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Background: Current risk estimates for hepatocellular carcinoma (HCC) in individuals with cirrhosis vary between studies. The risk has mostly been evaluated for single etiologies separately., Objectives: We examined the risk of HCC in Swedish outpatients with a new diagnosis of cirrhosis, aiming to identify subgroups with a particularly high risk for incident HCC., Methods: All patients with a first diagnosis of cirrhosis in the National Outpatient Register for whom the etiology of cirrhosis could be estimated were identified. Incident cases of HCC were ascertained until the end of 2016 using record linkage to national registers. The cumulative incidence of HCC across etiologies of cirrhosis, sex and age was calculated considering non-HCC death as a competing risk., Results: We identified 15,215 individuals with cirrhosis. The incidence rate for HCC in cirrhosis was 23/1000 person-years (95%CI = 22-24). Stratified on gender, it was 29/1000 person-years (95%CI = 27-31) in men versus 14/1000 person-years (95%CI = 13-16) in women. The cumulative incidence of HCC in cirrhosis was 8.3% (95%CI = 7.8-8.8) at 5 years and 12.2% (95%CI = 11.6-13.0) at 10 years. At 10 years, the lowest cumulative incidence was seen in women with alcohol-related liver disease (4.3%) and the highest in men with viral hepatitis (26.6%). These figures also varied by age., Conclusions: The risk of HCC differs extensively across subgroups of etiologies of cirrhosis, age and sex, suggesting that initiation of HCC surveillance could be individually tailored., (© 2022 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)

Background: The prevalence of diabetes in the world is projected to rise from 2.8% in the year 2000 to 4.4% in 2030, an increase suggesting an ongoing global epidemic of diabetes. Objective: To examine time trends in fasting and 2-h glucose concentrations, prevalence and 10-year cumulative incidence of diabetes, and the role of education in these trends. Design: Each year the Västerbotten Intervention Programme invites all 40, 50, and 60-year-old individuals to a health survey, which includes a cardiovascular risk factor screening and oral glucose tolerance test. The cross-sectional part of the study is based on health examinations conducted between 1990 and 2007 (n=102,822). The prospective subset (panel dataset) of the study is based on individuals who have had two health examinations 10 years apart and were not defined as having diabetes at their first health examination (n=23,546). Results: Between 1990 and 2007, the mean population fasting glucose concentration increased 0.5 mmol/L. Comparing the prevalence in 1990_1995 with 2002-2007 demonstrated a significant 44% increase in men (p<0.001) and a significant 17% increase in women (p<0.001). Socioeconomic status, here represented by education, clearly influenced both prevalence and incidence of diabetes and glucose concentration. In all time periods and in all age groups, individuals with low education were more likely to have or get diabetes. The 10-year risk of developing diabetes was four to five times higher in the oldest age group (50-60 years) compared with the youngest (30-40 years). A 30% reduction in the 10-year risk of developing diabetes was found in women (p>0.001) between 2000-2003 and 2004-2007. Conclusions: Despite a clear increase in glucose concentrations and diabetes prevalence between 1990 and 2007, especially in men, there was a decline in the 10-year risk of developing diabetes in women between 2000-2003 and 2004-2007. [ABSTRACT FROM AUTHOR]

Sweden has experienced an epidemic of symptomatic coeliac disease that has no likeness anywhere else in the world. This is quite unique for a disease that is genetically dependent, immune-mediated and chronic, and suggests an abrupt increase and decrease, respectively, of one or a few causal factors influencing a large proportion of Swedish infants during the period in question. We have shown that half of the epidemic was explained by an increase in the proportion of infants introduced to gluten in comparatively large amounts after breast-feeding had been ended. This was partly an effect of societal changes in national dietary recommendations and the food content of industrially produced infant foods. Thus, these changes over time in infant feeding practices had a large public health impact. In fact, when the Swedish epidemic began, the increase in incidence rate was larger in girls than in boys, as was the decrease during the post-epidemic period. Moreover, children born during summer had an increased risk for coeliac disease, possibly as they were mostly introduced to dietary gluten during winter when infections are more common. Notably, birth cohorts of the epidemic and post-epidemic periods differ considerably regarding coeliac disease occurrence at comparable ages, even when followed up to school age. A longer follow-up will reveal to what extent new cases develop later in life, and to what extent this difference in cumulative incidence remains. However, mass screening studies of both the epidemic and post-epidemic cohorts at comparable ages are also planned to determine to what extent ‘silent’ disease cases develop. Continuing to explore the Swedish epidemic of coeliac disease by means of an epidemiological approach provides a unique opportunity. This may include increasing our understanding of what determines the clinical expression of the disease, exploring the potentially causal role of environmental exposures, and possibly also identifying strategies for primary prevention. [Copyright &y& Elsevier]

