Birth outcomes of women with celiac disease: a nationwide historical cohort study

OBJECTIVE: We aimed to examine birthweight, low birthweight (<2500 g), and intrauterine growth retardation in offspring of women with celiac disease in relation to their first hospitalization for the disease. METHODS: This was a historical cohort study based on The Danish Medical Birth Registry data of celiac women discharged from Danish hospitals from 1977-1992. The study included 211 newborns to 127 mothers with celiac disease, and 1260 control deliveries. RESULTS: Before celiac women were first hospitalized the mean birthweight of their newborns was 238 g (95% confidence interval [95% CI] = 150, 325 g) lower than that of the control women, after adjustment for potential confounders. After the first hospitalization the mean birthweight for newborns of diseased women was higher than that of controls, by 67 g (95% CI = -88, 223 g) after adjustment for potential confounders. Before celiac women were first hospitalized we found an increased risk of low birthweight (odds ratio [OR] = 2.6, 95% CI = 1.3-5.5) and intrauterine growth retardation (OR = 3.4, 95% CI = 1.6-7.2). After celiac women were first hospitalized we found no increased risk of low birthweight and no babies with intrauterine growth retardation. CONCLUSIONS: Offspring of mothers with celiac disease had lower birthweight than expected and more than a three-fold higher risk of intrauterine growth retardation when birth occurred before the first hospitalization for the disease. After the mother's first hospitalization the birthweight was similar to controls and no increased risk of low birthweight was seen. Our study indicates that treatment of celiac women is important in the prevention of fetal growth retardation.     

Survival after colorectal cancer in patients with ulcerative colitis: a nationwide population-based Danish study

OBJECTIVES: Patients with ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC). Little is known about how UC impacts CRC prognosis. In a nationwide population-based study we examined the CRC prognosis in UC patients compared to CRC patients without UC. METHODS: From the Danish Cancer Registry and the Danish Hospital Discharge Registry, we identified all CRC patients and all patients with UC in Denmark from 1977 to 1999. We compared survival in 279 UC patients with CRC to all other 71,259 CRC patients and computed mortality rate ratios (MRR). We also compared stage distribution at time of cancer diagnosis. RESULTS: The mean age at time of CRC diagnosis was 62.6 yr in UC patients and 71.2 yr in patients without UC. Cancer stage distribution for localized cancer, regional spread, and distant metastasis were 46.6%, 30.1%, and 16.5% in UC patients compared to 44.0%, 28.3%, and 19.4% in CRC patients without UC. The overall MRR for UC patients with CRC compared with all other CRC patients were 1.24 (95% CI 1.02-1.51) in the first year and 1.17 (95% CI 1.01-1.36) after 5 yr of follow-up. CONCLUSION: UC patients with CRC have a stage distribution similar to patients with CRC without UC. The prognosis of CRC is poorer for UC patients than for patients without UC.     

The epidemiology of microscopic colitis: a 10-year pathology-based nationwide Danish cohort study

Abstract

Objective. Microscopic colitis (MC) includes two main types: collagenous colitis (CC) and lymphocytic colitis (LC). Previous studies have indicated an increasing incidence, but these have mainly been based on regional databases. We found it important to study the epidemiology based on a comprehensive nationwide cohort. Material and methods. We studied the epidemiological data of MC in Denmark from 2002 to 2011. The cohort consisted of all patients with a recorded diagnosis of either CC or LC in the Danish Pathology Register during the study period. Data on all patients with a registered colon biopsy were also included. Results. A total of 7777 patients, 4749 (61%) with CC and 3028 (39%) with LC, were identified. Over the study period, the annual incidence of diagnosed cases of CC increased from 2.9/10⁵ to 14.9/10⁵ and of LC from 1.7/10⁵ to 9.8/10⁵. In 2011, the incidence of MC was 24.7/10⁵ inhabitants. The age-specific incidence showed that the risk of both CC and LC increased with age. The female/male ratio, distribution of the type of colitis and mean age at diagnosis were relatively stable during the study period. The annual number of registered colon biopsies in the pathology register increased from 21.583 in 2002 to 39.733 in 2011, indicating an increased diagnostic activity. Conclusion. In a nationwide cohort study, the incidence of CC and LC continued to increase from 2002 to 2011. An increased diagnostic activity could in part explain the increase in the number of diagnosed cases.     

Pouch functional outcomes after restorative proctocolectomy with ileal-pouch reconstruction in patients with ulcerative colitis: Japanese multi-center nationwide cohort study

Journal of Gastroenterology - Although several complications capable of causing pouch failure may develop after restorative proctocolectomy (RPC) for ulcerative colitis (UC), the incidences and...     

