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Background & Aims: Childhood-onset inflammatory bowel disease (IBD) is believed to be a more severe disease than adult-onset IBD, but there is little information on all-cause and cause-specific mortality in patients with childhood-onset IBD. We performed a population-based cohort study, with 50 years of follow-up, to estimate absolute and relative risks for overall and cause-specific mortality in patients with childhood-onset IBD, during childhood and adulthood., Methods: We identified children with a diagnosis of IBD (younger than 18 years) in the Swedish nationwide health registers (1964-2014; n = 9442) and individuals from the general population matched for sex, age, calendar year, and place of residence (reference group; n = 93,180). Hazard ratios (HR) for death were estimated using Cox regression separately in patients with ulcerative colitis (n = 4671), Crohn's disease (n = 3780), and IBD unclassified (n = 991). HRs were compared among calendar periods., Results: During 138,690 person-years of follow-up, 294 deaths (2.1/1000 person-years) occurred among the patients with IBD compared with 940 deaths in the reference group (0.7/1000 person-years; adjusted HR, 3.2; 95% confidence interval [CI] 2.8-3.7). Mean age at end of follow-up was 30 years. HRs were increased for patients with ulcerative colitis 4.0, 95% CI 3.4-4.7; Crohn's disease 2.3, 95% CI 1.8-3.0; and IBD unclassified 2.0, 95% CI 1.2-3.4. Among patients younger than 18 years, there were 27 deaths from IBD 4.9, 95% CI 3.0-7.7. Among young adults with IBD, we found no evidence that HRs for death decreased from 1964 through 2014 (P = .90)., Conclusions: Children with IBD have a 3-fold increase in risk of death when followed through adulthood. The relative risk for death has not decreased with development of new drugs for treatment of IBD., (Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: Smoking in pregnancy is a well-documented risk factor for fetal growth impairment and poor perinatal outcomes. Less is known about the long-term effects of maternal smoking on offspring mortality., Methods: A follow-up study in national registers on total mortality and cancer based on a birth cohort from Helsingborg, Sweden, including data on 2,010 sons and 1,982 daughters born to mothers for whom the smoking habits during pregnancy (50% smokers) have been recorded., Results: A total of 92 offspring deaths were recorded (54 men, 38 women) during follow-up. Of these deaths, 43 deaths were related to trauma, 6 to circulatory disease, and 2 to endocrine disorders. In men, an elevated mortality risk was associated with increasing maternal smoking habits (p for trend 0.011), but in women with low birth weight (p for trend 0.006). A total of 47 incident offspring cancers were registered (18 in men and 29 in women). No significant relation was noted for maternal smoking habits and cancer in the offspring., Conclusions: Maternal smoking during pregnancy is associated with an increased mortality risk in early adult life for male offspring but not for female offspring. This could represent the possible consequence of an increased susceptibility in male fetuses.

Solid organ transplant recipients (OTRs) have an increased cancer risk but their survival once diagnosed with cancer has seldom been assessed. We therefore investigated cancer‐specific survival among OTRs with a wide range of cancer forms nationally in Sweden. The study included 2,143 OTRs with cancer, and 946,089 nontransplanted cancer patients diagnosed 1992–2013. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression models adjusted for age, sex and calendar year. Median follow‐up was 3.1 (range 0–22) years. Overall, OTRs diagnosed with any cancer had a 35% higher rate of cancer death compared to nontransplanted cancer patients (HR: 1.35, 95% CI: 1.24–1.47). Specifically, higher rates of cancer‐specific death were observed among OTRs diagnosed with Hodgkin lymphoma (HR: 15.0, 95% CI: 5.56–40.6), high‐grade non‐Hodgkin lymphoma (HR: 2.68, 95% CI: 1.90–3.77), malignant melanoma (HR: 2.80, 95% CI: 1.74–4.52) and urothelial (HR: 2.56, 95% CI: 1.65–3.97), breast (HR: 2.12, 95% CI: 1.38–3.25), head/neck (HR: 1.55, 95% CI: 1.02–2.36) and colorectal (HR: 1.42, 95% CI: 1.07–1.88) cancer. The worse outcomes were not explained by differences in distribution of cancer stage or histologic subtypes. For other common cancer forms such as prostate, lung and kidney cancer, the prognosis was similar to that in nontransplanted cancer patients. In conclusion, several but not all types of posttransplantation cancer diagnoses are associated with worse outcomes than in the general population. Reasons for this should be further explored to optimize posttransplantation cancer management. What's new? While cancer risk increases significantly following solid organ transplant, little is known about cancer‐specific survival in transplant recipients. Here, analyses of survival among post‐transplant and non‐transplanted cancer patients in Sweden reveal significantly increased rates of death among transplant recipients diagnosed with certain cancer types, including Hodgkin lymphoma and melanoma and cancers of the breast and colorectal tract. Differences in stage or histologic subtype did not account for worse prognosis of these cancers. Common cancers, such as prostate and kidney cancer, had similar prognosis in the two groups. The findings could have implications for post‐transplantation cancer management and screening. [ABSTRACT FROM AUTHOR]

