Published in 2021

BACKGROUND AND PURPOSE: Mortality following infections in dementia has not yet been comprehensively explored. The aim of this cohort study was to investigate the short- and long-term mortality following infections in dementia.

METHODS: Follow-up was from 1 January 2000 or the 65-year birthday until death, immigration, or 31 December 2015. Exposure was incident dementia and a first infection. The outcome was all-cause mortality. Mortality rate ratios (MRRs) were calculated using Poisson regression in 4 exposure groups (dementia yes/no, infection yes/no) by sex, infection site, and time since infection.

RESULTS: 1,496,436 people were followed with 12,739,135 person-years. MRR in dementia/infection was 6.52 (95% confidence interval: 6.43-6.60) and was increased for infections of all sites. Increased mortality was short term (30 days) and long term (10 years).

CONCLUSIONS: Increased mortality in people with dementia identifies them as a particularly vulnerable group that needs clinical attention.

Originalsprog Engelsk
Artikelnummer 2
Tidsskrift European Journal of Neurology
Vol/bind 28
Sider (fra-til) 411-420
ISSN 1351-5101
DOI
Status Udgivet - feb. 2021

Bibliografisk note

© 2020 European Academy of Neurology.

Inflammatory hallmarks of lesser prominence in psoriatic arthritis patients starting biologics: a Nordic population-based cohort study

Lund Hansen, R., Schoedt Jørgensen, T., Dreyer, L., Hetland, M. L., Glintborg, B., Askling, J., Di Giuseppe, D., Jacobsson, L. T. H., Wallman, J. K., Nordstrom, D., Aaltonen, K., Kristianslund, E. K., Kvien, T. K., Provan, S. A., Gudbjornsson, B., Love, T. J. & Kristensen, L. E., 1 jan. 2021, I: Rheumatology (Oxford, England). 60, 1, s. 140-146 7 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

OBJECTIVES: To assess secular trends in baseline characteristics of PsA patients initiating their first or subsequent biologic DMARD (bDMARD) therapy and to explore prescription patterns and treatment rates of bDMARDs from 2006 to 2017 in the Nordic countries.

METHODS: PsA patients registered in the Nordic rheumatology registries initiating any treatment with bDMARDs were identified. The bDMARDs were grouped as original TNF inhibitor [TNFi; adalimumab (ADA), etanercept (ETN) and infliximab (IFX)]; certolizumab pegol (CZP) and golimumab (GOL); biosimilars and ustekinumab, based on the date of release. Baseline characteristics were compared for the five countries, supplemented by secular trends with R2 calculations and point prevalence of bDMARD treatment.

RESULTS: A total of 18 089 patients were identified (Denmark, 4361; Iceland, 449; Norway, 1948; Finland, 1069; Sweden, 10 262). A total of 54% of the patients were female, 34.3% of patients initiated an original TNFi, 8% CZP and GOL, 7.5% biosimilars and 0.3% ustekinumab as a first-line bDMARD. Subsequent bDMARDs were 25.2% original TNFi, 9% CZP and GOL, 12% biosimilars and 2.1% ustekinumab. From 2015 through 2017 there was a rapid uptake of biosimilars. The total of first-line bDMARD initiators with lower disease activity increased from 2006 to 2017, where an R2 close to 1 showed a strong association.

CONCLUSION: Across the Nordic countries, the number of prescribed bDMARDs increased from 2006 to 2017, indicating a previously unmet need for bDMARDs in the PsA population. In recent years, PsA patients have initiated bDMARDs with lower disease activity compared with previous years, suggesting that bDMARDs are initiated in patients with a less active inflammatory phenotype.

Originalsprog Engelsk
Tidsskrift Rheumatology (Oxford, England)
Vol/bind 60
Udgave nummer 1
Sider (fra-til) 140-146
Antal sider 7
ISSN 1462-0324
DOI
Status Udgivet - 1 jan. 2021

Bibliografisk note

COPECARE

OBJECTIVE: The aim of this study is to investigate the influence of local anesthetic (LA), operator experience level and needle type on patient procedural pain in relation to diagnostic lumbar puncture (LP).

METHODS: LP was performed with either a 22 gauge traumatic needle (22 TN) or a 22 gauge atraumatic needle (22 ATN). Immediately after LP patients documented a procedural pain score (PPS) on a 10-point Likert scale. Use of LA, needle type, anesthetic time interval (ATI), number of needle insertions and the LP operator experience level were registered. ATI was defined as the time from administration of LA to first needle insertion.

RESULTS: 104 patients had the LP procedure performed by 66 physicians (40 novices and 26 experienced physicians). Patients having the procedure performed by novices had a lower PPS of 2.56 if LA was administered compared to a higher PPS of 5.80 if LA was not administered (P = .046). Among experienced physicians there was no difference in PPS regardless of administration of LA. If novices administered LA, patient PPS was equal to patients having the procedure performed by an experienced operator. If novices performed the procedure with a 22 TN PPS decreased with increasing ATI (P = .01). No similar correlation was identified with the 22 ATN.

CONCLUSION: Our study suggests that LP operator experience level, the needle type used and ATI may influence patient PPS. Further studies are necessary for final conclusions. These studies must consider these factors to avoid fault conclusions.

Originalsprog Engelsk
Tidsskrift International Journal of Emergency Medicine
ISSN 0735-6757
DOI
Status E-pub ahead of print - 2021

Bibliografisk note

Copyright © 2020 Elsevier Inc. All rights reserved.

