Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare

Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0–19 years, during 1991–2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (OR_{adj_Low_vs_High} 1.65 [95% CI 1.22–2.23]) and income (OR_{adj_Q1(lowest)_vs_Q4(highest)} 1.77 [1.25–2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1–5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population-based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis.     

Adverse health effects among women living with heavy snorers

Women living with heavy snorers were more frequently affected by symptoms of insomnia, morning headache, daytime sleepiness, and fatigue than women living with non-snorers. Questionnaire data were collected from 1,032 women 30 to 64 years of age residing in Dalarna county, in mid-Sweden. There were indications of a "dose-response relationship" between the conjectured sound exposure and reported symptoms, regardless of whether the female herself snored. Sleeping in separate bedrooms did not seem to give the women any alleviation. The results point to a possible contributory cause of disturbed sleep, morning headache, and daytime sleepiness among women living with a snoring spouse. The results also indicate that prevention and treatment of snoring are important issues for the couple as well as for the snorer.     

Up-to-date long-term survival of cancer patients: an evaluation of period analysis on Swedish Cancer Registry data

The natural development of cancers as well as the measures to fight the disease are often long processes that require decades of follow up. Available information on long-term survival will thus often appear outdated and irrelevant. A few years ago, period-survival analysis was proposed as a means to obtain more up-to-date information on long-term cancer survival. This article assesses period and conventional cohort-based survival analyses on their ability to predict future survival. Based on historical data from the nationwide Swedish Cancer Registry 5-, 10- and 15-year relative survival actually observed for patients diagnosed at one particular point in time are compared to the most recent period and cohort-based survival estimates available at that point in time. The study shows that period analysis can, in most cases, be used to provide more up-to-date long-term estimates of cancer survival. Period analysis reduces the time lag of the survival estimates by some 5-10 years for all cancers combined and especially affects the survival estimates for small intestine carcinoids, meningioma and intracranial neurinoma of the brain, non-seminoma testicular cancer, chronic lymphocytic leukaemia and Hodgkin's lymphoma.     

Cancer survival in Sweden 1960-1998--developments across four decades

This paper summarizes a comprehensive study of cancer survival in Sweden from 1960 to 1998. A total of 1021421 persons and 40 different cancer sites were included in the analyses. The main outcome measure is the relative survival rate (RSR) for different sites and follow-up times after diagnosis. The 10-year RSR for all sites combined has increased steadily-from 26.6% among men and 41.8% among women in the 1960s, to 44.6% (men) and 57.6% (women) in the 1990s. The expectation of life for a person diagnosed with cancer today is about 7 years longer than that of one diagnosed during the mid-1960s. About 3 years are gained due to changes in the relative distribution of various cancer types and about 4 years due to improved relative survival. During the 1990s substantial survival improvements were observed not only for uncommon types, such as testicular cancer, Hodgkin's lymphoma and some other haematologic malignancies, but also for cancer of the rectum, kidney and malignant melanoma. Survival for breast and cervical cancer also improved during the 1990s, but not that for pancreatic, liver or lung cancer.     

Headache,snoring and sleep apnoea

To evaluate reported headache prevalence among the general population and patients suffering from snoring and obstructive sleep apnoea syndrome (OSAS), a cross-sectional study was performed among those aged 30–64 years residing in Kopparberg county in central Sweden. Consecutive patients referred to the sleep laboratory in the catchment area who fulfilled objective diagnostic criteria (snorers = 448, OSAS = 324) and a random sample of the general population (n = 583) responded to the same questionnaire. Patients were selected following sleep apnoea screening with 100% specificity for both OSAS and snoring. Responders from the general population were divided into snorers or non-snorers on the basis of self-report. To validate the self-report question on snoring in the questionnaire, 50 males and 49 females, randomly selected from the sample of the general population, underwent sleep apnoea screening in their homes. Headache among both men and women was found to be more prevalent among heavy snorers and OSAS patients compared with the control group. Morning headache, in particular, was at least three times more common among male and female heavy snorers and OSAS patients then among the general population. Headache in the control group was more common among snorers than non-snorers. Among responders, 5% of the general population reported experiencing headache often or very often upon awakening. For the heavy snoring and OSAS groups, 18% reported experiencing headache often or very often upon awakening. The results indicate that headache is common among heavy snorers and OSAS patients regardless of gender.