Chronic non-cancer pain and the epidemic prescription of opioids in the Danish population: trends from 2000 to 2013.

BACKGROUND: Chronic pain has serious consequences for individuals and society. In addition, opioid prescription for chronic non-cancer pain (CNCP) has become more frequent. This study aims to examine the trends regarding the prevalence of CNCP, dispensed opioids, and concurrent use of benzodiazepine (BZD)/BZD-related drugs in the Danish population. METHODS: Data from the cross-sectional national representative Danish Health and Morbidity Surveys (2000, 2005, 2010, and 2013) were combined with The Danish National Prescription Registry at an individual level. The study populations varied between 5000 and 13,000 individuals ≥16 years (response rates: 51-63%). Respondents completed a self-administered questionnaire, which included the analyzed items on identification of chronic pain (≥6 months). RESULTS: From 2000 to 2013, the prevalence of CNCP increased and subsequently the annual prevalence of opioid use from 4.1% to 5.7% among CNCP individuals. Higher CNCP prevalence was related to female gender, no cohabitation partner, short education, non-Western origin, and overweight/obesity. In addition, women with CNCP, especially >65 years, became more frequent users of opioids and used higher doses than men. Concurrent use of BZD/BZD-related drugs decreased (13%) from 2010 to 2013, still one-third of long-term opioid user were co-medicated with these drugs. CONCLUSIONS: The use of opioids has increased in Denmark, especially among elderly women. The concurrent use of BZD/BZD-related drugs has decreased from 2010 to 2013, but still one-third of long-term opioid users were co-medicated.

Association between passive smoking in adulthood and phalangeal bone mineral density: results from the KRAM study--the Danish Health Examination Survey 2007-2008.

UNLABELLED: The study investigates an association between phalangeal bone mineral density (BMD) and self-reported passive smoking using data on 15,038 persons (aged 18-95 years), who underwent a BMD scan in the Danish KRAM study. BMD was significantly lower in persons exposed to long-term passive smoking in their home during adulthood. INTRODUCTION: Smoking is associated with decreased bone mineral density (BMD) and increased risk of osteoporotic fractures. This study aimed to investigate a possible association between BMD at the phalangeal bones and self-reported passive smoking. METHODS: The study included a cohort of 15,544 men and women aged 18-95 years, who underwent a BMD scan in the Danish KRAM study. BMD scans of the middle phalanges of the second, third and fourth digits of the non-dominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). Also, height, weight and body fat percentage were measured and 96.7% (n = 15,038) of the participants answered a self-reported questionnaire with information on passive smoking, other lifestyle factors, education, etc. The association between passive smoking and BMD was examined using multiple linear regression analysis. RESULTS: A total of 39.1% (n = 5,829) of the participants had been exposed to passive smoking in adulthood at home. BMD was significantly lower in subjects exposed to passive smoking, 0.343 vs. 0.331 g/cm(2); p < 0.01 (unadjusted) and 0.339 vs. 0.337 g/cm(2); p < 0.05 (adjusted for age, gender, height and weight, and smoking). Multiple linear regression analysis showed that exposure to passive smoking for more than 20 years in adulthood at home was significantly related to BMD when adjusted for potential confounders (men, ß = -4.4 × 10(-3); r = -0.05; p < 0.01 and women, ß = -2.3 × 10 (-3); r = -0.03; p < 0.05). This relationship was also seen in the group of never smokers (ß = -3.3 × 10(-3); r = -0.03; p = 0.01). CONCLUSION: Our study supports a potential negative effect of long-term passive smoking in adulthood at home on phalangeal BMD.

Effects of preconceptional irradiation on mortality and cancer incidence in the offspring of patients given injections of Thorotrast.