Disease activity in pregnant women with Crohn's disease and birth outcomes: a regional Danish cohort study

OBJECTIVES: CD is associated with increased risk of adverse birth outcomes, but existing studies have not assessed the impact of disease activity during pregnancy. We examined the impact of disease activity on birth outcomes: LBW, preterm birth, LBW at term, and CAs. METHODS: All births by CD women in North Jutland County, Denmark, from January 1, 1977 to December 31, 2005, were evaluated in a cohort study based on linkage between the Danish National Registry of Patients and the Medical Birth Registry. After identification of all births by CD women, review of medical records allowed collection of clinical details (including disease activity and drug therapy during pregnancy). The exposed cohort (N = 71) constituted pregnancies with low/moderate-high disease activity during pregnancy, and the unexposed cohort (N = 86) those with inactive disease. Logistic regression analyses were used to estimate the adjusted relative risks (with 95% confidence intervals) for adverse birth outcomes associated with disease activity in CD pregnancies. In subanalysis, we examined the impact of moderate-high activity. RESULTS: In women with disease activity, the adjusted risks of LBW, LBW at term, preterm birth, and CAs were 0.2 (0.0-2.6), 0.4 (0.0-3.7), 2.4 (0.6-9.5), and 0.8 (0.2-3.8), respectively. The crude risk of preterm birth was 3.4 (1.1-10.6) in those with moderate-high disease activity. CONCLUSIONS: Disease activity during pregnancy only increased the risk of preterm birth (especially in those with high disease activity). Further research is needed to assess the critical impact of disease activity in larger cohorts of CD women.     

The Danish 1905 cohort: a genetic-epidemiological nationwide survey

OBJECTIVES. The authors studied nonagenarians, a rapidly growing age group whose cognitive and physical abilities have yet to be investigated systematically. METHODS. All Danes born in 1905 were invited to participate in a home-based 2-hour multidimensional interview, including cognitive and physical performance tests and collection of DNA, carried out by lay interviewers. Population-based registers were used to evaluate representativeness. RESULTS. There were 2,262 participants. A total of 1,632 (72%) gave a DNA sample. Participants and nonparticipants were highly comparable with regard to marital status, institutionalization, and hospitalization patterns, but men and rural area residents were more likely to participate. Six months after the survey began, 7.2% of the participants and 11.8% of the nonparticipants had died. DISCUSSION. Despite the known difficulties of conducting surveys among the extremely old, it was possible to conduct a nationwide survey, including collection of DNA, among more than 2,000 fairly nonselected nonagenarians using lay interviewers.     

Comorbidity and survival of Danish cirrhosis patients: a nationwide population-based cohort study

Patients with liver cirrhosis have a high mortality, not just from cirrhosis-related causes, but also from other causes. This observation indicates that many patients with cirrhosis have other chronic diseases, yet the prognostic impact of comorbidities has not been examined. Using data from a nationwide Danish population-based hospital registry, we identified patients who were diagnosed with cirrhosis between 1995 and 2006 and computed their burden of comorbidity using the Charlson comorbidity index. We compared survival between comorbidity groups, adjusting for alcoholism, sex, age, and calendar period. We also examined the risks of cirrhosis-related and non-cirrhosis-related death using data from death certificates and identified a matched comparison cohort without cirrhosis from the Danish population. We included 14,976 cirrhosis patients, 38% of whom had one or more comorbidities. The overall 1-year survival probability was 65.5%; the 10-year survival probability was 21.5%. Compared with patients with a Charlson comorbidity index of 0, the mortality rate was increased 1.17-fold in patients with an index of 1 [95% confidence interval (CI), 1.11-1.23], 1.51-fold in patients with an index of 2 (95% CI, 1.42-1.62), and two-fold in patients with an index of 3 or higher (95% CI, 1.85-2.15). In the first year of follow-up, but not later, comorbidity increased the risk of cirrhosis-related death, and this was consistent with an apparent synergy between the cirrhosis and comorbidity effects on mortality in the same period. CONCLUSION: Our findings demonstrate that comorbidity is an important prognostic factor for patients with cirrhosis. Successful treatment of comorbid diseases in the first year after diagnosis may substantially reduce the mortality rate.     

