Diagnostic tests and treatment procedures performed prior to cardiovascular death in individuals with severe mental illness.

OBJECTIVE: To examine whether severe mental illnesses (i.e., schizophrenia or bipolar disorder) affected diagnostic testing and treatment for cardiovascular diseases in primary and specialized health care. METHODS: We performed a nationwide study of 72 385 individuals who died from cardiovascular disease, of whom 1487 had been diagnosed with severe mental illnesses. Log-binomial regression analysis was applied to study the impact of severe mental illnesses on the uptake of diagnostic tests (e.g., 24-h blood pressure, glucose/HbA1c measurements, electrocardiography, echocardiography, coronary angiography, and ultrasound of peripheral vessels) and invasive cardiovascular treatments (i.e., revascularization, arrhythmia treatment, and vascular surgery). RESULTS: Patients with and without severe mental illnesses had similar prevalences of cardiovascular diagnostic tests performed in primary care, but patients with schizophrenia had lower prevalences of specialized cardiovascular examinations (prevalence ratio (PR) 0.78; 95% CI 0.73-0.85). Subjects with severe mental illnesses had lower prevalences of invasive cardiovascular treatments (schizophrenia, PR 0.58; 95% CI 0.49-0.70, bipolar disorder, PR 0.78; 95% CI 0.66-0.92). The prevalence of invasive cardiovascular treatments was similar in patients with and without severe mental illnesses when cardiovascular disease was diagnosed before death. CONCLUSION: Better access to specialized cardiovascular examinations is important to ensure equal cardiovascular treatments among individuals with severe mental illnesses.

Undiagnosed cardiovascular disease prior to cardiovascular death in individuals with severe mental illness.

OBJECTIVE: To examine whether individuals with schizophrenia (SCZ) or bipolar disorder (BD) had equal likelihood of not being diagnosed with cardiovascular disease (CVD) prior to cardiovascular death, compared to individuals without SCZ or BD. METHODS: Multivariate logistic regression analysis including nationwide data of 72 451 cardiovascular deaths in the years 2011-2016. Of these, 814 had a SCZ diagnosis and 673 a BD diagnosis in primary or specialist health care. RESULTS: Individuals with SCZ were 66% more likely (OR: 1.66; 95% CI: 1.39-1.98), women with BD were 38% more likely (adjusted OR: 1.38; 95% CI: 1.04-1.82), and men with BD were equally likely (OR: 0.88, 95% CI: 0.63-1.24) not to be diagnosed with CVD prior to cardiovascular death, compared to individuals without SMI. Almost all (98%) individuals with SMI and undiagnosed CVD had visited primary or specialized somatic health care prior to death, compared to 88% among the other individuals who died of CVD. CONCLUSION: Individuals with SCZ and women with BD are more likely to die due to undiagnosed CVD, despite increased risk of CVD and many contacts with primary and specialized somatic care. Strengthened efforts to prevent, recognize, and treat CVD in individuals with SMI from young age are needed.

Atrial fibrillation is associated with cognitive decline in stroke-free subjects: the Tromsø Study.

BACKGROUND AND PURPOSE: Previous studies have shown associations between atrial fibrillation (AF) and cognitive decline. We investigated this association in a prospective population study, focusing on whether stroke risk factors modulated this association in stroke-free women and men. METHODS: We included 4983 participants (57% women) from the fifth survey of the Tromsø Study (Tromsø 5, 2001), of whom 2491 also participated in the sixth survey (Tromsø 6, 2007-2008). Information about age, education, blood pressure, body mass index, lipids, smoking, coffee consumption, physical activity, depression, coronary and valvular heart disease, heart failure and diabetes was obtained at baseline. AF status was based on hospital records. The outcome was change in cognitive score from Tromsø 5 to Tromsø 6, measured by the verbal memory test, the digit-symbol coding test and the tapping test. RESULTS: Mean age at baseline was 65.4 years. The mean reduction in the tapping test scores was significantly larger in participants with AF (5.3 taps/10 s; 95% CI: 3.9, 6.7) compared with those without AF (3.8 taps/10 s; 95% CI: 3.5, 4.1). These estimates were unchanged when adjusted for other risk factors and were similar for both sexes. AF was not associated with change in the digit-symbol coding or the verbal memory tests. CONCLUSION: Atrial fibrillation in stroke-free participants was independently associated with cognitive decline as measured with the tapping test.