BACKGROUND: Findings from a British case-control study suggest that a preconceptional paternal external radiation dose of more than 100 mSv (10 rem) is significantly related to risk for leukemia and non-Hodgkin's lymphoma in offspring. The suggestion, however, has not been supported by experimental or other epidemiologic studies. PURPOSE: The purpose of this study was to investigate if preconceptional irradiation of males and females from internally deposited radionuclides affects mortality and risk of developing cancer in their offspring. METHODS: The offspring of 260 females (n = 143) and 320 males (n = 226) who lived longer than 1 year after receiving Thorotrast (a compound no longer in use) for cerebral arteriography were studied for mortality rate and the risk for developing cancer. Thorotrast was used as a contrast medium containing a 20% colloidal solution of thorium dioxide-Th 232, an alpha particle-emitting radionuclide, which is retained lifelong in nearly all organs. The offspring of the exposed patients were identified by manual linkage with the municipal population registers and followed-up for vital status by computerized linkage with the Danish National Central Population Registry and for incidence of cancer by computerized linkage with the Danish National Cancer Registry. The standardized mortality/morbidity ratios (SMRs) for death and for site-specific incidence of cancer in the offspring were calculated as ratios of the observed rates in the study population to the expected rates in the general population. RESULTS: After a median follow-up of 40 years, four cases of cancer (breast [one], uterine cervix [one], melanoma of skin [one], and retinoblastoma [one]) versus 2.9 cases expected, developed among 143 children born to mothers who received injections of Thorotrast (SMR = 1.4; 95% confidence interval [CI] = 0.4-3.5), while six cases of cancer (one case each of cancer of lung, testis, thyroid, and Hodgkin's lymphoma and two cases of melanoma of skin), versus 4.5 expected, occurred among 226 children of exposed fathers (SMR = 1.3; 95% CI = 0.5-2.9). No case of leukemia or non-Hodgkin's lymphoma occurred in any of the offspring studied. Mortality was lower than expected both for children of exposed mothers (SMR = 0.7; 95% CI = 0.3-1.5) and of exposed fathers (SMR = 0.5; 95% CI = 0.2-1.0). CONCLUSIONS: This study does not support the previously proposed association between parental exposure to radiation and the risk of childhood leukemia and lymphoma. Furthermore, since mortality from all causes was not increased in any offspring, our results do not support the belief that preconceptional parental low-dose exposure to alpha radiation increases the incidence of cancer or mortality in the offspring.

Cancer incidence and mortality in workers exposed to fluoride.

BACKGROUND: Although a recent bioassay showed increased frequency of bone cancer in rats with high oral intake of fluoride, the data are reported as equivocal evidence of carcinogenicity. In humans, occupational fluoride exposure may cause skeletal fluorosis, and our earlier follow-up of fluoride-exposed workers showed increased incidence of respiratory cancers. PURPOSE: To further evaluate occupational fluoride exposure as a carcinogenic risk factor, we extended by approximately one decade the follow-up of a cohort of 425 men and 97 women employed for at least 6 months in the period 1924-1961 at the Copenhagen cryolite processing plant. Cryolite ore contains about 50% fluoride. METHODS: Cancer mortality was determined for the period 1941-1989, and incidence for 1943-1987. For comparison, we used national mortality rates and cancer incidence rates for the Copenhagen area. RESULTS: Among the men, 300 deaths occurred; 223 were expected. Respiratory (lung and laryngeal) cancers and violent death were responsible for most of this excess; rates for mortality from cardiovascular disease were close to the rates expected. Of the 423 male workers, 119 developed cancers; 103.6 were expected. There was excess incidence of cancers of the lungs (35 men; standard incidence ratio [SIR] = 1.35), larynx (5 men; SIR = 2.29), and urinary bladder (17 men; SIR = 1.84). Maximum incidence occurred after 10-19 years of employment, but otherwise, no stable relationship between cancer incidence and duration of employment was observed. The incidence of respiratory and urinary cancers was particularly high in men less than 35 years old at first employment. Cancers in female workers were too few to allow detailed evaluation. CONCLUSIONS: The increased incidence of respiratory cancers suggests that cigarette smoking was frequent in this cohort, despite the unremarkable cardiovascular mortality, but the disproportionate increase in the incidence of bladder cancer is difficult to explain by smoking habits alone. Because this industrial cohort was exposed to high concentrations of fluoride dust, heavy respiratory exposure to fluoride may have contributed to the increased cancer risk. If these workers inhaled a carcinogenic substance partly excreted in the urine, an increased incidence of respiratory and bladder cancers would not be inconceivable. IMPLICATION: The potential role of fluoride as a cause of bladder cancer needs to be explored.

Reduced fertility after the crash of a U.S. bomber carrying nuclear weapons? A register-based study on male fertility.

A register-based study was performed to elucidate whether workers employed on the Thule air base in the clean-up period after the crash of a U.S. B-52 bomber carrying nuclear bombs had reduced fertility, as measured by the numbers of liveborn children. The highest birth rates were among 25-34-year olds with 1-3 years of employment on the base, but who had not worked at the base the year before, who already had one child, with a 2-5-year interval since the birth of the last child. No difference was seen between the group of men who had worked at the base during the clean-up period after the crash--the possibly exposed group--and those people who had worked at the base only outside the clean-up period. Because of the massive media coverage and possible claims for damages a register-based study is the only practicable way of elucidating statements about infertility. The main conclusion is that the accident has not reduced fertility.