Instruments Measuring Physical Function for Psoriatic Arthritis Endorsed at GRAPPA 2020 Annual Meeting: Updates of the GRAPPA-OMERACT Working Group

Leung, Y. Y., Orbai, A-M., Tillett, W., Ogdie, A., Eder, L., Goel, N., Hojgaard, P., Holland, R., Mathew, A. J., Lindsay, C. A., Antony, A., Chau, J., Christensen, R., Coates, L. C., Mease, P. J., Strand, V., FitzGerald, O., de Wit, M., Duffin, K. C. & Gladman, D. D., jun. 2021, I: The Journal of rheumatology. Supplement. 97, s. 60-63 4 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) Psoriatic Arthritis (PsA) Working Group provided updates at the 2020 GRAPPA annual meeting on its work toward developing a core outcome set for PsA. Working groups were set up for the 4 prioritized domains: enthesitis, fatigue, structural damage, and physical function. Two instruments for measurement of physical function were provisionally endorsed: (1) the Health Assessment Questionnaire-Disability Index and (2) the physical functioning domain in the Medical Outcomes Study 36-item Short Form survey.

Originalsprog Engelsk
Tidsskrift The Journal of rheumatology. Supplement
Vol/bind 97
Sider (fra-til) 60-63
Antal sider 4
ISSN 0380-0903
DOI
Status Udgivet - jun. 2021

Purpose: Intention and perceptions of healthy eating may affect diet-related behavior. We assessed the intention and perceptions of eating healthily in patients with type 1 (T1D) and type 2 diabetes (T2D) compared with the general population. Secondly, differences in diet quality were assessed in patients with diabetes perceiving their dietary habits as more or less healthy.

Materials and Methods: This cross-sectional study included data on socioeconomic status, dietary intake, and questions on healthy eating from adults with T1D (n=426), T2D (n=348) and from the general population (n=2899).

Results: Patients with T2D were less likely to perceive their dietary habits as healthy compared with T1D and the general population. Patients with T1D or T2D perceiving their dietary habits as healthy reported higher intake of vegetables, fruit, fish, fibre and protein. In addition, patients with T1D with perceived healthy versus less healthy dietary habits had lower sugar intake and higher alcohol intake. Overall, adherence to dietary guidelines in patients with T1D and T2D was too low both in self-perceived healthy and less healthy eaters. In comparison with T1D patients, patients with T2D were less likely and the general population was more likely to strive to eat a healthy diet.

Conclusion: Patients with T2D had poorer self-perception of their dietary healthiness and less intention of eating healthily, compared with patients with T1D and the general population. Actual diet quality was higher amongst patients with T1D and T2D perceiving their dietary habits as healthy than those perceiving their dietary habits as less healthy. But inadequate intakes were found in all groups. Health care providers should address and explore the patient's intention and perceptions of healthy eating when discussing dietary changes in diabetes to improve nutritional support.

Originalsprog Engelsk
Tidsskrift Patient Preference and Adherence
Vol/bind 15
Sider (fra-til) 2027-2037
Antal sider 11
ISSN 1177-889X
DOI
Status Udgivet - 2021

Bibliografisk note

© 2021 Ewers et al.

Intra-articular therapies: patient preferences and professional practices in European countries

de la Torre-Aboki, J., Uson, J., Pitsillidou, I., Vardanyan, V., Nikiphorou, E., Rodriguez-Garcia, S. C., Castellanos-Moreira, R., Pandit, H., O'Neill, T. W., Doherty, M., Boesen, M., Möller, I., Terslev, L., D'Agostino, M. A., Kampen, W. U., Berenbaum, F., Naredo, E. & Carmona, L., 11 nov. 2021, (E-pub ahead of print) I: Rheumatology International.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

To assess patient perspective and professional practice of intraarticular therapies (IATs) across Europe, an expert international multidisciplinary panel designed two open web-based surveys: one targeting people who had experienced at least two IATs (44 items); and one targeting health care providers (HCPs) (160 items). Surveys were disseminated via patient and professional associations and social media. A descriptive analysis was performed. The surveys were answered by 200 patients and 186 HCPs from 26 countries, showing that IAT is routinely performed by rheumatologists (97%) and orthopaedic surgeons (89%), with specific training being compulsory in a few countries. The most frequent indications for IAT are arthritis (76%), osteoarthritis (74%), crystal arthritis (71%) and bursitis (70%); the most frequently injected joints are knee (78%) and shoulder (70%); and the most used compounds are glucocorticoids. The majority of HCPs report informing patients about side-effects (73%), benefits (72%), and the nature of the procedure (72%), which coincides with 27% of patients reporting that they had not been informed about benefits or potential complications of IATs; 73% of patients had not been asked whether they wanted an anaesthetic. Few HCPs (10%) obtain written consent (56% get oral consent, being mandatory for 32%), a procedure deemed necessary by 41% of the patients. 50% of patients reported a clear benefit of IAT and 20% experienced complications including pain, impaired mobility, rashes, or swelling. In summary, the practice of IAT is variable across Europe, and although patients perceive it as relatively safe and usually effective procedure, some gaps were identified.

Originalsprog Engelsk
Tidsskrift Rheumatology International
ISSN 0172-8172
DOI
Status E-pub ahead of print - 11 nov. 2021

Bibliografisk note

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Knee replacement outcome predicted by physiotherapists: a prospective cohort study

Henriksen, M., Mukriyani, H. & Juhl, C., 23 feb. 2021, I: PeerJ. 9, s. e10838 e10838.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Background: Knee arthroplasty (KA) is commonly used for osteoarthritis of the knee joint and it is a highly successful procedure. Still, KA leaves 20% of patients dissatisfied with their outcome. The purpose of this study was to determine if a prognosis made by physiotherapists at the orthopaedic wards during the first post-operative days could predict the 6- and 12-months outcome of KA.