Carotid atherosclerosis and relation to growth of infrarenal aortic diameter and follow-up diameter: the Tromsø Study.

OBJECTIVES: This research aims to study how carotid atherosclerosis is related to growth of infrarenal aortic diameter and aneurysmal formation. DESIGN: Population-based follow-up study. MATERIALS AND METHODS: At baseline, ultrasound examination of the carotid artery and the abdominal aorta was performed in 4241 persons from a general population with no evidence of abdominal aortic aneurysm (AAA). The burden of atherosclerosis was assessed as carotid total plaque area (TPA). After a mean follow-up of 6.3 years, a new ultrasound examination was performed and measurements of the aortic diameter and carotid TPA were repeated. The effects on aortic diameter progression, follow-up diameter and risk for AAA were assessed in multiple linear and logistic regression models according to carotid TPA, adjusted for known risk factors. RESULTS: When analysing AAA as a dichotomous variable, a borderline association between atherosclerosis and AAA could be demonstrated. When modelling aortic diameter as a continuous variable, a 1-SD increase in 5 years' carotid plaque area (ΔTPA) was associated with a 0.12-mm growth in infrarenal aortic diameter (standard error (SE) 0.04) and a 0.20-mm wider aorta at follow-up (SE 0.06). No independent relation was seen for baseline atherosclerosis. CONCLUSIONS: Carotid plaque progression was positively related to growth in infrarenal aortic diameter and aortic diameter at follow-up. Whether this co-variation between plaque growth and aortic diameter growth is causally related or independent events is still an open question.

Hip fractures in a city in Northern Norway over 15 years: time trends, seasonal variation and mortality : the Harstad Injury Prevention Study.

UNLABELLED: In this open population-based study from Northern Norway, there was no increase in hip fracture incidence in women and men from 1994 to 2008. Age-adjusted hip fracture rates was lower compared to reported rates from the Norwegian capital Oslo, indicating regional differences within the country. INTRODUCTION: The aim of the present population-based study was to describe age- and sex-specific incidence of hip fractures in a Northern Norwegian city, compare rates with the Norwegian capital Oslo, describe time trends in hip fracture incidence, place of injury, seasonal variation and compare mortality after hip fracture between women and men. METHODS: Data on hip fractures from 1994 to 2008 in women and men aged 50 years and above were obtained from the Harstad Injury Registry. RESULTS: There were altogether 603 hip fractures in Harstad between 1994 and 2008. The annual incidenc rose exponentially from 5.8 to 349.2 per 10,000 in men, and from 8.7 to 582.2 per 10,000 in women from the age group 50-54 to 90+ years. The age-adjusted incidence rates were 101.0 and 37.4 in women and men, respectively, compared to 118.0 in women (p = 0.005) and 44.0 in men (p = 0.09) in Oslo. The age-adjusted incidence rates did not increase between 1994-1996 and 2006-2008. The majority of hip fractures occurred indoors and seasonal variation was significant in fractures occurring outdoors only. After adjusting for age at hip fracture, mortality after fracture was higher in men than in women 3, 6 and 12 months (p ≤ 0.002) after fracture. CONCLUSIONS: There are regional differences in hip fracture incidence that cannot be explained by a north-south gradient in Norway. Preventive strategies must be targeted to indoor areas throughout the year and to outdoor areas in winter.

BMI change is associated with fracture incidence, but only in non-smokers. The Tromsø Study.