Decline in mortality from heart disease in Denmark: some methodological problems.

Mortality rates in Denmark from ischemic heart diseases (IHD), other heart diseases and unknown causes are presented for the period 1968-92. In all age groups, mortality from IHD is higher at the beginning of the period than at the end. For other heart disease, the plot of the mortality rate is U-shaped for the age groups 65-84 and > or = 85, but first decreases and is then constant for the age group 30-64. There are an increasing number of deaths from symptomatic heart disease. For the group of unknown causes, the rates are increasing for all sex and age groups. The relationship between deaths from IHD and deaths from unknown causes varies with period, age, sex and region. For women in Copenhagen in the age group 30-64, the mortality rate from unknown cause is higher than the rate for IHD at the end of period. Vital statistics must therefore be used cautiously in analysing trends for IHD, and even the validity of temporal changes within a country must be questioned.

Pattern of mortality among Danish thorotrast patients.

The mortality pattern among 999 Danish patients who had been subjected to angiography of the carotid artery with the alpha-ray emitting X-ray contrast media Thorotrast during the period 1935-47 was assessed by record linkage with the National Death Registry through 1989. Standardized mortality ratios (SMR) were calculated relative to the general population. The overall SMR was increased by 18 times during the first 3 years after Thorotrast injection. This rate reflects the often serious, underlying neurological conditions for which angiography was performed, however, mortality was increased by 3-4 fold even for the follow up period after the first 3 years. The increase in mortality was evident for all categories of cause of death, the SMR being 11.1 (95% confidence interval (CI) 7.1-16.4) for cirrhosis of the liver, 4.7 (4.1-5.3) for cancer, 1.6 (1.3-1.9) for cardiac disease, 3.3 (2.6-4.2) for cerebrovascular diseases, 3.9 (3.3-4.5) for other natural causes, and 4.4 (3.4-5.6) for violent causes (including suicides). The SMR was generally related positively to young age at injection, to time since injection, and to the amount injected. The excess mortality can be explained only partially by underlying neurological conditions and by diseases known to be induced by Thorotrast (cirrhosis and cancer of the liver, leukaemia and other haematological diseases), and it is suggested that unspecific effects induced by the alpha-radiation of Thorotrast may have contributed.

High mortality in the Thule cohort: an unhealthy worker effect.

BACKGROUND: The objective was to study mortality in the Thule cohort in order to clarify whether it is a selected population and to ascertain the possibility of misinterpretation when national mortality rates are used as reference in the analysis of occupational mortality. METHODS: The cohort consists of 4322 Danish men who were employed between 1963 and 1971 at the Thule air base in Greenland. One part of the cohort were employed during the clean-up period after the crash, in 1968, of a US bomber carrying nuclear weapons, the other part had been employed only outside the clean-up period. The cohort was followed up until 1992. RESULTS: After 30 years of follow-up, SMR was 1.38 for all causes (95% confidence interval [CI]: 1.28-1.49), 1.25 for cancer (95% CI: 1.07-1.45), 1.17 for circulatory diseases (95% CI: 1.01-1.34), 1.58 for other natural causes (95% CI: 1.35-1.84), and 1.46 for violent deaths (95% CI: 1.22-1.74). Marked excess mortality measured by SMR was found from lung cancer 1.70, AIDS 3.55, alcoholism 4.04, cirrhosis of the liver 2.45, symptoms and ill-defined conditions 1.93, and suicide 1.63. The SMR was 1.09 for the age group 17-24 at entry, 1.42 for the age group 25-34, and 1.45 for the age group > or = 35. CONCLUSIONS: The high mortality and the mortality pattern in the Thule cohort shows strong evidence for selection and provides strong support for the suggestion that these workers constitute a group in poor health probably caused by lifestyle. The study demonstrates that an incomplete analysis (i.e., one limited to a subgroup of workers involved in the radiation clean-up) could lead to spurious conclusions about hazardous occupational exposures.

Demographic factors and cancer mortality. A mathematical model for cancer mortality in Denmark 1943-78.

