Monocytosis in primary care and risk of haematological malignancies.

Monocytosis (≥0.5 × 109 /L in peripheral blood) is the hallmark of chronic myelomonocytic leukaemia (CMML) but may be present in a spectrum of diseases including other haematological malignancies. In the primary care sector, monocytosis is a relatively common finding, but its predictive value for haematological malignancy is unknown. We included 663 184 adult primary care patients from the greater Copenhagen area with one or more differential cell counts registered between 2000 and 2016 and followed them in the extensive nationwide Danish health data registers for 3 years after blood sampling. We used logistic regression to model the risk of haematological malignancy and death following monocytosis. Monocytosis was associated with an increased risk of all types of haematological malignancy with the greatest relative risk increase observed in CMML with an OR of 105.22 (95% confidence interval: 38.27-289.30). Sustained monocytosis (at least two requisitions in 3 months) further increased CMML risk, although the diagnosis was still very rare, that is, observed in only 0.1% of these individuals. Outside the haematological setting, the absolute risk of haematological malignancy associated with monocytosis is low and haematological malignancy should mainly be suspected when monocytosis is sustained or the clinical presentation raises suspicion of malignancy.

Increasing illness among people out of labor market - A Danish register-based study.

In spite of decades of very active labor market policies, 25% of Denmark's population in the working ages are still out-of-work. The aim of this study was to investigate whether that is due to consistent or even increasing prevalence of ill health. For the period of 2002-2011, we investigated if i) the prevalence of four chronic diseases (cardiovascular disease, diabetes, cancer and mental disorders) among those out-of-work had changed, ii) the occurrence of new cases of those diseases were higher among those who were already out-of-work, or iii) if non-health-related benefits were disproportionately given to individuals recently diagnosed with a disease compared to those without disease. The study was register-based and comprised all Danish residents aged 20-60. During the study period, the prevalence of cardiovascular diseases and mental disorders increased among both employed and non-employed people. The increased prevalence for mental disorder was particularly high among people receiving means-tested benefits. Disease incidence was higher among people outside rather than inside the labor market, especially for mental disorders. Employed people with incident diseases had an unsurprisingly increased risk of leaving the labor market. However, a high proportion of people with incident mental disorders received low level means-tested benefits in the three years following this diagnosis, which is concerning. Men treated for mental disorders in 2006 had high excess probability of receiving a cash-benefit, OR = 4.83 (4.53-5.14) for the period 2007-2010. The estimates were similar for women.

The use of healthcare resources in the last 3†years of life in patients with COPD and lung cancer in Denmark. A retrospective nationwide study.

OBJECTIVE: The aim was to describe the use of healthcare resources during the last 3 years of life in patients who died from chronic obstructive pulmonary disease (COPD) or lung cancer (LC), including patients with LC and COPD. METHODS: Using data from Danish health registers, we identified 6648 individuals who, in 2010, died from COPD (n=3013) and LC (n=3635), including 775 from LC and COPD. RESULTS: Patients with COPD and LC had a high use of services in the last 3 years of life, but the trajectory for COPD was different from that of LC. Fifty-five per cent of subjects with LC received a reimbursement for the terminally ill compared to only 4% of subjects with COPD (p<0.0001). There was a significant increase in the number of individuals with COPD who received non-invasive ventilation (NIV) for the first time in the last 6 months of life. Individuals with COPD and LC had the highest consumption of health resources. CONCLUSIONS: The high use of health resources together with the underuse of economic reimbursement in patients with terminal COPD suggest that more focus should be given to these patients. The need for NIV might be an indicator of poor prognosis and reflect an intensified need for palliative care. The high use of healthcare resources in patients with COPD and LC might indicate a substantial need for palliative care in these patients.

Rapid report on methodology: does loss to follow-up in a cohort study bias associations between early life factors and lifestyle-related health outcomes?

PURPOSE: To examine the consequences of non-response in a follow-up survey for associations between early-life factors and lifestyle-related health outcomes in adulthood. METHODS: In a cohort of 11532 Danish men born in 1953 we had nearly complete follow-up in the National Patient Register, but only 66% of 9507 eligible cohort members participated in a follow-up survey, in 2004. We examined whether characteristics measured early in life and discharge from hospital for alcohol abuse or tobacco-related lung diseases, were associated with survey response. Associations between the early-life characteristics and these two health outcomes were calculated in the entire cohort and among responders, and the effect of non-response was described by a Relative Odd Ratio (ROR=OR(responders)/OR(entire cohort)). RESULTS: A low response rate at age 50 years was related to having a single mother at birth, low educational attainment at age 18, and low cognitive function at ages 12 and 18. The risk of alcohol overuse and tobacco-related diseases was also highest among non-responders. However, the associations between early-life characteristics and the outcomes were nearly the same in responders as in the entire cohort. CONCLUSIONS: Although non-responders differed from responders in terms of early-life exposures and incidence of the lifestyle-related outcomes, we found no overt effects of this on the exposure-risk associations.