UNLABELLED: Few studies have examined the association between body mass index (BMI) change and fracture in a general population. We observed that BMI loss was associated with increased fracture risk in non-smoking men and women, but not in smokers. BMI gain was associated with decreased fracture risk in women. INTRODUCTION: Weight loss has been associated with increased fracture risk, but few studies have included men. The aim of this study was to examine the association between BMI change and fracture risk in both genders. METHODS: A population-based cohort study in Tromsø, Norway, of adults, aged 20 to 54 years in 1979, who participated in two or three health surveys in 1979-1980, 1986-1987, and 1994-1995. Weight and height were measured at each survey. Information about lifestyle was obtained by questionnaires. Poisson regression was used to estimate incidence rates and Cox proportional hazards regression model to assess the association between fracture risk and BMI change. Fractional polynomials were used to accommodate non-linear associations. RESULTS: A total of 5,549 men and 5,428 women participated. There were 1,135 fractures during 10 years of follow-up. Reduction in BMI was associated with increased non-vertebral fracture risk in non-smokers, but not in smokers. The hazard ratio in male and female non-smokers per 10-year BMI decrease of 2 kg/m(2) versus a BMI increase of 1 kg/m(2) was 1.79 (95% confidence interval (CI), 1.17-2.75) and 1.60 (95% CI, 1.28-1.99), respectively. The association was not significantly modified by initial BMI or age or by exclusion of subjects with cardiovascular diseases, diabetes, or cancer. In female non-smokers, weight gain was inversely associated with fracture risk. CONCLUSIONS: In a general Norwegian population, reduction in BMI was significantly associated with increased fracture risk in male and female non-smokers, but not in smokers. These findings could not be explained by preexisting disease.

Smoking is a strong risk factor for non-vertebral fractures in women with diabetes: the Tromsø Study.

UNLABELLED: In this longitudinal study of 4,160 postmenopausal women (3,947 without and 213 with self-reported diabetes), smoking was strongly related to fracture risk in those with diabetes. INTRODUCTION: Smoking is related to low bone mass and increased risk of fracture risk in postmenopausal women of the general population. The aim of the present longitudinal population-based study was to examine the effect of smoking on the risk of non-vertebral fractures in women ≥ 55 years of age, with specific focus on its relationship with diabetes. METHODS: A total of 4,160 women (3,947 without and 213 with self-reported diabetes) from the municipality of Tromsø, Norway, were followed for a mean of 7.6 years. Measurements of height and weight and questionnaire information concerning smoking and alcohol consumption habits, physical activity, prevalent diseases, and use of medication were collected before the start of follow-up. Non-vertebral fractures were registered during follow-up. RESULTS: A total of 1,015 without and 66 with diabetes sustained a new non-vertebral fracture. Smoking status (never, past, and current) was significantly associated with an increased risk of fracture both in women with and without diabetes (p values for trend 0.02 and <0.001, respectively, after adjustments for age), but in women without diabetes, the relationship was no longer significant after multiple adjustments. There was a strong interaction between smoking status and diabetes on fracture risk (p= 0.004). Women with diabetes who were current smokers had a 3.47 (95% CI 1.82-6.62) higher risk of non-vertebral fractures than diabetic women who were never smokers (p value for linear trend = 0.001, after multiple adjustments). CONCLUSION: We conclude that smoking is strongly related to fracture risk in postmenopausal women with self-reported diabetes.

Anemia and the risk of non-vertebral fractures: the Tromsø Study.

