kg/m, and an almost constant risk across the BMI range above 25 kg/m. Height was not associated with bipolar disorder or depression. Comparison of brothers, assumed to share family factors of possible influence on the risk of mood disorders, showed similar results although with wider confidence intervals. BMI in the lower range at men's entry into adulthood is inversely associated with risk of bipolar disorder and depression throughout adult life, whereas height is not related.
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http://dx.doi.org/10.1007/s10654-021-00783-zDOI Listing
July 2021

Use of register- and survey-based measures of anxiety in a population-based Danish cohort.

Acta Psychiatr Scand 2021 Jun 17. Epub 2021 Jun 17.

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Frederiksberg, Copenhagen, Denmark.

Objective: We explored the comparability of anxiety measures from register- and survey-based data including analyses of prevalence and associations with selected psychiatric and somatic diseases.

Methods: We measured anxiety using Danish registers (hospital diagnosis and anxiolytic drug prescriptions), self-reports, symptom checklist (SCL) scores, and a clinical interview in 7493 adults with mean age 52 (SD 13.3) years who participated in a health survey between 2012 and 2015. We estimated the prevalence of anxiety, agreement between different measures and performed quantitative bias analysis.

Results: The lifetime prevalence of hospital diagnosed anxiety, anxiolytic drug prescriptions, and self-reported anxiety were 4.4%, 6.2%, and 5.1%, respectively, after adjusting for selective participation. The agreement between the different anxiety measures was low. Thus, 25% with an anxiety diagnosis and 20% with anxiolytic drug prescriptions also had a high SCL score. Anxiolytic drugs were the only measure significantly associated with higher odds of heart disease. Hospital diagnosis and self-reported anxiety were associated with depression with odds ratio (OR) above 15, whereas anxiolytic drug prescriptions were less strongly associated (OR = 2.2(95% confidence interval: 1.26-3.91)). The risk estimates attenuated considerably when correcting for measurement error, whereas the ORs became slightly higher when the selective participation in the survey was accounted for.

Conclusion: Anxiety diagnosed in hospitals and self-reported anxiety showed low level of agreement but provide comparable results regarding frequency measures and associations with disease outcomes.
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http://dx.doi.org/10.1111/acps.13339DOI Listing
June 2021

An analysis of the relative and absolute incidence of somatic morbidity in patients with affective disorders-A nationwide cohort study.

J Affect Disord 2021 Sep 7;292:204-211. Epub 2021 Jun 7.

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Section for Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K 1014, Denmark.

Background: Patients with affective disorder seem to experience higher risks of several somatic diseases, but no studies have provided estimates of both absolute and relative risks for these diseases in the same population.

Methods: A prospective cohort of all patients age ≥18 years old with a hospital contact with affective disorder between 1997-2014 (n=246,282) and a random sample from the background population (n=167,562) was followed for hospitalizations with cardiovascular disease, diabetes, cancers, chronic obstructive pulmonary disease (COPD), asthma, inflammatory bowel disease, hip fracture, psoriasis, migraine, or dementia. Adjusted absolute and relative risk estimates were calculated using multivariable adjusted Aalen's additive and Cox proportional hazard regression models.

Results: After adjustments, the absolute risk difference was 130.6 (95% confidence interval [CI] 125.5-135.7) additional cases per 10,000 person-years among affective disorder patients compared to the reference population. The corresponding hazard ratio for any somatic disease was 1.50 (95% CI 1.48-1.52). The strongest associations were found for dementia, hip fracture, COPD, and stroke on both the relative and absolute scale. The patients did not have higher risk of cancers except for lung cancer and brain tumors. Risk estimates tended to be slightly higher for individuals with depression or other affective disorder compared to bipolar disorder.

Limitations: Limitations include use of register-based data, risk of reverse causation and Berkson's bias.

