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Research Interests: Public Health, Adolescent, Medicine, Denmark, Humans, and 15 moreChild, Female, Male, Cohort Study, Infant, Clinical Sciences, Newborn Infant, Aged, Middle Aged, Adult, Proportional Hazards Models, Child preschool, Antipsychotic agents, Peptic ulcer perforation, and Pharmacology and pharmaceutical sciences
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Previous research suggests that platelet transfusion is associated with adverse events after coronary artery bypass grafting (CABG). The aim of the current analysis was to verify this hypothesis. Data from 6745 consecutive patients... more
Previous research suggests that platelet transfusion is associated with adverse events after coronary artery bypass grafting (CABG). The aim of the current analysis was to verify this hypothesis. Data from 6745 consecutive patients undergoing CABG from 2006 through 2012 were collected. Patients receiving platelet transfusions intraoperatively or postoperatively in the intensive care unit were compared with control patients. To adjust for possible confounders, propensity score matching and conditional regression analyses were performed. Short-term outcomes were 30-day mortality, in-hospital myocardial infarction and stroke. Mid-term outcomes were 6-month mortality, and need for coronary angiography or repeat coronary revascularization within 6 months after surgery. Data were retrieved from the Western Denmark Heart Registry. Using propensity scores, 982 patients exposed to platelets were matched with 982 control patients. Platelet transfusion was associated with a higher rate of post...
Continuous sciatic nerve block is used for pain management following major ankle surgery. Pain from the saphenous nerve territory often persists. We conducted a double-blinded randomized placebo-controlled trial to evaluate the effect of... more
Continuous sciatic nerve block is used for pain management following major ankle surgery. Pain from the saphenous nerve territory often persists. We conducted a double-blinded randomized placebo-controlled trial to evaluate the effect of a supplementary saphenous catheter in the proximal thigh combined with a popliteal sciatic catheter and single-shot saphenous nerve block after major ankle surgery. Fifty patients received both sciatic and saphenous continuous catheters inserted along the short axis of the nerves with ultrasound-guidance. All patients had an initial sciatic nerve block followed by a continuous sciatic catheter infusion and an initial saphenous nerve block with ropivacaine. Participants were then randomized to infusion of either ropivacaine or isotonic saline in the saphenous catheter for 48 hr postoperatively. The primary outcome was total intravenous morphine consumption during the first 48 hr postoperatively. Secondary outcomes were clinical analgesia, saphenous a...
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INTRODUCTION: Hospital standardised mortality ratios (HSMR) are widely used in quality improvement campaigns. No data exist on whether HSMR can be computed based on Danish administrative registries. We therefore used data from Danish... more
INTRODUCTION: Hospital standardised mortality ratios (HSMR) are widely used in quality improvement campaigns. No data exist on whether HSMR can be computed based on Danish administrative registries. We therefore used data from Danish registries to compute HSMRs.MATERIALS AND METHODS: By linking hospital discharge registries with the Danish Civil Registration System, we identified 77 primary discharge diagnoses that accounted for 80% of all deaths within 30 days of admission. We calculated overall death rates stratified by the 77 primary discharge diagnoses, age, gender, and type of admission and used these to compute the expected number of deaths. HSMR for each hospital was calculated as the ratio of observed to expected number of deaths.RESULTS: Pneumonia, non-specified was the diagnosis that accounted for most deaths within 30 days after admission. The crude mortality rate varied from 5.7% to 6.3%. HSMR varied little--from 95 and 98 in Hospitals B and D to 102 and 103 in Hospitals A and C, respectively.CONCLUSION: We found that it was possible to use data from Danish administrative registries to compute HSMR and that HSMR varied little between hospitals with comparable case-mixes.
