Do animation videos increase participation in national health surveys? A randomised controlled trial.

BACKGROUND: Declining response proportions in surveys have been observed internationally. Improving response proportions is important for the generalizability of the outcome. The aim of this study was to examine the potential of animation videos to improve response proportions and sample composition in health surveys. METHODS: A randomized trial was embedded in the Danish National Health Survey 2021 (n = 186,113) where the use of animation videos in the digital invitation letter was tested as a mean to increase response proportion. The effect of both demographic-targeted videos and a general video was tested. The sample was stratified into four subsamples; (1) individuals with non-western background and a non-Danish citizenship (n = 9,956), (2) men aged 16-24 years (n = 12,481), (3) women aged 75 years or older (n = 7,815) and (4) the remaining individuals (n = 155,861). The fourth subsample was randomized into two equal sized groups; a group receiving the general video and a control group receiving no video. Each of the first three subsamples was subsequently randomized into three subgroups with 25% receiving the target group video, 25% receiving the general video and 50% receiving no video. A total of four reminders (one digital and three postal) were sent to the eligible population. RESULTS: The use of animation videos resulted in similar or slightly lower overall response proportion compared to the control group. The different animation videos were found to have heterogeneous effects on response proportions. A positive effect was found among men aged 16-24 years before the delivery of the postal reminder for the targeted animation video compared to no video (odds ratio: 1.13; 95% confidence interval: 1.02-1.26). Overall, the targeted animation videos tended to produce higher response proportions than the general animation video. CONCLUSIONS: The heterogeneous effects of the videos suggest that there is some potential for the use of animation videos to improve response proportions and sample composition. The content, target group and timing of evaluation seem to be important for the animation videos to be successful. This warrants further research to better identify in which contexts, in which subgroups and under which circumstances, animation videos are useful to increase response proportions. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT05520242, registered 08/26/2022.

An updated validation of the Dietary Quality Score: associations with risk factors for cardiometabolic diseases in a Danish population.

PURPOSE: This study assessed the validity of the Dietary Quality Score (DQS) and investigated the association between the DQS and risk factors for cardiometabolic diseases. METHODS: The DQS was calculated based on an updated 23-item FFQ and validated against a 376-item FFQ. A sub-sample of 450 men and women aged 18-73 years, from the Danish Diet, Cancer and Health-Next generations (DCH-NG) cohort, completed the updated 23-item FFQ. We investigated the associations between the DQS and risk factors for cardiometabolic diseases (lipids, haemoglobin A1c (HbA1c), high-sensitive C-reactive protein (hs-CRP), blood pressure (BP), waist circumference (WC), visceral and total fat mass) using linear regression models. RESULTS: A high DQS, i.e. healthy dietary habits, was significantly associated with a higher intake of fruits, vegetables, fish, fibre, several vitamins and minerals and a lower intake of saturated fat. Moreover, a high DQS was significantly associated with lower levels of LDL cholesterol (P = 0.0133), Hs-CRP (P = 0.0449), WC (P = 0.0161), visceral fat (P = 0.0003), total fat mass (P = 0.0106) and total fat percentage (P = 0.0030) and significantly associated with a higher HDL cholesterol (P = 0.0379) level, when adjusting for education, smoking habits and physical activity. There was no association with total cholesterol, triglycerides, HbA1c, BP and BMI. CONCLUSION: The DQS, based on the updated 23-item FFQ, is a valid tool to classify individuals into groups with low, average and high dietary quality in the Danish population. Furthermore, a high DQS is significantly associated with lower levels of several risk factors for cardiometabolic diseases.

Social support and risk of mortality in cirrhosis: A cohort study.