UNLABELLED: In this longitudinal study of 5,286 persons, men with anemia had a 2.15 higher risk of non-vertebral fractures than men with high hemoglobin levels. Women with anemia had no increased fracture risk. INTRODUCTION: Low hemoglobin levels are associated with several risk factors for fractures such as low physical function, impaired cognition, and low bone mass. The aim of this population-based, prospective study was to examine whether anemia predicts non-vertebral fractures. METHODS: A total of 5,286 inhabitants from the municipality of Tromsø, Norway (2,511 men and 2,775 women), 55-74 years old at baseline, were followed for mean 8.3 years. Measurements of hemoglobin, mean corpuscular volume, height, weight, blood pressure, blood lipids, serum creatinine, and bone mineral density and questionnaire information concerning smoking and drinking habits, physical activity, prevalent diseases, and use of medication was collected before start of follow-up. Non-vertebral fractures were registered during follow-up. RESULTS: A total of 235 men and 641 women sustained a new non-vertebral fracture. One SD lower value of hemoglobin was associated with a 1.27 higher risk of fracture in men (p < 0.001, after multiple adjustments) and 1.08 (p = 0.07) in women. Men with anemia (hemoglobin levels <13 g/dL) had a 2.15 higher risk of non-vertebral fractures than men with high levels (15.2-18.8, g/dL) whereas women with anemia (hemoglobin levels <12 g/dL) had no increased fracture risk. CONCLUSION: Anemia is associated with non-vertebral fractures in men but not in women.

Diameter of the infrarenal aorta as a risk factor for abdominal aortic aneurysm: the Tromsø Study, 1994-2001.

OBJECTIVES: We aim to study whether the diameter of the non-aneurysmatic infrarenal aorta influences the risk for abdominal aortic aneurysm (AAA) and whether the larger diameter in men can explain the male predominance in AAA. DESIGN: This is a population-based follow-up study. MATERIALS AND METHODS: In 4265 men and women with a normal-sized aorta in 1994-1995, 116 incident cases of AAA were diagnosed 7 years later. The risk of an incident AAA was analysed in a multiple logistic regression model according to baseline maximal infrarenal aortic diameter, adjusted for known risk factors. RESULTS: Compared with subjects with aortic diameter in the 21-23 mm bracket, men and women with a diameter <18mm and > or =27mm had an adjusted odds ratio (OR) of 0.30 (95% confidence interval (CI): 0.10-0.88) and 4.22 (95% CI: 1.94-9.19), respectively, for an incident AAA. When adjusted for age and baseline aortic diameter, male sex was not statistically significantly associated with the incidence of AAA (OR=1.45, 95% CI: 0.93-2.30, P=0.10). CONCLUSIONS: Increased baseline diameter of the infrarenal aorta was a highly significant, strong and independent risk factor for developing an AAA. The larger aortic diameter in men than in women may be the most important explanation for the higher AAA risk in men.

Age at menarche, total mortality and mortality from ischaemic heart disease and stroke: the Adventist Health Study, 1976-88.

BACKGROUND: Little is known about the relationship between age at menarche and total mortality and mortality from ischaemic heart disease and stroke. METHODS: A cohort study of 19 462 Californian Seventh-Day Adventist women followed-up from 1976 to 1988. A total of 3313 deaths occurred during follow-up, of which 809 were due to ischaemic heart disease and 378 due to stroke. RESULTS: An early menarche was associated with increased total mortality (P-value for linear trend <0.001), ischaemic heart disease (P-value for linear trend = 0.01) and stroke (P-value for linear trend = 0.02) mortality. There were, however, also some indications of an increased ischaemic heart disease mortality in women aged 16-18 at menarche (5% of the women). When assessed as a linear relationship, a 1-year delay in menarche was associated with 4.5% (95% CI 2.3-6.7) lower total mortality. The association was stronger for ischaemic heart disease [6.0% (95% CI 1.2-10.6)] and stroke [8.6% (95% CI 1.6-15.1)] mortality. CONCLUSIONS: The results suggest that there is a linear, inverse relationship between age at menarche and total mortality as well as with ischaemic heart disease and stroke mortality.

The combined effect of albuminuria and inflammation on all-cause and cardiovascular mortality in nondiabetic persons.