Deaths from cancer in Denmark from 1943-1978 were extracted from the Danish National Death Register at the Danish Institute for Clinical Epidemiology. This paper illustrates the relationship between demographic factors and mortality from a large group of cancers, which increases progressively from young adult life into old age. One-year age-specific mortality rates between 30 and 79 years of age were computed for 14 different cancer sites among both males and females, in five ten-year birth cohorts and for the capital and provinces. The number of deaths at a particular age were found to follow a Poisson distribution and the mortality rate could be expressed by the function lx = bxk, where lx is the mortality rate at age x, and b and k are parameters to be estimated. With this model a straight line is obtained, when mortality and age are plotted on a double logarithmic scale. The maximum likelihood estimates of b and k were found iteratively for each of the 280 combinations of sex--cancer site--residence--cohort. For fixed sex and cancer site the relationship between age, residence and cohort was examined. It appeared that k was independent of residence. For 10 of the male cancers and 12 of the female cancers, k was found to be independent of cohort and in the last 6 cases k was found to be a linear function of cohort. For 12 out of 14 cancer sites among males the ratio of mortality in the capital to mortality in the provinces was significantly greater than one.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality and causes of death among Danish medical doctors 1973-1992.

BACKGROUND: To examine the mortality pattern of Danish doctors for the period 1973-1992. METHODS: A historical prospective cohort study based on the membership register of the Danish Medical Association. The study population consisted of 21,943 medical doctors, 6012 of whom were women. The doctors' cause-specific mortality was compared with that of the general population. RESULTS: The study covered about 277,000 person-years. A total of 2387 deaths occurred from 1 January 1973 to 31 December 1992. The doctors' mortality was lower than that of the general population. Both sexes showed a standardized mortality ratio (SMR) below one for cancer, circulatory diseases and other natural causes. Mortality due to lung cancer was particularly low. The SMR for suicide was significantly increased, 1.6 for males (95% CI: 1.4-1.9) and 1.7 for females (95% CI: 1.1-2.5). The suicide rate was increased, in particular because of an increased number of suicides by poisoning. In addition female doctors displayed a relatively high mortality due to accidents and other types of violent death. CONCLUSIONS: Compared with the general population the doctors' mortality was low, but the mortality from external causes was increased, mainly due to an excess number of suicides.

The Thule episode epidemiological follow up after the crash of a B-52 bomber in Greenland: registry linkage, mortality, hospital admissions.

STUDY OBJECTIVES: The aim was to explore the pattern of disease in staff associated with a bomber that crashed in 1968 when carrying nuclear bombs. DESIGN: The database was constructed from staff files of Danish workers employed from 1 April 1963 to 1 July 1971. Comparison was made between subsequent mortality and hospital admissions of workers employed during the clean up of the crashed bomber, and those employed outside this period. SETTING: The study involved workers employed at Thule US air base in Greenland. MAIN RESULTS: During 1963-1971, 4322 staff were employed at the air base. Of these, 4265 (98.7%) were identified in 1987, among whom 1202 workers were employed during the clean up period. No differences were found in total mortality, or mortality from cancer, heart disease, or accidents, after allowing for differences in age, marital status, or length of employment, between those employed during the clean up period and those employed at other times. Similarly, no difference in hospital admissions between the two groups was found. CONCLUSIONS: No harmful effects on health due to the crash were found, as measured by mortality and hospital admissions.

Cardiovascular death and manic-depressive psychosis.

In order to study if tricyclic antidepressant drugs (TCA) in therapeutic doses increase the risk of death due to cardiovascular causes, the relative mortality from cardiovascular diseases was studied in two large groups of first hospitalized manic-depressive patients, one from the TCA era, the other from the period just before the introduction of TCA. Both groups were selected from the Danish Psychiatric Central Register and followed for an average of 4.5 years. Among 2662 manic-depressive men hospitalized between 1969 and 1976, the relative cardiovascular mortality was 1.53 compared to the general population. Among 1133 such cases admitted between 1950 and 1956, the rate was 1.87. Our findings do not support the hypothesis that TCA contribute to the cardiovascular mortality in manic-depressives and even support suggestions that TCA treatment may lower the risk of death by cardiovascular disease, suicide, and other non-cancer causes.

Impact of work-related and psychosocial factors on the development of ischemic heart disease among urban bus drivers in Denmark.