Aims: Dental personnel are exposed to mercury when using dental amalgam. This exposure constitutes a potential hazard to offspring of women working in dentistry. The present study examined increased mortality risk in offspring of mothers working in dentistry. Methods: Mortality was compared between sons of dental personnel and sons of nondental health-care personnel. Hazard ratios were calculated for three decades (1960s-1980s), when the magnitude of mercury exposure in dentistry was likely to have varied. Results: During the 1960s, there was a statistically significant increase in the risk of neonatal mortality for sons of dental nurses when compared with sons of assistant nurses: hazard ratio (HR) 1.82 (95% confidence interval, CI: 1.04-3.22). There was no increased risk in the subsequent decades, but a trend test demonstrated a consistent decrease in the risk over the three decades: HR for trend 0.63 (95% CI: 0.44-0.90). The raised mortality risk was limited to neonatal mortality. The comparison between dentists and physicians had insufficient statistical power. Conclusions: There is no increased mortality risk among sons of female dentists after the 1960s. Although the results should be interpreted with caution, they suggest a modestly raised risk of neonatal mortality, during the 1960s, when exposure to mercury was thought to be highest. [ABSTRACT FROM AUTHOR]

The risk for hepatocellular carcinoma (HCC) remained at a low level long-term (up to 8 years) after achievement of sustained virologic response (SVR) in patients with hepatitis C virus–associated liver cirrhosis. Continued surveillance for HCC after SVR is warranted.Background. The long-term effect of sustained virologic response (SVR) to antiviral therapy on the risk of developing hepatocellular carcinoma (HCC), liver complications, liver-related death, and overall death in hepatitis C virus (HCV)–infected patients with liver cirrhosis is not fully known.Methods. These risks were evaluated during long-term follow-up in 351 patients with HCV-related cirrhosis. One hundred ten patients with SVR, 193 with non-SVR, and 48 who were untreated were included in a multicenter cohort that was initiated in 2001 and prospectively followed up for a mean of 5.3 (SD, 2.8) years. Complementary follow-up data from national registries were used to minimize the loss of patients during follow-up.Results. Six patients with SVR developed HCC at 0.04, 0.64, 2.4, 7.4, 7.4, and 7.6 years, respectively, after achieving SVR. The incidences of HCC, any liver complication, liver-related death, and overall death per 100 person-years were significantly lower in SVR time with 1.0, 0.9, 0.7, and 1.9, compared to 2.3, 3.2, 3.0, and 4.1 in non-SVR and 4.0, 4.9, 4.5, and 5.1 in untreated time. The long-term consequences did not decline significantly after >3 years versus during the first 3 years of follow-up.Conclusions. The risk for HCC, liver decompensation, and death in patients with liver cirrhosis related to HCV was markedly reduced after SVR, but a long-term risk of developing HCC remains for up to 8 years. Cirrhotic patients with HCV who achieve SVR should therefore maintain long-term surveillance for HCC. Future studies aimed to better identify those with remaining long-term risk for HCC are needed. [ABSTRACT FROM PUBLISHER]