Methods: Physiotherapists at two orthopaedic wards in Denmark were asked to predict the 6- and 12-months outcome of the KA patients they have treated post-operatively on a 0-10 scale (10 representing the best prognosis). At 6 and 12 months post-operatively the patients answered the Oxford Knee Score (OKS), EuroQol 5D-3L and Patient Acceptable Symptom State (PASS). Multivariable logistic regression analyses were performed to assess the prediction of PASS and treatment success. We assessed predictive performance by examining measures of calibration and discrimination.

Results: A total of 361 patients were included. The models for PASS and Treatment Success showed poor to acceptable discriminative values (OR between 1.47 and 1.92 and areas under the curves of 0.62-0.73), however the calibration plots indicated significant uncertainties in the prediction.

Conclusion: Physiotherapists prognoses of recovery after KA are associated with 6- and 12-months patient reported outcomes and satisfaction but have weak predictive value. This study suggests that physiotherapists' prognoses may be useful as an additional source of information when identifying patients in need of additional post-operative care.

Originalsprog Engelsk
Artikelnummer e10838
Tidsskrift PeerJ
Vol/bind 9
Sider (fra-til) e10838
ISSN 2167-8359
DOI
Status Udgivet - 23 feb. 2021

Laminar airflow versus turbulent airflow in simulated total hip arthroplasty: measurements of colony-forming units, particles, and energy consumption

Marsault, L. V., Ravn, C., Overgaard, A., Frich, L. H., Olsen, M., Anstensrud, T., Nielsen, J. & Overgaard, S., sep. 2021, I: The Journal of hospital infection. 115, s. 117-123 7 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: The optimal type of ventilation in operating theatres for joint arthroplasty has been debated for decades. Recently, the World Health Organization changed its recommendations based on articles that have since been criticized. The economic and environmental impact of ventilation is also currently an important research topic but has not been well investigated.

AIM: To compare how large, high-volume, laminar airflow (LAF) and turbulent airflow (TAF) ventilation systems perform during standardized simulated total hip arthroplasty (THA), as they pertain to colony-forming units (cfu), particle counts, and energy consumption.

METHODS: Two identical operating theatres were used to perform simulated THA. The only difference was that one was equipped with LAF and the other with TAF. Cfu and particles were collected from key points in the operating theatre, and energy was measured for each simulation. Thirty-two simulations were done in total.

FINDINGS: LAF had significantly reduced cfu and particle count when compared with TAF, at both 100% and 50% air influx. Furthermore, it was shown that lowering the air influx by 50% in LAF did not significantly affect cfu or particles, although reducing the fresh air influx from 100% to 50% significantly lowered the energy consumption. Most simulations in TAF did not meet the cleanroom requirements.

CONCLUSION: Cfu were significantly lower in LAF at both 100% and 50% air influx. It is possible to reduce fresh air influx in LAF operating theatres by 50%, significantly reducing energy consumption, while still maintaining cfu and particle counts below the ISO classification threshold required for THA surgery.

Originalsprog Engelsk
Tidsskrift The Journal of hospital infection
Vol/bind 115
Sider (fra-til) 117-123
Antal sider 7
ISSN 0195-6701
DOI
Status Udgivet - sep. 2021

Less improvement following meniscal repair compared with arthroscopic partial meniscectomy: a prospective cohort study of patient-reported outcomes in 150 young adults at 1- and 5-years' follow-up

Pihl, K., Englund, M., Christensen, R., Lohmander, L. S., Jørgensen, U., Viberg, B., Fristed, J. V. & Thorlund, J. B., okt. 2021, I: Acta Orthopaedica . 92, 5, s. 589-596 8 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Background and purpose - Meniscal repair may reduce long-term risk of knee osteoarthritis compared with arthroscopic partial meniscectomy (APM), whereas patient-reported outcomes may be poorer at short term than for APM. We compared patient-reported outcomes in young adults undergoing meniscal repair or APM up to ∼5 years after surgery.Patients and methods - We included 150 patients aged 18-40 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing meniscal repair or APM. Between-group differences in change in a composite of 4 of 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, sport and recreation, and quality of life-KOOS4) from baseline, 12, and 52 weeks, and a median of 5 years (range 4-6 years) were analyzed using adjusted mixed linear models, with 52 weeks being the primary endpoint.Results - 32 patients had meniscal repair (mean age 26 [SD 6]), and 118 patients underwent APM (mean age 32 [SD 7]). The repair and APM groups improved in KOOS4 from before to 52 weeks after surgery (least square means 7 and 19, respectively; adjusted mean difference -12, [95% CI -19 to -4] in favor of APM). Both groups improved further from 52 weeks to 5 years after surgery with the difference in KOOS4 scores between the groups remaining similar.Interpretation - Patients having meniscal repair experienced less improvements in patient-reported outcomes from baseline to 52 weeks and 5 years post-surgery. The findings highlight the need for randomized trials comparing these interventions in terms of patient-reported outcomes and knee OA development.

Originalsprog Engelsk
Tidsskrift Acta Orthopaedica
Vol/bind 92
Udgave nummer 5
Sider (fra-til) 589-596
Antal sider 8
ISSN 1745-3674
DOI
Status Udgivet - okt. 2021

BACKGROUND: Weight loss is critical for preventing and managing obesity-related diseases. There is a notable lack of valid and reliable means to manage patients with overweight/obesity and knee osteoarthritis (KOA).

OBJECTIVE: To determine the efficacy and safety of liraglutide in a 30 mg/d dosing in patients with overweight/obesity and KOA.