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To examine whether there is geographical variation in the use of intensive care resources in Denmark concerning both intensive care unit (ICU) admission and use of specific interventions. Substantial variation in use of intensive care has... more
To examine whether there is geographical variation in the use of intensive care resources in Denmark concerning both intensive care unit (ICU) admission and use of specific interventions. Substantial variation in use of intensive care has been reported between countries and within the US, however, data on geographical variation in use within more homogenous tax-supported health care systems are sparse. We conducted a population-based cross-sectional study based on linkage of national medical registries including all Danish residents between 2008 and 2012 using population statistics from Statistics Denmark. Data on ICU admissions and interventions, including mechanical ventilation, noninvasive ventilation, acute renal replacement therapy, and treatment with inotropes/vasopressors, were obtained from the Danish Intensive Care Database. Data on patients' residence at the time of admission were obtained from the Danish National Registry of Patients. The overall age- and gender stand...
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Proton pump inhibitor (PPI) use leads to hypergastrinaemia, which has been associated with gastrointestinal neoplasia. We evaluated the association between PPI use and risk of gastric cancer using population-based health-care registers in... more
Proton pump inhibitor (PPI) use leads to hypergastrinaemia, which has been associated with gastrointestinal neoplasia. We evaluated the association between PPI use and risk of gastric cancer using population-based health-care registers in North Jutland, Denmark, during 1990-2003. We compared incidence rates among new users of PPI (n=18,790) or histamine-2-antagonists (H2RAs) (n=17,478) and non-users of either drug. Poisson regression analysis was used to estimate incidence rate ratios (IRRs) adjusted for multiple confounders. We incorporated a 1-year lag time to address potential reverse causation. We identified 109 gastric cancer cases among PPI users and 52 cases among H2RA users. After incorporating the 1-year lag time, we observed IRRs for gastric cancer of 1.2 (95% CI: 0.8-2.0) among PPI users and 1.2 (95% CI: 0.8-1.8) among H2RA users compared with non-users. These estimates are in contrast to significant overall IRRs of 9.0 and 2.8, respectively, without the lag time. In lag ...
Research Interests: Health Care, Cancer, Apoptosis, Nature, Cell Division, and 19 moreAdipose tissue, Denmark, Humans, Female, Gastric Cancer, Male, Poisson regression, Cohort Study, Risk factors, Aged, Middle Aged, Adult, Reproducibility of Results, Cancer cells, Risk Factors, Cancers, Adenocarcinoma, Cohort Studies, and Proton Pump Inhibitor
Hospital standardised mortality ratios (HSMR) are widely used in quality improvement campaigns. No data exist on whether HSMR can be computed based on Danish administrative registries. We therefore used data from Danish registries to... more
Hospital standardised mortality ratios (HSMR) are widely used in quality improvement campaigns. No data exist on whether HSMR can be computed based on Danish administrative registries. We therefore used data from Danish registries to compute HSMRs. By linking hospital discharge registries with the Danish Civil Registration System, we identified 77 primary discharge diagnoses that accounted for 80% of all deaths within 30 days of admission. We calculated overall death rates stratified by the 77 primary discharge diagnoses, age, gender, and type of admission and used these to compute the expected number of deaths. HSMR for each hospital was calculated as the ratio of observed to expected number of deaths. Pneumonia, non-specified was the diagnosis that accounted for most deaths within 30 days after admission. The crude mortality rate varied from 5.7% to 6.3%. HSMR varied little--from 95 and 98 in Hospitals B and D to 102 and 103 in Hospitals A and C, respectively. We found that it was...
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Research Interests:
Intensive care contributes to a substantial part of health care expenses. Admission to intensive care units is associated with a high mortality rate and a high risk of long-term disability. Data from several studies suggest that... more
Intensive care contributes to a substantial part of health care expenses. Admission to intensive care units is associated with a high mortality rate and a high risk of long-term disability. Data from several studies suggest that suboptimal standards of intensive care are relatively common. Lack of knowledge regarding the use of intensive care and long-term outcome as well as the effectiveness and adverse effects of intensive care impede a systematic and evidence-based development and quality improvement. An initiative to establish a Danish national clinical database for intensive care has been launched.