Conclusions: Patients with affective disorder have both higher absolute and relative risk of most somatic diseases except for cancers. Further identification of the shared mechanisms will facilitate the development of targeted interventions.
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http://dx.doi.org/10.1016/j.jad.2021.05.103DOI Listing
September 2021

The familial and genetic contribution to the association between depression and cardiovascular disease: a twin cohort study.

Mol Psychiatry 2020 Nov 20. Epub 2020 Nov 20.

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg F, Denmark.

Depression and cardiovascular disease (ischemic heart disease and stroke) are associated in a bidirectional manner. Their relatively high heritability has led to the hypothesis that this co-occurrence is related to shared familial and genetic factors; this study aims to test this hypothesis. We included 23,498 monozygotic and 39,540 same-sex dizygotic twins from the Danish Twin Registry followed from January 1977 until December 2011 in nationwide Danish registries. We used survival analyses accounting for censoring and competing risk of death to estimate cumulative incidence, casewise concordance, relative recurrence risk, and heritability of the co-occurrence of depression and cardiovascular disease by age using monozygotic and same-sex dizygotic twin pairs. The casewise concordance of ischemic heart disease or stroke in twins whose co-twin was diagnosed with depression was at all ages similar for the monozygotic and dizygotic twin pairs and to the cumulative incidence of ischemic heart disease or stroke, respectively, in the entire twin population. A similar pattern was seen in analyses of depression risk given the co-twin being diagnosed with ischemic heart disease or stroke. Relative recurrence risk and heritability estimates were also of modest size and with confidence intervals including unity. Results were similar after stratification by gender as well as when redefining depression to include the use of antidepressant medication from 1995. Our findings do not support that co-occurrence between depression and cardiovascular disease is explainable by shared genetic factors, nor did we find strong evidence of a familial effect.
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http://dx.doi.org/10.1038/s41380-020-00954-6DOI Listing
November 2020

Antidiabetic medication and risk of dementia in patients with type 2 diabetes: a nested case-control study.

Eur J Endocrinol 2019 Nov;181(5):499-507

Center for Clinical Research and Prevention, Frederiksberg Hospital, Frederiksberg, Denmark.

Objective: Diabetes is a risk factor for dementia, but whether antidiabetic medication decreases the risk is unclear. We examined the association between antidiabetic medication and dementia.

Design: We performed a nested case-control study within a cohort of all 176 250 patients registered with type 2 diabetes in the Danish National Diabetes Register between 1995 and 2012. This population was followed for dementia diagnosis or anti-dementia medication use until May 2018. Using risk-set sampling, each dementia case (n = 11 619) was matched on follow-up time and calender year of dementia with four controls randomly selected among cohort members without dementia (n = 46 476). Ever use and mean daily defined dose of antidiabetic medication was categorized in types (insulin, metformin, sulfonylurea and glinides combined, glitazone, dipeptidyl peptidase 4 (DPP4) inhibitors, glucagon-like peptide 1 (GLP1) analogs, sodium-glucose transport protein 2 (SGLT2) inhibitors and acarbose).

Methods: Conditional logistic regression models were fitted to calculate odds ratios (ORs) for dementia associated with antidiabetic medication use, adjusting for potential confounders.

Results: Use of metformin, DPP4 inhibitors, GLP1 analogs, and SGLT2 inhibitors were associated with lower odds of dementia after multible adjustments (ORs of 0.94 (95% confidence interval (CI): 0.89-0.99), 0.80 (95% CI 0.74-0.88), 0.58 (95% CI: 0.50-0.67), and 0.58 (95% CI: 0.42-0.81), respectively), with a gradual decrease in odds of dementia for each increase in daily defined dose. Analyses of the most frequent treatment regimes did not show any synergistic effects of combined treatment.

Conclusion: Use of metformin, DPP4 inhibitors, GLP1 analogs and SGLT2 inhibitors was associated with lower risk of dementia in patients with diabetes.
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http://dx.doi.org/10.1530/EJE-19-0259DOI Listing
November 2019

An attempt to explain the bidirectional association between ischaemic heart disease, stroke and depression: a cohort and meta-analytic approach.