Background & Aims: The function and structure of social relationships influence mortality in individuals within the general population. We compared aspects of social relationships in individuals with cirrhosis and a matched comparison cohort and studied their association with health-related quality of life (HRQoL) and mortality in cirrhosis. Methods: Individuals with cirrhosis and comparators were identified among participants of the Danish National Health Surveys 2010-2017. The surveys included questions on functional (social support and loneliness) and structural (living alone/cohabitating and frequency of contacts with relatives and friends) aspects of social relationships and HRQoL (Short Form-12). We estimated associations of aspects of social relationships with HRQoL and all-cause mortality in individuals with cirrhosis through 2020. Results: Of 541 individuals with cirrhosis and 2,157 comparators, low social support (22% in cirrhosis vs. 13% in comparators), loneliness (35% vs. 20%), and living alone (48% vs. 22%) were more frequent in individuals with cirrhosis than comparators, whereas the frequency of contacts with relatives and friends was similar. Except for living alone, weak functional and structural social relationships were associated with lower mental HRQoL in those with cirrhosis. Physical HRQoL was only marginally associated with social relationships. During 2,795 person-years of follow-up, 269 individuals with cirrhosis died. Functional and not structural aspects of social relationships were associated with risk of mortality in cirrhosis. Specifically, the adjusted hazard ratio was 1.4 (95% CI 1.1-1.9), p = 0.011, for low vs. moderate-to-high social support (functional aspect), and 1.0 (95% CI 0.8-1.3), p = 0.85 for living alone vs. cohabitating (structural aspect). Conclusions: Individuals with cirrhosis have weaker functional and structural social relationships than matched comparators. Weak functional relationships are associated with lower mental HRQoL and increased risk of mortality in individuals with cirrhosis. Impact and implications: This study investigated the prevalence of weak social relationships in individuals with cirrhosis and their influence on health-related quality of life and risk of mortality. Individuals with cirrhosis were nearly twice as likely to report low social support, loneliness, and to live alone than a matched comparison cohort. Low social support and loneliness (functional measures of social relationships) were associated with lower mental health-related quality of life and increased risk of mortality risk in cirrhosis, when adjusting for known confounders. We hope that these results will make healthcare providers aware of the functional aspects of the social relationships of individuals with cirrhosis, in addition to the traditional clinical management, and motivate further research of interventions to strengthen the social support of individuals with cirrhosis.

Agreement between self-reported diseases from health surveys and national health registry data: a Danish nationwide study.

BACKGROUND: Agreement may be low when comparing self-reported diseases in health surveys with registry data. The aim of the present study was to examine the agreement between seven self-reported diseases among a representative sample of Danish adults aged ≥16 years and data from medical records. Moreover, possible associations with sociodemographic variables were examined. METHODS: Nationally representative data on self-reported current or previous diabetes, asthma, rheumatoid arthritis, osteoporosis, myocardial infarction, stroke and cancer, respectively, were derived from the Danish National Health Survey in 2017 (N=183 372). Individual-level data were linked to data on the same diseases from medical records in registries. Logistic regression models were used to explore potential associations between sociodemographic variables and total agreement. RESULTS: For all included diseases, specificity was >92% and sensitivity varied between 66% (cancer) and 95% (diabetes). Negative predictive value (NPV) was >96% for all diseases and positive predictive value (PPV) varied between 13% (rheumatoid arthritis) and 90% (cancer). Total agreement varied between 91% (asthma) and 99% (diabetes), whereas the kappa value was lowest for rheumatoid arthritis (0.21) and highest for diabetes (0.88). Sociodemographic variables were demonstrated to be significantly associated with total agreement for all diseases, with sex, age and educational level exhibiting the strongest associations. However, the directions of the associations were inconsistent across diseases. CONCLUSION: Overall, self-reported data were accurate in identifying individuals without the specific disease (ie, specificity and NPV). However, sensitivity, PPV and kappa varied greatly between diseases. These findings should be considered when interpreting similar results from surveys.

The healthy donor effect and survey participation, becoming a donor and donor career.

