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Alma B Pedersen,1,2 Søren P Johnsen,3,4 Erzsébet Horváth-Puhó2 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; 3Center for Clinical Health Services Research, Aalborg University Hospital, Aalborg, Denmark; 4Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkCorrespondence: Alma B Pedersen, Email abp@clin.au.dkIntroduction: Population-based data on survival trends over time among patients with advanced cutaneous melanoma are lacking. We examined changes in mortality for patients diagnosed from 1980 to 2011 in a nationwide historical follow-up study using population-based medical registries from Denmark.Material and Methods: The study population included all Danish patients with an incident diagnosis of advanced (metastatic or unresectable stage IIIA, IIIB, IIIC, or IV) cutaneous melanoma (ie, initial diagnosis for melanoma at stage III/IV) between 1980– 2011 and who were followed-up until 2013. For each patient, we randomly matched 100 individuals from the general population on sex and year of birth. Age-standardized mortality rates were calculated by calendar year of diagnosis overall, 30 days after diagnosis, and during 31 to 364 days and 0– 10 years after diagnosis. Stratified Cox’s proportional hazards regression was used to compute hazard ratios.Results: We identified a total of 1236 patients and 123,600 comparison cohort members. We observed that the standardized mortality rates of patients with advanced melanoma dropped from the 1980s onwards, but remain high (eg, 74.3 and 248.4 per 1000 person-years in 0– 30 days and 31– 364 days after diagnosis, respectively, for patients diagnosed during 2008– 2011). Compared with the general population, patients with advanced melanoma had a 10.4-fold increased hazard of death during 0– 10 years of follow-up. The highest relative mortality was found for the first year following mela

Helle Jørgensen,1– 3 Erzsébet Horváth-Puhó,2 Kristina Laugesen,2 Sigrid K Braekkan,1,3 John-Bjarne Hansen,1,3 Henrik Toft Sørensen2 1Thrombosis Research Center (TREC), Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway; 2Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark; 3Division of Internal Medicine, University Hospital of North Norway, Tromsø, NorwayCorrespondence: Helle Jørgensen, Email helle.jorgensen@uit.noBackground: Venous thromboembolism (VTE) is associated with increased risk of disability pension. How socioeconomic status (SES) impacts the risk of disability pension after a VTE is unknown. The aim of this nationwide population based cohort study to investigate the interaction between SES and incident VTE on the risk of subsequent disability pension.Methods: Using Danish national medical and administrative databases, we established a nationwide cohort of 41,781 individuals aged 25– 65 years with incident VTE during 1995– 2016 and a comparison cohort (n=208,905) from the general population matched on year of birth, sex, and calendar year of VTE. We computed incidence rates (IRs) as the number of disability pension events per 1000 person-years at risk and measured the interaction between VTE and levels of SES (high, medium, low) on an additive scale by calculating interaction contrasts (difference in IR difference).Results: Among individuals with high SES, the disability pension IR per 1000 person-years was 5.4 (95% CI: 4.8– 6.1) in the VTE cohort and 1.6 (95% CI: 1.5– 1.7) in the comparison cohort (IR difference 3.8). The corresponding disability pension IR in individuals with low SES was 55.1 (95% CI: 52.1– 58.1) in the VTE cohort and 26.1 (95% CI: 25.1– 27.1) in the comparison cohort (IR difference 24.0). An interaction contrast of 25.1 indicated that interaction accounted for 45.6% (25.1/55.1) of the disability pe

Eyal Cohen,1– 3 Péter Szentkúti,4 Erzsébet Horváth-Puhó,4 Hilary K Brown,3,5 Sonia M Grandi,2 Henrik Toft Sørensen,4,6 Joel G Ray2,3,7 1Department of Pediatrics and Edwin S.H. Leong Centre for Healthy Children, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; 2Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 5Department of Health & Society, University of Toronto Scarborough; 6Clinical Excellence Research Center, Stanford University, Stanford, CA, USA; 7St.Michael’s Hospital Department of Medicine, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Eyal Cohen, Department of Pediatrics and Edwin S.H. Leong Centre for Healthy Children, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, Tel +1 416-813-7654, Email eyal.cohen@sickkids.caBackground: The mother of an infant with a major congenital anomaly is at a higher risk of premature cardiometabolic disease, possibly from chronic caregiver stress and distraction from self-care, including maintaining a healthy lifestyle and body weight.Objective: To compare the interpregnancy weight gain in women whose first infant had a major congenital anomaly vs those without an affected child.Methods: Multivariable linear regression compared women whose infant had an anomaly vs those whose infant did not, adjusting for interpregnancy time interval, demographics, smoking and health status at the first pregnancy.Results: Of the 199,536 women who had two consecutive singleton births, 4035 (2.0%) had a child with an anomaly at the first birth. The mean (SD) maternal BMI at the start of the first pregnancy was 24.1 (4.7) and 23.7 (4.4) kg/m2 in women with, and without, an anomaly-affected newborn. By the start of the second p