Br J Psychiatry 2020 08;217(2):434-441

Professor, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital; and Department of Public Health, Section of Epidemiology, University of Copenhagen, Denmark.

Background: Depression and cardiovascular diseases (CVDs) are common diseases and associated in a bidirectional manner.

Aims: To examine whether a bidirectional association between CVD and depression could be explained by shared risk factors, misclassification of disease measures or non-response.

Method: A total of 10 population-based cohorts including 93 076 men and women (mean age 54.4 years, s.d. = 9.2) and an additional 10 510 men (mean age 51.2 years, s.d. = 0.3) were followed for subsequent depression, ischaemic heart disease (IHD) and stroke in the Danish National Patient Registry from health examinations between 1982 and 2015 and until end of follow-up in 2017-2018. Exposures were physicians' diagnoses of IHD, stroke, depression or self-reported chest pain, depression, use of antidepressant medication and the Major Depression Inventory at the time of study entry in the Metropolit study. Associations were analysed using Cox proportional hazard regression with disease as time-dependent variables.

Results: IHD and stroke were associated with subsequent depression (hazard ratio (HR) for IHD: 1.79, 95% CI 1.43-2.23 and HR for stroke: 2.62, 95% CI 2.09-3.29) and the associations were present in both men and women. Adjustment for the shared risk factors socioeconomic status, lifestyle, body mass index, statin use and serum lipids did not change the risk estimates. Furthermore, depression was associated with higher risk of subsequent IHD (HR = 1.63, 95% CI 1.36-1.95) and stroke (HR = 1.94, 95% CI 1.63-2.30). The associations were also present when the analyses were based on self-reported disease measures or restricted to include non-responders.

Conclusions: The bidirectional association between CVD and depression was not explained by shared risk factors, misclassification or non-response.
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http://dx.doi.org/10.1192/bjp.2019.130DOI Listing
August 2020

Migraine and risk of stroke and acute coronary syndrome in two case-control studies in the Danish population.

Clin Epidemiol 2017 31;9:439-449. Epub 2017 Aug 31.

Research Center for Prevention and Health, Rigshospitalet - Glostrup, Copenhagen University, Glostrup, Denmark.

Introduction: Migraine has consistently been associated with increased risk of ischemic stroke, while the evidence for a relation with other types of stroke or coronary outcomes is limited. We examined the association between migraine and stroke and acute coronary syndrome (ACS) subtypes and the influence of potential confounding factors.

Methods: All first-time hospital contacts for stroke (n=155,216) or ACS (n=97,799) were identified in Danish National Patient Registers and matched with 2 control groups of the background population. A hospital diagnosis of migraine and use of migraine medication were the main exposures and associations (odds ratios [OR]) were estimated using multiple logistic regression. Confounding was also addressed by including use of general headache medication as a negative control exposure.

Results: The diagnosis of migraine was associated with increased odds of both stroke (OR, age <50 years: 4.80 [95% CI: 3.75-6.21]; OR age ≥50 years:1.91 [95% CI: 1.67-2.19]) and ACS (OR:1.88 [95% CI: 1.53-2.32]), while the ORs for the associations between migraine medication and stroke and ACS were lower. Patients with a diagnosis of migraine or redeemed migraine medication had increased ORs of all stroke subtypes (ischemic, hemorrhagic stroke and transient ischemic attacks). The diagnosis of migraine was also associated with both angina and myocardial infarction (ST-elevation Myocardial Infarction [STEMI], non-STEMI and unspecified) with the highest OR for angina. These associations were not fully explained by adjustment for confounding co-variables or when compared with the negative control exposure that were assumed to be influenced by similar confounding factors, but no shared pathogenesis.