BACKGROUND: The healthy donor effect (HDE) is a selection bias caused by the health criteria blood donors must meet. It obscures investigations of beneficial/adverse health effects of blood donation and complicates the generalizability of findings from blood donor cohorts. To further characterize the HDE we investigated how self-reported health and lifestyle are associated with becoming a blood donor, lapsing, and donation intensity. Furthermore, we examined differences in mortality based on donor status. STUDY DESIGN AND METHODS: The Danish National Health Survey was linked to the Scandinavian Donations and Transfusions (SCANDAT) database and Danish register data. Logistic- and normal regression was used to compare baseline characteristics and participation. Poisson regression was used to investigate future donation choices. Donation intensity was explored by the Anderson-Gill model and Poisson regression. Mortality was investigated using Poisson regression. RESULTS: Blood donors were more likely to participate in the surveys, OR = 2.45 95% confidence interval (2.40-2.49) than non-donors. Among survey participants, better self-reported health and healthier lifestyle were associated with being or becoming a blood donor, donor retention, and to some extent donation intensity, for example, current smoking conveyed lower likelihood of becoming a donor, OR = 0.70 (0.66-0.75). We observed lower mortality for donors and survey participants, respectively, compared with non-participating non-donors. CONCLUSION: We provide evidence that blood donation is associated with increased likelihood to participate in health surveys, possibly a manifestation of the HDE. Furthermore, becoming a blood donor, donor retention, and donation intensity was associated with better self-reported health and healthier lifestyles.

Making smoking history: temporal changes in support for a future smoking ban and increasing taxes in the general population of Denmark.

BACKGROUND: An end date for smoking has been adopted in several countries and is now being discussed by governments all over the world. However, little is known about temporal changes in citizens' support for a future smoking ban. AIM: To examine temporal changes in support for a future smoking ban and for increasing taxes on tobacco in Denmark, and to explore whether these changes differ across sex, age, educational attainment, smoking status and between smokers with/without intention to quit. METHOD: The study was based on two waves of 'The Danish Capital Region Health Survey' conducted in 2013 and 2017. The pooled study sample included 96 521 citizens aged ≥16 years old. RESULTS: Public support for a future smoking ban increased from 30.6% in 2013 to 50.3% in 2017, whereas support for increasing tobacco taxes remained unchanged at 59%. Support for a future smoking ban increased significantly in almost all subgroups from 2013 to 2017: Support among daily smokers increased by 27% between 2013 and 2017. Support among never smokers was almost 2.63 times higher than among smokers in 2013 and increased further in 2017 (OR: 2013=2.63; 2017=5.13). CONCLUSION: This study indicates a readiness to support a future smoking ban and increasing tobacco taxes. Support for a future smoking ban has increased from 2013 to 2017 among both young people and adults. By 2017, about half of the population supported a future smoking ban and increasing tobacco taxes. Findings may help inform policy-making related to endgame strategies.

The impact of non-response weighting in health surveys for estimates on primary health care utilization.

BACKGROUND: Low response rates in health surveys may affect the representativeness and generalizability of results if non-response is systematically related to the indicator of interest. To account for such potential bias, weighting procedures are widely used with an overall aim to obtain less biased estimates. The aim of this study was to assess the impact of applying calibrated weights on prevalence estimates of primary health care utilization among respondents compared to the entire sample of a representative Danish survey of adults aged ≥16 years. METHODS: Registry-based 1-year prevalence data on health care utilization of chiropractor/physiotherapist, dentist and psychologist in 2016 were linked to the entire sample (n = 312 349), including respondents (n = 183 372), from the Danish National Health Survey in 2017. Calibrated weights, which applied information on e.g. sex, age, ethnic background, education and overall health service use were used to assess their impact on prevalence estimates among respondents. RESULTS: Across all included types of health care, weighting for non-response decreased prevalence estimates among respondents, which resulted in less biased estimates. For example, the overall 1-year prevalence of chiropractor/physiotherapist, dentist and psychologist utilization decreased from 19.1% to 16.9%, 68.4% to 62.5% and 1.9% to 1.8%, respectively. The corresponding prevalence in the entire sample was 16.5%, 59.4% and 1.7%. CONCLUSIONS: Applying calibrated weights to survey data to account for non-response reduces bias in primary health care utilization estimates. Future studies are needed to explore the possible impact of weighting on other health estimates.

Motivation to Reduce Drinking and Engagement in Alcohol Misuse Treatment in Alcohol-Related Liver Disease: A National Health Survey.

INTRODUCTION: The study aim was to identify predictors of motivation to reduce alcohol consumption and whether motivation predicts engagement in alcohol misuse treatment in alcohol-related liver disease (ALD). METHODS: Data from health surveys and health-care registries were combined. RESULTS: Of 674 patients with ALD, 65% consumed alcohol. Recent hospital admission and severe alcohol problems were associated with motivation to reduce alcohol consumption. Two-year probability for engagement in misuse treatment was 29% for patients with motivation to reduce alcohol consumption versus 6.5% for patients without motivation. DISCUSSION: ALD patients with recent hospital admission were more motivated to cut down alcohol consumption, and motivation predicted engagement in alcohol misuse treatment. This insight can help us target brief interventions.