METHODS: The trial was designed as a randomized controlled trial including patients between the age of 18 and 74 y with KOA and a BMI ≥27 (measured in kg/m2).Patients underwent a pre-random assignment diet intervention (week -8 to 0). At week 0, patients having lost >5% of their body weight were randomly assigned to liraglutide 3 mg/d or placebo for 52 wk. The coprimary outcomes were changes in body weight and the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale from week 0 to 52.

RESULTS: In total, 168 patients enrolled and 156 were randomly assigned to receive liraglutide or placebo. Patients experienced a significant reduction in body weight and KOOS pain during the pre-random assignment dietary intervention period (week -8 to 0). From week 0 to 52 there was a significant difference in body weight between the liraglutide and placebo group (mean changes: -2.8 and +1.2 kg, respectively; group difference, 3.9 kg; 95% CI: -6.9, -1.0; P = 0.008). There was, however, no group difference in KOOS pain (mean changes: 0.4 and -0.6 points, respectively; group difference, 0.9 points; 95% CI: -3.9, 5.7; P = 0.71). Treatment-emergent adverse events related to the gastrointestinal system were experienced by 50.2% and 39.2% of patients in the liraglutide and placebo groups, respectively.

CONCLUSIONS: In patients with KOA and overweight/obesity liraglutide added after an 8-wk pre-random assignment diet induced a significant weight loss at >52 wk but did not reduce knee pain compared to placebo. This trial was registered at clinicaltrials.gov as NCT02905864.

Originalsprog Engelsk
Tidsskrift The American journal of clinical nutrition
Vol/bind 113
Udgave nummer 2
Sider (fra-til) 314-323
Antal sider 10
ISSN 0002-9165
DOI
Status Udgivet - feb. 2021

Bibliografisk note

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Long-term air pollution and road traffic noise exposure and COPD: the Danish Nurse Cohort

Liu, S., Pedersen, M., Jørgensen, J., Amini, H., Cole-Hunter, T., Mehta, A., So, R., Mortensen, L., Westendorp, R., Loft, S., Bräuner, E., Ketzel, M., Hertel, O., Brandt, J., Jensen, S., Christensen, J., Sigsgaard, T., Geels, C., Frohn, L., Brboric, M., Radonic, J., Sekulic, M., Bønnelykke, K., Backalarz, C., Simonsen, M. K. & Andersen, Z., dec. 2021, I: European Respiratory Journal. 58, 6, 2004594.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: While air pollution has been linked to the development of chronic obstructive pulmonary disease (COPD), evidence on the role of environmental noise is just emerging. We examined the associations of long-term exposure to air pollution and road traffic noise with COPD incidence.

METHODS: We defined COPD incidence for 24 538 female nurses from the Danish Nurse Cohort (age >44 years) as the first hospital contact between baseline (1993 or 1999) and 2015. We estimated residential annual mean concentrations of particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) since 1990 and nitrogen dioxide (NO2) since 1970 using the Danish Eulerian Hemispheric Model/Urban Background Model/Air Geographic Information System modelling system, and road traffic noise (Lden) since 1970 using the Nord2000 model. Time-varying Cox regression models were applied to assess the associations of air pollution and road traffic noise with COPD incidence.

RESULTS: 977 nurses developed COPD during a mean of 18.6 years' follow-up. We observed associations with COPD for all three exposures with HRs and 95% CIs of 1.19 (1.01-1.41) per 6.26 µg·m-3 for PM2.5, 1.13 (1.05-1.20) per 8.19 µg·m-3 for NO2 and 1.15 (1.06-1.25) per 10 dB for Lden. Associations with NO2 and Lden attenuated slightly after mutual adjustment, but were robust to adjustment for PM2.5. Associations with PM2.5 were attenuated to null after adjustment for either NO2 or Lden. No potential interaction effect was observed between air pollutants and noise.

CONCLUSION: Long-term exposure to air pollution, especially traffic-related NO2, and to road traffic noise were independently associated with COPD.

Originalsprog Engelsk
Artikelnummer 2004594
Tidsskrift European Respiratory Journal
Vol/bind 58
Udgave nummer 6
ISSN 0903-1936
DOI
Status Udgivet - dec. 2021

Long-term exposure to air pollution and liver cancer incidence in six European cohorts

So, R., Chen, J., Mehta, A. J., Liu, S., Strak, M., Wolf, K., Hvidtfeldt, U. A., Rodopoulou, S., Stafoggia, M., Klompmaker, J. O., Samoli, E., Raaschou-Nielsen, O., Atkinson, R., Bauwelinck, M., Bellander, T., Boutron-Ruault, M-C., Brandt, J., Brunekreef, B., Cesaroni, G., Concin, H., Forastiere, F., van Gils, C. H., Gulliver, J., Hertel, O., Hoffmann, B., de Hoogh, K., Janssen, N., Lim, Y-H., Westendorp, R., Jørgensen, J. T., Katsouyanni, K., Ketzel, M., Lager, A., Lang, A., Ljungman, P. L., Magnusson, P. K. E., Nagel, G., Simonsen, M. K., Pershagen, G., Peter, R. S., Peters, A., Renzi, M., Rizzuto, D., Sigsgaard, T., Vienneau, D., Weinmayr, G., Severi, G., Fecht, D., Tjønneland, A., Leander, K., Hoek, G. & Andersen, Z. J., 1 dec. 2021, I: International Journal of Cancer. 149, 11, s. 1887-1897 11 s.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Particulate matter air pollution and diesel engine exhaust have been classified as carcinogenic for lung cancer, yet few studies have explored associations with liver cancer. We used six European adult cohorts which were recruited between 1985 and 2005, pooled within the "Effects of low-level air pollution: A study in Europe" (ELAPSE) project, and followed for the incidence of liver cancer until 2011 to 2015. The annual average exposure to nitrogen dioxide (NO2 ), particulate matter with diameter <2.5 μm (PM2.5 ), black carbon (BC), warm-season ozone (O3 ), and eight elemental components of PM2.5 (copper, iron, zinc, sulfur, nickel, vanadium, silicon, and potassium) were estimated by European-wide hybrid land-use regression models at participants' residential addresses. We analyzed the association between air pollution and liver cancer incidence by Cox proportional hazards models adjusting for potential confounders. Of 330 064 cancer-free adults at baseline, 512 developed liver cancer during a mean follow-up of 18.1 years. We observed positive linear associations between NO2 (hazard ratio, 95% confidence interval: 1.17, 1.02-1.35 per 10 μg/m3 ), PM2.5 (1.12, 0.92-1.36 per 5 μg/m3 ), and BC (1.15, 1.00-1.33 per 0.5 10-5 /m) and liver cancer incidence. Associations with NO2 and BC persisted in two-pollutant models with PM2.5 . Most components of PM2.5 were associated with the risk of liver cancer, with the strongest associations for sulfur and vanadium, which were robust to adjustment for PM2.5 or NO2 . Our study suggests that ambient air pollution may increase the risk of liver cancer, even at concentrations below current EU standards.