Conclusion: Hospital-diagnosed migraine was associated with all stroke and ACS subtypes, with ischemic stroke and angina having the highest odds. Confounding did not explain the associations.
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http://dx.doi.org/10.2147/CLEP.S144441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587091PMC
August 2017

Anti-inflammatory treatment and risk of depression in 91,842 patients with acute coronary syndrome and 91,860 individuals without acute coronary syndrome in Denmark.

Int J Cardiol 2017 Nov;246:1-6

Research Center for Prevention and Health, Rigshospitalet-Glostrup, Glostrup, Denmark; Department of Public Health, University of Copenhagen, Denmark.

Background: We examined if treatment with acetylsalicylic acid (ASA), non-steroid anti-inflammatory drugs (NSAID), or statins after acute coronary syndrome (ACS) are associated with decreased risk of depression.

Method: This register-based cohort study included all individuals with a first-time hospital admissions with an ACS diagnosis registered between January 2001 to December 2009 (N=91,842) and a comparable reference population without ACS (N=91,860). Information of ASA, NSAID, and statin use were retrieved from a national prescription register. The study population was followed for hospitalization with depression or receiving prescription of antidepressant medication for up to one year after ACS or study entry (early depression) or one to twelve years after ACS or study entry (late depression).

Results: ASA use after ACS was associated with decreased risk of early depression with hazard ratios (HR) of 0.89 (95% confidence interval 0.85-0.93) but not with late depression 0.96 (0.90-1.01). The corresponding HRs for statin were 0.90 (0.86-0.94) and 0.86 (0.82-0.90). In the non-ACS population, statin use was not associated with neither early nor late depression (HRs 1.04 (0.96-1.12) and 1.00 (0.95-1.06)), while ASA was associated with increased risk of late (HR 1.09 (1.04-1.14)) but not early depression (HR 1.03 (0.97-1.09)). In both populations, NSAID use was associated with increased risk of late but not early depression.

Conclusion: Use of ASA or statins were associated with decreased risk of depression in ACS patients but not in individuals without ACS, while use of NSAID was associated with increased risk of late depression in both populations.
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http://dx.doi.org/10.1016/j.ijcard.2017.05.105DOI Listing
November 2017

Anti-inflammatory treatment and risk for depression after first-time stroke in a cohort of 147 487 Danish patients.

J Psychiatry Neurosci 2017 Sep;42(5):320-330

From the Psychiatric Center Ballerup, Ballerup, Denmark (I. Wium-Andersen); the Research Center for Prevention and Health, Glostrup Hospital, Glostrup, Denmark (I. Wium-Andersen, M. Wium-Andersen, Osler); the Psychiatric Center Frederiksberg, Frederiksberg, Denmark (M. Wium-Andersen); the Psychiatric Center Copenhagen, Department O, and Institute of Clinical medicine University of Copenhagen, Denmark (I. Wium-Andersen, K. Wium-Andersen, Jørgensen); and the Department of Public Health, Section of Social Medicine, University of Copenhagen, Denmark (Osler).

Background: Depression is a common complication after stroke, and inflammation may be a pathophysiological mechanism. This study examines whether anti-inflammatory treatment with acetylsalicylic acid (ASA), nonsteroid anti-inflammatory drugs (NSAIDs) or statins influence the risk of depression after stroke.

Methods: A register-based cohort including all patients admitted to hospital with a first-time stroke from Jan. 1, 2001, through Dec. 31, 2011, and a nonstroke population with a similar age and sex distribution was followed for depression until Dec. 31, 2014. Depression was defined as having a hospital contact with depression or having filled prescriptions for antidepressant medication. The associations between redeemed prescriptions of ASA, NSAIDs or statins with early- (≤ 1 year after stroke or study entry) and late-onset (> 1 year after stroke or study entry) depression were analyzed using Cox proportional hazard regression.

