Social Disconnectedness in Individuals with Cardiovascular Disease: Associations with Health Literacy and Treatment Burden.

BACKGROUND: Knowledge is limited on associations between social disconnectedness (i.e. loneliness and social isolation), health literacy and perceived treatment burden in individuals with cardiovascular disease (CVD). However, understanding these associations may be important for clinical practice. METHODS: This study used cross-sectional self-reported data from the 2017 Danish health and morbidity survey entitled 'How are you?', investigating the associations of loneliness and social isolation with low health literacy and high treatment burden in individuals with CVD (n = 2521; mean age = 65.7 years). RESULTS: Logistic regression analysis showed that loneliness and social isolation were associated with low health literacy in terms of difficulties in 'understanding health information' (loneliness: adjusted odds ratio (AOR) = 1.32, 95% confidence intervals (CI) [1.16, 1.50]; social isolation: AOR = 1.47, 95% CI [1.24, 1.73]) and 'engaging with healthcare providers' (loneliness: AOR = 1.53, 95% CI [1.37, 1.70]; social isolation: AOR = 1.21, 95% CI [1.06, 1.40]) and associated with high treatment burden (loneliness: AOR = 1.49, 95% CI [1.35, 1.65]; social isolation: AOR = 1.20, 95% CI [1.06, 1.37]). CONCLUSIONS: Our findings show that loneliness and social isolation coexisted with low health literacy and high treatment burden in individuals with CVD. These findings are critical as socially disconnected individuals experience more health issues. Low health literacy and a high treatment burden may potentially exacerbate these issues.

Tattoo-Associated Skin Reactions: A Danish Population-Based Survey in 5,914 Tattooed Individuals.

BACKGROUND: In Europe, Australia, and the USA, the estimated overall prevalence of tattooing is around 10-20%. Tattoo ink often comprises harmful chemicals and epidemiological studies on adverse effects of tattoos are lacking. OBJECTIVES: We aimed to estimate the prevalence of tattoo-associated skin reactions in the general Danish population and describe individuals with tattoo-associated skin reactions by socio-demographic factors and tattoo characteristics. METHODS: The study was based on respondents aged 16 years or older from a population-based 2021 survey entitled "How are you?" conducted in the Central Denmark Region (n = 33,925). Logistic regression was used to characterise individuals with tattoo-associated skin reactions by socio-demographic factors (gender, age, educational level, and ethnic background). Also, the relationship between size, age and colour of the tattoo, and tattoo-associated skin reactions was studied. Model 1 was adjusted for all socio-demographic variables (gender, age, educational level, and ethnic background); model 2, for all socio-demographic variables and tattoo characteristics (size, age, and colour). RESULTS: In total, 21.1% reported that they had at least one tattoo, 10.2% hereof reported that they had experienced tattoo-associated skin reactions (itching, pain, inflammation, and swelling) beyond the first 3 weeks after the tattoo was made. Lower age (16-44 years) (adjusted odds ratio (AOR) ≥1.75), larger tattoos (AOR ≥1.61) and having had tattoos for more than 10 years (AOR = 2.92, 95% confidence interval 1.45-5.88) increased the odds of tattoo-associated skin reactions. In general, tattooed individuals with colours other than black had higher odds of tattoo-associated skin reactions. CONCLUSION: Among participants with at least one tattoo, 10.2% had experienced tattoo-associated skin reactions beyond the first 3 weeks after their tattoo was made. This finding highlights the need for safer tattoo inks to prevent the adverse health problems experienced by many individuals with tattoos.

Multimorbidity and health literacy: A population-based survey among 28,627 Danish adults.

