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2. Long-term prognosis after coronary artery bypass surgery

Author

Ketonen, M., Pajunen, P., Koukkunen, H., Immonen-Räihä, P., Mustonen, J., Mähönen, M., Niemelä, M., Kuulasmaa, K., Palomäki, P., Arstila, M., Vuorenmaa, T., Lehtonen, A., Lehto, S., Miettinen, H., Torppa, J., Tuomilehto, J., Airaksinen, J., Pyörälä, K., and Salomaa, V.

Published
2008
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6. Working group on epidemiology & prevention of the european society of cardiology: Proceedings of meeting held at Shannon May 14th–17th, 1998

Author

Sullivan, P. A., Murphy, D., Sullivan, P. A., Keogh, S., Sullivan, P. A., Nash, P., Kaarisalo, M. M., Marttila, J., Immonen-Raiha, P., Salomaa, V., Torppa, J., Tuomilehto, J., Siani, A., Racone, R., Ragone, E., Stinga, F., Strazzullol, P., Cappuccio, F. P., Trevisan, M., Farinaro, E., Mellone, C., Fox, K. F., Cowie, M. R., Wood, D. A., Coats, A. J., Poole Wilson, P. A., Sutton, G. C., Yarnell, J., Sweetnam, P., Thomas, H., Piwonski, J., Piotrowski, W., Pytlak, A., Wannamethee, S. G., Shaper, A. G., Walker, M., Sharpe, P. C., Young, I. S., Hasselwander, O., McMaster, D., Mercer, C., McGrath, L. T., Evans, A. E., Thomas, F., Guize, L., Ducimetiere, P., Benetos, A., Rosolova, H., Simon, J., Mayer, O., Sefrna, F., Mayer, O., Šimon, J., Rosolova, H., Racek, J., Trefil, L., Marin-Tarlea, M., Carp, C., Apetrei, E., Ginghina, C., Serban, I., Florica, N., Ceck, C., Patrascoiu, M., Ginghina, C., Carp, C., Apetrei, E., Tarlea, M., Cioranu, R., Florica, N., Ceck, C., Vaduva, M., Mihaescu, D., Lapadat, M., Ashton, W. D., Wood, D., Nanchahahal, K., Kelleher, C. C., Brennan, P. J., Howarth, D., Meade, T. W., Kelleher, C. C., Fallon, U. B., McCarthy, U., O’Donnell, M. M. K., Dineen, B., Jousilahti, P., Vartiainen, E., Tuomilehto, J., Puska, P., Kastarinen, M., Nissinen, A., Salomaa, V., Vartiainen, E., Jousilahti, P., Tuomilehto, J., Puska, P., Rosengren, A., Wedel, H., Wilhelmsen, L., Liese, A. D., Hense, H. W., Keil, U., Keil, U., Liese, A. D., Hense, H. W., Filipiak, B., Döring, A., Stieber, J., Lowel, H., De Laet, C., Brasseur, D., Kahn, A., Wautrecht, J. C., Decuyper, J., Boeynaems, J. M., Jousilahti, P., Vartiainen, E., Tuomilehto, J., Sundvall, J., Puska, P., Marques-Vidal, P., Ferrières, J., Haas, B., Evans, A., Amouyel, P., Luc, G., Ducimetiere, P., Marques-Vidal, P., Ferrieres, J., Arveiler, D., Montaye, M., Evans, A., Ducimetiere, P., Fuentes, R., Notkola, I. -L., Shemeikka, S., Tuomilehto, J., Nissinen, A., Mak, R., De BacquerBacquer, D., De Backer, G., Stam, M., Koyuncu, R., de Smet, P., Kornitzer, M., Braeckman, L., De Backer, G., De Bacquer, D., Claeys, L., Delanghe, J., De Bacquer, D., Kornitzer, M., De Backer, G., Cífkova, R., Pit’ha, J., Červenka, L., Šejda, T., Lanska, V., Škodová, Z., Stavek, P., Poledne, R., Cífková, R., Duskova, A., Hauserová, G., Hejl, Z., Lánská, V., Škodova, Z., Pistulková, H., Poledne, R., Hubáček, J., Pit’ha, J., Stávek, P., Lánská, V., Cífková, R., Faleiro, L. L., Rodrigues, D., Fonseca, A., Martins, M. C., Norris, R. M., Nyyssönen, K., Seppänen, K., Salonen, R., Kantola, M., Salonen, J. T., Parviainen, M. T., De Henauw, S., Myny, K., Doyen, Z., Van Oyen, H., Tafforeau, J., Kornitzer, M., De Backer, G., Benetos, A., Thomas, F., Guize, L., Immonen-Räihä, P., Kaarisalo, M., Marttila, R. J., Torppa, J., Tuomilehto, J., Houterman, S., Hofman, B., Witteman, J. C. M., Verschuren, W. M. M., van de Vijver, L. P. L., Kardinaal, A. F. M., Grobbee, D. E., van Poppel, G., Princen, H. M. G., Kornitzer, M., Doven, M., Koyuncu, R., De Bacquer, D., Myny, K., De Backer, G., Tafforeau, J., Van Oven, H., Doyen, M., Koyuncu, R., Kornitzer, M., De Bacquer, D., Myny, K., De Backer, G., Tafforeau, J., Van Oyen, H., de Bree, A., Verschuren, W. M. M., Blom, H. J., Mulder, I., Smit, H. A., Menotti, A., Kromhout, D., Van den Hoogen, P. C. W., Hofman, A., Witteman, J. C. M., Feskens, E. J. M., Štika, L., Bruthans, J., Wierzbicka, M., Bolinska, H., Voutilainen, S., Nyyssönen, K., Salonen, R., Lakka, T. A., Salonen, J. T., Lakka, H -M., Lakka, T. A., Salonen, J. T., Tuomainen, T-P., Nyyssonen, K., Salonen, J. T., Punnonen, K., Yarnell, J., Patterson, C., Thomas, H., Sweetnam, P., Smith, W. C. S., Campbell, S. E., Cardy, A., Phillips, D. O., Helms, P. J., Squair, J., Smith, W. C. S., Cardy, A., Phillips, D. O., Helms, P. J., Squair, J., Smith, W. C. S., Cardy, A., Phillips, D. O., Helms, P. J., Squair, J., Pytlak, A., Piotrowski, W., Rywik, S., Waskiewicz, A., Sygnowska, E., Szczesniewska, D., Sygnowska, E., Waskiewicz, A., Wagrowska, H., Polakowska, M., Rywik, S., Broda, G., Jasinski, B., Piotrowski, W., Elandt-Johnson, R. C., Wagrowska, H., Kupsé, W., Szczesniewska, D., Platonov, D. Y., Haapanen, N., Miilunpalo, S., Vuori, I., Pasanen, M., Oja, P., Urponen, H., Kopp, M. S., Skrabski, A., Szedmák, S., Boaz, M., Biro, A., Katzir, Z., Matas, T., Smetana, S., Green, M., Whincup, P. H., Morris, R., Walker, M., Lennon, L., Thomson, A., Ebrahim, S. J. B., Refsum, H., Ueland, P. M., Perry, I. J., Boer, J. M. A., Kuivenhoven, J. A., Feskens, E. J. M., Schouten, E. G., Havekes, L. M., Seidell, J. C., Kastelein, J. J. P., Kromhout, D., Oomen, C. M., Feskens, E. J. M., Rasanen, L., Nissinen, A., Fidanza, F., Menotti, A., Kok, F. J., Kromhout, D., Sileikiene, L., Klambienne, J., Milasauskiene, Z., Cappuccio, F. P., Siani, A., Barba, G., Russo, L., Ragone, E., Strazzullo, P., Farinaro, E., Trevisan, M., Schnohr, P., Parner, J., Lange, P., Meleady, R., Graham, I. M., Ueland, P. M., Refsum, H., Blom, H., Whitehead, A. S., Daly, L. E., Stefanovic, B., Boskovic, D., Mitrovic, P., Perunicic, J., Vukcevic, V., Radovanovic, N., Terzic, B., Mrdovic, I., Orilc, D., Matic, G., Vasiljevic, Z., Mitrovic, P., Boskovic, D., Stefanovic, B., Perunicic, J., Vukcevic, V., Mrdovic, I., Radovanovic, N., Orlic, D., Matic, G., Milentijevic, B., Rajic, D., Mitrovic, N., Boskovic, S., Vasiljevic, Z., Marin-Tarlea, M., Carp, C., Apetrei, E., Serban, I., Ceck, C., Patrascsoiu, M., Florica, N., Mihaescu, D., Murphy, C., Meleady, R., Ingram, S., Love, J., Graham, I., Graham, I. M., Meleady, R., van Berkel, T. F. M., Deckers, J. W., and De Bacquer, D.