Originalsprog Engelsk
Tidsskrift International Journal of Cancer
Vol/bind 149
Udgave nummer 11
Sider (fra-til) 1887-1897
Antal sider 11
ISSN 0020-7136
DOI
Status Udgivet - 1 dec. 2021

Bibliografisk note

© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

Long-Term Exposure to Air Pollution, Road Traffic Noise, and Heart Failure Incidence: The Danish Nurse Cohort

Lim, Y-H., Jørgensen, J. T., So, R., Cole-Hunter, T., Mehta, A. J., Amini, H., Bräuner, E. V., Westendorp, R. G. J., Liu, S., Mortensen, L. H., Hoffmann, B., Loft, S., Ketzel, M., Hertel, O., Brandt, J., Jensen, S. S., Backalarz, C., Simonsen, M. K., Tasic, N., Maric, M. & Andersen, Z. J., 19 okt. 2021, I: Journal of the American Heart Association. 10, 20, s. e021436 e021436.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Background We examined the association of long-term exposure to air pollution and road traffic noise with incident heart failure (HF). Methods And Results Using data on female nurses from the Danish Nurse Cohort (aged >44 years), we investigated associations between 3-year mean exposures to air pollution and road traffic noise and incident HF using Cox regression models, adjusting for relevant confounders. Incidence of HF was defined as the first hospital contact (inpatient, outpatient, or emergency) between cohort baseline (1993 or 1999) and December 31, 2014, based on the Danish National Patient Register. Annual mean levels of particulate matter with a diameter <2.5 µm since 1990 and NO2 and road traffic noise since 1970 were estimated at participants' residences. Of the 22 189 nurses, 484 developed HF. We detected associations with all 3 pollutants, with hazard ratios (HRs) of 1.17 (95% CI, 1.01-1.36), 1.10 (95% CI, 0.99-1.22), and 1.12 (95% CI, 0.99-1.26) per increase of 5.1 µg/m3 in particulate matter with a diameter <2.5 µm, 8.6 µg/m3 in NO2, and 9.3 dB in road traffic noise, respectively. We observed an enhanced risk of HF incidence for those exposed to high levels of the 3 pollutants; however, the effect modification of coexposure was not statistically significant. Former smokers and nurses with hypertension showed the strongest associations with particulate matter with a diameter <2.5 µm (Peffect modification<0.05). Conclusions We found that long-term exposures to air pollution and road traffic noise were independently associated with HF.

Originalsprog Engelsk
Artikelnummer e021436
Tidsskrift Journal of the American Heart Association
Vol/bind 10
Udgave nummer 20
Sider (fra-til) e021436
ISSN 2047-9980
DOI
Status Udgivet - 19 okt. 2021

Long-term exposure to ambient air pollution and road traffic noise and asthma incidence in adults: The Danish Nurse cohort

Liu, S., Lim, Y. H., Pedersen, M., Jørgensen, J. T., Amini, H., Cole-Hunter, T., Mehta, A. J., So, R., Mortensen, L. H., Westendorp, R. G. J., Loft, S., Bräuner, E. V., Ketzel, M., Hertel, O., Brandt, J., Jensen, S. S., Christensen, J. H., Sigsgaard, T., Geels, C., Frohn, L. M., Brborić, M., Radonić, J., Sekulic, M. T., Bønnelykke, K., Backalarz, C., Simonsen, M. K. & Andersen, Z. J., 1 jul. 2021, I: Environment International. 152, s. 106464 106464.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Ambient air pollution is likely a risk factor for asthma, and recent evidence suggests the possible relevance of road traffic noise.

OBJECTIVES: We examined the associations of long-term exposure to air pollution and road traffic noise with adult-asthma incidence.

METHODS: We followed 28,731 female nurses (age > 44 years) from the Danish Nurse Cohort, recruited in 1993 and 1999, for first hospital contact for asthma from 1977 until 2015. We estimated residential annual mean concentrations of particulate matter with diameter < 2.5 µm (PM
2.5) since 1990 and nitrogen dioxide (NO
2) since 1970 with the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (L
den) since 1970 with the Nord2000 model. Time-varying Cox regression models were used to associate air pollution and road traffic noise exposure with asthma incidence.