OBJECTIVES AND DESIGN: Recent studies have shown that albuminuria accompanied by evidence of subclinical inflammation is more strongly associated with metabolic abnormalities and the development of atherosclerosis than albuminuria alone. The aim of this population-based prospective study was to examine the combined effect of albuminuria and inflammatory markers on all-cause and cardiovascular-mortality in nondiabetic individuals without macroalbuminuria. SUBJECTS AND METHODS: Urinary albumin and creatinine, some inflammatory markers (fibrinogen, white blood cell and monocyte count) and cardiovascular risk factors were measured in 5702 persons in Tromsø, Norway. Baseline data were collected in 1994-1995 and follow-up was through 2005. RESULTS: For a one standard deviation higher value of the log-transformed ratio between albumin and creatinine (ACR), the mortality rate ratio for all-cause mortality was 1.21 when adjusted for age, gender, established cardiovascular risk factors as well as fibrinogen and white blood cell count (P < 0.001). The corresponding mortality rate ratio for cardiovascular mortality was 1.24 (P < 0.001). Persons in the upper quartile of both ACR and either of the inflammatory markers had an age- and gender-adjusted all-cause and cardiovascular mortality rate that was four times that of subjects in the lowest quartiles (P < 0.001). CONCLUSION: ACR predicts all-cause and cardiovascular mortality in persons without known diabetes and macroalbuminuria. The mortality is especially high amongst individuals with elevated levels of both ACR and inflammatory markers.

Reproductive factors and pancreatic cancer risk: a Norwegian cohort study.

A cohort of 63,090 Norwegian women born 1886-1928 was followed more than 38 years, and relations between reproductive factors and risk of pancreatic cancer were explored; 449 cases were recorded at ages 50-89 years. Age at menopause showed a moderately positive association with risk (rate ratio (RR)=1.08 per 2 years delay in menopause; 95% confidence interval (CI)=1.00-1.17). Neither parity nor duration of breastfeeding showed significant associations with risk after adjusting only for demographic factors. With mutual adjustment, however, parity became positively associated (RR=1.13 per delivery; 95% CI=1.05-1.22) while duration of breastfeeding was inversely associated (RR=0.87 per 12 months; 95% CI=0.78-0.97). These associations lessened in magnitude with increasing age, and were essentially absent above age 80 years. Risk was raised among women reporting at least one abortion, but no trend was seen with number of abortions. Together with previous studies, the findings raise questions about the role of chance, but do not exclude hormonal factors related to breastfeeding and pregnancy from affecting pancreatic cancer risk.

Carotid plaque echogenicity and risk of nonvertebral fractures in women: a longitudinal population-based study.

Atherosclerosis and osteoporosis appear to be related, but prospective studies on the relationship are sparse. In order to examine whether carotid artery plaques with different morphology predict nonvertebral fractures, we followed 2,733 women, aged 55-74 years (75% of the eligible population in Tromsø, Norway), for 6 years. At baseline, plaque morphology in terms of ultrasound echogenicity was categorized into three groups, ranging from low echogenicity (echolucent plaques with a high content of soft tissue) to strong echogenicity (echogenic plaques with a high content of dense fibrous tissue and calcified material). We found that the age-adjusted relative risk (RR) of fracture was significantly higher among women with echogenic plaques than among women without plaques: 1.7 (95% confidence interval [CI] 1.0-2.7). After adjustment for bone mineral density at baseline in addition to age, the RR was 1.6 (95% CI 1.0-2.6), and further adjustments for body mass index, body height, high-density lipoprotein cholesterol, smoking status, and muscle strength did not influence the association. Subjects with other plaque types were not at an increased risk compared to subjects without plaques: RR < or = 1.1, after multiple adjustments. We conclude that in the general population elderly women with echogenic carotid plaques are at higher risk of nonvertebral fractures than women without plaques.

Increased growth rate of abdominal aortic aneurysms in women. The Tromsø study.