Published
1998
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12. Service screening mammography reduces breast cancer mortality among elderly women in Turku

Author

Ahti Anttila, I Parvinen, PekkaJ. Klemi, O. Räsänen, Hans Helenius, Immonen-Räihä P, Liisa Pylkkänen, and Lea Kauhava

Subjects
Risk, medicine.medical_specialty, Breast cancer mortality, Breast Neoplasms, Age groups, Humans, Mass Screening, Medicine, Finland, Aged, Gynecology, Screening mammography, business.industry, Obstetrics, Incidence, Health Policy, Incidence (epidemiology), Carcinoma, Age Factors, Public Health, Environmental and Occupational Health, Middle Aged, Survival Analysis, Female, Breast carcinoma, business, Mammography
Abstract

Objectives: The aim of this study was to assess the effects of service screening mammography on breast carcinoma incidence and refined mortality among women aged 55–69 at entry in three cities employing different screening policies. Methods: Since 1987, the city of Turku, Finland, has provided service screening mammography for women aged 55–69 at entry (in 1987), and Tampere provided screening for women aged 55–59 at entry, whereas Helsinki did not screen any of these age groups. The incidence of breast carcinoma during the screening period 1987–97 in women born in 1918–32 (1918–22, 1923–27, 1928–32) was compared with incidence during the pre-screening period 1976–86 in women born in 1907–21 (1907–11, 1912–16, 1917–21) in each city. The follow-up for mortality was four years longer. Results: Breast carcinoma incidence was 31–38% higher in the screening period in all three cities irrespective of screening. In breast carcinoma mortality, no significant changes were seen in Helsinki or Tampere. In Turku, a 36% mortality reduction (relative risk [RR] 0.64; 95% confidence interval [CI] 0.47–0.88; P=0.007) in the whole study population and a 47% reduction in women aged 65–69 at entry (RR 0.53; 95% CI 0.28–0.99; P=0.047) were seen. Conclusions: The incidence of breast carcinoma increased in all study cities irrespective of screening. The comprehensive screening programme in Turku including women aged 55–69 at entry was associated with a significant reduction in breast carcinoma mortality. The pronounced decrease in mortality in the oldest age group (65–69 years at entry) also indicated that women of this age group greatly benefit from mammography screening.

Published
2006

13. Mammographic screening reduces risk of breast carcinoma recurrence

Author

Lea Kauhava, Anne Kaljonen, Kaija Holli, Osmo Räsänen, Immonen-Räihä P, Pekka J. Klemi, Ilmo Parvinen, Hans Helenius, Liisa Pylkkänen, and Pauliina Kronqvist

Subjects
Gynecology, Cancer Research, medicine.medical_specialty, Univariate analysis, education.field_of_study, Multivariate analysis, business.industry, Hazard ratio, Population, Cancer, medicine.disease, Confidence interval, Oncology, Internal medicine, Medicine, Risk factor, Breast carcinoma, business, education
Abstract

BACKGROUND The current report is a long-term evaluation of breast carcinoma recurrence, factors predicting recurrence, and postrecurrence prognosis in relation to patients' use of service screening, which has been provided in Turku, Finland, since 1987 for women ages 40–74 years. METHODS The current study included 527 invasive breast carcinomas: 418 in the screening group (which included screen-detected and interval malignancies) and 109 in the nonscreening group (which included breast carcinomas detected before initial screening and those detected in patients who chose not to undergo screening). These breast carcinomas were diagnosed among women ages 40–74 years between 1987 and 1993, with follow-up extending until the end of 2001. RESULTS In the screening group, the risk of recurrence was only approximately half of the corresponding risk in the nonscreening group (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.39–0.83; P = 0.003). Five years after the primary diagnosis, 16% of patients in the screening group and 28% of patients in the nonscreening group (P = 0.001) had experienced recurrence; 10 years after diagnosis, the corresponding rates were 21% and 34%, respectively (P = 0.001). Postrecurrence prognosis was comparable for both detection groups (HR, 1.17; 95% CI, 0.70–1.94; P = 0.551), with approximately half of all patients dying of disease 5 years after recurrence. Detection of breast carcinoma via a method other than mammographic screening was associated with a high risk of recurrence on univariate analysis. On Cox multivariate analysis, risk factors for recurrence included lobular histologic type (HR, 2.23; 95% CI, 1.44–3.48; P < 0.001), poor histologic grade (HR, 2.02; 95% CI, 1.20–3.39; P = 0.008), and large tumor size (HR, 1.60; 95% CI, 1.07–2.37; P = 0.021). CONCLUSIONS Long-term data from a population-based program demonstrated that mammographic screening reduced patients' risk of breast carcinoma recurrence. Specifically, the risk for patients with screen-detected disease was only approximately half of the risk for patients with non-screen-detected disease. Nonetheless, postrecurrence prognosis was comparable for patients in both detection groups. Cancer 2005. © 2004 American Cancer Society.

Published
2004

14. Trends in coronary events in Finland during 1983–1997; The FINAMI study

Author

Y. A. Kesaniemi, Mika Niemelä, Veikko Salomaa, J. Tuomilehto, H. Miettinen, Kari Kuulasmaa, Aapo Lehtonen, Kärjä-Koskenkari P, Heli Koukkunen, Vuorenmaa T, Mähönen M, P. Palomäki, T. Jerkkola, M. Arstila, Immonen-Räihä P, Kalevi Pyörälä, Matti Ketonen, Jorma Torppa, and Seppo Lehto

Subjects
Adult, Male, medicine.medical_specialty, Population, Coronary Disease, Recurrence, Case fatality rate, Epidemiology, Myocardial Revascularization, Humans, Medicine, Thrombolytic Therapy, Registries, Myocardial infarction, Mortality, Sex Distribution, education, Finland, Secondary prevention, education.field_of_study, business.industry, Incidence (epidemiology), Middle Aged, medicine.disease, Confidence interval, Coronary heart disease, Surgery, Female, Cardiology and Cardiovascular Medicine, business, Demography
Abstract