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Randomized controlled trials (RCTs) have been considered the reference standard for evaluation of drug effects. Controversy exists concerning observational studies because of the lack of blinding and the risk of uncontrolled confounding.... more
Randomized controlled trials (RCTs) have been considered the reference standard for evaluation of drug effects. Controversy exists concerning observational studies because of the lack of blinding and the risk of uncontrolled confounding. However, RCTs also have limitations, including short follow-up and relatively small study populations, which make it impossible to examine rare events and cross-over problems. None of the designs provides perfect information and both designs are needed in the evaluation of drug effects.
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Nonsteroidal anti-inflammatory drug (NSAID) use is a strong risk factor for peptic ulcer perforation, yet little is known about the outcome of this condition among NSAID users. We examined 30-day mortality after peptic ulcer perforation... more
Nonsteroidal anti-inflammatory drug (NSAID) use is a strong risk factor for peptic ulcer perforation, yet little is known about the outcome of this condition among NSAID users. We examined 30-day mortality after peptic ulcer perforation associated with the use of traditional NSAIDs and newer selective cyclo-oxygenase-2 (COX-2) inhibitors. We conducted a cohort study of patients with the first hospitalization for peptic ulcer perforation, identified in discharge registries of three Danish counties between 1991 and 2003. Data on preadmission NSAID use, other ulcer-related drugs, and comorbidity were likewise from population-based registries. Mortality was ascertained from the Civil Registration System. We compared 30-day mortality in NSAID users and nonusers while adjusting for age, gender, comorbidity, previous uncomplicated peptic ulcer, and ulcer medication use. Of the 2,061 patients hospitalized with peptic ulcer perforation, 38% were current NSAID users. The 30-day mortality was 25% overall, and 35% among current NSAID users. Compared with never-use, the adjusted 30-day mortality rate ratios (MRRs) were 1.8 (95% CI 1.4-2.3) for current use of NSAIDs alone and 1.6 (95% CI 1.2-2.2) for current use combined with other ulcer-associated drugs. The mortality increase associated with the use of COX-2 inhibitors was similar to that of traditional NSAIDs: adjusted MRR for users of COX-2 inhibitors alone and in combination, 2.0 (1.3-3.1) and 1.4 (0.8-2.5), and for users of traditional NSAIDs alone or in combination, 1.7 (1.3-2.3) and 1.6 (1.2-2.3). Current use of NSAIDs, including COX-2 inhibitors, is associated with a poor prognosis for patients hospitalized with peptic ulcer perforation.
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OBJECTIVE. Use of selective serotonin reuptake inhibitors (SSRIs) increases the risk of upper gastrointestinal bleeding and this risk is amplified by concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs). The aim of the study... more
OBJECTIVE. Use of selective serotonin reuptake inhibitors (SSRIs) increases the risk of upper gastrointestinal bleeding and this risk is amplified by concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs). The aim of the study was to examine the impact of SSRI use alone or in combination with NSAIDs on 30-day mortality after peptic ulcer bleeding (PUB). MATERIAL AND METHODS. A population-based cohort study of patients with a first hospitalization with PUB in three Danish counties was carried out between 1991 and 2005 using medical databases. We calculated 30-day mortality rate ratios (MRRs) associated with the use of SSRIs, alone or in combination with NSAIDs, adjusted for important covariates. RESULTS. Of 7415 patients admitted with PUB, 5.9% used SSRIs only, and 3.8% used SSRIs in combination with NSAIDs, with a 30-day mortality of 11.8% and 11.3%, respectively. Compared with patients who used neither SSRIs nor NSAIDs, the adjusted 30-day MRR was 1.02 (95% CI: 0.76-1.36) for current users of SSRIs and 0.89 (0.62-1.28) for the combined use of SSRIs with NSAIDs. There was a 2.11-fold (95% CI 1.35-3.30) increased risk of death associated with SSRI use starting within 60 days of admission; for those younger than 80 years, the adjusted MRR was 1.54 (0.72-3.29), and 2.57 (1.47-4.49) for those older than 80 years. CONCLUSIONS. Use of SSRIs, alone or in combination with NSAIDs, was not associated with increased 30-day mortality following PUB. However, increased mortality was found in patients who started SSRI therapy, particularly among those older than 80 years. We can only speculate on whether this finding is due to pharmacological action or confounding factors.