OBJECTIVES: The present study was undertaken in order to assess the effect of gender on the growth rate of abdominal aortic aneurysms (AAAs). METHODS: One hundred and eighty-five men and 49 women with AAAs were studied, mean follow-up 62 months, giving 14,544 patient-months of follow-up. A mean of 16 ultrasound examinations was performed on each patient. RESULTS: The mean growth rate was 1.82; 1.65 and 2.43 mm per year in men and women, respectively. In a weighted linear regression analysis, high initial diameter and female gender were independent and significant (p < 0.001 and p = 0.003, respectively) predictors for increased growth rate of AAAs. None of the other considered risk factors predicted the growth rate. CONCLUSIONS: This is the first study to report a significantly different growth rate of AAAs in females compared to males. It, thus, adds evidence to the view that AAA is a more malignant condition in females than in males and could have implications for the frequency of follow-up in women.

The difference between ultrasound and computed tomography (CT) measurements of aortic diameter increases with aortic diameter: analysis of axial images of abdominal aortic and common iliac artery diameter in normal and aneurysmal aortas. The Tromsø Study, 1994-1995.

OBJECTIVE: To assess agreement between ultrasound and computed tomography (CT) measurements from axial images of normal and aneurysmatic aortic and common iliac artery diameter. DESIGN: Part of a population health screening for abdominal aortic aneurysm conducted in 1994-1995. MATERIALS AND METHODS: Three hundred and thirty-four subjects with and 221 subjects without ultrasound-detected aneurysm were scanned with CT. Three technicians and one radiologist measured ultrasonographic diameters and five radiologists measured CT diameters. The paired ultrasound-CT measurement differences were analyzed to assess agreement. RESULTS: Compared to CT measurements, ultrasound slightly underestimated the diameter in normal aortas and tended to overestimate the diameter in aneurysmal aortas. In 555 ultrasound-CT pairs of measurements, the absolute differences for measurements of maximal aortic diameter were 2 mm or less in 62, 60 and 77% in anterior-posterior, transverse and maximum diameter in any plane, respectively. The corresponding figures for an absolute difference of 5 mm or more were 14, 18 and 8%, respectively. Variability increased with increasing diameter. CONCLUSIONS: Both ultrasound and CT measurements of abdominal aortic diameter are liable to variability and neither of these methods can be considered to be 'gold standard'. Both methods can be used, while taking variability into consideration when making clinical decisions.

The association between mental distress and the use of alternative medicine among cancer patients in North Norway.

PURPOSE OF THE STUDY: To study the association between mental distress and the use of alternative medicine (AM) among cancer patients. PATIENTS AND METHODS: A longitudinal questionnaire-based study was carried out at the Department of Oncology, University Hospital of Tromsø, Norway, during the period 1990-1991. The level of mental distress in 158 patients aged less than 75 years was assessed 4 months after first admission to the cancer ward. The patients answered five questions about mental distress selected from the General Health Questionnaire (GHQ). The questions were scored continuously according to the Likert scoring procedure. The level of mental distress was also ranked from 1 (little or no mental distress) to 3 (high mental distress). RESULTS: A total of 53 of the 158 patients reported use of AM at inclusion of the study or during the 4 months of follow-up. Among patients with low mental distress, 21% were users of AM, 36% of patients with medium distress and 48% in patients with high level of mental distress (p-value for linear trend = 0.02). Adjusted for all known relevant variables, patients with medium level of mental distress had 1.9 times higher prevalence of use of AM than patients with low level of mental distress, patients with high mental distress had a 2.9 times higher prevalence (p = 0.15 and 0.07, respectively). Analyzed as a continuous variable (Likert score between 5 and 20), mental distress was associated with use of AM (p = 0.007). CONCLUSION: These findings suggest that seeking alternative treatment is more common among mentally distressed cancer patients.

Intra- and interobserver variability in the measurements of abdominal aortic and common iliac artery diameter with computed tomography. The Tromsø study.