RESULTS: During 18.6 years' mean follow-up, 528 out of 23,093 participants had hospital contact for asthma. The hazard ratios (HR) and 95% confidence intervals for asthma incidence associated with 3-year moving average exposures were 1.29 (1.03, 1.61) per 6.3 µg/m
3 for PM
2.5, 1.16 (1.07, 1.27) per 8.2 µg/m
3 for NO
2, and 1.12 (1.00, 1.25) per 10 dB for L
den. The HR for NO
2 remained unchanged after adjustment for either PM
2.5 or L
den, while the HRs for PM
2.5 and L
den attenuated to unity after adjustment for NO
2.

CONCLUSIONS: Long-term exposure to air pollution was associated with adult-asthma incidence independently of road traffic noise, with NO
2 most relevant. Road traffic noise was not independently associated with adult-asthma incidence.

Originalsprog Engelsk
Artikelnummer 106464
Tidsskrift Environment International
Vol/bind 152
Sider (fra-til) 106464
ISSN 0160-4120
DOI
Status Udgivet - 1 jul. 2021

Long-term exposure to ambient air pollution and road traffic noise and asthma incidence in adults: The Danish Nurse cohort: The Danish Nurse cohort

Liu, S., Lim, Y-H., Pedersen, M., Jørgensen, J. T., Amini, H., Cole-Hunter, T., Mehta, A. J., So, R., Mortensen, L. H., Westendorp, R. G. J., Loft, S., Bräuner, E. V., Ketzel, M., Hertel, O., Brandt, J., Jensen, S. S., Christensen, J. H., Sigsgaard, T., Geels, C., Frohn, L. M., Brborić, M., Radonić, J., Sekulic, M. T., Bønnelykke, K., Backalarz, C., Simonsen, M. K. & Andersen, Z. J., 1 jul. 2021, I: Environment International. 152, s. 106464 106464.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Ambient air pollution is likely a risk factor for asthma, and recent evidence suggests the possible relevance of road traffic noise.

OBJECTIVES: We examined the associations of long-term exposure to air pollution and road traffic noise with adult-asthma incidence.

METHODS: We followed 28,731 female nurses (age > 44 years) from the Danish Nurse Cohort, recruited in 1993 and 1999, for first hospital contact for asthma from 1977 until 2015. We estimated residential annual mean concentrations of particulate matter with diameter < 2.5 µm (PM
2.5) since 1990 and nitrogen dioxide (NO
2) since 1970 with the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (L
den) since 1970 with the Nord2000 model. Time-varying Cox regression models were used to associate air pollution and road traffic noise exposure with asthma incidence.

RESULTS: During 18.6 years' mean follow-up, 528 out of 23,093 participants had hospital contact for asthma. The hazard ratios (HR) and 95% confidence intervals for asthma incidence associated with 3-year moving average exposures were 1.29 (1.03, 1.61) per 6.3 µg/m
3 for PM
2.5, 1.16 (1.07, 1.27) per 8.2 µg/m
3 for NO
2, and 1.12 (1.00, 1.25) per 10 dB for L
den. The HR for NO
2 remained unchanged after adjustment for either PM
2.5 or L
den, while the HRs for PM
2.5 and L
den attenuated to unity after adjustment for NO
2.

CONCLUSIONS: Long-term exposure to air pollution was associated with adult-asthma incidence independently of road traffic noise, with NO
2 most relevant. Road traffic noise was not independently associated with adult-asthma incidence.

Originalsprog Engelsk
Artikelnummer 106464
Tidsskrift Environment International
Vol/bind 152
Sider (fra-til) 106464
ISSN 0160-4120
DOI
Status Udgivet - 1 jul. 2021

Bibliografisk note

Copyright © 2021. Published by Elsevier Ltd.

Long-Term Exposure to Road Traffic Noise and Air Pollution, and Incident Atrial Fibrillation in the Danish Nurse Cohort

Andersen, Z. J., Cramer, J., Jørgensen, J. T., Dehlendorff, C., Amini, H., Mehta, A., Cole-Hunter, T., Mortensen, L. H., Westendorp, R., So, R., Li, S., Hoffmann, B., Loft, S., Bräuner, E. V., Ketzel, M., Hertel, O., Brandt, J., Jensen, S. S., Christensen, J. H., Geels, C., Frohn, L. M., Backalarz, C., Simonsen, M. K. & Lim, Y-H., aug. 2021, I: Environmental Health Perspectives. 129, 8, s. 87002 087002.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Associations between long-term exposure to air pollution and road traffic noise have been established for ischemic heart disease, but findings have been mixed for atrial fibrillation (AF).

OBJECTIVES: The goal of the study was to examine associations of long-term exposure to road traffic noise and air pollution with AF.

METHODS: Time-varying Cox regression models were used to estimate associations of 1-, 3-, and 23-y mean road traffic noise and air pollution exposures with AF incidence in 23,528 women enrolled in the Danish Nurse Cohort (age >44y at baseline in 1993 or 1999). AF diagnoses were ascertained via the Danish National Patient Register. Annual mean weighted 24-h average road traffic noise levels (Lden) at the nurses' residences, since 1970, were estimated using the Nord2000 model, and annual mean levels of particulate matter with a diameter <2.5μm (PM2.5) and nitrogen dioxide (NO2) were estimated using the DEHM/UBM/AirGIS model.

RESULTS: Of 23,528 nurses with no prior AF diagnosis at the cohort baseline, 1,522 developed AF during follow-up. In a fully adjusted model (including PM2.5), the estimated risk of AF was 18% higher [hazard ratio (HR); 95% confidence interval (CI): 1.18; 1.02, 1.36] in nurses with residential 3-y mean Lden levels >58 dB vs. <48 dB, with similar findings for 1-y mean exposures. A 3.9-μg/m3 increase in 3-y mean PM2.5 was associated with incident AF before and after adjustment for concurrent exposure to road traffic noise (HR 1.09; 95% CI: 1.00, 1.20 and 1.08; 95% CI: 0.97, 1.19, respectively). Associations with 1-y mean PM2.5 exposures were positive but closer to the null and not significant. Associations with NO2 were null for all time periods before and after adjustment for road traffic noise and inverse when adjusted for concurrent PM2.5.