Objective: To assess the association between childbearing and mortality from anorexia nervosa (AN). Method: A total of 5,251 females, from a population-based Swedish registry, admitted with an AN diagnosis during the period 1973-2003 were included. Standardized mortality ratios (SMR) were estimated and hazard ratios (HR) were calculated using Cox regression. Results: Nulliparous women had a sixfold higher mortality due to natural causes and ninefold higher mortality due to unnatural causes compared to the general population. Parous women had higher mortality compared to the general population only due to unnatural causes. Suicide was the most common cause of death. Childbearing was associated with a 65% lower mortality. One hundred forty four women out of 1,941 parous women were hospitalized perinatally for any psychiatric disorder (7.4%). Discussion: Childbearing is associated with lower mortality among women with AN. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]

During the last decades, a multitude of different treatments for chronic liver disease have been introduced. New surveillance programs have been established to detect esophageal varices and liver cancer. The aims of our study were to assess whether the prognosis for patients hospitalized with liver diseases between 1969 and 2006 had improved and to study the differences in mortality and complications between patients with alcoholic liver disease and nonalcoholic liver diseases. We used the Swedish Hospital Discharge Register and Cause of Death Register at the National Board of Health and Welfare in Sweden between 1969 and 2006 to identify and follow-up a cohort of patients with liver disease according to the International Classification of Diseases-8, -9, and -10. There were 36,462 patients hospitalized with alcoholic and 95,842 with nonalcoholic liver diseases. The main finding was that patients hospitalized with alcoholic liver disease had an increased mortality risk, compared to patient with nonalcoholic liver disease, 1.89 (1.85 to 1.92). In addition, the patients with alcoholic liver disease had an increased risk for esophageal varices and liver cancer. There was a reduced risk for hospitalization with esophageal varices for patients with nonalcoholic liver disease up to 1998. We found that the prognosis for patients hospitalized with chronic liver diseases had not improved. Patients with alcoholic liver disease have an increased risk of complications, which suggest that the disease is more aggressive and are in need of closer follow-up than other chronic liver diseases. [ABSTRACT FROM AUTHOR]

Background & Aims: Hereditary hemochromatosis (HH) is an autosomal-recessive disorder characterized by iron overload. Relatives of HH patients were screened and those with HH-associated mutations and an increased iron load were identified. However, little is known about their mortality or strategies for their management. We assessed mortality among Swedish patients with HH and their first-degree relatives using health and census registers. Methods: We performed a matched population-based cohort study of 3832 patients with HH and their 14,496 first-degree relatives using data collected from 1990 through 2007. Mortality data from these groups were compared with that of 38,969 population controls and their 143,349 first-degree relatives using Cox regression analyses. Results: Patients identified on the basis of hospitalization with HH had an increased risk (relative risk [RR]) for death (RR, 2.45; 95% confidence interval [CI], 2.27–2.64; 857 deaths). Patients identified through other means had a mortality risk that was lower than those identified in the hospital but higher than controls (RR, 1.15; 95% CI, 1.00–1.33; 216 deaths). Their first-degree relatives had only a marginally increased mortality risk (RR, 1.05; 95% CI, 1.01–1.10); this RR was similar to that of patients'' spouses (RR, 1.09; 95% CI, 0.86–1.38; 82 deaths). Patients with HH who also had a family history of HH did not have an increased mortality risk compared with other groups (RR, 1.05; 95% CI, 0.67–1.62; 21 deaths). Conclusions: Patients with HH have a modestly increased mortality risk compared with controls. The mortality of relatives is increased marginally compared with controls, and is similar among biological and nonbiological relatives. [Copyright &y& Elsevier]

Background. Recent research has shown cystatin C to predict mortality and cardiovascular morbidity independent of renal function. The aim of this study was to evaluate the prognostic value of cystatin C on mortality in adult general ICU patients with acute kidney injury (AKI). We later expanded the study and included patients without signs of AKI. [ABSTRACT FROM PUBLISHER]

The article focuses on a retrospective cohort study which examined mortality in celiac disease according to small-intestinal histopathology. The data used in the study were from duodenal/jejunal biopsies performed between July 1969 and February 2008 on celiac disease and inflammation from all 28 pathology departments in Sweden. It was found that absolute mortality rate was 10.4 per 1000 person-years, 25.9 in inflammation and 6.7 in latent celiac disease. The study concluded that the risk of death is modestly increased in patients with celiac disease, inflammation or latent celiac disease.