AIM: Individuals with multimorbidity often have complex healthcare needs challenging their health literacy skills. This study aimed to investigate the association between the number of physical conditions and health literacy and to examine the difference in health literacy levels between individuals with multimorbidity based on physical conditions and individuals with additional mental disorders. METHODS: Respondents aged 25 years or older from a Danish population-based survey were included (N = 28,627). Multimorbidity was assessed based on 18 self-reported chronic conditions; health literacy was measured using two scales from the Health Literacy Questionnaire focusing on understanding health information and engaging with healthcare providers. Associations were examined using multiple logistic regression analysis. RESULTS: We found a positive association between number of physical conditions and the odds of having difficulties in understanding health information and engaging with healthcare providers. For example, the adjusted odds ratio (OR) of having difficulties in understanding health information was 1.45 (95% confidence interval (CI): 1.09-1.94) for individuals with two physical conditions compared with individuals without multimorbidity. The associations formed a positive exposure-response pattern. Furthermore, respondents with both mental and physical conditions had more than twice the odds of having health literacy difficulties compared to respondents with only physical conditions (adjusted OR 2.53 (95% CI 2.02-3.18) and 2.28 (95% CI 1.92-2.72) for the scales, respectively). CONCLUSIONS: Our results suggest that responding to patients' health literacy needs is crucial for individuals with multimorbidity - especially those with combined mental and physical conditions.

Post-Transjugular Intrahepatic Portosystemic Shunt (TIPS) Hepatic Encephalopathy-A Review of the Past Decade's Literature Focusing on Incidence, Risk Factors, and Prophylaxis.

Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for portal hypertension and its' complications in liver cirrhosis, yet the development of hepatic encephalopathy (HE) remains a significant concern. This review covers the reported incidence, risk factors, and management strategies for post-TIPS HE over the past decade. Incidence varies widely (7-61%), with factors like age, liver function, hyponatremia, and spontaneous portosystemic shunts influencing risk. Procedural aspects, including TIPS timing, indication, and stent characteristics, also contribute. Pharmacological prophylaxis with lactulose and rifaximin shows promise, but current evidence is inconclusive. Procedural preventive measures, such as shunt embolization and monitoring portal pressure gradients, are explored. Treatment involves pharmacological options like lactulose and rifaximin, and procedural interventions like stent diameter reduction. Ongoing studies on novel predictive markers and emerging treatments, such as faecal microbiota transplant, reflect the evolving landscape in post-TIPS HE management. This concise review provides clinicians with insights into the multifaceted nature of post-TIPS HE, aiding in improved risk assessment, prophylaxis, and management for patients undergoing TIPS procedures.

Danish validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and findings from a population health survey: a mixed-methods study.

OBJECTIVE: To validate the Danish Multimorbidity Treatment Burden Questionnaire (MTBQ) and obtain a population-based evaluation of treatment burden. DESIGN: Mixed-methods. SETTING: Danish population-based survey. PARTICIPANTS: Translation by professional translators and an expert group. The scale was tested by 13 407 participants (aged ≥25 years) in treatment. MEASURES: The 10-item MTBQ was translated into Danish using forward-backward translation and used in a large population health survey. A global MTBQ score was calculated and factor analysis and Cronbach's alpha assessed dimensional structure and internal consistency reliability, respectively. Spearman's rank correlations between global MTBQ scores and scores of self-rated health, health-related quality of life and the number of long-term conditions, respectively, assessed construct validity. MTBQ scores were grouped into four categories (no, low, medium, high burden) to assess interpretability and population-based evaluation of treatment burden. RESULTS: The scale showed high internal consistency (α=0.87), positive skewness and large floor effects. Factor analysis supported a one-dimensional structure of the scale with a three-dimensional structure as a less parsimonious alternative. The MTBQ score was negatively associated with self-rated health (rS-0.45, p<0.0001) and health-related quality of life (rS-0.46/-0.51, p<0.0001), and positively associated with the number of long-term conditions (rS 0.26, p<0.0001) and perceived stress (rS 0.44, p<0.0001). Higher treatment burden was associated with young age, male sex, high educational level, unemployment, being permanently out of work, not living with a spouse/cohabitant, living with child(ren) and long-term conditions (eg, heart attack, stroke, diabetes and mental illness). CONCLUSION: The Danish MTBQ is a valid measure of treatment burden with good construct validity and high internal reliability. This is the first study to explore treatment burden at a population level and provides important evidence to policy makers and clinicians about sociodemographic groups at risk of higher treatment burden.