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.

Poor social support and loneliness in chronic headache: Prevalence and effect modifiers.

OBJECTIVE: To explore the prevalence of poor social support and loneliness among people with chronic headache, and how these might be effect modifiers in the relationships between chronic headache and stress, medication overuse, and self-rated health. BACKGROUND: Poor social support and loneliness are consistently linked to worse health outcomes. There are few epidemiologic studies on their effect on headache. METHODS: The Danish Capital Region Health Survey, a cross-sectional survey, was conducted in 2017. Participants were asked about headache, pain medication use, social support, loneliness, perceived stress, and self-rated health. Data were accessed from sociodemographic registers. Logistic regression analyses were performed to test for effect modification. RESULTS: The response rate was 52.6% (55,185 respondents) and was representative of the target population. People with chronic headache were more likely to report poor social support and loneliness compared to those without chronic headache (p < 0.0001 for both). Odds ratios for the combination of chronic headache and poor social support were very high for stress (odds ratio 8.1), medication overuse (odds ratio 21.9), and poor self-rated health (odds ratio 10.2) compared to those without chronic headache and with good social support. Those who reported both chronic headache and loneliness had a very high odds ratio for stress (odds ratio 14.4), medication overuse (odds ratio 20.1), and poor self-rated health (odds ratio 15.9) compared to those without chronic headache and low loneliness score. When adjusted for sociodemographic factors, poor social support and loneliness were not significant effect modifiers in almost all these associations. Loneliness was a significant effect modifier in the association between chronic headache and medication overuse, but exerted greater effect among those who did not report they were lonely. CONCLUSION: Poor social support and loneliness were prevalent among people with chronic headache. The combination of chronic headache and poor social support or loneliness showed higher odds ratios for stress, medication overuse, and poor self-rated health compared to those with good social support and low loneliness scores. The effect of loneliness in the relationship between chronic headache and medication overuse warrants further study.

History of healthcare use and disease burden in older adults with different levels of alcohol use. A register-based cohort study.

BACKGROUND: Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help-seeking behavior in the healthcare system can identify possibilities for prevention and intervention. METHOD: The current study describes healthcare use, burden of disease, and prior morbidities over a 15-year period by current alcohol use behavior among Danish adults aged 60-70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014-2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12-month abstinent (n = 691), low-risk drinkers (n = 1978), moderate-risk drinkers (n = 602), and high-risk drinkers (n = 467)], and a group of treatment-seeking individuals with a 12-month DSM-5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses. RESULTS: Low-, moderate-, and high-risk drinkers had similar rates of past healthcare utilization (low-risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25-8.45), outpatient care 0.80 (0.41-1.32) and inpatient care 0.13 (0.10-0.21)). Higher rates were observed for both the 12-month abstinent group (adjusted RR = 1.16-1.26) and the group with AUD (ARR = 1.40-1.60) compared to the group with low-risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve-month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10). CONCLUSIONS: Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol-related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention.

Physical activity, self-rated fitness and stress among 55,185 men and women in the Danish Capital Region Health survey 2017.

Previous studies have indicated that both low physical activity and low physical fitness are associated with a higher level of stress but the influence of age and health status on the associations is unknown. This was examined in a cross-sectional study based on data from the Danish Capital Region Health Survey 2017. Among all adults ≥ 16 years residing in the largest of five regions in Denmark 1. January 2017 a random sample of 104,950 was invited to participate. Hereof, 55.185 responded (52,6%). Physical activity during leisure time, fitness, self-rated health and stress (Cohens Perceived Stress Scale) was self-reported by questionnaire. Logistic regression weighted for size of municipality and non-response was used. Age modified the associations. In all age-groups odds ratio (OR) for a high level of stress was increasingly higher the lower the level of physical activity. The association was strongest among the 16-24-year-olds and persisted after adjustment for self-rated health, that otherwise attenuated the associations to an increasing extent the older the age-group. Similar models investigating the modifying effect of age on the association between self-rated fitness and stress showed the same patterns and tendencies. This study showed that physical activity and self-rated fitness were both associated with stress. The OR for a high level of stress was increasingly higher the lower the level of physical activity or self-rated fitness. This was found in all age-groups, but most pronounced among the 16-24-year-olds. Furthermore, findings suggest that health condition explains the associations to an increasing extent with increasing age.