CONCLUSION: Our analysis of prospective data from a cohort of Danish female nurses followed for up to 14 y provided suggestive evidence of independent associations between incident AF and 1- and 3-y exposures to road traffic noise and PM2.5. https://doi.org/10.1289/EHP8090.

Originalsprog Engelsk
Artikelnummer 087002
Tidsskrift Environmental Health Perspectives
Vol/bind 129
Udgave nummer 8
Sider (fra-til) 87002
ISSN 0091-6765
DOI
Status Udgivet - aug. 2021

Long-term exposure to road traffic noise and stroke incidence: a Danish Nurse Cohort study

Cole-Hunter, T., Dehlendorff, C., Amini, H., Mehta, A., Lim, Y-H., Jørgensen, J. T., Li, S., So, R., Mortensen, L. H., Westendorp, R., Hoffmann, B., Bräuner, E. V., Ketzel, M., Hertel, O., Brandt, J., Jensen, S. S., Christensen, J. H., Geels, C., Frohn, L. M., Backalarz, C., Simonsen, M. K., Loft, S. & Andersen, Z. J., 6 nov. 2021, I: Environmental Health: A Global Access Science Source. 20, 1, s. 115 115.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Road traffic noise has been linked to increased risk of ischemic heart disease, yet evidence on stroke shows mixed results. We examine the association between long-term exposure to road traffic noise and incidence of stroke, overall and by subtype (ischemic or hemorrhagic), after adjustment for air pollution.

METHODS: Twenty-five thousand six hundred and sixty female nurses from the Danish Nurse Cohort recruited in 1993 or 1999 were followed for stroke-related first-ever hospital contact until December 31st, 2014. Full residential address histories since 1970 were obtained and annual means of road traffic noise (Lden [dB]) and air pollutants (particulate matter with diameter < 2.5 μm and < 10 μm [PM2.5 and PM10], nitrogen dioxide [NO2], nitrogen oxides [NOx]) were determined using validated models. Time-varying Cox regression models were used to estimate hazard ratios (HR) (95% confidence intervals [CI]) for the associations of one-, three-, and 23-year running means of Lden preceding stroke (all, ischemic or hemorrhagic), adjusting for stroke risk factors and air pollutants. The World Health Organization and the Danish government's maximum exposure recommendations of 53 and 58 dB, respectively, were explored as potential Lden thresholds.

RESULTS: Of 25,660 nurses, 1237 developed their first stroke (1089 ischemic, 148 hemorrhagic) during 16 years mean follow-up. For associations between a 1-year mean of Lden and overall stroke incidence, the estimated HR (95% CI) in the fully adjusted model was 1.06 (0.98-1.14) per 10 dB, which attenuated to 1.01 (0.93-1.09) and 1.00 (0.91-1.09) in models further adjusted for PM2.5 or NO2, respectively. Associations for other exposure periods or separately for ischemic or hemorrhagic stroke were similar. There was no evidence of a threshold association between Lden and stroke.

CONCLUSIONS: Long-term exposure to road traffic noise was suggestively positively associated with the risk of overall stroke, although not after adjusting for air pollution.

Originalsprog Engelsk
Artikelnummer 115
Tidsskrift Environmental Health: A Global Access Science Source
Vol/bind 20
Udgave nummer 1
Sider (fra-til) 115
ISSN 1476-069X
DOI
Status Udgivet - 6 nov. 2021

Bibliografisk note

© 2021. The Author(s).

Long-Term Exposure to Transportation Noise and Risk of Incident Stroke: A Pooled Study of Nine Scandinavian Cohorts

Roswall, N., Pyko, A., Ögren, M., Oudin, A., Rosengren, A., Lager, A., Poulsen, A. H., Eriksson, C., Segersson, D., Rizzuto, D., Andersson, E. M., Aasvang, G. M., Engström, G., Jørgensen, J. T., Selander, J., Christensen, J. H., Thacher, J., Leander, K., Overvad, K., Eneroth, K., Mattisson, K., Barregård, L., Stockfelt, L., Albin, M., Ketzel, M., Simonsen, M. K., Spanne, M., Raaschou-Nielsen, O., Magnusson, P. K. E., Tiittanen, P., Molnar, P., Ljungman, P., Lanki, T., Lim, Y-H., Andersen, Z. J., Pershagen, G. & Sørensen, M., okt. 2021, I: Environmental Health Perspectives. 129, 10, s. 107002 107002.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND: Transportation noise is increasingly acknowledged as a cardiovascular risk factor, but the evidence base for an association with stroke is sparse.

OBJECTIVE: We aimed to investigate the association between transportation noise and stroke incidence in a large Scandinavian population.

METHODS: We harmonized and pooled data from nine Scandinavian cohorts (seven Swedish, two Danish), totaling 135,951 participants. We identified residential address history and estimated road, railway, and aircraft noise for all addresses. Information on stroke incidence was acquired through linkage to national patient and mortality registries. We analyzed data using Cox proportional hazards models, including socioeconomic and lifestyle confounders, and air pollution.