The Danish National Health Survey: Study design, response rate and respondent characteristics in 2010, 2013 and 2017.

Aim: This article aims to describe the study design, including descriptive statistics on changes in response rates, characteristics associated with response and response mode distribution, in the Danish National Health Survey (DNHS) in 2010, 2013 and 2017. Methods: Each survey was based on five regional stratified random samples and one national random sample drawn from the Danish Civil Registration System. The subsamples were mutually exclusive. Around 300,000 individuals (aged ⩾16 years) were invited to participate in each survey using a mixed-mode approach (paper/web). A questionnaire with a minimum of 52 questions was used in all subsamples. In 2010 and 2013, invitations were sent via the regular postal service, whereas a secure electronical mail service was used to invite the majority (around 90%) in 2017. Weights accounted for survey design and non-response. Results: Participation decreased from 59.5% in 2010 to 54.0% in 2013 after which it increased to 58.7% in 2017. The proportion answering the web questionnaire increased from 31.0% to 77.4% between 2013 and 2017 and varied from 73.8% to 79.7% between the subsamples in 2017. Overall, the response rate was low among young men and old women and among individuals who were unmarried, had low sociodemographic status, were from ethnic minority backgrounds or were living in the eastern part of Denmark. Conclusions: The survey mode, response mode distribution as well as response rate have changed over time. Weights to handle non-response can be applied to accommodate possible problems in generalising the results. However, efforts should continuously be made to ensure that response is missing at random.

Population differences in health-related quality of life between cancer survivors and controls: Does low educational attainment widen the gap?

Aims: This study aimed to compare health-related quality of life (HRQOL) among cancer survivors and controls in the Danish population, with special attention given to the impact of low educational attainment. Comparisons were made at population level and for subgroups stratified by education. Furthermore, comparisons were made for all cancer diagnoses combined and for the 14 most prevalent cancer sites and 'other cancer sites'. Finally, the importance of time since initial diagnosis was examined. Methods: HRQOL was measured using the physical component score (PCS) and mental component score (MCS) of the 12-item Short-Form Health Survey version 2 in a population-based survey. By linking data with the Danish Cancer Registry, 11,166 cancer survivors and 151,117 individuals with no history of cancer were identified. Results: HRQOL was reduced in cancer survivors for all cancers combined and most cancer sites. Differences were found at population level and stratified by educational attainment. PCS was reduced to a similar extent in the three educational groups, whereas MCS was reduced slightly more in the low than in the high educational attainment group. HRQOL increased with time since initial diagnosis during the first years. Conclusions: Cancer survivors had lower HRQOL than controls, and HRQOL was lower in the low than in the high educational attainment group. However, low educational attainment did not widen the gap in HRQOL following a cancer diagnosis. Despite this, the combined effect of low educational attainment and a cancer diagnosis markedly reduced HRQOL in some cancer survivors. The study identified groups of cancer survivors with low HRQOL who may have unmet rehabilitation needs.

Low Health Literacy and Mortality in Individuals with Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Diabetes, and Mental Illness: A 6-Year Population-Based Follow-Up Study.

BACKGROUND: The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. METHODS: Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year follow-up. RESULTS: Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 (95% CI 1.11-1.73)) compared with those without difficulties. Higher risk was also observed among people reporting CVD (HR 1.47 (95% CI 1.01-2.14)), diabetes (HR 1.91 (95% CI 1.13-3.22)) and mental illness (HR 2.18 (95% CI 1.25-3.81)), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with an increase in the risk of dying in the general population or in any of the four long-term condition groups. CONCLUSIONS: Aspects of health literacy predict a higher risk of dying during a 6-year follow-up period. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.