Research Interests: Adolescent, Denmark, Humans, Child, Female, and 17 moreMale, Young Adult, Infant, Follow-up studies, Clinical Sciences, Newborn Infant, Scandinavian, Aged, Middle Aged, Outpatients, Adult, Time Factors, Survival Rate, Retrospective Studies, Combination drug therapy, Peptic Ulcer, and Serotonin Uptake Inhibitors
Multiple sclerosis (MS) patients may be at increased risk of venous thromboembolism (VTE), but evidence is limited. To examine long-term risk of VTE among MS patients. We conducted a population-based cohort study among 17,418 Danish MS... more
Multiple sclerosis (MS) patients may be at increased risk of venous thromboembolism (VTE), but evidence is limited. To examine long-term risk of VTE among MS patients. We conducted a population-based cohort study among 17,418 Danish MS patients and 87,090 comparison cohort members from the general population. Data on MS, VTE and comorbidities were obtained from the Danish National Registry of Patients including all admissions to Danish hospitals since 1977. We computed cumulative risks for VTE and adjusted incidence rate ratios (IRRs). A total of 34 (0.2%) MS patients and 36 (0.04%) comparison cohort members had a deep venous thrombosis (DVT) within 1 year following the date of initial MS diagnosis/index date [adjusted IRR = 3.02 (95% CI: 2.14-4.27)]. During this period, 16 (0.09%) MS patients and 26 (0.03%) comparison cohort members had a documented pulmonary embolism (PE) [adjusted IRR = 2.85 (95% CI: 1.72-4.70)]. During the subsequent up to 29 years, 315 (1.9% of MS patients alive at year 1) MS patients had a record of a DVT [adjusted IRR = 2.28 (95% CI: 2.01-2.59)] and 129 (0.8%) had PE [IRR = 1.58 (95% CI: 1.31-1.92]. MS is a risk factor for VTE, but the absolute risk is low.
Research Interests: Multiple sclerosis, Neuroepidemiology, Risk, Denmark, Humans, and 18 moreFemale, Pulmonary Embolism, Male, Cohort Study, cerebral Venous sinus thrombosis, Risk factors, Aged, Middle Aged, Adult, Public health systems and services research, Risk Factors, Venous thromboembolism, Indexation, Neurosciences, Deep Venous Thrombosis, General Population, Cohort Studies, and Cumulant
We examined rates of first hospitalization for COPD, rates of 5-year mortality among patients hospitalized for COPD, and comparisons of mortality between COPD patients and a matched cohort free of COPD. We computed standardized rates of... more
We examined rates of first hospitalization for COPD, rates of 5-year mortality among patients hospitalized for COPD, and comparisons of mortality between COPD patients and a matched cohort free of COPD. We computed standardized rates of first COPD hospitalization. Using Cox regression, we compared 180- and 181-day to 5-year mortality among COPD patients with the comparison cohort. We used medical databases in Denmark (population 5.4 million) from 1997 to 2006. We included patients 40 years or older with first hospitalization for COPD (64,499) and an age- and gender-matched comparison cohort of persons without COPD hospitalization (322,495). We examined the incidence of COPD hospitalization and risks and rates of mortality in the 5 years after hospitalization. Standardized rates of first hospitalization for COPD declined from 276 per 100,000 person-years in 1999 to 231 per 100,000 person-years in 2006. Within 180 days of hospitalization, 16% of COPD patients and 2.4% of persons in the matched cohort died (adjusted hazard ratio = 7.00, 95% CI = 6.79-7.22). Between 181 days and 5 years, 46% of COPD patients who survived the first 180 days and 19% of persons in the comparison cohort died (adjusted hazard ratio = 2.91, 95% CI = 2.86-2.95). COPD and comorbid diseases interacted to increase mortality in the first 180 days, but not thereafter. COPD continues to be a major public health problem causing substantial mortality in the 5 years after hospitalization, particularly in the first 180 days and in patients with comorbid diseases.