OBJECTIVES: to assess intra- and interobserver variability in the measurement of aortic and common iliac artery diameter by means of computed tomography (CT). DESIGN: reproducibility study. MATERIAL AND METHODS: three radiologists performed measurements of aortic diameter at five different levels and of both common iliac arteries with CT. Fifty-nine subjects were examined, 29 with and 30 without abdominal aortic aneurysms (AAA) as assessed by ultrasound. RESULTS: intraobserver variability varied between radiologists, measurement plane (anterior-posterior vs transverse) and measurement level. The interobserver variability was markedly higher at the bifurcation than at the suprarenal level and higher than intraobserver variability for measurements at all levels. Both intraobserver and interobserver variability increased with increasing vessel diameter and were largest in patients with AAA. The absolute intraobserver difference of the maximal infrarenal aortic diameter was 2mm or less in 94% of intraobserver pairs. The corresponding interobserver difference was 82%. CONCLUSIONS: interobserver variability of CT measurements of aortic and common iliac artery diameter is not negligible and should be taken into account when making clinical decisions. When assessing change in aortic diameter, previous CT-scans should be reviewed simultaneously as a routine to exclude interobserver variability.

High mortality in patients with rheumatoid arthritis and atlantoaxial subluxation.

OBJECTIVE: To study relationships between atlantoaxial subluxation (AAS) and total mortality in patients with rheumatoid arthritis (RA). METHODS: Radiological reports and clinical files of patients with RA were reviewed for the presence of cervical spine involvement verified by cervical radiographs. RESULTS: Among 241 patients with cervical radiographs, anterior AAS > or = 4 mm was found in 5% [95% confidence interval (CI) 2-8] of patients. Vertical and posterior subluxations were found in 1.4 and 0.5%, respectively. The mean observation time from RA diagnosis to AAS was 3.9 years. Patients with AAS had 8 times higher mortality than patients without AAS (95% CI 3-25). According to the death certificate, the patients died from cancer, stroke, and myocardial infarction. Cervical spine disorder was not mentioned on the death certificate. However, an autopsy was not performed. CONCLUSION: We found high mortality in RA patients with AAS. AAS in the cervical spine developed relatively early in the course of the disease. Analyses adjusted for seropositivity, erosiveness, and glucocorticosteroids did not reduce the mortality rate ratio. Our results underline the need for careful evaluation of patients with RA with respect to development of AAS.

Prevalence of serious psychiatric morbidity in attenders and nonattenders to a health survey of a general population : the Tromsø Health Study.

The objective was to study the effect of serious psychiatric disorders on participation in a general health population study. This was done by linking the records of the Second Tromsø Health Study to the case register of a mental hospital. The participants in the Second Tromsø Health Study were 21,441 persons, the total population of men aged 20-54 and women aged 20-49 years who resided in Tromsø, Norway, in 1979. The authors found that both men and women with psychiatric illness had approximately 20% lower attendance rates. Nonattenders to the survey had 2.5 times higher prevalence of psychiatric disorders than did attenders of both sexes. Age, marital status, and various psychiatric diagnoses were all significant predictors of nonattendance. Nonattendance led to underestimation of the prevalence of psychiatric disorders in the population. The conclusion is that in general health studies, even those with high attendance rates, the estimates of prevalence of psychiatric disorders in the population are seriously affected by nonattendance. Prevalence ratios between groups of the population were not much affected by nonattendance.

Cause-specific mortality in psychiatric patients after deinstitutionalisation.

BACKGROUND: Since the late 1970s, the psychiatric service system in Norway has been changed gradually according to the principles of deinstitutionalisation. AIMS: To document the mortality of psychiatric patients in a deinstitutionalised service system. METHODS: The case register of a psychiatric hospital covering the period 1980-1992 was linked to the Central Register of Deaths. Age-adjusted death rates and standardised mortality ratios (SMRs) were computed. RESULTS: Patients with organic psychiatric disorders had significantly higher mortality regardless of cause of death. SMRs ranged from 0.9 for death by cancer in women to 36.3 for suicide in men. For unnatural death, SMRs were highest in the first year after discharge. Compared to the periods 1950-1962 and 1963-1974, there has been an increase in SMRs for cardiovascular death and suicide in both genders. CONCLUSIONS: Deinstitutionalisation seems to have had as its cost a relative rise both in cardiovascular death and unnatural deaths for both genders, but most pronounced in men.