Sociodemographic inequality in children aged 0-19 years with and without parents diagnosed with heart disease: a Danish nationwide register-based study.

OBJECTIVES: This study aimed to estimate the prevalence of children aged 0-19 years who have a parent with a history of heart disease and investigate their sociodemographic characteristics. STUDY DESIGN: A national register-based study. METHODS: From the Danish Fertility Register and the Danish National Patient Register information on children of parents with ischemic heart disease, arrhythmia, heart failure and heart valve disease in the period 1981-2018 were obtained. Statistical analyses including descriptive statistics, logistic and linear regression were used to illuminate associations between parental heart disease and sociodemographic characteristics. RESULTS: The study population consisted of 142,480 children aged 0-19 years with at least one parent diagnosed with heart disease, corresponding to every 9th child in Denmark in 2018. The number increased from 4.5% in 2002 to 11.1% in 2018. In the study population most had a father with heart disease (57.8%) and 4.6% had two parents with heart disease. Parents with heart disease had significantly higher odds of being out of work (OR 1.68, 95% CI 1.64; 1.72), in a single-parent household (OR 1.09, 95% CI 1.07; 1.11), divorced or widowed (OR: 1.10, 95% CI 1.08; 1.12), having a lower educational level (OR 1.35, 95% CI 1.33; 1.37), and a lower family income (-42,410 DKR, 95% CI -50,306; -34,514, P < 0.0001) compared to those without heart disease. CONCLUSION: Children affected by parental heart disease comprise a substantial part of the Danish population. These have significantly different sociodemographic characteristics than children in families without parental heart disease, which might affect social heritage and parental capacity.

Long-term opioid therapy in Denmark: A disappointing journey.

BACKGROUND: Longitudinal population-based studies of long-term opioid therapy (L-TOT) in chronic non-cancer pain (CNCP) patients are sparse. Our study investigated incidence and predictors for initiating L-TOT and changes in self-rated health, pain interference and physical activities in long-term opioid users. METHODS: Data were obtained from the national representative Danish Health and Morbidity Surveys and The Danish National Prescription Registry. Respondents with no dispensed opioids the year before the survey were followed from 2000 and from 2005 until the end of 2012 (n = 12,145). A nationally representative subsample of individuals (n = 2015) completed the self-administered questionnaire in both 2000 and 2013. Collected information included chronic pain (≥6 months), health behaviour, self-rated health, pain interference with work activities and physical activities. Long-term users were defined as those who were dispensed at least one opioid prescription in six separate months within a year. RESULTS: The incidence of L-TOT was substantially higher in CNCP patients at baseline than in others (9/1000 vs. 2/1000 person-years). Smoking behaviour and dispensed benzodiazepines were significantly associated with initiation of L-TOT in individuals with CNCP at baseline. During follow-up, L-TOT in CNCP patients increased the likelihood of negative changes in pain interference with work (OR 9.2; 95% CI 1.9-43.6) and in moderate activities (OR 3.7; 95% CI 1.1-12.6). The analysis of all individuals indicated a dose-response relationship between longer treatment duration and the risk of experiencing negative changes. CONCLUSIONS: Individuals on L-TOT seemed not to achieve the key goals of opioid therapy: pain relief, improved quality of life and functional capacity. SIGNIFICANCE: Long-term opioid therapy does not seem to provide pain relief, improvement in HRQOL and physical capacity in CNCP patients in a general population.

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.

Renal function and symptoms/adverse effects in opioid-treated patients with cancer.

BACKGROUND: Renal impairment and the risk of toxicity caused by accumulation of opioids and/or active metabolites is an under-investigated issue. This study aimed at analysing if symptoms/adverse effects in opioid-treated patients with cancer were associated with renal function. METHODS: Cross-sectional multicentre study (European Pharmacogenetic Opioid Study, 2005-2008), in which 1147 adult patients treated exclusively with only one of the most frequently reported opioids (morphine/oxycodone/fentanyl) for at least 3 days were analysed. Fatigue, nausea/vomiting, pain, loss of appetite, constipation and cognitive dysfunction were assessed (EORTC QLQ-C30). Glomerular filtration rate (GFR) was estimated using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI Creatinine) equations. RESULTS: Mild to severe low GFR was observed among 40-54% of patients. CG equation showed that patients with mild and moderate/severe low GFR on morphine treatment had higher odds of having severe constipation (P < 0.01) than patients with normal GFR. In addition, patients with moderate/severe low GFR on morphine treatment were more likely to have loss of appetite (P = 0.04). No other significant associations were found. CONCLUSION: Only severe constipation and loss of appetite were associated with low GFR in patients treated with morphine. Oxycodone and fentanyl, in relation to the symptoms studied, seem to be safe as used and titrated in routine cancer pain care.