Research Interests: Public Health, Risk assessment, Comorbidity, Denmark, Humans, and 19 moreCox Regression, Hospitalization, Female, Male, Cohort Study, Risk factors, Lung, Registries, Aged, Middle Aged, Adult, Time Factors, Survival Rate, Chronic obstructive pulmonary disease, Risk Factors, Risk Assessment, Proportional Hazards Models, Case Control Studies, and Cohort Studies
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Bisphosphonates have been associated with an increased risk of atrial fibrillation and may thus be associated with an increased risk of ischemic stroke. This would have substantial clinical and public health implications. We found no... more
Bisphosphonates have been associated with an increased risk of atrial fibrillation and may thus be associated with an increased risk of ischemic stroke. This would have substantial clinical and public health implications. We found no evidence of an association between bisphosphonate use and risk of ischemic stroke.
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Research Interests: Adolescent, Humans, Female, Male, Confidence intervals, and 19 moreYoung Adult, Subarachnoid hemorrhage, Thromboembolism, Anticoagulants, Risk factors, Clinical Sciences, European, Aged, Middle Aged, Adult, Warfarin, Odds ratio, Risk Factors, Subarachnoid haemorrhage, Case Control Study, Drug Toxicity, Logistic Models, Gastrointestinal bleeding, and Case Control Studies
Limited and inconsistent data exist on simple, readily available predictors of long-term mortality of critically ill chronic obstructive pulmonary disease patients requiring invasive mechanical ventilation. We therefore examined the... more
Limited and inconsistent data exist on simple, readily available predictors of long-term mortality of critically ill chronic obstructive pulmonary disease patients requiring invasive mechanical ventilation. We therefore examined the influence of arterial blood gas derangement and burden of comorbidities on 90-day and 1-yr mortality of chronic obstructive pulmonary disease patients treated with invasive mechanical ventilation. We identified all chronic obstructive pulmonary disease patients (n = 230) treated with invasive mechanical ventilation between 1994 and 2004 at a Danish primary-level hospital. Data on arterial blood gas specimens and comorbidity were obtained from medical records and Hospital Discharge Registries. We used Cox's regression analysis to estimate mortality ratios according to arterial blood gas values and level of comorbidity. Ninety-day and 1-yr mortality among chronic obstructive pulmonary disease patients requiring invasive mechanical ventilation was 30.8% and 40.5%, respectively. All 90-day and 1-yr mortality ratios according to arterial blood gas values were close to one and one was included in all 95% CI. Among patients with a high level of comorbidity 90-day mortality ratio was 1.3 (95% CI: 0.6-2.7) when compared with patients without comorbidity. The corresponding 1-yr mortality ratio was 1.4 (95% CI: 0.7-2.9). Chronic obstructive pulmonary disease patients treated with invasive mechanical ventilation have substantial long-term mortality. Neither the levels of arterial blood gas values measured immediately before invasive mechanical ventilation was initiated nor the burden of comorbidity were strong determinants of long-term mortality among these patients.
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Diabetes may influence the outcome of complicated peptic ulcer disease, due to angiopathy, blurring of symptoms, and increased risk of sepsis. We examined whether diabetes increased 30-day mortality among Danish patients hospitalized with... more
Diabetes may influence the outcome of complicated peptic ulcer disease, due to angiopathy, blurring of symptoms, and increased risk of sepsis. We examined whether diabetes increased 30-day mortality among Danish patients hospitalized with bleeding or perforated peptic ulcers. This population-based cohort study took place in the three Danish counties of North Jutland, Viborg, and Aarhus between 1991 and 2003. Patients hospitalized with a first-time diagnosis of peptic ulcer bleeding or perforation were identified using the counties' hospital discharge registries. Data on diabetes, other comorbidities, and use of ulcer-associated drugs were obtained from discharge registries and prescription databases. The Danish Civil Registry System allowed complete follow-up for mortality. The outcome under study was 30-day mortality in diabetic versus nondiabetic patients, adjusted for potential confounders. We identified 7,232 patients hospitalized for bleeding ulcers, of whom 731 (10.1%) had diabetes. The 30-day mortality among diabetic patients was 16.6 vs. 10.1% for other patients with bleeding ulcers. The adjusted 30-day mortality rate ratio (MRR) for diabetic patients was 1.40 (95% CI 1.15-1.70). We also identified 2,061 patients with perforated ulcers, of whom 140 (6.8%) had diabetes. The 30-day mortality among diabetic patients was 42.9 vs. 24.0% in other patients with perforated ulcers, corresponding to an adjusted 30-day MRR of 1.51 (1.15-1.98). Among patients with peptic ulcer bleeding and perforation, diabetes appears to be associated with substantially increased short-term mortality.