Participation in recreational activities varies with socioeconomic position and is associated with self-rated health and well-being.

Recreational activities may promote and maintain health and well-being, but empirical evidence is limited. The aim of this study was to explore socioeconomic variations in participation in recreational activities in the local community and to examine associations with health and well-being in the general population. Participants ≥ 16 years from the Danish Capital Region Health Survey, conducted in 2017 (N = 55,185, response rate 52.6%) were included. Participation in community-based recreational activities, self-rated health, quality of life, and health status was assessed by questionnaire. Socioeconomic variables (educational level, occupational and marital status) were obtained from national registers. Multiple logistic regression models were used to examine associations. Less than half of the population participated in community-based recreational activities. Individuals with a higher educational level were 55% more likely to participate in recreational activities compared to those with a lower educational level (OR = 1.55, CI:1.45-1.66). Individuals with a low educational level who participated in recreational activities, were more likely to have an excellent/good quality of life (OR = 2.03 (95% CI:1.86-2.21)) and an excellent/very good self-rated health (OR = 1.61 (95% CI:1.51-1.71)), than those who did not participate in recreational activities. Regardless of educational level, recreational activity participation was associated with better self-rated health and quality of life. Thus, to counter-balance social inequality in health, a focus on participation in recreational activities is important when planning community public health interventions.

Adverse health behaviours in long-term testicular cancer survivors: a Danish nationwide study.

BACKGROUND: Treatment for disseminated testicular cancer increases the risk of secondary malignancy and cardiovascular disease. The risk of developing these serious adverse effects may be positively affected by healthy living. The purpose of this study was to identify health behaviours with possible influence on late effects that could be targets for intervention. MATERIAL AND METHODS: In this cross-sectional study, testicular cancer survivors diagnosed in the period 1984-2007 from the Danish Testicular Cancer database completed a questionnaire on health behaviours (2014-2016). We estimated prevalence of smoking, alcohol consumption, sedentary lifestyle and overweight. Prevalence ratios described with 95% confidence intervals of adverse health behaviours were stratified by treatment modalities and compared to a reference population by means of logistic regression with adjustment for sociodemographic confounders. RESULTS: In total, 2395 testicular cancer survivors (surveillance, 1175; chemotherapy, 897; radiotherapy, 323), median time since diagnosis 19 years, and 65,289 noncancer males were included, questionnaire response rates were 60% and 54%, respectively. There were more current smokers (prevalence ratio; 1.14, 95% confidence interval (CI): 1.03-1.26) and patients with body mass index above 25 kg/m2 (prevalence ratio; 1.10, 95% CI: 1.01-1.20) among testicular cancer survivors than in the reference population. Testicular cancer survivors reported less sedentary lifestyle (prevalence ratio; 95% CI: 0.74, 0.64-0.85) and everyday drinkers were fewer (prevalence ratio; 0.79, 95% CI: 0.68-0.92) than in the reference population. CONCLUSION: We identified smoking cessation as primary target for intervention studies in testicular cancer survivors. The effect of smoking cessation interventions as part of treatment should be investigated. Whether drug-based intervention is effective in minimising the risk of exposure to conventional risk factors for cardiovascular disease is also of interest.

Twenty Years Socioeconomic Trajectories in Older Adults with Varying Alcohol Use: A Register-Based Cohort Study.