Jaimie L Gradus,1 Erzsébet Horváth-Puhó,2 Tammy Jiang,1 Anthony J Rosellini,3 Timothy L Lash,4 Henrik Toft Sørensen2 1Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 3Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA; 4Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USACorrespondence: Jaimie L GradusDepartment of Epidemiology, Boston University School of Public Health, Boston, MA, USAEmail jgradus@bu.eduComplications following organ transplant – such as complex medical regimens involving adherence to lifelong immunosuppressant medications, adverse effects, infection, and rejection of the transplanted organ – may increase the risk of stress and mental disorders.1 Only one population-based study has examined the association between organ transplant and suicide, and found that the suicide rate among liver transplant recipients was five times that of the Nordic general population between the years 2000 and 2010.2 In this study, we examined associations between heart, lung, kidney, and liver transplants and suicide and non-fatal suicide attempts in the population of Denmark.

Erzsébet Horváth-Puhó,1 Marit M Suttorp,2 Henrik Frederiksen,1,3 Tiny Hoekstra,2 Olaf M Dekkers,1,2 Lars Pedersen,1 Suzanne C Cannegieter,2 Friedo W Dekker,2 Henrik Toft Sørensen1 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Haematology, Odense University Hospital, Odense, Denmark Introduction: Erythropoiesis-stimulating agent (ESA) treatment has been associated with an increased risk of venous thromboembolism (VTE) in patients with solid tumors and with an increased risk of cardiovascular events in patients with chronic kidney disease. The ESA-related risk in patients with hematological neoplasms remains unclear. We, therefore, aimed to assess the ESA-related risk of VTE, myocardial infarction (MI), and stroke in patients with multiple myeloma (MM) and myelodysplastic syndrome (MDS). Materials and methods: We conducted a population-based cohort study in Denmark, using medical databases to identify 2,114 MDS patients and 3,105 MM patients diagnosed in 2004–2013. Incidence rates per 1,000 person-years and hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE, MI, and stroke associated with ESA treatment were computed. HRs were calculated in time-dependent Cox regression and adjusted for age, sex, MDS prognosis group, comorbidities, and treatments. Results: Incidence rates per 1,000 person-years for VTE, MI, and stroke were 10.8, 8.2, and 16.0 in MDS patients, and 21.9, 10.2 and 9.9 in MM patients without ESA treatment, respectively. MDS patients with ESA treatment had a 1.6-fold increased risk of MI (HR 1.60 [95% CI 0.90–2.86]) and an almost twofold increased risk of stroke (HR 1.94 [95% CI 1.28–2.94]). Adjusted HR for VTE was 1.04 (95% CI 0.57–1.89) compared with MDS patients without ESAs. In MM patients with ESAs com

Jennifer L Lund,1,2 Erzsébet Horváth-Puhó,2 Szimonetta Komjáthiné Szépligeti,2 Henrik Toft Sørensen,2 Lars Pedersen,2 Vera Ehrenstein,2 Til Stürmer1,2 1Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA; 2Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark Background: A principle of cohort studies is that cohort membership is defined by current rather than future exposure information. Pharmacoepidemiologic studies using existing databases are vulnerable to violation of this principle. We evaluated the impact of using data on future redemption of prescriptions to determine cohort membership, motivated by a published example seeking to emulate a “per-protocol” association between continuous versus never use of low-dose acetylsalicylic acid (ASA) and major bleeding (e.g., cerebral hemorrhage or gastrointestinal bleeding). Materials and methods: Danish medical registry data from 2004 to 2011 were used to construct two analytic cohorts. In Cohort 1, we used information about future redemption of low-dose ASA prescriptions to identify cohorts of continuous and never-ASA users. In Cohort 2, we identified ASA initiators and non-initiators using only contemporaneous data and censored follow-up for changes in use over time. We implemented propensity score-matched Poisson regression to evaluate associations between ASA use and major bleeding and estimated adjusted incidence rate differences (IRDs) per 1,000 person-years and ratios (IRRs) overall and stratified by time since initiation. Results: Among >6 million eligible Danish adults, we identified 403,693 low-dose ASA initiators (Cohort 2), of whom 189,150 were defined as continuous users (Cohort 1). Overall, IRDs and IRRs were similar across cohorts. However, the IRD for major bleeding in the first 90 days was substantially larger in Cohort 1 (IRD=25 per 1,000 person