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Research Interests: Treatment Outcome, Risk assessment, Critical Care, Denmark, Prospective studies, and 22 moreHumans, INTENSIVE CARE, Female, Male, Cohort Study, Follow-up studies, Propensity Score Matching, Logistic Regression Analysis, Socioeconomic Status, Intensive Care Unit, Medical Diagnosis, Aged, Middle Aged, Time Factors, Odds ratio, Risk Assessment, Intensive Care Units, Hospital Mortality, Beta Blockers, Laboratory Tests, Confidence Interval, and Relative Risk
Research Interests: Risk assessment, Mortality, Social status, Critical Care, Denmark, and 19 moreHumans, Cox Regression, INTENSIVE CARE, Female, Male, Cohort Study, Patient Admission, Propensity Score Matching, Intensive Care Unit, Aged, Middle Aged, Risk Assessment, Intensive Care Units, Proportional Hazards Models, Critical Illness, Confidence Interval, Mortality rate, Cohort Studies, and Cumulant
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There are data to suggest that anemia is associated with increased mortality in patients with chronic obstructive pulmonary disease (COPD). In contrast, critically ill patients with low hemoglobin levels (4.3-5.5 mmol/L, 7.0-9.0 g/dL) in... more
There are data to suggest that anemia is associated with increased mortality in patients with chronic obstructive pulmonary disease (COPD). In contrast, critically ill patients with low hemoglobin levels (4.3-5.5 mmol/L, 7.0-9.0 g/dL) in general do not appear to have a worsened clinical outcome. The effects of anemia in critically ill patients with COPD remain to be clarified. We examined the association between anemia (hemoglobin <7.4 mmol/L, <12.0 g/dL) and 90-day mortality in COPD patients with acute respiratory failure treated with invasive mechanical ventilation in a single-institution follow-up study. We identified all COPD patients at our institution (n = 222) admitted for the first time to the intensive care unit (ICU) requiring invasive mechanical ventilation in 1994-2004. Data on patient characteristics (eg, hemoglobin, pH, blood transfusions, and Charlson Comorbidity Index), and mortality were obtained from population-based clinical and administrative registries and medical records. We used Cox's regression analysis to estimate mortality rate ratios (MRR) in COPD patients with and without anemia. A total of 42 (18%) COPD patients were anemic at time of initiating invasive mechanical ventilation. The overall 90-day mortality among anemic COPD patients was 57.1% versus 25% in nonanemic patients. The corresponding adjusted 90-day MRR was 2.6 (95% confidence interval 1.5-4.5). Restricting analyses to patients not treated with blood transfusions during their intensive care unit stay did not materially change the MRR. We found anemia to be associated with increased mortality among COPD patients with acute respiratory failure requiring invasive mechanical ventilation.