Impact of low health literacy on healthcare utilization in individuals with cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental disorders. A Danish population-based 4-year follow-up study.

BACKGROUND: Previous research from the USA has shown that low health literacy is associated with higher hospitalization rates and higher rates of emergency service use. However, studies in a European context using more comprehensive health literacy definitions are lacking. The aim was to study the impact of low health literacy on healthcare utilization in a Danish context. METHODS: In this prospective cohort study, baseline survey data from 2013 were derived from a large Danish health and morbidity survey and merged with individual-level longitudinal register data for a 4-year follow-up period. The study included people in the general population (n = 29 473) and subgroups of people with four different chronic conditions: cardiovascular disease (CVD) (n = 2389), chronic obstructive pulmonary disease (COPD) (n = 1214), diabetes (n = 1685) and mental disorders (n = 1577). RESULTS: In the general population, low health literacy predicted slightly more visits to the general practitioner and admissions to hospital and longer hospitalization periods at 4 years of follow-up, whereas low health literacy did not predict planned outpatient visits or emergency room visits. In people with CVD, low health literacy predicted more days with emergency room visits. In people with mental disorders, difficulties in actively engaging with healthcare providers were associated with a higher number of hospital admission days. No significant association between health literacy and healthcare utilization was found for diabetes or COPD. CONCLUSIONS: Even though Denmark has a universal healthcare system the level of health literacy affects healthcare use in the general population and in people with CVD and mental disorders.

Health Literacy among People in Cardiac Rehabilitation: Associations with Participation and Health-Related Quality of Life in the Heart Skills Study in Denmark.

Health literacy (HL) is a dynamic determinant of health and a promising target of health equity interventions in noncommunicable disease prevention. Among people referred to a cardiac rehabilitation program, we examined the associations between (1) HL and participation in cardiac rehabilitation and (2) HL and health-related quality of life (HRQoL). Using a cross-sectional design, we invited 193 people referred to cardiac rehabilitation in Randers Municipal Rehabilitation Unit, Denmark, to respond to a questionnaire in 2017. Of these, 150 people responded (77.7%). HL was measured using the nine scales of the Health Literacy Questionnaire (HLQ), while HRQoL was measured using the Short Form Health Survey 12 (version 2) (SF-12). The mean age of respondents was 67.0 years; 71.3% of the sample were men. Nonrespondents had significantly lower educational attainment and more often lived alone than respondents. Using multiple regression analyses, we found no significant associations between HL and participation in cardiac rehabilitation. There were significant positive associations between several aspects of HL and physical and mental HRQoL. HL could be a factor of interest in initiatives aimed at improving participation and outcomes of cardiac rehabilitation.

Educational attainment and work disability in cancer survivors: Do diagnosis and comorbidity affect this association?

OBJECTIVES: To study whether educational attainment had less impact on work disability in cancer survivors than in individuals without cancer. To study whether comorbidity had a higher impact on work disability in low-educated cancer survivors than in high-educated and whether this impact differed when compared with individuals without cancer. METHODS: Linkage of population-based public health survey data and the Danish Cancer Registry formed two groups: cancer survivors (n = 3,514) and cancer-free individuals (n = 171,262). In logistic regression models, the risk of experiencing an 8-week sick leave spell and the granting of disability pension within a 3-year follow-up period was studied in three educational levels and whether these associations were modified by history of cancer and comorbidity. Odds ratios (OR) with 95% confidence intervals (CI) are reported. RESULTS: Non-stratified adjusted risk of experiencing an 8-week sick leave spell (OR: 1.41, 95% CI (1.33-1.49)) or being granted a disability pension (OR: 1.61, 95% CI (1.31-1.97)) was significantly higher in low-educated than in high-educated respondents. Cancer or comorbidity did not significantly interact with education on the risk of work disability. CONCLUSIONS: A moderate impact of low education on future work disability was found for all respondents, neither history of cancer nor comorbidity modified this association.