Aims To analyse the trends in incidence, recurrence, case fatality, and treatments of acute coronary events in Finland during the 15-year period 1983–97. Methods and results Population-based MI registration has been carried out in defined geographical areas, first as a part of the FINMONICA Project and then continued as the FINAMI register. During the study period, 6501 coronary heart disease (CHD) events were recorded among men and 1778 among women aged 35–64 years. The CHD mortality declined on average 6.4%/year (95% confidence interval −5.4, −7.4%) among men and 7.0%/year (−4.7, −9.3%) among women. The mortality from recurrent events declined even more steeply, 9.9%/year (−8.3, −11.4%) among men and 9.3%/year (−5.1, −13.4%) among women. The proportion of recurrent events of all CHD events also declined significantly in both sexes. Of all coronary deaths, 74% among men and 61% among women took place out-of-hospital. The decline in 28-day case fatality was 1.3%/year (−0.3, −2.3%) among men and 3.1%/year (−0.7, −5.5%) among women. Conclusions The study period was characterized by a marked reduction in the occurrence of recurrent CHD events and a relatively modest reduction in the 28-day case fatality. The findings suggest that primary and secondary prevention have played the main roles in the decline in CHD mortality in Finland.

Published
2003

15. Gender differences in recurrent coronary events. The FINMONICA MI register

Author

Pamela J. Schreiner, J. Tuomilehto, H. Miettinen, Mähönen M, Vuorenmaa T, Kaarsalo E, P. Palomäki, Kalevi Pyörälä, Seppo Lehto, Immonen-Räihä P, Jorma Torppa, Mika Niemelä, Harri Mustaniemi, Matti Ketonen, M. Arstila, Veikko Salomaa, and Pekka Puska

Subjects
Adult, Male, medicine.medical_specialty, Population, Myocardial Infarction, Disease, Sex Factors, Recurrence, Internal medicine, Case fatality rate, medicine, Humans, Survivors, Myocardial infarction, Risk factor, education, Proportional Hazards Models, education.field_of_study, Proportional hazards model, business.industry, Hazard ratio, Middle Aged, Prognosis, medicine.disease, Surgery, Regression Analysis, Female, Myocardial infarction diagnosis, Cardiology and Cardiovascular Medicine, business
Abstract

Background Male gender is an established risk factor for first myocardial infarction, but some studies have suggested that among myocardial infarction survivors, women fare worse than men. Therefore, we examined the long-term prognosis of incident myocardial infarction survivors in a large, population-based MI register, addressing gender differences in mortality as well as the number of events and time intervals between recurrent events. Methods and Results Study subjects included 4900 men and women, aged 25–64 years, with definite or probable first myocardial infarctions who were alive 28 days after the onset of symptoms. At first myocardial infarction, women were older and more likely to be hypertensive or diabetic than men, and had a greater proportion of probable vs definite events. After adjustment for age and geographic region, men had 1·74 times the risk of fatal coronary heart disease relative to women (hazard ratio=1·63 and 1·55 for cardiovascular disease and all-cause mortality, respectively) over an average of 5·9 years of follow-up. Number and time intervals between any recurrent event—fatal and non-fatal—did not differ by gender. Conclusion These data suggest that men are far more likely to have a fatal recurrent event than women despite comparable numbers of events.

Published
2001

16. Long-term predictors of stroke in a cohort of people aged 70 years

Author

Jorma Torppa, Immonen-Räihä P, Reijo J. Marttila, Aapo Lehtonen, Jaakko Tuomilehto, and Minna M. Kaarisalo

Subjects
Aging, medicine.medical_specialty, Health (social science), business.industry, Atrial fibrillation, 030204 cardiovascular system & hematology, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Blood pressure, Diabetes mellitus, Internal medicine, Concomitant, Cohort, medicine, Hospital discharge, Cardiology, cardiovascular diseases, Myocardial infarction, Geriatrics and Gerontology, business, Gerontology, Stroke, 030217 neurology & neurosurgery
Abstract

This paper aims at studying the development and the risk factors for stroke prospectively during a 6-year follow-up in the Turku Elderly Study, Turku, Finland. The study cohort consisted of 1032 people aged 70 years at baseline. The stroke events (ICD-9 codes 430–434) were identified by computer linkage from the hospital discharge and death registers, and from a follow-up questionnaire. During the 6 years of follow-up, 71 patients (6.9%) suffered a stroke. Previous stroke (RR 5.82), history of transient ischemic attack (RR 4.14), diabetes mellitus (RR 2.50), poorly controlled hypertension (RR 2.42), smoking (RR 1.94) and male sex (RR 1.65) were independent risk factors for stroke. Atrial fibrillation, cardiac failure and previous myocardial infarction did not appear to be significant independent predictors of stroke in the elderly. The risk of stroke in the elderly population appears to be strongly related to the concomitant clinical disease, and this should be remembered when identifying persons at increased risk of stroke. Poorly controlled hypertension was associated with an increased risk of stroke. Thus, achieving a good control of blood pressure in elderly hypertensives receiving treatment has the potential to prevent strokes.

Published
2000

17. Long-term prognosis after coronary artery bypass surgery

Author

Juha Mustonen, Veikko Salomaa, Pia Pajunen, Mika Niemelä, Aapo Lehtonen, Matti Ketonen, Kari Kuulasmaa, Vuorenmaa T, P. Palomäki, J. Tuomilehto, H. Miettinen, Heli Koukkunen, Juhani Airaksinen, Seppo Lehto, Mähönen M, Jorma Torppa, Immonen-Räihä P, M. Arstila, and Kalevi Pyörälä

Subjects
Adult, Male, medicine.medical_specialty, Population, Myocardial Infarction, Body Mass Index, Diabetes Complications, Coronary artery bypass surgery, Sex Factors, Risk Factors, Internal medicine, Cause of Death, Epidemiology, medicine, Humans, cardiovascular diseases, Myocardial infarction, Poisson Distribution, Registries, Coronary Artery Bypass, education, Survival rate, Finland, Cause of death, Proportional Hazards Models, education.field_of_study, business.industry, Proportional hazards model, Smoking, Age Factors, Middle Aged, medicine.disease, Prognosis, Survival Rate, Population Surveillance, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Body mass index, Follow-Up Studies
Abstract

Objective To analyse the risk of coronary heart disease (CHD) events and total mortality among patients who had coronary artery bypass graft (CABG) surgery during 1988–1992. Methods A population-based myocardial infarction (MI) register included data on invasive cardiac procedures among residents of the study area. The subjects aged 35–64 years were followed-up for 12 years for non-fatal and fatal CHD events and all-cause mortality, excluding events within 30 days of the CABG operation. CABG was performed on 1158 men and 215 women. Results The overall survival of men who underwent CABG was similar to the survival of the corresponding background population for about ten years but started to worsen after that. At twelve years of follow-up, 23% ( n = 266, 95% CI 234–298) of the men who had undergone the operation had died, while the expected proportion, based on mortality in the background population, was 20% ( n = 231, 95% CI 226–237). The CHD mortality of men who had undergone the operation was clearly higher than in the background population. Among women, the mortality after CABG was about twice the expected mortality in the corresponding background population. In Cox proportional hazards models age, smoking, history of MI, body mass index and diabetes were significant predictors of mortality. Conclusions The prognosis of male CABG patients did not differ from the prognosis of the corresponding background population for about ten years, but started to deteriorate after that. History of MI prior to CABG and major cardiovascular risk factors was a predictor of an adverse outcome.