Prognosis following first-time myocardial infarction in patients with psoriasis: a Danish nationwide cohort study

Abstract. Ahlehoff O, Gislason GH, Lindhardsen J, Olesen JB, Charlot M, Skov L, Torp‐Pedersen C, Hansen PR. (Copenhagen University Hospital Gentofte, Hellerup; Copenhagen University Hospital Roskilde, Roskilde, Denmark). Prognosis following first‐time myocardial infarction in patients with psoriasis: a Danish nationwide cohort study. J Intern Med 2011; 270 : 237–244. Objectives. The magnitude of cardiovascular risk associated with psoriasis has been debated and the prognostic impact of psoriasis following myocardial infarction (MI) is unknown. Therefore, we investigated the risk of mortality and adverse cardiovascular events in patients with psoriasis following first‐time MI. Design, setting and participants. Cohort study of the entire Danish population including all individuals who experienced first‐time MI during the period 2002–2006. Multivariable Cox regression models were used to assess the post‐MI prognostic impact of psoriasis. Main outcome measures. All‐cause mortality and a composite cardiovascular end‐point of recurrent MI, stroke and cardiovascular death. Results. A total of 462 patients with psoriasis and 48 935 controls (mean age 69.5 and 70.6 years, respectively) were identified with first‐time MI during the study period. The mean follow‐up was 19.5 months [standard deviation (SD) 16.5] for patients with psoriasis and 22 .0 months (SD 18.7) for those without psoriasis. Incidence rates (IRs) per 1000 patient‐years for all‐cause mortality were 119.4 [95% confidence interval (CI) 117.2–138.3] and 138.3 (95% CI 114.1–167.7) for patients without and with psoriasis, respectively, and the adjusted hazard ratio (HR) associated with psoriasis was 1.18 (95% CI 0.97–1.43). For the composite end‐point, the IRs were 149.7 (95% CI 147.1–152.4) and 185.6 (95% CI 155.8–221.0) for patients without and with psoriasis, respectively, with an HR of 1.26 (95% CI 1.04–1.54) for patients with psoriasis. Conclusion. This first study of the impact of psoriasis on prognosis after first‐time MI indicated a significantly impaired prognosis in patients with psoriasis. Further studies of this novel association are warranted.     

Increased risk of cancer in ulcerative colitis: a population-based cohort study

OBJECTIVE: There is an increased risk of colorectal cancer among patients with ulcerative colitis (UC). However, the overall and site specific cancer risks in these patients have been investigated to a limited extent. To study the association between UC and cancer, a population-based study of 1547 patients with UC in Stockholm diagnosed between 1955 and 1984 was carried out. METHODS: The patients were followed in both the National Cancer Register and the National Cause of Death Register until 1989. For comparisons, regional cancer incidence rates in Stockholm County were used together with individually computed person-years at risk in the UC disease cohort. RESULTS: A total of 121 malignancies occurred among 97 individuals as compared with 89.8 expected (standardized morbidity ratio [SMR] = 1.4; 95% confidence interval (CI), 1.1-1.6). Overall, an excess number of colorectal cancers (SMR, 4.1; 95% CI, 2.7-5.8), and hepatobiliary cancers in men (SMR = 6.0; 95% CI, 2.8-11.1) associated with primary sclerosing cholangitis, was observed. The risk of pulmonary cancer was decreased (SMR = 0.3; 95% CI, 0.1-0.9). In all, 91 extracolonic malignancies were observed, compared with the 82.3 expected (SMR = 1.11; 95% CI, 0.9-1.3). CONCLUSIONS: In UC patients, the overall cancer incidence is increased mainly because of an increased incidence of colorectal and hepatobiliary cancer. This increase is partly counterbalanced by a decreased risk of pulmonary cancer compared with that in the general population.     

Candida infection and cancer risk: A Danish nationwide cohort study

BackgroundCandida species infection may be associated with increased cancer risk.MethodsWe linked data from the nationwide medical registries and examined the incidence of various cancers in patients with a first-time hospital presentation with candida infection. We computed the cumulative incidence of cancer and standardized incidence ratios (SIRs) of cancer overall, immune-related cancers, and specific cancer types by comparing observed versus expected incidences based on age-, sex-, and anatomical site-specific incidence rates.ResultsAmong 21,247 candida-infected patients, we identified 1534 cancers during a combined follow-up of 187,993 years (standardized incidence ratio (SIR) = 1.6 (95% confidence interval (CI): 1.5–1.7)). The 1- and 10-year risks of cancer were 2.6%, and 8.3%, respectively. In the first year after a candida diagnosis, the SIR for cancer was 3.7 (95% CI: 3.4–4.0). In the second and subsequent years of follow-up, the SIRs were 1.2 (95% CI: 1.1–1.3) for any cancer and 1.4 (95% CI 1.2–1.7) for immune-related cancers. The risk of mouth and throat cancers remained more than 3-fold increased in the second and subsequent years of follow-up.ConclusionsHospital presentation with candida infection is associated with increased short- and long-term cancer risk.