Health literacy, multimorbidity, and patient-perceived treatment burden in individuals with cardiovascular disease. A Danish population-based study.

OBJECTIVE: The aim was to investigate the association between: 1) multimorbidity and high treatment burden 2) health literacy and high treatment burden, and 3) the interaction between multimorbidity and health literacy in relation to high treatment burden. METHODS: We included respondents with cardiovascular disease who participated in a Danish population-based survey from 2017 (N = 2,111). Logistic regression analyses were used to study associations. RESULTS: The study showed that multimorbid individuals with cardiovascular disease were more likely to experience a high treatment burden than individuals with cardiovascular disease only (2+ additional conditions OR 4.16 [2.80-6.18]). Also, individuals with difficulties in understanding health information were more likely to report a high treatment burden than individuals who found it easy to understand information about health (OR 9.97 [6.23-15.95]). Finally, individuals with multimorbidity and difficulties in understanding health information had markedly higher odds of experiencing a high treatment burden. CONCLUSION: If individuals find it difficult to understand health information, there is a risk they might feel overwhelmed by the treatment. PRACTICE IMPLICATIONS: Healthcare professionals should be aware of health literacy challenges in planning medical treatment particularly for patients with both low health literacy levels and multimorbidity.

Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease.

Background Health literacy may constitute a modifiable determinant of health behaviour and affect cardiovascular disease prevention. This study investigates the associations between health literacy and health behaviour as well as health status. Design A cross-sectional study on a population-based sample of people with acute myocardial infarction, angina pectoris or stroke ( N = 3116). Methods Health literacy was assessed using two dimensions from the Health Literacy Questionnaire: 'understanding health information' and 'engaging with healthcare providers'. Health behaviour included physical activity, dietary habits, smoking, alcohol consumption and body mass index. Health status was examined using Short Form Health Survey 12 version 2 (four-week recall) (physical and mental components). We used regression analyses to examine the associations. Results 'Understanding health information' was inversely associated with physical inactivity (odds ratio (OR) 0.48 (0.39;0.59), unhealthy diet (OR 0.64 (0.47;0.88)), underweight (OR 0.43 (0.21;0.89)) and obesity (OR 0.79 (0.63;0.99)). 'Engaging with healthcare providers' was inversely associated with physical inactivity (OR 0.64 (0.53;0.77)), less than healthy diet (OR 0.79 (0.64;0.96)) and daily smoking (OR 0.81 (0.66;1.0)). An increase in 'understanding health information' as well as 'engaging with healthcare providers' was associated with an increase in both physical and mental health status. Conclusions The findings suggest that aspects of health literacy are associated with health status and health behaviour in cardiovascular patients and should be considered in interventions regarding cardiovascular disease prevention.

Young people's attitudes towards illicit drugs: A population-based study.

AIMS: Previous studies indicate that young people who have positive attitudes towards illicit drugs are more inclined to experiment with them. The first aim of our study was to identify the sociodemographic and risk behaviour characteristics of young people (16-24 years) with positive attitudes towards illicit drug use. The second aim was to identify the characteristics of young people with positive attitudes towards illicit drugs among those who had never tried drugs, those who had tried cannabis but no other illicit drugs, and those who regularly used cannabis and/or had tried other illicit drugs. METHODS: The analysis was based on a population-based survey from 2013 ( N = 3812). Multiple logistic regression was used to analyse the association between sociodemographic and risk behaviour characteristics and positive attitudes towards illicit drugs. RESULTS: Young men had twice the odds of having positive attitudes towards illicit drug use compared with young women (AOR = 2.1). Also, young age, being single, being employed, smoking tobacco, practising unprotected sex, and experimental cannabis use were associated with positive attitudes towards illicit drug use. Finally, use of cannabis at least 10 times during the previous year and/or use of other illicit drugs had the strongest association with positive attitudes to illicit drug use (AOR = 6.0). CONCLUSIONS: Young people who have positive attitudes towards illicit drug use are characterized by a broad range of risky behaviours. These findings may help to identify young people at risk of initiating illicit drug use and thereby support the development and implementation of prevention programmes.