Background: Anorexia nervosa is a mental disorder with high mortality.Aims: To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors.Method: Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers.Results: The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome.Conclusions: Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome. [ABSTRACT FROM AUTHOR]

Objectives Primary adrenocortical insufficiency is mostly caused by an autoimmune destruction of the adrenal cortex. The disease may appear isolated or as a part of an autoimmune polyendocrine syndrome (APS). APS1 is a rare hereditary disorder with a broad spectrum of clinical manifestations. In APS2, primary adrenocortical insufficiency is often combined with autoimmune thyroid disease and/or type 1 diabetes. We analysed mortality and cancer incidence in primary adrenocortical insufficiency patients during 40 years. Data were compared with the general Swedish population. Design and patients A population based cohort study including all patients with autoimmune primary adrenocortical insufficiency (3299) admitted to Swedish hospitals 1964–2004. Measurements Mortality risk was calculated as the standardized mortality ratio (SMR) and cancer incidence as the standardized incidence ratio (SIR). Results A more than 2-fold increased mortality risk was observed in both women (SMR 2·9, 95% CI 2·7–3·0) and men (SMR 2·5, 95% CI 2·3–2·7). Highest risks were observed in patients diagnosed in childhood. SMR was higher in APS1 patients (SMR 4·6, 95% CI 3·5–6·0) compared with patients with APS2 (SMR 2·1, 95% CI 1·9–2·4). Cancer incidence was increased (SIR 1·3, 95% CI 1·2–1·5). When tumours observed during the first year of follow-up were excluded, only the cancer risk among APS1 patients remained increased. Cause-specific cancer incidence analysis revealed significantly higher incidences of oral cancer, nonmelanoma skin cancer, and male genital system cancer among patients. Breast cancer incidence was lower than in the general population. Conclusions Our study shows a reduced life expectancy and altered cancer incidence pattern in patients with autoimmune primary adrenocortical insufficiency. [ABSTRACT FROM AUTHOR]

Objective. In Sweden, there is stable or slightly increased total alcohol consumption but a decrease in mortality in liver disease. The aim of the study was to determine the temporal relation between alcohol-related liver disease morbidity and mortality and type of alcohol beverage consumption. Material and methods. Data on patients with liver disease from the Swedish Hospital Discharge Register and from the Causes of Death Register between 1969 and 2001were analysed. Data on the registered sales of the different beverages were taken from the Swedish State Monopoly. Results. Liver disease mortality increased from 1969 to 1976, coinciding with the increase in sales of spirits. Both mortality and spirits sales decreased thereafter, whereas there was no decrease in beer or wine sales. Hospitalization rates were reduced after 1987. Depending on age and gender, there was a 30–80% 5-year mortality rate following discharge. Among men, but not among women, differences in the alcohol and non-alcohol-related liver diagnoses in the Hospital Discharge Register and in the Cause of Death Register were sometimes recorded in the same patient. Conclusions. There was a reduction in hospitalization rates and mortality in liver diseases, and the reduction in mortality in liver diseases in Sweden from 1969 to 2001 seems to be associated with sales of spirits. Patients hospitalized for liver disease have a poor prognosis. There were difficulties in differentiating between alcohol and non-alcohol liver diseases. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Dupuytren''s contracture (DC) is a fibromatous disease of the palmar fascia of unknown etiology. The objective of this study was to assess whether individuals treated for DC exhibited an altered standardized mortality ratio. Study design and setting: A total of 16,517 patients operated on for DC between 1965 and 1995 were identified by the Swedish Inpatient Register. For the 7,579 patients who had died during that period, cause of death was obtained from the Swedish Death Register. Results: There was an overall increased mortality (standardized mortality ratio [SMR]=1.06), inversely related to age and significant for both sexes, in patients under 70 years of age. The risk estimate was highest for endocrine diseases (highest value in patients 40–49 years of age at surgery; SMR=2.82), gastrointestinal diseases (highest value in those 40–49 years of age at surgery; SMR=2.69), accidents (highest value in those 30–39 years of age at surgery; SMR=2.40), and respiratory diseases (highest value in those 50–59 years of age at surgery; SMR=1.61). There was also an increased SMR for cardiovascular diseases in patients 40–59 years of age more than 10 years after surgery (highest value in those 40–49 years of age at surgery; SMR=1.65). Conclusion: The most probable mechanism for the increased mortality is related to smoking and other lifestyle factors. [Copyright &y& Elsevier]