Published
2006

18. Population-based mammography screening results in substantial savings in treatment costs for fatal breast cancer

Author

Pauliina Kronqvist, Lea Kauhava, Immonen-Räihä P, Anne Kaljonen, Pekka J. Klemi, Hans Helenius, Liisa Pylkkänen, Osmo Räsänen, Kaija Holli, and Ilmo Parvinen

Subjects
Adult, Cancer Research, medicine.medical_specialty, Cost-Benefit Analysis, Population, Breast Neoplasms, Population based, Breast cancer, Cost Savings, Internal medicine, medicine, Mammography, Humans, Treatment costs, education, health care economics and organizations, Aged, Gynecology, education.field_of_study, medicine.diagnostic_test, business.industry, Cancer, Health Care Costs, Middle Aged, medicine.disease, Oncology, Fatal disease, Female, Mammography screening, business
Abstract

The aim was to assess the effect of population-based mammography screening on treatment costs for fatal breast cancer in Turku, Finland.The study included 556 women with invasive breast cancer, diagnosed at the age of 40-74 years in 1987-1993: 427 in the screened group (screen-detected or interval cancer) and 129 in the unscreened group (not yet invited or refused screening). Both groups were followed up for 8 years from diagnosis.In the unscreened group, 32 (25%) patients died of breast cancer versus 49 (12%) in the screened group (p0.001). The non-discounted mean treatment costs were 2.8-fold for those dying of breast cancer compared to survivors: 26,222 euros versus 9,434 euros; the difference between means was 16,788 euros (95% CI 14,915-18,660) (p0.001). The mean costs for fatal cases were high, irrespective of the way cancer was detected: 23,800 euros in the unscreened group versus 27,803 euros in the screened group; the difference between means was -4,003 euros (-10,810 to 2802) (p=0.245). In the unscreened group, patients with fatal breast cancer accounted for 41% (0.76/1.87 million euros) of the total treatment costs versus 29% (1.36/4.76 million euros) in the screened group. It was estimated that about one third of costs for fatal breast cancer were avoided through mammography screening, accounting for 72-81% of the estimated total treatment cost savings achieved by screening. About 31-35% of the screening costs for 1987 to 1993 were offset by savings in treatment costs.Treatment costs for fatal breast cancer are high. Mammography screening results in substantial treatment cost savings, in which reduction of fatal disease is the key element.

Published
2005

19. Effects of annual vs triennial mammography interval on breast cancer incidence and mortality in ages 40-49 in Finland.

Author

Parvinen, I, Chiu, S, Pylkkänen, L, Klemi, P, Immonen-Räihä, P, Kauhava, L, Malila, N, Hakama, M, Pylkkänen, L, and Immonen-Räihä, P

Subjects
MAMMOGRAMS, BREAST cancer, CANCER-related mortality, MEDICAL screening
Abstract

Background: The aim of this study was to evaluate the effects of mammography screening invitation interval on breast cancer mortality in women aged 40-49 years.Methods: Since 1987 in Turku, Finland, women aged 40-49 years and born in even calendar years were invited for mammography screening annually and those born in odd years triennially. The female cohorts born during 1945-1955 were followed for up to 10 years for incident breast cancers and thereafter for an additional 3 years for mortality.Results: Among 14,765 women free of breast cancer at age 40, there were 207 incident primary invasive breast cancers diagnosed before the age of 50. Of these, 36 women died of breast cancer. The mean follow-up time for cancer incidence was 9.8 years and for mortality 12.8 years. The incidence of breast cancer was similar in the annual and triennial invitation groups (RR: 0.98, 95% confidence interval (CI): 0.75-1.29). Further, there were no significant differences in overall mortality (RR: 1.20, 95% CI: 0.99-1.46) or in incidence-based breast cancer mortality (RR: 1.14, 95% CI: 0.59-1.27) between the annual and triennial invitation groups.Conclusions: There were no differences in the incidence of breast cancer or incidence-based breast cancer mortality between the women who were invited for screening annually or triennially. [ABSTRACT FROM AUTHOR]

Published
2011
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23. Decline in Out-of-Hospital Coronary Heart Disease Deaths Has Contributed the Main Part to the Overall Decline in Coronary Heart Disease Mortality Rates Among Persons 35 to 64 Years of Age in Finland

Author

Salomaa, V., primary, Ketonen, M., additional, Koukkunen, H., additional, Immonen-Räihä, P., additional, Jerkkola, T., additional, Kärjä-Koskenkari, P., additional, Mähönen, M., additional, Niemelä, M., additional, Kuulasmaa, K., additional, Palomäki, P., additional, Mustonen, J., additional, Arstila, M., additional, Vuorenmaa, T., additional, Lehtonen, A., additional, Lehto, S., additional, Miettinen, H., additional, Torppa, J., additional, Tuomilehto, J., additional, Kesäniemi, Y.A., additional, and Pyörälä, K., additional

Published
2003
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24. Customer fee and participation in breast-cancer screening

Author

Immonen-Räihä P, Hans Helenius, Pekka J. Klemi, Lea Kauhava, and Ilmo Parvinen

Subjects
Adult, medicine.medical_specialty, Adolescent, Breast cancer screening, Age Distribution, medicine, Humans, Mammography, Breast screening, Child, Socioeconomic status, Finland, Aged, Retrospective Studies, Gynecology, medicine.diagnostic_test, business.industry, Attendance, Retrospective cohort study, General Medicine, Middle Aged, Socioeconomic Factors, Family medicine, Income, Female, business
Abstract

Summary Until 1997, breast screening by mammography was free for all women living in Turku, Finland. After this date, women born in certain years had to pay to be screened. We did a retrospective study, using data obtained from Statistics Finland, to ascertain whether or not the introduction of a fee affected attendance. We also assessed the effect of socioeconomic status on attendance. Our findings show that people who had to pay for mammography attended less often than women who were entitled to free screening, irrespective of their socioeconomic status.

Published
2001

25. More than half of acute stroke events occur in persons older than 74 years

Author

Aapo Lehtonen, J Tuomilehto, Veikko Salomaa, Jorma Torppa, Sarti C, and Immonen-Räihä P

Subjects
medicine.medical_specialty, business.industry, Rehabilitation, Emergency medicine, medicine, Surgery, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Acute stroke
Published
1997

26. Lower recurrence risk through mammographic screening reduces breast cancer treatment costs.

Author

Kauhava, Lea, Immonen-Räihä, Pirjo, Parvinen, Ilmo, Holli, Kaija, Pylkkänen, Liisa, Kaljonen, Anne, Helenius, Hans, Kronqvist, Pauliina, and Klemi, Pekka J.

Subjects
BREAST cancer treatment, CANCER relapse, MAMMOGRAMS, MEDICAL screening, MEDICAL care costs, RADIOSCOPIC diagnosis, PREVENTION
Abstract

Abstract: Mammographic screening is associated with a reduced risk of breast cancer recurrence. The objective of the study was to evaluate treatment costs due to breast cancer recurrence in relation to patients’ use of mammographic screening, consecutively collected in a defined population. The study included 418 women exposed to screening and 109 women unexposed to screening diagnosed with stage I–III breast cancer. During the first eight years after primary diagnosis, 19% (N =80) of the exposed women and 33% (N =36) of the unexposed women developed recurrent disease, P =0.002. In the exposed group, 41% of the 8-year treatment costs were for the treatment of patients who developed recurrent disease, compared with 52% in the unexposed group, P =0.039. Among the relapsed patients, the mean post-recurrence costs were EUR14,950, accounting for 65% of their total 8-year costs. The mean post-recurrence costs were comparable for both exposure groups irrespective of the detection method. [Copyright &y& Elsevier]

Published
2008
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27. Trends in coronary events in Finland during 1983–1997; The FINAMI study.