A Latent Class Analysis of Multimorbidity and the Relationship to Socio-Demographic Factors and Health-Related Quality of Life. A National Population-Based Study of 162,283 Danish Adults.

OBJECTIVES: To identify patterns of multimorbidity in the general population and examine how these patterns are related to socio-demographic factors and health-related quality of life. STUDY DESIGN AND SETTING: We used latent class analysis to identify subgroups with statistically distinct and clinically meaningful disease patterns in a nationally representative sample of Danish adults (N = 162,283) aged 16+ years. The analysis was based on 15 chronic diseases. RESULTS: Seven classes with different disease patterns were identified: a class with no or only a single chronic condition (59% of the population) labeled "1) Relatively Healthy" and six classes with a very high prevalence of multimorbidity labeled; "2) Hypertension" (14%); "3) Musculoskeletal Disorders" (10%); "4) Headache-Mental Disorders" (7%); "5) Asthma-Allergy" (6%); "6) Complex Cardiometabolic Disorders" (3%); and "7) Complex Respiratory Disorders" (2%). Female gender was associated with an increased likelihood of belonging to any of the six multimorbidity classes except for class 2 (Hypertension). Low educational attainment predicted membership of all of the multimorbidity classes except for class 5 (Asthma-Allergy). Marked differences in health-related quality of life between the seven latent classes were found. Poor health-related quality of life was highly associated with membership of class 6 (Complex Cardiometabolic Disorders) and class 7 (Complex Respiratory Disorders). Despite different disease patterns, these two classes had nearly identical profiles in relation to health-related quality of life. CONCLUSION: The results clearly support that diseases tend to compound and interact, which suggests that a differentiated public health and treatment approach towards multimorbidity is needed.

The Relationship between Health Literacy and Health Behaviour in People with Diabetes: A Danish Population-Based Study.

Background. People with diabetes who have poor health behaviours are at greater risk for a range of adverse health outcomes. We aimed to investigate the relationship between health literacy and health behaviour (smoking, alcohol, physical activity, and diet) in people with diabetes. Methods. The study was based on respondents aged 25 years or older from a population-based survey in 2013 who reported having diabetes (n = 1685). Two dimensions from the Health Literacy Questionnaire were used: "understand health information" and "actively engage with healthcare providers." We used logistic regression to examine the association between health literacy and health behaviour. Results. After adjustment for sociodemographic factors, individuals with diabetes who found it difficult to understand information about health had higher odds of being physically inactive (OR: 3.43, 95% CI: 2.14-5.51) and having unhealthy dietary habits (OR: 3.01, 95% CI: 1.63-5.58). Similar results were observed for individuals who found it difficult to actively engage with healthcare providers. No associations were found between the two dimensions of health literacy and smoking and alcohol consumption. Conclusion. When developing health services and interventions to improve health behaviour among people with diabetes, our results suggest that they may benefit by including focus on health literacy.

Health Literacy Mediates the Relationship Between Educational Attainment and Health Behavior: A Danish Population-Based Study.

Individuals with a lower education level frequently have unhealthier behaviors than individuals with a higher education level, but the pathway is not fully understood. The aim of this study was to investigate whether health literacy mediates the association between educational attainment and health behavior (smoking, physical inactivity, poor diet) and obesity. The study included respondents ages 25 years or older drawn from a large population-based survey conducted in 2013 (N = 29,473). Two scales from the Health Literacy Questionnaire were used: (a) Understanding health information well enough to know what to do and (b) Ability to actively engage with health care providers. Multiple mediation analyses were conducted using the Karlson-Holm-Breen method. The study showed that health literacy in general and the ability to understand health information in particular mediated the relationship between educational attainment and health behavior, especially in relation to being physically inactive (accounting for 20% of the variance), having a poor diet (accounting for 13% of the variance), and being obese (accounting for 16% of the variance). These findings suggest that strategies for improving health behavior and reducing health inequalities may benefit from adopting a stronger focus on health literacy within prevention, patient education, and other public health interventions.