Background: Selected groups of patients with bipolar and unipolar disorder have an increased mortality rate from suicide and natural causes of death. However, there has been no population-based study of mortality of patients followed up from the onset of the illness. Methods: All patients with a hospital diagnosis of bipolar (n = 15 386) or unipolar (n = 39 182) disorder in Sweden from 1973 to 1995 were identified from the inpatient register and linked with the national cause-of-death register to determine the date and cause of death. Overall and cause-specific standardized mortality ratios (SMRs) and numbers of excess deaths were calculated by 5-year age classes and 5-year calendar periods. Results: The SMRs for suicide were 15.0 for males and 22.4 for females with bipolar disorder, and 20.9 and 27.0, respectively, for unipolar disorder. For all natural causes of death, SMRs were 1.9 for males and 2.1 for females with bipolar disorder, and 1.5 and 1.6, respectively, for unipolar disorder. For bipolar disorder, most excess deaths were from natural causes, whereas for unipolar disorder, most excess deaths were from unnatural causes. The SMR for suicide was especially high for younger patients during the first years after the first diagnosis. Increasing SMR for suicide during the period of study was found for female patients with unipolar disorder. Conclusions: This population-based study of patients treated in the hospital documented increased SMRs for suicide in patients with bipolar and unipolar disorder. The SMR for all natural causes of death was also increased, causing about half the excess deaths. [ABSTRACT FROM AUTHOR]

The article presents a study which explored intensive care unit (ICU) patients' characteristics and outcome based on admittance mode through conventional contact or rapid response team. Participants include 694 admissions from general wards to ICU. Results showed the importance of rapid response team in the identification of complex patients.

Summary: Objective: To make a preliminary estimation of the workload for a medical emergency team (MET) in a Scandinavian University Hospital by recording prevalent physiological data on all adult patients and to see if the patients with deviating physiology (i.e. fulfilling the study criteria, in essence a set of simplified MET-criteria) had an elevated mortality. We also tested sensitivity and specificity by altering the cut-off levels of the calling criteria. Design: Cross sectional prevalence study. Setting: University hospital in the capital of Sweden. Patients: Adult patients treated in the general wards of the hospital. Patients from psychiatric wards and intensive care units were excluded from the study. Interventions: None. Measurements and main results: 4.5% of the scored patients fulfilled the study criteria. These patients had a 30-day mortality of 25% (confidence interval 12.7–41.2) as compared to 3.5% (2.4–5) for the patients not fulfilling the study criteria. Extended criteria revealed 18 deaths within 30 days, 8 more deaths than the original study criteria. However, 123 patients – equalling 13.8% of the cohort (CI 11.6–16.2) – fulfilled these criteria as compared to the 40 patients fulfilling the original study criteria. Thus, the 30-day mortality of the patients with positive extended criteria totalled 14.6% (CI 8.9–22.1). Restricted criteria showed a mere 20 patients (2.2%; CI 1.4–3.5) and only 4 deaths, making 30-day mortality 20% (CI 5.7–43.7); thus, sensitivity was actually lower using restricted criteria. Conclusions: Even these modified – and simplified – MET-criteria proved to be able to single out patients with elevated mortality as compared to the rest of the hospital population. Extending the criteria significantly lowered sensitivity and would extend the MET-workload enormously. Restricting the criteria led to missed mortalities where intervention could be beneficial. The results suggest that a routine use of simple physiological tests can be of help in the identification of patients at risk. [Copyright &y& Elsevier]