Results: We identified 147 487 patients with first-time stroke and 160 235 individuals without stroke for inclusion in our study. Redeemed prescriptions of ASA, NSAIDs or statins after stroke decreased the risk for early-onset depression, especially in patients with ischemic or severe stroke. Patients who received a combination of anti-inflammatory treatments had the lowest risk for early-onset depression. On the other hand, use of ASA or NSAIDs 1 year after stroke increased the risk for late-onset depression, whereas statin use was associated with a tendency toward a decreased risk.

Limitations: The study used prescription of antidepressant medication as a proxy measure for depression and did not include anti-inflammatory drugs bought over the counter.

Conclusion: Anti-inflammatory treatment is associated with a lower risk for depression shortly after stroke but a higher risk for late depression. This suggests that inflammation contributes differently to the development of depression after stroke depending on the time of onset.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573574PMC
http://dx.doi.org/10.1503/jpn160244DOI Listing
September 2017

Personalized medicine in psychiatry.

Nord J Psychiatry 2017 Jan 26;71(1):12-19. Epub 2016 Aug 26.

c Mood Disorders Psychopharmacology Unit , University Health Network , Toronto , ON , Canada.

Background: Personalized medicine is a model in which a patient's unique clinical, genetic, and environmental characteristics are the basis for treatment and prevention. Aim, method, and results: This review aims to describe the current tools, phenomenological features, clinical risk factors, and biomarkers used to provide personalized medicine. Furthermore, this study describes the target areas in which they can be applied including diagnostics, treatment selection and response, assessment of risk of side-effects, and prevention.

Discussion And Conclusion: Personalized medicine in psychiatry is challenged by the current taxonomy, where the diagnostic categories are broad and great biological heterogeneity exists within each category. There is, thus, a gap between the current advanced research prospects and clinical practice, and the current taxonomy is, thus, a poor basis for biological research. The discussion proposes possible solutions to narrow this gap and to move psychiatric research forward towards personalized medicine.
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http://dx.doi.org/10.1080/08039488.2016.1216163DOI Listing
January 2017

Depression following acute coronary syndrome: a Danish nationwide study of potential risk factors.

Soc Psychiatry Psychiatr Epidemiol 2016 11 19;51(11):1509-1523. Epub 2016 Aug 19.

Research Centre for Prevention and Health, Rigshospitalet Glostrup Hospital, Nordre ringvej 57, 2600, Glostrup, Denmark.

Purpose: Depression is common following acute coronary syndrome, and thus, it is important to provide knowledge to improve prevention and detection of depression in this patient group. The objectives of this study were to examine: (1) whether indicators of stressors and coping resources were risk factors for developing depression early and later after an acute coronary syndrome and (2) whether prior depression modified these associations.

Methods: The study was a register-based cohort study, which includes 87,118 patients with a first time diagnosis of acute coronary syndrome during the period 2001-2009 in Denmark. Cox regression models were used to analyse hazard ratios (HRs) for depression.

Results: 1.5 and 9.5 % develop early (≤30 days) and later (31 days-2 years) depression after the acute coronary syndrome. Among all patients with depression, 69.2 % had first onset depression, while 30.8 % developed a recurrent depression. Most patient characteristics (demographic factors, socioeconomic status, psychosocial factors, health-related behavioural factors, somatic comorbidities, and severity of acute coronary syndrome) were significantly associated with increased HRs for both early and later depressions. Prior depression modified most of these associations in such a way that the association was attenuated in patients with a prior depression.

Conclusion: Our results indicate that first time and recurrent depression following acute coronary syndrome have different risk profiles. This is important knowledge that may be used to focus future interventions for prevention and detection.
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http://dx.doi.org/10.1007/s00127-016-1275-7DOI Listing
November 2016

Time trend in depression diagnoses among acute coronary syndrome patients and a reference population from 2001 to 2009 in Denmark.