Background: Acquired aortic stenosis (AS) increases with age and has high mortality without intervention. Factors predicting its development are unclear, although atherosclerotic factors are assumed to be involved. Our aim in this study is to estimate the lifetime cumulative incidence and predictors of AS in middle-aged men., Methods: We included a random sample of men (n = 9998) born 1915-1925 in Gothenburg, Sweden. From them, 7,494 were examined and followed until a diagnosis of AS or death (maximum follow-up time 42.8 years). We identified AS diagnosis from the Swedish National Patient Registry and deaths from the Swedish Cause of Death Registry by using International Classification of Disease (ICD) diagnostic criteria. To study time-dependent relationships between AS and risk factors with death as the competing risk, we divided the cohort into three overlapping follow-up groups: 25-43, 30-43 and 35-43 years. We used age-adjusted Cox proportional hazards model to identify predictors of AS., Results: The lifelong cumulative incidence of AS was 3.2%. At baseline, participants in the third group had a healthier lifestyle, lower body mass index (BMI), blood pressure, and serum cholesterol levels. Higher BMI, obesity, cholesterol, hypertension, atrial fibrillation, smoking and heredity for stroke were associated with AS. With BMI of 20-22.5 as a reference, hazard ratios of being diagnosed with AS for men with a baseline BMI of 25-27.5 kg/m 2 , 27.5-30 kg/m 2 and > 30 kg/m 2 were 1.99 (95% CI 1.12-3.55), 2.98 (95% CI 1.65-5.40) and 3.55 (95% CI 1.84-6.87), respectively., Conclusions: The lifetime cumulative incidence of AS in middle-aged male population was 3.2%. Multiple atherosclerotic risk factors, particularly high BMI might be associated with a higher risk of developing AS., (© 2022. The Author(s).)

Background: With continuous increases in survival rates following breast cancer (BC) diagnosis, the challenge of multiple primary cancers has become an issue. The data on familial risk of SPCs after BC diagnosis and the related mortality in BC patients are scarce., Methods: A total of 87 752 female BC patients were followed for SPC diagnoses and records of death. Relative risks (RRs) of SPC in BC patients who had first-degree relatives (parents or siblings) affected by the same cancer were compared to the patients without family history. Causes of death were compared between patients with and without SPC., Results: After a median follow-up of 5 years, 14 952 BC patients developed SPCs, among which 10 280 (68.8%) had first-degree relatives diagnosed with cancer. Familial risks were significant for 14 site-specific SPCs, and the highest risk was for second ovarian cancer (RR = 6.28, 95%CI: 4.50-8.75), compared to those without family history (1.49, 1.34-1.65). In patients with SPC, SPC was the main cause of death, including diverse cancers and BC in approximately equal proportions., Conclusions: Family history contributed to the excess number of patients with SPCs, and SPC was the leading cause of death in patients with SPC. Taking family history at diagnosis of BC may provide warning signs with regard to possible subsequent SPCs and may offer possibilities for counseling, intervention and management., (© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Purpose: To examine whether neighborhood deprivation increases the odds of hospital registration for childhood and adolescent epilepsy, after accounting for family- and individual-level sociodemographic characteristics., Methods: An open cohort of all children aged 2-17 years was followed between January 1, 2000 and December 31, 2010. Children's residential addresses were geocoded and classified according to neighborhood deprivation. Data were analyzed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighborhood deprivation at the second level., Results: During the study period, among a total of 1,020,766 children, 9309 (0.9%) were registered with childhood and adolescent epilepsy. Age-adjusted cumulative hospital rates of childhood and adolescent epilepsy increased with increasing neighborhood-level deprivation across all family- and individual-level sociodemographic categories. The odds ratio (OR) for hospital registration for childhood and adolescent epilepsy for those living in high-deprivation neighborhoods versus those living in low-deprivation neighborhoods was 1.15. High level deprivation remained significantly associated with higher odds of childhood and adolescent epilepsy after adjustment for family- and individual-level sociodemographic characteristics (OR=1.12, 95% CI=1.04-1.21, p=0.003)., Conclusions: Our results suggest that neighborhood characteristics modestly affect the odds of hospital registration for childhood and adolescent epilepsy independently of family- and individual-level sociodemographic characteristics., (Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)