AIMS: The objective of this paper was to examine 20-year trends of the socioeconomic status (SES) measures income and employment and their association with current alcohol use behaviors in Danish adults aged 60-70. METHODS: Data from The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2013-2016) were combined to form four groups from the general population with various drinking patterns, but with no recent treatment for alcohol use disorder (AUD), and one group seeking treatment: Abstinent (n = 691), low- (n = 1978), moderate- (n = 602), and high-risk (HR) drinkers (n = 467), and DSM-5 AUD seeking treatment (n = 262). For all groups, Danish national register data were linked at the individual level obtain find annual information on income and employment during the 20 years prior to interview. Mixed effects models were utilized to model trajectories of income and employment for the five groups. RESULTS: Lower income and employment status was observed from middle-aged adulthood when comparing 12-month abstinence or AUD to individuals with low or moderate alcohol consumption. At the end of the study period, moderate-risk drinkers experienced an increase, and HR drinkers a decrease, in income and rate of employment relative to the low-risk drinkers. CONCLUSIONS: Alcohol use behaviors observed in older adults are related to distinct long-term trajectories regarding income and employment status, which are observable already in middle-aged adulthood.

Comparing older people's drinking habits in four Nordic countries: Summary of the thematic issue.

Aim: The present article summarises status and trends in the 21st century in older people's (60-79 years) drinking behaviour in Denmark, Finland, Norway and Sweden and concludes this thematic issue. Each country provided a detailed report analysing four indicators of alcohol use: the prevalence of alcohol consumers, the prevalence of frequent use, typical amounts of use, and the prevalence of heavy episodic drinking (HED). The specific aim of this article is to compare the results of the country reports. Findings: Older people's drinking became more common first in Denmark in the 1970s and then in the other countries by the 1980s. Since 2000 the picture is mixed. Denmark showed decreases in drinking frequency, typically consumed amounts and HED, while in Sweden upward trends were dominant regarding prevalence of consumers and frequency of drinking as well as HED. Finland and Norway displayed both stable indicators except for drinking frequency and proportion of women consumers where trends increased. In all four countries, the gender gap diminished with regard to prevalence and frequency of drinking, but remained stable in regard to consuming large amounts. In Norway the share of alcohol consumers among women aged 60-69 years exceeded the share among men. During the late 2010s, Denmark had the highest prevalence of alcohol consumers as well as the highest proportion drinking at a higher frequency. Next in ranking was Finland, followed by Sweden and Norway. This overall rank ordering was observed for both men and women. Conclusion: As the populations aged 60 years and older in the Nordic countries continue to grow, explanations for the drivers and consequences of changes in older people's drinking will become an increasingly relevant topic for future research. Importantly, people aged 80 years and older should also be included as an integral part of that research.

Trends in alcohol consumption among older adults in Denmark in the 21st century.

Background: Previous studies have indicated that the alcohol consumption among older Danish individuals has increased during the last three decades of the 20th century. However, the research is limited and, hence, the aim of the present article is to describe the trends and peculiarities in the development of the present situation in older people's drinking patterns in Denmark. Methods: Data were obtained from the Danish Health and Morbidity Survey (2005) and the Danish National Health Survey (2010, 2013, and 2017). Data used in this study were collected via self-administered questionnaires from random samples of the adult (≥ 16 years) Danish population. Response rates varied between 50.8% (2005) and 59.5% (2010). Drinking patterns are described using the following indicators: alcohol consumption during the past 12 months; alcohol consumption at least two days a week; mean number of standard drinks consumed in a typical week and heavy episodic drinking (at least monthly). Results are presented as percentages or means. Results: The prevalence of overall 12-month alcohol use in all individuals aged 60 years or older has slightly increased between 2010 (83.9%) and 2017 (85.2%). On the other hand, the prevalence of consuming alcohol at least twice a week has overall decreased slightly between 2010 (54.0%) and 2017 (52.0%) in the same age group. A decrease was also observed in the mean number of standard drinks consumed in a typical week, from 8.3 in 2010 to 7.0 in 2017. Additionally, the prevalence of consuming at least five standard drinks on one occasion at least monthly decreased markedly from 24.8% in 2005 to 14.8% in 2013 (the prevalence remained stable between 2013 and 2017). The trends in prevalence of various alcohol indicators varied by sex and age. Conclusions: The findings of this study suggest an overall decline in alcohol consumption among older Danes in the study period. The continuation of this trend will be the subject of future studies.

Monitoring chronic headache and medication-overuse headache prevalence in Denmark.