"Where are all the lonely people?" A population-based study of high-risk groups across the life span.

BACKGROUND: Loneliness is a prevalent and urgent public health issue. Optimal planning of community approaches to loneliness requires a differentiated understanding of loneliness across the life span. We identified groups at high risk of loneliness by exploring the relationship between loneliness and socio-demographic and health-related factors across multiple age groups. METHODS: This was a combined population-based questionnaire survey and register data study based on a representative sample, including 33,285 Danish individuals aged 16-102 years. Loneliness was measured using the Three-Item Loneliness Scale. RESULTS: The relation between loneliness and age took a shallow U-shaped distribution. Ethnic minority status, receiving disability pensions or being unemployed, living alone, prolonged mental disorder, and psychiatric treatment were strongly associated with severe loneliness. Socio-demographic and health-related factors were associated with an increased risk of severe loneliness in specific age groups. Being female, having a low educational level and living in a deprived area were only associated with loneliness in adolescence/emerging adulthood. Receiving disability pensions and living alone (i.e., divorced), on the other hand, were strongly associated with loneliness in early and middle adulthood and young-old age. CONCLUSION: Ethnic minority status, living alone, and prolonged mental disorder may well be key factors in determining the generic level of loneliness in a given population. Other conditions are associated with an increased risk of severe loneliness in specific age groups and may moderate the age-loneliness relation. These findings may help to identify populations within communities at risk of loneliness and thereby support the implementation of policies and public health interventions across the life span.

A National Population Study of the Co-Occurrence of Multiple Long-Term Conditions in People With Multimorbidity, Denmark, 2013.

The objective of this study was to describe the prevalence of pairwise combinations of 17 long-term conditions. Data were obtained from a national, representative population-based study including 162,283 Danish citizens aged 16 years or older. We calculated the prevalence of each long-term condition given the presence of another long-term condition. Compared with the general population, people with angina pectoris had more than twice the odds of having 12 of the 16 other long-term conditions, and inversely, people with cancer, tinnitus, or cataracts did not have notably higher odds for any of the other long-term conditions.

Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29,473 Danish citizens.

OBJECTIVES: To (1) quantify levels of subjective health literacy in people with long-term health conditions (diabetes, cardiovascular disease, chronic obstructive pulmonary disease, musculoskeletal disorders, cancer and mental disorders) and compare these to levels in the general population and (2) examine the association between health literacy, socioeconomic characteristics and comorbidity in each long-term condition group. DESIGN: Population-based survey in the Central Denmark Region (n=29,473). MAIN OUTCOME MEASURES: Health literacy was measured using two scales from the Health Literacy Questionnaire (HLQ): (1) Ability to understand health information and (2) Ability to actively engage with healthcare providers. RESULTS: People with long-term conditions reported more difficulties than the general population in understanding health information and actively engaging with healthcare providers. Wide variation was found between disease groups, with people with cancer having fewer difficulties and people with mental health disorders having more difficulties in actively engaging with healthcare providers than other long-term condition groups. Having more than one long-term condition was associated with more difficulty in engaging with healthcare providers and understanding health information. People with low levels of education had lower health literacy than people with high levels of education. CONCLUSIONS: Compared with the general population, people with long-term conditions report more difficulties in understanding health information and engaging with healthcare providers. These two dimensions are critical to the provision of patient-centred healthcare and for optimising health outcomes. More effort should be made to respond to the health literacy needs among individuals with long-term conditions, multiple comorbidities and low education levels, to improve health outcomes and to reduce social inequality in health.