Diana Hedevang Christensen,1,2 Erzsébet Horváth-Puhó,1 Morten Schmidt,1 Christian Fynbo Christiansen,1 Lars Pedersen,1 Bente Lomholt Langdahl,2 Reimar Wernich Thomsen1 1Department of Clinical Epidemiology, 2Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Purpose: Bisphosphonate use has been associated with increased risk of fatal stroke. We examined the association between preadmission use of oral bisphosphonates and 30-day mortality following hospitalization for stroke. Patients and methods: We conducted a nationwide population-based cohort study using medical databases and identified all patients in Denmark with a first-time hospitalization for stroke between 1 July 2004 and 31 December 2012 (N=100,043). Cox regression was used to compute adjusted hazard ratios as a measure of 30-day mortality rate ratios (MRRs) associated with bisphosphonate current use (prescription filled within 90 days prior to the stroke) or recent use (prescription filled in the 90–180 days prior to the stroke). Current use was further classified as new or long-term use. Results: We found 51,982 patients with acute ischemic stroke (AIS), 11,779 with intracerebral hemorrhage (ICH), 4,528 with subarachnoid hemorrhage (SAH), and 31,754 with unspecified stroke. Absolute 30-day mortality risks were increased among current vs nonusers of bisphosphonates for AIS (11.9% vs 8.5%), ICH (43.2% vs 34.5%), SAH (40.3% vs 23.2%), and unspecified strokes (18.8% vs 14.0%). However, in adjusted analyses, current bisphosphonate use did not increase 30-day mortality from AIS (MRR, 0.87; 95% confidence interval [CI]: 0.75, 1.01); ICH (MRR, 1.05; 95% CI: 0.90, 1.23); SAH (MRR, 1.15; 95% CI: 0.83, 1.61); or unspecified stroke (MRR, 0.94; 95% CI: 0.81, 1.09). Likewise, no association with mortality was found for recent use. Adjusted analyses by type of bisphosphonate showed increased mortality following stroke among new users

Sigrun Alba Johannesdottir, Erzsébet Horváth-Puhó, Vera Ehrenstein, Morten Schmidt, Lars Pedersen, Henrik Toft SørensenDepartment of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, DenmarkAbstract: The Danish health care system provides partial reimbursement of most prescription medications in Denmark. The dispensation of prescription medications is registered in administrative databases. Each time a prescription is redeemed at a pharmacy, an electronic record is generated with information related to the user, prescriber, the pharmacy, and the dispensed drug. The National Health Service gathers this information for administration of the drug reimbursement plan. Recently, this information became the basis for the establishment of a new research database, the Danish National Database of Reimbursed Prescriptions (DNDRP). In this paper, we review the content, coverage, quality, linkage, access, and research possibilities of this new database. The database encompasses the reimbursement records of all reimbursed drugs sold in community pharmacies and hospital-based outpatient pharmacies in Denmark since 2004. On average, approximately 3.5 million users are recorded in the database each year. During the coverage period, the number of annual prescription redemptions increased by 15%. Most dispensed prescriptions are in the categories “alimentary tract and metabolism”, “cardiovascular system”, “nervous system”, and “respiratory system”. Individuals are identified by the unique central personal registration (CPR) number assigned to all persons born in or immigrating to Denmark. The new database fully complies with Denmark’s Act on Processing of Personal Data, while avoiding additional restrictions imposed on data use at the Danish National Prescription Registry, administered by Statistics Denmark. Most