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Research Interests: Epidemiology, Risk, Public Health, Medicine, British medical history, and 19 moreOsteoporosis, Population, Humans, Female, Population Control, Atrial Fibrillation, Risk factors, Aged, Middle Aged, Risk Factor, Adult, Public health systems and services research, BMJ, Risk Factors, Atrial Flutter, Case Control Study, Confidence Interval, Case Control Studies, and Relative Risk
Research Interests: Adolescent, Denmark, Humans, Child, Female, and 10 moreMale, Young Adult, Infant, Incidence, Registries, Newborn Infant, Aged, Middle Aged, Adult, and Retrospective Studies
Research Interests: Electronic Health Records, Adolescent, Comorbidity, Denmark, Humans, and 17 moreCongestive Heart Failure, Female, Male, Personal Health Records / Clouds, Registries, Aged, Middle Aged, International Classification of Diseases, Peripheral Vascular Disease, Adult, Public health systems and services research, Liver Disease, Medical Records, Renal disease, Pulmonary disease, Positive predictive value, and Clinical Coding
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Research Interests: Epidemiology, Risk, Asthma, Public Health, Risk assessment, and 16 moreMedicine, Comorbidity, Denmark, Humans, Atrial Fibrillation, Risk factors, Risk Factor, Odds ratio, Chronic obstructive pulmonary disease, Risk Factors, Risk Assessment, Atrial Flutter, Case Control Study, Glucocorticoids, Logistic Models, and Case Control Studies
While some experimental and clinical research suggests that statins improve outcomes after severe infections, the evidence for pneumonia is conflicting. We examined whether preadmission statin use decreased risk of death, bacteremia, and... more
While some experimental and clinical research suggests that statins improve outcomes after severe infections, the evidence for pneumonia is conflicting. We examined whether preadmission statin use decreased risk of death, bacteremia, and pulmonary complications after pneumonia. We conducted a population-based cohort study of 29,900 adults hospitalized with pneumonia for the first time between January 1, 1997, and December 31, 2004 in northern Denmark. Data on statin and other medication use, comorbidities, socioeconomic markers, laboratory findings, bacteremia, pulmonary complications, and death were obtained from medical databases. We used regression analyses to compute adjusted mortality rate ratios within 90 days and relative risks of bacteremia and pulmonary complications after hospitalization in both statin users and nonusers. Of patients with pneumonia, 1371 (4.6%) were current statin users. Mortality among statin users was lower than among nonusers: 10.3% vs 15.7% after 30 days and 16.8% vs 22.4% after 90 days, corresponding to adjusted 30- and 90-day mortality rate ratios of 0.69 (95% confidence interval, 0.58-0.82) and 0.75 (0.65-0.86). Decreased mortality associated with statin use remained robust in various subanalyses and in a supplementary analysis using propensity score matching. In contrast, former use of statins and current use of other prophylactic cardiovascular drugs were not associated with decreased mortality from pneumonia. In statin users, adjusted relative risk for bacteremia was 1.07 (95% confidence interval, 0.69-1.67) and for pulmonary complications was 0.69 (0.42-1.14). The use of statins is associated with decreased mortality after hospitalization with pneumonia.
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Systemic glucocorticoid use is associated with an increased risk for peptic ulcer bleeding (PUB); however, little is known about whether glucocorticoid use is associated with PUB outcome. We conducted a population-based cohort study to... more
Systemic glucocorticoid use is associated with an increased risk for peptic ulcer bleeding (PUB); however, little is known about whether glucocorticoid use is associated with PUB outcome. We conducted a population-based cohort study to examine the association between preadmission use of systemic glucocorticoids and 30-day mortality following PUB. We identified all patients (n = 7,486) hospitalized with a first-time diagnosis of PUB in Western Denmark between 1991 and 2004. Data on PUB; systemic glucocorticoid use (n = 574; 7.7%), including cumulative dose; use of other ulcer-related drugs; previous uncomplicated ulcer; comorbidities; and complete follow-up for mortality were obtained from population-based medical databases. We computed 30-day mortality and mortality rate ratios (MRRs) comparing glucocorticoid users and nonusers, controlling for potential confounding factors. Thirty-day mortality was 14.0% among users of systemic glucocorticoids and no other ulcer-related drugs and 8.7% among nonusers of glucocorticoids, corresponding to an adjusted MRR of 1.30 (95% confidence interval [CI], 0.81-2.08). Among users of systemic glucocorticoids in combination with other ulcer-related drugs, 30-day mortality was 18.9%, corresponding to an adjusted MRR of 1.54 (95% CI, 1.20-1.99). Among both short-term and long-term users, high-dose glucocorticoid use was associated with a greater increase in mortality than low-dose use. Former use of systemic glucocorticoids was not associated with increased mortality. Thus, preadmission use of systemic glucocorticoids was associated with increased 30-day mortality following PUB. Increased mortality was most pronounced when glucocorticoids were used in high doses or were combined with other ulcer-related drugs.