Reach and uptake of Internet- and phone-based smoking cessation interventions: results from a randomized controlled trial.

OBJECTIVE: To study whether demographic and smoking-related characteristics are associated with participation (reach) in a smoking cessation trial and subsequent use (uptake) of two specific smoking interventions (Internet-based program and proactive telephone counseling). METHODS: We used data from a four-arm randomized smoking cessation trial (2011). Participants (n=1,809) were recruited among 9,924 smokers who previously participated in two health surveys in Denmark (2007-2008 and 2010). Interventions were as follows: (1) an Internet-based smoking cessation program, (2) proactive telephone counseling, (3) reactive telephone counseling and (4) a self-help booklet. RESULTS: Reach (defined as the proportion accepting to participate in the trial of those invited) was highest among persons aged 40-59 years, women, heavy smokers and persons with long education. Among trial participants, uptake (defined as any use of the specific intervention at 1-month follow-up) was 69% for the Internet-based program, 74% and 9% for proactive and reactive telephone counseling, respectively, and 84% for the self-help booklet. Young age was associated with the uptake of the Internet-based program, and short education was associated with using proactive telephone counseling. CONCLUSIONS: Internet-based interventions and proactive telephone counseling appeal to different age and educational groups. Further, offering similar intervention content by a proactive and a reactive approach can be associated with different intervention uptake.

Importance of questionnaire context for a physical activity question.

Adequate information about physical activity habits is essential for surveillance, implementing, and evaluating public health initiatives in this area. Previous studies have shown that question order and differences in wording result in systematic differences in people's responses to questionnaires; however, this has never been shown for physical activity questions. The aim was to study the influence of different formulations and question order on self-report physical activity in a population-based health interview survey. Four samples of each 1000 adults were drawn at random from the National Person Register. A new question about physical activity was included with minor differences in formulations in samples 1-3. Furthermore, the question in sample 2 was included in sample 4 but was placed in the end of the questionnaire. The mean time spent on moderate physical activity varied between the four samples from 57 to 100 min/day. Question order was associated with the reported number of minutes spent on moderate-intensity physical activity and with prevalence of meeting the recommendation, whereas physical inactivity was associated with the differences in formulation of the question. Questionnaire context influences the way people respond to questions about physical activity significantly and should be tested systematically in validation studies of physical activity questionnaires.

Explaining educational differences in leisure-time physical activity in Europe: the contribution of work-related factors.

Although educational differences in leisure-time physical activity (LTPA) exist across Europe, the independent effect of educational level on leisure-time physical activity has rarely been explored. This study examines the relative contribution of occupational class, employment status, and educational level to LTPA across 12 European countries. The data were obtained from 12 European health surveys conducted at the turn of the century and identified in the EUROTHINE project. All information was self-reported. Logistic regression was applied and relative inequality index (RII) was calculated. Analyses were limited to those in the prime working-age (age 30-59; total N=137,646) men and women. In all 12 European countries, LTPA was more common in the high-educated than in the low-educated. The association between education and LTPA remained mostly unchanged after adjusting for marital status, urbanization, and self-rated health. After further adjusting for occupational class and employment status, the educational differences in LTPA were only slightly attenuated. An inverse association was found between educational level and LTPA across almost all 12 European countries. Occupational class and employment status had only a modest effect on educational differences in LTPA in most of the examined countries, suggesting that education remains an important predictor of LTPA.

Influence of the recall period on a beverage-specific weekly drinking measure for alcohol intake.

BACKGROUND/OBJECTIVES: Our knowledge of the association between alcohol intake and alcohol-related health outcomes depends, to a large extent, on the validity and reliability of self-reported alcohol intake. Weekly drinking measures are frequently used in epidemiological surveys, but it has been shown that respondents have problems in correctly reporting intake for a full week. The aim of this study is to investigate whether a beverage-specific question implies better recall and, thereby, eliminates or diminishes the previously reported association between the recall period and the self-reported weekly alcohol intake. SUBJECTS/METHODS: The data is derived from the Danish Health Interview Survey 2005, which is based on a region-stratified random sample of 21,832 Danish citizens aged ≥16 years (response rate: 67%). The data were collected via face-to-face interviews. RESULTS: A beverage-specific question on alcohol intake on each day during the last week did not alter the strong association between the recall period and self-reported alcohol intake. However, the overall self-reported alcohol intake increased substantially when using the beverage-specific question instead of asking for the overall alcohol intake on each day. Moreover, the analyses indicated that interviews on Sundays should be avoided if the purpose is to assess alcohol intake for the previous day (Saturdays). CONCLUSIONS: It seems problematic to recall alcohol intake even when the recall period is as short as 1 week. Weekly drinking measures should primarily be used when the main aim of the study is to assess the average volume of alcohol intake in a specific population.