Author

Salomaa, V., Ketonen, M., Koukkunen, H., Immonen-Räihä, P., Jerkkola, T., Kärjä-Koskenkari, P., Mähönen, M., Niemelä, M., Kuulasmaa, K., Palomäki, P., Arstila, M., Vuorenmaa, T., Lehtonen, A., Lehto, S., Miettinen, H., Torppa, J., Tuomilehto, J., Kesäniemi, Y.A., and Pyörälä, K.

Abstract

Aims To analyse the trends in incidence, recurrence, case fatality, and treatments of acute coronary events in Finland during the 15-year period 1983–97.Methods and results Population-based MI registration has been carried out in defined geographical areas, first as a part of the FINMONICA Project and then continued as the FINAMI register. During the study period, 6501 coronary heart disease (CHD) events were recorded among men and 1778 among women aged 35–64 years. The CHD mortality declined on average 6.4%/year (95% confidence interval −5.4, −7.4%) among men and 7.0%/year (−4.7, −9.3%) among women. The mortality from recurrent events declined even more steeply, 9.9%/year (−8.3, −11.4%) among men and 9.3%/year (−5.1, −13.4%) among women. The proportion of recurrent events of all CHD events also declined significantly in both sexes. Of all coronary deaths, 74% among men and 61% among women took place out-of-hospital. The decline in 28-day case fatality was 1.3%/year (−0.3, −2.3%) among men and 3.1%/year (−0.7, −5.5%) among women.Conclusions The study period was characterized by a marked reduction in the occurrence of recurrent CHD events and a relatively modest reduction in the 28-day case fatality. The findings suggest that primary and secondary prevention have played the main roles in the decline in CHD mortality in Finland. [ABSTRACT FROM PUBLISHER]

Published
2003
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29. Gender differences in recurrent coronary events. The FINMONICA MI register.

Author

Schreiner, P.J, Niemelä, M, Miettinen, H, Mähönen, M, Ketonen, M, Immonen-Räihä, P, Lehto, S, Vuorenmaa, T, Palomäki, P, Mustaniemi, H, Kaarsalo, E, Arstila, M, Torppa, J, Puska, P, Tuomilehto, J, Pyörälä, K, and Salomaa, V

Abstract

Background Male gender is an established risk factor for first myocardial infarction, but some studies have suggested that among myocardial infarction survivors, women fare worse than men. Therefore, we examined the long-term prognosis of incident myocardial infarction survivors in a large, population-based MI register, addressing gender differences in mortality as well as the number of events and time intervals between recurrent events.Methods and Results Study subjects included 4900 men and women, aged 25–64 years, with definite or probable first myocardial infarctions who were alive 28 days after the onset of symptoms. At first myocardial infarction, women were older and more likely to be hypertensive or diabetic than men, and had a greater proportion of probable vs definite events. After adjustment for age and geographic region, men had 1·74 times the risk of fatal coronary heart disease relative to women (hazard ratio=1·63 and 1·55 for cardiovascular disease and all-cause mortality, respectively) over an average of 5·9 years of follow-up. Number and time intervals between any recurrent event—fatal and non-fatal—did not differ by gender.Conclusion These data suggest that men are far more likely to have a fatal recurrent event than women despite comparable numbers of events. [ABSTRACT FROM PUBLISHER]

Published
2001
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31. Prognosis of acute coronary events is worse in patients living alone: the FINAMI myocardial infarction register

Author

Lammintausta, Aino, Airaksinen, Juhani, Immonen-Räihä, Pirjo, Torppa, Jorma, Kesäniemi, Antero, Ketonen, Matti, Koukkunen, Heli, Kärjä-Koskenkari, Päivi, Lehto, Seppo, and Salomaa, Veikko

Abstract

BackgroundSingle living has been associated with a worse prognosis of acute coronary syndrome (ACS). We aimed to study the relation of sociodemographic characteristics to the morbidity, mortality, and case fatality (CF) of ACS in a large population-based ACS register.MethodsThe population-based FINAMI myocardial infarction register recorded 15,330 cases of ACS among persons aged 35–99 years in Finland in 1993–2002. Record linkage with the files of Statistics Finland provided information on sociodemographic characteristics (marital status, household size).ResultsACS incidence and 28-day mortality rate were higher in unmarried men and women in all age groups. The prehospital CF of incident ACS was higher in single living and/or unmarried 35–64-year-old people. The 28-day CF was 26% (95% confidence interval, CI, 24–29%) in married men, 42% (95% CI 37–47%) in men who had previously been married, and 51% (95% CI 46–57%) in never-married men. Among women, the corresponding figures were 20% (95% CI 15–24%), 32% (95% CI 25–39%), and 43% (95% CI 31–56%). Most of these CF differences were apparent already at the prehospital phase. The only difference in treatment was that middle-aged men living alone or unmarried received thrombolysis less often. The disparities in ACS morbidity and mortality by marital status tended to widen during the study period.ConclusionsSingle living and/or being unmarried increases the risk of having a heart attack and worsens its prognosis both in men and women regardless of age. Most of the excess mortality appears already before the hospital admission and seems not to be related to differences in treatment of ACS.

Published
2014
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36. Mammographic screening reduces risk of breast carcinoma recurrence

Author

Immonen‐Räihä, Pirjo, Kauhava, Lea, Parvinen, Ilmo, Holli, Kaija, Kronqvist, Pauliina, Pylkkänen, Liisa, Helenius, Hans, Kaljonen, Anne, Räsänen, Osmo, and Klemi, Pekka J.

Abstract

The current report is a long‐term evaluation of breast carcinoma recurrence, factors predicting recurrence, and postrecurrence prognosis in relation to patients' use of service screening, which has been provided in Turku, Finland, since 1987 for women ages 40–74 years.The current study included 527 invasive breast carcinomas: 418 in the screening group (which included screen‐detected and interval malignancies) and 109 in the nonscreening group (which included breast carcinomas detected before initial screening and those detected in patients who chose not to undergo screening). These breast carcinomas were diagnosed among women ages 40–74 years between 1987 and 1993, with follow‐up extending until the end of 2001.In the screening group, the risk of recurrence was only approximately half of the corresponding risk in the nonscreening group (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.39–0.83; P = 0.003). Five years after the primary diagnosis, 16% of patients in the screening group and 28% of patients in the nonscreening group (P = 0.001) had experienced recurrence; 10 years after diagnosis, the corresponding rates were 21% and 34%, respectively (P = 0.001). Postrecurrence prognosis was comparable for both detection groups (HR, 1.17; 95% CI, 0.70–1.94; P = 0.551), with approximately half of all patients dying of disease 5 years after recurrence. Detection of breast carcinoma via a method other than mammographic screening was associated with a high risk of recurrence on univariate analysis. On Cox multivariate analysis, risk factors for recurrence included lobular histologic type (HR, 2.23; 95% CI, 1.44–3.48; P < 0.001), poor histologic grade (HR, 2.02; 95% CI, 1.20–3.39; P = 0.008), and large tumor size (HR, 1.60; 95% CI, 1.07–2.37; P = 0.021).Long‐term data from a population‐based program demonstrated that mammographic screening reduced patients' risk of breast carcinoma recurrence. Specifically, the risk for patients with screen‐detected disease was only approximately half of the risk for patients with non‐screen‐detected disease. Nonetheless, postrecurrence prognosis was comparable for patients in both detection groups. Cancer 2005. © 2004 American Cancer Society.