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To assess hospitalization rates (HR) for poisoning with heroin, methadone or strong analgesics and relate them to quantities of prescribed methadone and strong analgesics in Denmark between 1998 and 2004. Population-based ecological... more
To assess hospitalization rates (HR) for poisoning with heroin, methadone or strong analgesics and relate them to quantities of prescribed methadone and strong analgesics in Denmark between 1998 and 2004. Population-based ecological study. We extracted data on all emergency department visits and hospital admissions registered in the Danish National Patient Registry with a diagnosis of poisoning with heroin (n = 1688), methadone (n = 173) or strong analgesics (n = 384). To ascertain sale of prescribed medications we used data from the Danish Medicines Agency. Age- and gender-standardized HR and defined daily doses (DDD) per 1000 people per day. HR for heroin poisoning was 4.4 [95% confidence interval (CI): 3.8-4.9] per 100,000 person-years (p-y) in 1998 and 4.6 (CI: 4.0-5.2) per 100,000 p-y in 2004. HR for methadone poisoning increased from 0.1 (CI: 0.0-0.2) per 100,000 p-y in 1998 to 1.1 (CI: 0.8-1.4) per 100,000 p-y in 2004. HR for poisoning with strong analgesics increased from 0.6 (CI: 0.4-0.9) per 100,000 p-y in 1998 to 2.1 (CI: 1.8-2.6) per 100,000 p-y in 2004. The sale of prescribed strong analgesics (5.0 DDD per 1000 people per day in 1998 to 5.9 DDD in 2004) and methadone (3.0 DDD per 1000 people per day in 1998 to 3.4 DDD in 2004) increased slightly between 1998 and 2004. Increasing sale of prescribed methadone and strong analgesics coincided with increasing HRs of poisoning with these drugs, whereas HR of heroin poisoning varied. Further longitudinal studies are important for the guidance of future policy making.
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Patients with multiple sclerosis (MS) may have a higher risk of cardiovascular diseases (CVD) than the general population, but data are limited. We conducted a population-based cohort study involving Danish citizens diagnosed with MS (n =... more
Patients with multiple sclerosis (MS) may have a higher risk of cardiovascular diseases (CVD) than the general population, but data are limited. We conducted a population-based cohort study involving Danish citizens diagnosed with MS (n = 13,963) from 1977 to 2006 and an age- and sex-matched population cohort (n = 66,407) using data on MS, arterial CVD and comorbidity from the Danish National Registry of Patients. We calculated the risk of arterial CVD for all subjects and computed adjusted incidence rate ratios (IRRs). During the first year of follow-up, the risk of myocardial infarction (MI) was 0.2% among patients with MS (adjusted IRR = 1.84; 95% confidence interval, CI: 1.28-2.65, compared with population cohort members), whereas the 1-year risk of overall stroke was 0.3% (adjusted IRR = 1.96; 95% CI: 1.42-2.71). IRRs were 1.92 (95% CI: 1.27-2.90) for heart failure and 0.77 (95% CI: 0.42-1.39) for atrial fibrillation/flutter. During the subsequent 2-30 years of follow-up, IRRs remained elevated for overall stroke (1.23; 95% CI: 1.10-1.38) and heart failure (1.53; 95% CI: 1.37-1.71) but decreased for acute MI (1.10; 95% CI: 0.97-1.24). In this Danish cohort, the risk of CVD among MS patients was low, but greater than that in the general population, particularly in the short term.