Nord J Psychiatry 2016 Jul 11;70(5):335-41. Epub 2016 Jan 11.

a Research Centre for Prevention and Health , Rigshospitalet - Glostrup University of Copenhagen , Denmark ;

Introduction In the last decade a range of recommendations to increase awareness of depression in acute coronary syndrome patients have been published. To test the impact of those recommendations we examine and compare recent time trends in depression among acute coronary syndrome patients and a reference population. Methods 87 218 patients registered with acute coronary syndrome from 2001-2009 in Denmark and a match reference population were followed through hospital registries and medication prescriptions for early (≤30 days), intermediate (31 days to 6 months) and later (6 months to 2 years) depression in the acute coronary syndrome population and overall depression in the reference population. Cox regression models were used to compare hazard ratios (HRs) for depression over calendar years. Results During the study period, 11.0% and 6.2% were diagnosed with depression in the acute coronary syndrome population and in the reference population, respectively. For the acute coronary syndrome population, the adjusted HRs increased for early (HR (95% CI) 1.04 (1.01-1.06)) and intermediate depression (HR (95% CI) 1.01 (1.00-1.03)), whereas the adjusted HRs did not change for later depression (HR (95% CI) 0.99 (0.98-1.00)). For the reference population the adjusted HRs for depression increased through the study period (HR (95% CI) 1.01 (1.01-1.03)). Conclusion Increase in diagnoses of depressions within 6 months of acute coronary syndrome may be explained by increased focus on depression in this patient group in combination with increased awareness of depression in the general population.
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http://dx.doi.org/10.3109/08039488.2015.1114681DOI Listing
July 2016

Depression After First Hospital Admission for Acute Coronary Syndrome: A Study of Time of Onset and Impact on Survival.

Am J Epidemiol 2016 Feb 5;183(3):218-26. Epub 2016 Jan 5.

We examined incidence of depression after acute coronary syndrome (ACS) and whether the timing of depression onset influenced survival. All first-time hospitalizations for ACS (n = 97,793) identified in the Danish Patient Registry during 2001-2009 and a reference population were followed for depression and mortality via linkage to patient, prescription, and cause-of-death registries until the end of 2012. Incidence of depression (as defined by hospital discharge or antidepressant medication use) and the relationship between depression and mortality were examined using time-to-event models. In total, 19,520 (20.0%) ACS patients experienced depression within 2 years after the event. The adjusted rate ratio for depression in ACS patients compared with the reference population was 1.28 (95% confidence interval (CI): 1.25, 1.30). During 12 years of follow-up, 39,523 (40.4%) ACS patients and 27,931 (28.6%) of the reference population died. ACS patients with recurrent (hazard ratio (HR) = 1.62, 95% CI: 1.57, 1.67) or new-onset (HR = 1.66, 95% CI: 1.60, 1.72) depression had higher mortality rates than patients with no depression. In the reference population, the corresponding relative estimates for recurrent (HR =1.98, 95% CI: 1.92, 2.05) and new-onset (HR = 2.42, 95% CI: 2.31, 2.54) depression were stronger. Depression is common in ACS patients and is associated with increased mortality independently of time of onset, but here the excess mortality associated with depression seemed to be lower in ACS patients than in the reference population.
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http://dx.doi.org/10.1093/aje/kwv227DOI Listing
February 2016

The Impact of Comorbid Depression on Educational Inequality in Survival after Acute Coronary Syndrome in a Cohort of 83 062 Patients and a Matched Reference Population.

PLoS One 2015 29;10(10):e0141598. Epub 2015 Oct 29.

Research Center for Prevention and Health, Rigshospitalet - Glostrup, Copenhagen University, Glostrup, Denmark.

Background: Patients with low socioeconomic position have higher rates of mortality after diagnosis of acute coronary syndrome (ACS), but little is known about the mechanisms behind this social inequality. The aim of the present study was to examine whether any educational inequality in survival after ACS was influenced by comorbid conditions including depression.