Published
2005
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37. Relation of socioeconomic position to the case fatality, prognosis and treatment of myocardial infarction events; the FINMONICA MI Register Study

Author

Palomäki, P., Salomaa, V., Mustaniemi, H., Miettinen, H., Kaarsalo, E., Niemelä, M., Arstila, M., Ketonen, M., Torppa, J., Mähönen, M., Kuulasmaa, K., Immonen-Räihä, P., Puska, P., Lehto, S., Pyörälä, K., Vuorenmaa, T., Tuomilehto, J., and Koskinen, S.

Abstract

OBJECTIVE: To examine socioeconomic differences in case fatality and prognosis of myocardial infarction (MI) events, and to estimate the contributions of incidence and case fatality to socioeconomic differences in coronary heart disease (CHD) mortality. DESIGN: A population-based MI register study. METHODS: The FINMONICA MI Register recorded all MI events among persons aged 35-64 years in three areas of Finland during 1983-1992. A record linkage of the MI Register data with the files of Statistics Finland was performed to obtain information on socioeconomic indicators for each individual registered. First MI events (n=8427) were included in the analyses. MAIN RESULTS: The adjusted risk ratio of prehospital coronary death was 2.11 (95% CI 1.82, 2.46) among men and 1.68 (1.14, 2.48) among women with low income compared with those with high income. Even among persons hospitalised alive the risk of death during the next 12 months was markedly higher in the low income group than in the high income group. Case fatality explained 51% of the CHD mortality difference between the low and the high income groups among men and 38% among women. Incidence contributed 49% and 62%, respectively. CONCLUSIONS: Considerable socioeconomic differences were observed in the case fatality of first coronary events both before hospitalisation and among patients hospitalised alive. Case fatality explained a half of the CHD mortality difference between the low and the high income groups among men and more than a third among women.

Published
2001

38. Socioeconomic Differences in the Incidence, Mortality and Prognosis of Intracerebral Hemorrhage in Finnish Adult Population

Author

Jakovljević, Dimitrije, Sarti, Cinzia, Sivenius, Juhani, Torppa, Jorma, Mähönen, Markku, Immonen-Räihä, Pirjo, Kaarsalo, Esko, Alhainen, Kari, Tuomilehto, Jaakko, Puska, Pekka, and Salomaa, Veikko

Abstract

AbstractWe examined the association of socioeconomic status (SES) with the incidence, mortality and case fatality of intracerebral hemorrhage (ICH). During 1982–1992, 909 ICH events were registered among persons aged 25–74 years. Taxable income was used as an indicator of SES. It was stratified into three categories: low, middle and high. The age-standardized incidence and mortality of ICH were significantly higher in the low- than in the high-income group in both genders. Among men aged 25–59 years, the adjusted odds ratio (OR) of ICH death within 1 year after the onset of the event was twice as high in the low-income group as in the high-income group (OR = 2.12, 95% confidence interval 1.02–4.40). In conclusion, marked socioeconomic differences were found in the incidence and mortality of ICH, in particular among working aged men.Copyright © 2001 S. Karger AG, Basel

Published
2001
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39. Socioeconomic Inequalities in the Incidence, Mortality and Prognosis of Subarachnoid Hemorrhage: The FINMONICA Stroke Register

Author

Jakovljević, Dimitrije, Sivenius, Juhani, Sarti, Cinzia, Torppa, Jorma, Mähönen, Markku, Immonen-Räihä, Pirjo, Kaarsalo, Esko, Alhainen, Kari, Tuomilehto, Jaakko, Puska, Pekka, and Salomaa, Veikko

Abstract

Low socioeconomic status (SES) is associated with increased mortality from stroke, but usually no distinction is made between stroke subtypes. We analyzed the relationship of SES with mortality and morbidity of subarachnoid hemorrhage (SAH). In the FINMONICA Stroke Register, 956 consecutive SAH events were recorded during 1983–1992 in patients aged 25–74 years. We used taxable income stratified into three categories, low, middle, and high, as an indicator of SES. The age-standardized incidence of SAH among men and women aged 25–44 years was approximately three times higher in the low-income group than in the high-income group. In older individuals, differences between the income groups were less pronounced. Among survivors of the acute stage, a poorer prognosis was observed in patients with low income than in those with high income. In conclusion, there is a clear excess mortality and morbidity of SAH in young individuals with low income, particularly among men.

Published
2001
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40. Atrial Fibrillation in Older Stroke Patients: Association with Recurrence and Mortality After First Ischemic Stroke

Author

Kaarisalo, Minna M., Immonen‐Räihä, Pirjo, Marttila, Reijo J., Lehtonen, Aapo, Salomaa, Veikko, Sarti, Cinzia, Sivenius, Juhani, Torppa, Jorma, and Tuomilehto, Jaakko

Abstract

OBJECTIVES: The objective of this study was to determine the association of atrial fibrillation (AF) with stroke recurrence and mortality and with the causes of death in ischemic stroke patients aged 75 years and older.

Published
1997
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41. Secondary prevention of coronary heart disease is disappointing among patients of working age

Author

Sumanen, Markku, Koskenvuo, Markku, Immonen-Räihä, Pirjo, Suominen, Sakari, Sundell, Jari, and Mattila, Kari

Abstract

Background. The risk factors underlying coronary heart disease (CHD) are well known. Objective. The purpose of this study was to evaluate risk factors related to secondary prevention of working-age CHD patients. Methods. CHD patients with (n = 139) and without (n = 203) myocardial infarction were selected from a postal questionnaire study (n = 21 101) of randomly selected Finns aged 20–54 years (HeSSup study). Four age- and sex-matched controls were chosen for every patient. Results. CHD patients still smoke, are obese and suffer hangovers more frequently than the control population. Conclusion. The health care system has not succeeded in the secondary prevention of CHD.

Published
2004
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43. Aging of the population may not lead to an increase in the numbers of acute coronary events: a community surveillance study and modelled forecast of the future.

Author

Salomaa V, Havulinna AS, Koukkunen H, Kärjä-Koskenkari P, Pietilä A, Mustonen J, Ketonen M, Lehtonen A, Immonen-Räihä P, Lehto S, Airaksinen J, and Kesäniemi YA

Subjects
Acute Coronary Syndrome mortality, Age Factors, Age of Onset, Aged, Bayes Theorem, Comorbidity, Epidemiology trends, Female, Finland epidemiology, Forecasting, Humans, Incidence, Logistic Models, Male, Markov Chains, Middle Aged, Monte Carlo Method, Registries, Survivors statistics & numerical data, Time Factors, Acute Coronary Syndrome epidemiology, Aging, Computer Simulation, Models, Statistical
Abstract

Objective: To examine the incidence, mortality and case fatality of acute coronary syndrome (ACS) in Finland during 1993-2007 and to create forecasts of the absolute numbers of ACS cases in the future, taking into account the aging of the population., Design: Community surveillance study and modelled forecasts of the future., Setting and Methods: Two sets of population-based coronary event register data from Finland (FINAMI and the National Cardiovascular Disease Register (CVDR)). Bayesian age-period-cohort (APC) modelling., Participants: 24 905 observed ACS events in the FINAMI register and 364 137 in CVDR., Main Outcome Measures: Observed trends of ACS events during 1993-2007, forecasted numbers of ACS cases, and the prevalence of ACS survivors until the year 2050., Results: In the FINAMI register, the average annual declines in age-standardised incidence of ACS were 1.6% (p<0.001) in men and 1.8% (p<0.001) in women. For 28-day case fatality of incident ACS, the average annual declines were 4.1% (p<0.001) in men and 6.7% (p<0.001) in women. Findings in the country-wide CVDR data were consistent with the FINAMI register. The APC model, based on the CVDR data, suggested that both the absolute numbers of ACS events and the prevalence of ACS survivors reached their peak in Finland around 1990, have declined since then, and very likely will continue to decline until 2050., Conclusions: The ACS event rates and absolute numbers of cases have declined steeply in Finland. The declining trends are likely to continue in the future despite the aging of the population.