Health care utilisation and characteristics of long-term breast cancer survivors: nationwide survey in Denmark.

AIM: To investigate long-term female breast cancer survivors' (BCS') health care utilisation, health, and employment. METHODS: An age-stratified random sample of 2000 female breast cancer survivors (BCS) 5-15 years after primary surgery without recurrence was drawn from the Danish Breast Cancer Cooperative Group register. A self-administered questionnaire assessed sociodemography, health care utilisation, employment, and health-related quality of life (HRQOL). Associations with breast cancer treatment were investigated. RESULTS: Response rate was 79%. Significantly more BCS than the general women population reported health care utilisation (61% versus. 56%; age-standardised risk ratio (SRR): 1.10; 95% confidence interval (CI) 1.05-1.15), but significantly fewer BCS were disability pensioners (15% versus 19%; SRR: 0.77; 95% CI 0.64-0.93). 'Daily activities limited due to sequelae' were reported by 20%, and 'stopped working/changed job due to sequelae' by 11% of BCS. In multiple logistic regression analysis, radiotherapy (odds ratio (OR) 2.54; 95% CI 1.34-4.80) and endocrine therapy (OR 2.48; 95% CI 1.13-5.45, postmenopausal women only) were significantly related to 'stopped working/changed job due to sequelae'. Time since surgery 5-10 years (versus >10 years) was significantly associated with 'daily activities limited due to sequelae' (OR 2.02; CI 1.43-2.84), which, in turn, was significantly related to poorer HRQOL (all p<0.05). Chemotherapy, receptor status, and protocol allocation did not show significant associations in any analyses. CONCLUSION: Significantly more BCS reported health care utilisation. Radiotherapy, shorter time since surgery, and endocrine therapy predicted daily activity and work limitations due to sequelae.

Chronic pain and other sequelae in long-term breast cancer survivors: nationwide survey in Denmark.

OBJECTIVES: To investigate self-reported chronic pain and other sequelae in a nationally representative sample of long-term breast cancer survivors (BCS). DESIGN: Age-stratified random sample of 2,000 female BCS 5 years after primary surgery without recurrence drawn from the Danish Breast Cancer Cooperative Group register, which is representative regarding long-term BCS in Denmark. ASSESSMENT: Self-administered questionnaire including questions on sociodemography, chronic pain (6 months), health-related quality of life (HRQOL) and other sequelae related to breast cancer. Associations with treatment were investigated. Report of chronic pain was compared to normative data. RESULTS: The response rate was 79%. Chronic pain prevalence of 42% was significantly higher in BCS compared to general population women (SRR: 1.32; 95% CI: 1.23-1.42). Sequelae related to breast cancer were paraesthesia 47%, chronic pain 29%, arm/shoulder swelling 25%, phantom sensations 19%, and allodynia 15%. Chronic pain related to breast cancer was significantly associated with poorer HRQOL and higher medicine consumption, and, in multiple logistic regression analysis, with age (<70 years), short education, being single (divorced, widowed, separated), radiotherapy, and time since operation <10 years. Radiotherapy and younger age were significantly associated with most sequelae. CONCLUSION: Chronic pain was more prevalent in BCS compared to the general population. Significant predictors for sequelae related to breast cancer were radiotherapy and younger age. Future research should therefore prioritize sequelae prevention.

Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries.

BACKGROUND: Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups. METHODS: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS). RESULTS: Quit ratios were especially high (>45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban. CONCLUSION: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Comparison of assessment methods for self-reported alcohol consumption in health interview surveys.

OBJECTIVE: To select a simple method for assessing alcohol consumption and to compare how different reference periods and response categories influence the self-reported frequency of binge drinking. DESIGN: Four random samples of 1000 adult Danes. Data were collected via personal interview at the respondents' home. SETTING: Denmark, nationwide. PARTICIPANTS: The total number of interviewed was 2593 individuals. MEASUREMENTS: The assessment methods in the four samples were (1) the 7-day recall method, (2) intake each day in a typical week, (3) intake last weekend, and (4) intake in a typical week. Furthermore, binge drinking was assessed in the samples using different reference periods and response formats. FINDINGS: The sex- and age-adjusted mean number of drinks in the last week (the 7-day recall method) was 10.6 drinks compared to 10.4 drinks among respondents reporting their intake for each day in a typical week and 8.7 drinks among subjects reporting the average intake in a typical week. Furthermore, subjects that reported their typical intake for each day were as likely as subjects that had the 7-day recall method to report a high weekly alcohol intake. Respondents who had close-ended questions were more likely to report binge drinking compared to respondents that had open-ended questions. CONCLUSIONS: Questions concerning typical alcohol intake for each day of the week are feasible to use in epidemiological studies. Furthermore, it is more appropriate to use close-ended questions compared to open-ended questions in measuring binge-drinking when the reference period is long.