From 1978 to 1985, 2,465 male bus drivers in the three major cities in Denmark were followed with regard to hospital admission due to myocardial infarction (MI) and death due to ischemic heart disease (IHD). In all 2,045 (83%) of these men responded in 1978 to a questionnaire on psychosocial well-being and work conditions. The respondents did not differ from the nonrespondents regarding hospital admissions and death in the follow-up period (1978-1984). Sixty-two cases of MI were registered among the 2,045 bus drivers in 1978-1984. On this basis relative risk for MI was calculated with a multiple regression model for independent variables regarding psychosocial well-being and work conditions. High work load (driving in heavy traffic) was significantly associated with the occurrence of MI. Of the psychosocial factors "no social contact with colleagues" and "increased work pace" were also significantly associated with the occurrence of MI. Smoking habits tended to be associated with the occurrence of MI, while stress symptoms and job dissatisfaction did not. The mental burden on bus drivers working in heavy traffic seems a possible explanation for the findings.

[Why is life expectancy a problem for the Danes? The influence of smoking during the last 50 years]. / Hvorfor har danskerne problemer med middellevetiden? Rygningens betydning i de seneste 50 år.

The study quantifies the influence of smoking on mortality in Denmark and computes measures for the individual risk. Mortality due to lung cancer among Danish women is now the highest in Europe. Smoking-attributable deaths among men amounted to 3% in 1945, 26% in 1985, and 25% in 1995; the proportion is lower among women, but is increasing considerably. In 1995 in the age-group 35-69 years such deaths make up the same proportion among men and women. The risk that a 35-year old Dane dies before attaining the age of 70 due to other than smoking-attributable causes has decreased since 1945, most significantly among women. Women have experienced a considerable increase in smoking-attributable mortality over the last 20 years, increasing the total risk of a 35 year-old of dying before reaching the age of 70. In 1995 a little over 13,000 of a total of a little less than 63,000 deaths could be attributed to smoking. Smoking is responsible for a significant part of the adverse development in Danish life expectancy.

[The Thule case. Mortality and hospitalization after the crash of an American B-52 bomber in 1968]. / Thulesagen. Dødelighed og hospitalsindloeggelser efter nedstyrtning of et amerikansk B-52 bombefly i 1968.

In 1968, a B-52 bomber carrying nuclear bombs crashed near the Thule US Air-Base in Greenland. By 1986, many cases of disease had been reported among Danish workers employed at the base. A database has been constructed from staff files of workers employed from 1963 to 1971. Of 4,322 workers, 98.7% were identified in 1987. The study group consisted of 1,202 workers employed during the clean up period (from the time of the crash until the last of the contaminated material had been removed). The reference group consisted of 3,120 workers employed outside the clean up period. No differences were found in total mortality, or mortality from cancer, heart disease or accidents between the groups after adjusting for age, marital status and length of employment. Mortality from suicide was lower in the study group. The hospitalization rates for the period 1977-1985 also showed no differences between the two groups. The conclusion of the register surveys is that no harmful effect on health due to the crash can be established by measuring mortality or hospital admissions.

[Impact of tobacco, alcohol overconsumption and drug abuse on mortality in Denmark. Trends over 25 years, 1973-1997]. / Betydning af tobak, stort alkoholforbrug og stofmisbrug på dødeligheden i Danmark. Udviklingen gennem 25 år, 1973-1997.

INTRODUCTION: The aim of the study was to estimate the national impact of smoking, alcohol, and drugs on mortality. MATERIAL AND METHODS: The analysis was based on the cause of death register. Deaths attributable to smoking were calculated by an indirect method. Deaths related to alcohol and drugs (illegal drugs and prescription drugs) were defined by the underlying and contributory causes of death. RESULTS: In the period, 1993-1997, 30% of all deaths in men and 20% in women were related to tobacco, alcohol, or drugs. The percentages of all deaths for tobacco, alcohol, and drugs were respectively 22.8%, 6.3%, and 1.2% for men and 16.5%, 2.5%, and 0.7% for women. Every year 12,000 Danes die 11-13 years prematurely, because of tobacco, more than 2500 die more than 20 years prematurely, because of alcohol, and about 600 die almost 30 years prematurely, because of drugs. The standardised lifetime risk of death from one of these three causes was about 30% for men, highest in the middle five-year period. For women--because of substantially increased mortality attributable to smoking--there was a large increase from 8% to 20%. In the municipality of Copenhagen, the lifetime risk for men was about 50%, for women it increased from 15% in the middle of the 1970s to more than 30% in the middle of the 1990s. For both men and women, mortality in the age group 35-74 declined sharply, when mortality related to the three causes was excluded. However, the heavy increase in smoking-related deaths in women means that the total mortality over the entire period has been almost constant. DISCUSSION: It is a tremendous challenge to change the impact of tobacco, alcohol, and drugs on mortality in Denmark.