Published
2013
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44. Socioeconomic inequalities in the morbidity and mortality of acute coronary events in Finland: 1988 to 2002.

Author

Lammintausta A, Immonen-Räihä P, Airaksinen JK, Torppa J, Harald K, Ketonen M, Lehto S, Koukkunen H, Kesäniemi AY, Kärjä-Koskenkari P, and Salomaa V

Subjects
Adult, Aged, Aged, 80 and over, Coronary Disease epidemiology, Coronary Disease mortality, Cost Control methods, Economic Recession, Female, Finland epidemiology, Humans, Male, Middle Aged, State Medicine standards, State Medicine trends, Universal Health Insurance, Coronary Disease economics, Health Status Disparities, Healthcare Disparities economics, Social Class, State Medicine economics
Abstract

Purpose: To examine the changes in socioeconomic disparities in the incidence of coronary heart disease (CHD) and mortality in Finland and to analyze the effects of the severe economic recession of the early 1990s on these disparities., Methods: The population-based FINAMI Myocardial Infarction (MI) register recorded all suspected MI events among men and women ages 35 to 99 years in four geographical areas of Finland. Record linkage with the files of Statistics Finland provided us with detailed information on the indicators of socioeconomic status (SES; income, education, and profession). Rates were expressed per 100,000 inhabitants of each socioeconomic group per year and age-standardized to the European standard population. Poisson regression was used for analyzing rate ratios and time trends of coronary events in different socioeconomic groups., Results: The mortality rate ratio of coronary events among 35- to 64 year-old men was 5.21 (95% confidence interval, 4.23-6.41) when the lowest income sixth to the highest income sixth were compared. Among women, the respective rate ratio was 11.13 (5.77-21.45). Significant differences in the incidence and 28-day mortality by SES were seen also in the older age groups. Some socioeconomic differences were found in the proportions of patients receiving thrombolysis or undergoing early revascularization. No substantial changes were observed in inequalities between the socioeconomic groups during the study period., Conclusions: The excess CHD morbidity and mortality among persons with lower SES is still considerable in Finland, but the economic recession did not widen the differences., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Published
2012
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45. Myocardial infarction events and cardiovascular risk factor levels in Finnish- and Swedish-speaking populations of Finland.

Author

Lammintausta A, Immonen-Räihä P, Lehtonen A, Räihä I, Harald K, Torppa J, Airaksinen JK, and Salomaa V

Subjects
Adult, Age Factors, Aged, Aged, 80 and over, Blood Pressure, Body Mass Index, Cardiovascular Diseases etiology, Cholesterol, HDL blood, Female, Finland epidemiology, Health Surveys statistics & numerical data, Humans, Male, Middle Aged, Myocardial Infarction etiology, Registries, Risk Factors, Sex Factors, Socioeconomic Factors, Triglycerides blood, Cardiovascular Diseases epidemiology, Language, Myocardial Infarction epidemiology
Abstract

BACKGROUND. The Swedish-speaking minority of Finland is unique, because it has a higher socioeconomic status (SES) and longer life expectancy than the Finnish-speaking majority. We hypothesized that this minority may have a lower attack rate of coronary events and analysed whether this could be explained by their higher SES. METHODS. The population-based myocardial infarction (MI) registers recorded 4,845 MI events in Turku during 1988-1998. Individual-level indicators of SES were obtained from Statistics Finland. The population-based FINRISK surveys recorded cardiovascular risk factors and native languages of 10,432 people in 1987, 1997, and 2002. RESULTS. The age-standardized attack rate of MI was lower among the 35-64-year-old Swedish-speaking men than among Finnish-speaking men (rate ratio 0.66; 95% confidence interval 0.47-0.85) and the difference remained significant after adjustment for SES. The Swedish-speaking inhabitants had higher age-, sex-, and SES-adjusted high-density lipoprotein cholesterol, and lower triglycerides, body mass index, and diastolic blood pressure. Conclusion. The Swedish-speaking inhabitants of Turku had lower MI morbidity and coronary mortality than the Finnish-speaking inhabitants. After controlling for SES, these differences remained significant among men, suggesting that other factors, such as differences in the risk factor profiles may also play a role.

Published
2011
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46. Coronary events in persons aged 75 years or older in Finland from 1995 to 2002: the FINAMI study.

Author

Koukkunen H, Salomaa V, Lehto S, Ketonen M, Immonen-Räihä P, Lehtonen A, Havulinna A, Kesäniemi YA, and Pyörälä K

Subjects
Adult, Age Factors, Aged, Aged, 80 and over, Coronary Disease epidemiology, Female, Finland epidemiology, Humans, Incidence, Male, Middle Aged, Myocardial Infarction epidemiology, Myocardial Infarction therapy, Coronary Disease mortality, Myocardial Infarction mortality, Registries statistics & numerical data
Abstract

The authors used population-based myocardial infarction (MI) register data to examine trends in incidence, case fatality, treatment strategies of MI, and coronary heart disease (CHD) mortality in persons aged 75 to 99 years in 4 areas of Finland during 1995 through 2002. This age group contributed 53% (n=13,977) of all CHD events, and 65% occurred in women. CHD mortality declined among men annually by 3.5% and 1.0% in the 75- to 84-year-old and 85- to 99-year-old age groups, respectively. Among women, it declined by 2.2% per year in the 75- to 84-year-old age group but increased by 1.3% per year in the 85- to 99-year-old age group. MI attack rate did not change in men but increased significantly in women aged 85 to 99 years. Clinical management of MI in elderly patients was more conservative than in middle-aged patients. In conclusion, one-half of all CHD events occur among persons aged 75 years or older, and elderly patients with CHD represent an increasing burden to the health care system.