Methods: From 2001 to 2009 all first-time ACS patients were identified in the Danish National Patient Registry. This cohort of 83 062 ACS patients and a matched reference population were followed for incident depression and mortality until December 2012 by linkage to person, patients and prescription registries. Educational status was defined at study entry and the impact of potential confounders and mediators (age, gender, cohabitation status, somatic comorbidity and depression) on the relation between education and mortality were identified by drawing a directed acyclic graph and analysed using multiple Cox regression analyses.

Findings: During follow-up, 29 583(35.6%) of ACS patients and 19 105(22.9%) of the reference population died. Cox regression analyses showed an increased mortality in the lowest educated compared to those with high education in both ACS patients and the reference population. Adjustment for previous and incident depression or other covariables only attenuated the relations slightly. This pattern of associations was seen for mortality after 30 days, 1 year and during total follow-up.

Conclusion: In this study the relative excess mortality rate in lower educated ACS patients was comparable with the excess risk associated with low education in the background population. This educational inequality in survival remained after adjustment for somatic comorbidity and depression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141598PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4626047PMC
June 2016

Predictors of age at onset of tobacco and cannabis use in Danish adolescents.

Clin Respir J 2010 Jul;4(3):162-7

Department of Gastroenterology, Hvidovre Hospital, Copenhagen, Denmark.

Introduction: Early onset of tobacco and cannabis use predicts later substance abuse and risk behaviour and has large health consequences.

Objectives: The aim of this study was to examine risk factors for the age at onset of smoking and cannabis use among a group of Danish children between 7 years and 18 years of age.

Methods: Four hundred and eighty randomly selected children and their parents participated in a study about the prevalence of asthma. The study included questions about alcohol, tobacco and cannabis use. The children were interviewed face-to-face while the parents answered a questionnaire.

Results: The age at onset of daily smoking was significantly associated with the adolescents' tendency to binge drink [hazard ratio 4.78, 95% confidence interval (CI) (1.85-12.34), P = 0.001) and to use hard drugs [hazard ratio 2.81, 95% CI (1.03-7.78), P = 0.047], whereas the age at onset of cannabis use was significantly associated with binge drinking [hazard ratio 3.29, 95% CI (1.51-7.20), P = 0.003] and cigarette smoking [hazard ratio 2.51, 95% CI (1.26-5.00), P = 0.009]. There were no significant effect of the parents' smoking and alcohol habits, their socioeconomic or marital status on the adolescent' age at onset of smoking or cannabis.

Conclusion: This study shows a close connection between adolescent tobacco and cannabis use and alcohol habits. Knowledge of this is important when planning future prevention strategies.
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http://dx.doi.org/10.1111/j.1752-699X.2009.00169.xDOI Listing
July 2010

[Onset of alcohol consumption in 7-18-year-old children and adolescents].

Ugeskr Laeger 2009 Nov;171(46):3345-9

Bispebjerg Hospital, Lungemedicinsk Forskningsenhed, Denmark.

Introduction: Early onset of alcohol consumption contributes to increased risk of subsequent heavy alcohol use, alcohol dependence and alcohol-related problems. The objective of this study was to examine the onset of alcohol consumption in a group of Danish children.

Methods: The study was part of an asthma study and was based on face-to-face interviews with 480 randomly chosen children and adolescents between seven and 18 years of age. Questionnaires were sent to their parents. Onset of alcohol was defined as consumption of at least one unit of alcohol.

Results: Age at onset of alcohol consumption was 13.4 years for boys and 13.9 years for girls (p = 0.020). There was a significant association between age at onset and smoking of the adolescent (hazard ratio 2.19; 95% confidence interval (CI 1.16-4.12, p = 0.015) and maternal smoking during pregnancy (hazard ratio 2.23; 95% CI 1.31-3.78, p = 0.003). We found no association between early onset of alcohol consumption and parents' smoking, drinking, socioeconomic or marital status.

Conclusion: Further knowledge is needed to clarify the factors associated with early onset of alcohol consumption among Danish adolescents.
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November 2009