[Decline in mortality from heart disease in Denmark: some methodological problems]. / Fald i dødeligheden af hjertesygdomme i Danmark: nogle metodeproblemer.

Mortality rates in Denmark from ischaemic heart diseases (IHD), other heart diseases and sudden death of unknown cause are presented for the period 1968-1992. In all age groups, mortality from IHD is higher at the beginning of the period than at the end. For other heart disease, the plot of the mortality rate is U-shaped for the age groups 65-84 and > or = 85, whereas for the age group 30-64 it first decreases and is then constant. There are an increasing number of deaths from symptomatic heart disease. For the group of unknown cause, the rates are increasing for all sex and age groups The relationship between deaths from IHD and death from unknown cause varies with period, age, sex and region. For women in Copenhagen in the age group 30-64, the mortality rate from unknown cause is higher than the rate for IHD at the end of period. Vital statistics must therefore be used cautiously in analysing trends for IHD, and even the validity of temporal changes within a country must be questioned.

[Psychiatric admissions among city bus drivers. A prospective study]. / Psykiatriske indlaeggelser hos bybuschauffører. En prospektiv undersøgelse.

During the period from 1978 until and including 1984, 2,645 male bus drivers were followed as regards psychiatric admissions. In 1978, 83% of these had replied to a questionnaire about job-satisfaction and working conditions. Fifty-eight out of these 2,465 had been admitted to psychiatric departments during the follow-up period, corresponding to 117 admissions. The commonest diagnoses on discharge were affect reactions with a total of 35 discharges. The number of admissions to psychiatric hospitals among bus drivers was compared with the number of admissions among Danish men in 1981. Significantly fewer admissions among bus drivers were found in the diagnostic group manic depressive psychoses, reactive conditions and for all psychiatric admissions. On the other hand, the number of admissions among bus drivers where the diagnoses of affect reactions, paranoid conditions and non-specific psychoses were found to be significantly higher (standard morbidity ratio statistic = 217) than for Danish men. Odds-ratio for psychiatric admissions among the 2,045 bus drivers who had replied to the questionnaire in 1978 were significantly raised for the bus drivers who did not feel their work monotonous, were divorced, felt unbalanced and frequently stressed. Previous smokers had significantly lower odds ratio as compared with others.

[Increasing asthma mortality in Denmark 1969-1988. Not because of changed coding practices]. / Stigende astmadødelighed i Danmark 1969-1988. Ikke på grund af oendret kodepraksis.

We have studied asthma mortality in Denmark from 1969 to 1988. Age standardized mortality rates calculated in three age groups, 10-34, 35-59, and > 60 years, disclosed similar trends. Increasing mortality from asthma in the mid-1970s to 1988 was seen in all three age groups with higher mortality in 1979-1988 as compared with 1969-1978 of 95%, 55%, and 69%, respectively. Since the eighth revision of the International Classification of Diseases (ICD-8) was used in Denmark over the entire 20-year period, changes in coding practice due to change of classification system cannot explain the findings.

[Acute myocardial infarction in Denmark. Incidence development and prognosis during a 20-year period]. / Akut myokardieinfarkt i Danmark. Udvikling i incidens og prognose gennem 20 år.

INTRODUCTION: The paper describes the epidemiology of acute myocardial infarction in Denmark. The study provides statistics on mortality, incidence and case-fatality for 1996 and the time trend since 1978. The results are compared to the results from the international MONICA study. METHOD: The analyses are based on national population-based registers on causes of death and hospital admissions. RESULTS: The mortality from ischaemic heart disease has declined considerably. The study confirms that the decline in mortality can be ascribed to a decrease in incidence as well as a decrease in case fatality. In the period 1985-1996 the incidence decreased by 3.5% per year for men and 2.5% for women. Mortality rates within 28 days after admission to hospital with MI was almost constant until 1988 following which there was a significant drop. Despite the improved prognosis for MI patients, one quarter die before admission to hospital, and one quarter die within one year after an MI. DISCUSSION: The incidence rates of MI based on the national population-based registers are consistent with the results from the Danish MONICA study. The reduction in incidence rates is a little smaller than the results in the Danish part of the MONICA study, whereas the marked reduction in case-fatality found in this study is not in agreement with the results from MONICA. This discrepancy is not yet understood. The declining trend in case fatality started in 1988 and may be related to the introduction of thrombolysis and acetylsalcylic acid treatment.