RESULTS: During follow-up (median=19.5y), 11,056 stroke cases were identified. Road traffic noise (Lden) was associated with risk of stroke, with a hazard ratio (HR) of 1.06 [95% confidence interval (CI): 1.03, 1.08] per 10-dB higher 5-y mean time-weighted exposure in analyses adjusted for individual- and area-level socioeconomic covariates. The association was approximately linear and persisted after adjustment for air pollution [particulate matter (PM) with an aerodynamic diameter of ≤2.5μm (PM2.5) and NO2]. Stroke was associated with moderate levels of 5-y aircraft noise exposure (40-50 vs. ≤40 dB) (HR=1.12; 95% CI: 0.99, 1.27), but not with higher exposure (≥50 dB, HR=0.94; 95% CI: 0.79, 1.11). Railway noise was not associated with stroke.

DISCUSSION: In this pooled study, road traffic noise was associated with a higher risk of stroke. This finding supports road traffic noise as an important cardiovascular risk factor that should be included when estimating the burden of disease due to traffic noise. https://doi.org/10.1289/EHP8949.

Originalsprog Engelsk
Artikelnummer 107002
Tidsskrift Environmental Health Perspectives
Vol/bind 129
Udgave nummer 10
Sider (fra-til) 107002
ISSN 0091-6765
DOI
Status Udgivet - okt. 2021

Long-term low-level ambient air pollution exposure and risk of lung cancer - A pooled analysis of 7 European cohorts

Hvidtfeldt, U. A., Severi, G., Andersen, Z. J., Atkinson, R., Bauwelinck, M., Bellander, T., Boutron-Ruault, M-C., Brandt, J., Brunekreef, B., Cesaroni, G., Chen, J., Concin, H., Forastiere, F., van Gils, C. H., Gulliver, J., Hertel, O., Hoek, G., Hoffmann, B., de Hoogh, K., Janssen, N., Jöckel, K-H., Jørgensen, J. T., Katsouyanni, K., Ketzel, M., Klompmaker, J. O., Krog, N. H., Lang, A., Leander, K., Liu, S., Ljungman, P. L. S., Magnusson, P. K. E., Mehta, A. J., Nagel, G., Oftedal, B., Pershagen, G., Peter, R. S., Peters, A., Renzi, M., Rizzuto, D., Rodopoulou, S., Samoli, E., Schwarze, P. E., Sigsgaard, T., Simonsen, M. K., Stafoggia, M., Strak, M., Vienneau, D., Weinmayr, G., Wolf, K., Raaschou-Nielsen, O. & Fecht, D., jan. 2021, I: Environment International. 146, s. 106249 106249.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

BACKGROUND/AIM: Ambient air pollution has been associated with lung cancer, but the shape of the exposure-response function - especially at low exposure levels - is not well described. The aim of this study was to address the relationship between long-term low-level air pollution exposure and lung cancer incidence.

METHODS: The "Effects of Low-level Air Pollution: a Study in Europe" (ELAPSE) collaboration pools seven cohorts from across Europe. We developed hybrid models combining air pollution monitoring, land use data, satellite observations, and dispersion model estimates for nitrogen dioxide (NO2), fine particulate matter (PM2.5), black carbon (BC), and ozone (O3) to assign exposure to cohort participants' residential addresses in 100 m by 100 m grids. We applied stratified Cox proportional hazards models, adjusting for potential confounders (age, sex, calendar year, marital status, smoking, body mass index, employment status, and neighborhood-level socio-economic status). We fitted linear models, linear models in subsets, Shape-Constrained Health Impact Functions (SCHIF), and natural cubic spline models to assess the shape of the association between air pollution and lung cancer at concentrations below existing standards and guidelines.

RESULTS: The analyses included 307,550 cohort participants. During a mean follow-up of 18.1 years, 3956 incident lung cancer cases occurred. Median (Q1, Q3) annual (2010) exposure levels of NO2, PM2.5, BC and O3 (warm season) were 24.2 µg/m3 (19.5, 29.7), 15.4 µg/m3 (12.8, 17.3), 1.6 10-5m-1 (1.3, 1.8), and 86.6 µg/m3 (78.5, 92.9), respectively. We observed a higher risk for lung cancer with higher exposure to PM2.5 (HR: 1.13, 95% CI: 1.05, 1.23 per 5 µg/m3). This association was robust to adjustment for other pollutants. The SCHIF, spline and subset analyses suggested a linear or supra-linear association with no evidence of a threshold. In subset analyses, risk estimates were clearly elevated for the subset of subjects with exposure below the EU limit value of 25 µg/m3. We did not observe associations between NO2, BC or O3 and lung cancer incidence.

CONCLUSIONS: Long-term ambient PM2.5 exposure is associated with lung cancer incidence even at concentrations below current EU limit values and possibly WHO Air Quality Guidelines.

Originalsprog Engelsk
Artikelnummer 106249
Tidsskrift Environment International
Vol/bind 146
Sider (fra-til) 106249
ISSN 0160-4120
DOI
Status Udgivet - jan. 2021

Longitudinal association of nighttime sleep duration with emotional and behavioral problems in early childhood: results from the Danish Healthy Start Study

Zheng, M., Rangan, A., Olsen, N. J. & Heitmann, B. L., 1 jan. 2021, I: Sleep. 44, 1, zsaa138.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

STUDY OBJECTIVES: To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among preschool children.

METHODS: Data of children aged 2 to 6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores.

RESULTS: With adjustment for child, family factors, and parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (p = 0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β = -1.28, p = 0.02) compared with those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations.

CONCLUSIONS: Among preschool children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood.Clinical trials: The Healthy Start Study: https://clinicaltrials.gov/ct2/show/NCT01583335Trial registration: ID NCT01583335.

Originalsprog Engelsk
Artikelnummer zsaa138
Tidsskrift Sleep
Vol/bind 44
Udgave nummer 1
ISSN 1550-9109
DOI
Status Udgivet - 1 jan. 2021

Pages