Published
2008

47. The validation of the Finnish Hospital Discharge Register and Causes of Death Register data on stroke diagnoses.

Author

Tolonen H, Salomaa V, Torppa J, Sivenius J, Immonen-Räihä P, and Lehtonen A

Subjects
Adult, Age Distribution, Aged, Cause of Death, Cerebral Hemorrhage diagnosis, Cerebral Hemorrhage epidemiology, Cerebral Infarction diagnosis, Cerebral Infarction epidemiology, Cerebrovascular Disorders mortality, Female, Finland epidemiology, Humans, Incidence, International Classification of Diseases, Male, Middle Aged, Population Surveillance, Predictive Value of Tests, Reproducibility of Results, Sensitivity and Specificity, Sex Distribution, Stroke diagnosis, Stroke epidemiology, Subarachnoid Hemorrhage diagnosis, Subarachnoid Hemorrhage epidemiology, Survival Analysis, Cerebrovascular Disorders diagnosis, Cerebrovascular Disorders epidemiology, Hospital Records statistics & numerical data, Patient Discharge statistics & numerical data, Registries statistics & numerical data
Abstract

Background and Purpose: Administrative registers, like hospital discharge registers and causes of death registers are used for the monitoring of disease incidences and in the follow-up studies. Obtaining reliable results requires that the diagnoses in these registers are correct and the coverage of the registers is high. The purpose of this study was to evaluate the validity of the Finnish hospital discharge registers and causes of death registers stroke diagnoses against the population-based FINSTROKE register., Methods: All first stroke events from the hospital discharge registers and causes of death registers from the areas covered by the FINSTROKE register were obtained for years 1993-1998 and linked to the FINSTROKE register. The sensitivity and positive predictive values were calculated., Results: A total of 3633 stroke events, 767 fatal and 2866 non-fatal strokes, were included in the registers. The sensitivity for all first stroke events was 85%, for fatal strokes 86% and for non-fatal strokes 85%. The positive predictive values for all first strokes was 86%, for fatal strokes 92% and for non-fatal strokes 85%. The sensitivity as well as the positive predictive values for subarachnoid haemorrhage and intracerebral haemorrhage was higher than for cerebral infarctions. There were no marked differences in the sensitivity or positive predictive values between men and women., Conclusions: The sensitivity and the positive predictive values of the Finnish hospital discharge registers and causes of death registers are fairly good. Finnish administrative registers can be used for the monitoring of stroke incidence, but the number of cerebral infarctions should be interpreted with caution.

Published
2007
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48. The effect of correcting for troponins on trends in coronary heart disease events in Finland during 1993-2002: the FINAMI study.

Author

Salomaa V, Ketonen M, Koukkunen H, Immonen-Räihä P, Lehtonen A, Torppa J, Kuulasmaa K, Kesäniemi YA, and Pyörälä K

Subjects
Adult, Age Distribution, Aged, Biomarkers blood, Cost of Illness, Electrocardiography, Female, Finland epidemiology, Humans, Incidence, Male, Middle Aged, Mortality trends, Myocardial Infarction blood, Regression Analysis, Myocardial Infarction mortality, Troponin blood
Abstract

Aims: The object of this study is to analyse the trends in coronary events in Finland during 1993-2002, correcting for the effect of troponins., Methods and Results: A population-based myocardial infarction register recorded all coronary events (n=14 782) in four geographical areas of Finland during 1993-2002. Correction coefficients for the effect of troponins were calculated on the basis of 4359 coronary events, with simultaneous determination of troponins and the 'old' enzymatic markers of myocardial injury. Coronary mortality declined steeply, except in women aged > or = 75 years. The incidence of first coronary events declined 2.0% (95% confidence interval -3.0, -0.9%) per year among men and 1.0% (-2.7, 0.6%) per year among women aged 35-74 years. After correcting for the effect of troponins, also the decline among women became statistically significant: 2.7% (-4.5, -0.8%) per year. The effect of troponins tended to be stronger in women and older individuals than in men and younger individuals. The 28-day case fatality declined among men, but not among women. The effect of troponins on case fatality trends was weak., Conclusion: Declining trends in the incidence of coronary events in Finland during 1993-2002 were partly hidden by the effect of troponins. Both incidence and case fatality declines have contributed to the decline in mortality.

Published
2006
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49. Diabetes worsens the outcome of acute ischemic stroke.

Author

Kaarisalo MM, Räihä I, Sivenius J, Immonen-Räihä P, Lehtonen A, Sarti C, Mähönen M, Torppa J, Tuomilehto J, and Salomaa V

Subjects
Acute Disease, Aged, Female, Finland epidemiology, Humans, Male, Registries, Risk Factors, Smoking, Treatment Outcome, Brain Ischemia complications, Brain Ischemia epidemiology, Diabetic Angiopathies physiopathology
Abstract

Objective: To characterize acute stroke events in diabetic patients in a population-based stroke register and to determine the influence of diabetes on the outcome of acute stroke., Methods: Four thousand three hundred and ninety patients were recorded in the FINMONICA and FINSTROKE registers after their first ischemic stroke from 1990 to 1998. We followed mortality and stroke outcome for up to 4 weeks after the onset of acute stroke., Results: Of the 4390 patients who had had an ischemic stroke, 43.6% were male and 25.1% (1103) had diabetes. Their mean age was 72.4 (S.D. 12.0) years and this was similar in patients with and without diabetes (72.9 years versus 72.3 years, p=0.18). Subjects with diabetes were more likely to be hypertensive (55% versus 38%, p<0.001) and have a history of myocardial infarction (20% versus 16%, p<0.001) than the non-diabetic stroke patients. Mortality at 4 weeks from the onset was higher in diabetic than in non-diabetic patients (20.0% versus 16.9% p=0.020). At day 28 after the stroke attack, diabetic patients were more likely to be disabled when compared with non-diabetic subjects (43.3% versus 33.5%, p<0.001). Using logistic regression analysis, adjusted for age-group, sex, previous medical history (MI, AF or TIA), diabetes was found to be a significant predictor of disability after stroke (OR=1.51, 95% CI 1.27-1.81)., Conclusions: Diabetes, which affected one-fourth of the ischemic stroke patients on our register, was associated with a higher risk of death and disability after the onset of stroke. Preventing diabetes in the elderly population improves the short-term prognosis of acute ischemic stroke.

Published
2005
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50. A new definition for myocardial infarction: what difference does it make?

Author

Salomaa V, Koukkunen H, Ketonen M, Immonen-Räihä P, Kärjä-Koskenkari P, Mustonen J, Lehto S, Torppa J, Lehtonen A, Tuomilehto J, Kesäniemi YA, and Pyörälä K

Subjects
Adult, Aged, Biomarkers analysis, Female, Finland epidemiology, Hospitalization, Humans, Male, Middle Aged, Myocardial Infarction epidemiology, Prognosis, Registries, Survival Analysis, Troponin analysis, Myocardial Infarction diagnosis
Abstract

Aims: As a response to changing diagnostic tools of myocardial infarction (MI), new case definitions for acute coronary events were published in 2003 as the American Heart Association Scientific Statement. We assessed the new definition in hospitalized patients in a large population-based MI register study., Methods and Results: We identified all suspected acute coronary syndromes with data either on troponin T or on troponin I and at least one of the enzymatic markers of myocardial injury (n=6104). The 2003 definition with the use of troponins identified 83% more definite MIs than the WHO MONICA definition using cardiac enzymes. The additional patients were older, had more often diabetes, and received less often thrombolysis and revascularization than those having MI by both definitions. Adjusting for age, sex, study area, and study year, the additional patients with their first MI aged 25-74 had a higher risk of cardiovascular death within 1 year than patients having definite MI by both definitions (hazard ratio 1.6, 95% CI 1.1-2.2)., Conclusion: The changing diagnostic criteria present a considerable challenge for the assessment of long-term trends in MI events in the community as well as for longitudinal studies of the natural history of MI. The 2003 definition, when applied using troponins, identified a sizable new group of MI patients, among persons with suspected acute coronary syndrome, at high risk of a recurrent event.

Published
2005
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