OBJECTIVES: To study chronic headache and medication-overuse headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medications among respondents with chronic headache. BACKGROUND: Chronic headache and MOH prevalence in Denmark were last estimated in 2010. METHODS: In this cross-sectional study, 104,950 individuals aged ≥16 years were randomly sampled for the 2017 Danish Capital Region Health Survey. Responses to questions about headache and use of acute pain medications were linked to demographic registries. MOH was defined as headache ≥15 days/month plus self-report of use of pain medications ≥10 or 15 days/month, in the last three months. Weighted prevalence proportions were calculated. RESULTS: Among 55,185 respondents, chronic headache prevalence was 3.0% (95% CI: 2.3-3.2) and MOH prevalence was 2.0% (95% CI: 1.8-2.1). Both conditions were more common among females and the middle-aged. Respondents on social welfare or receiving early retirement pensions had the highest prevalences. Among those with chronic headache, 44.7% overused over-the-counter analgesics for headache; paracetamol 41.5%; a combination of different pain relievers 25.3%; ibuprofen 21.9%; opioids 17.0%; combination preparations 14.3%; and triptans 9.1%. CONCLUSIONS: The highest prevalence of chronic headache and MOH was seen among people with low socioeconomic position. Overuse of paracetamol was most common. Reported opioid use was higher than expected. Groups with high prevalence of MOH should be the focus of public health interventions on rational use of OTC and prescription pain medications.

Psychological stress in long-term testicular cancer survivors: a Danish nationwide cohort study.

PURPOSE: Long-term cancer survivors may develop psychological late effects. The aim of the present study was to determine prevalence of high level of stress in testicular cancer survivors (TCS) compared with the general population and prevalence of high level of stress among TCS stratified by type of treatment (surveillance, bleomycin, etoposide and cisplatin (BEP), or abdominal radiotherapy (RT)). METHODS: In this large, nationwide and population-based, cross-sectional study, a total of 2252 TCS filled in a questionnaire between 2014-2016 covering psychological stress (Perceived Stress Scale (PSS)), sociodemographic factors, and physical health variables. Results were compared with a reference population. The reference population consisted of 61,927 men without prior or present cancer and sampled at random from the central population. High level of stress was defined as a PSS score ≥ 16, equivalent to the highest scoring quintile in the reference population. Logistic regression models adjusted for relevant covariates were used to estimate prevalence ratios of high level of stress. RESULTS: Distribution of TCS was: surveillance, n = 1134; BEP, n = 807; and RT, n = 311 (median time since diagnosis was 19 years). TCS were more likely to have high level of stress compared to the reference population with a prevalence ratio of 1.56 (95% CI, 1.40-1.73). Individually, surveillance, BEP and RT groups had higher level of stress compared to the reference population. CONCLUSIONS: TCS are more likely to have high level of stress. Screening programs for psychological stress should be considered as part of the follow-up program. IMPLICATIONS FOR CANCER SURVIVORS: A higher level of stress is observed in TCS irrespective of treatment.

Educational level and living arrangements are associated with dietary intake of red meat and fruit/vegetables: A Danish cross-sectional study.

Aims: To evaluate the association between education and living arrangements and the intake of fish, red meat and fruit and vegetables.Methods: The study design was cross-sectional and conducted in Denmark in 2013. Participants filled in questionnaires about their educational level and living arrangements (living alone or with others) and dietary intake including fish, red meat, fruit and vegetables. Regression analyses were performed to assess the associations within 85,456 randomly sampled healthy men and women who were at least 25 years old.Results: Length of education was statistically significant and positively associated with the intake of fruit and vegetables and negatively associated with the intake of red meat for both men and women. Men with a high level of education had a 187g/week (95% confidence interval: 199-175g/week) lower intake of red meat and a 109g/day (95% confidence interval: 102-117g/day) higher intake of fruit and vegetables than men with a low level of education. Women with a high level of education had a 175g/week (95% confidence interval: 186-164g/week) lower intake of red meat and a 106g/day (95% confidence interval: 97-114g/day) higher intake of fruit and vegetables than women with a low level of education. Living with others was statistically significant and positively associated with the intake of red meat, and fruit and vegetables. There were no clear associations between education, living arrangements and intake of fish.Conclusions: Men and women with a high educational level ate more fruit and vegetables but less red meat than men and women with a low educational level. Men and women living with others ate more red meat, fruit and vegetables than men and women living alone.