Compared with the general population the doctors' mortality was low, but the mortality from external causes was increased, mainly due to an excess number of suicides.

A cohort of 113,732 stroke patients from Danish Hospital Discharge Registry were, by linkage to the Danish Cancer Registry, found to have developed a total of 5151 cases of cancer in a mean follow-up time of 2.4 years after the diagnosis of stroke. There was no excess of gastric cancer. The present findings fail to support the existence of a common, strong risk factor for stroke and gastric cancer in individuals. In the cohort, more cancer than expected was observed. In particular, a more than ten-fold increase in risk of brain tumours within the first year after stroke diagnosis was observed, suggesting some diagnostic misinterpretation of a brain tumour as a stroke. Minor excesses of cancer of other sites were also found in the first year of follow-up. They are probably due to increased medical surveillance and diagnostic misinterpretation of an underlying malignancy as an incident of cerebrovascular disease, eg through metastatic spread to the brain.

SummaryThe data recorded in the National Registry of Hospitalized Patients in Denmark (Landspatient-registeret [LPR]) are based on reports from the somatic departments of hospitals throughout the country. For the purpose of evaluating the quality of these data, information from LPR concerning patient diagnoses was compared with corresponding information in the records from 924 consecutive admissions to the Frederiksborg County Hospital, Hiller0d. The diagnoses in these records were registered and given priority based on predetermined criteria for selection of primary and secondary diagnoses, respectively. For each hospitalized case a total of 4 primary and 4 secondary diagnoses might be registered. In order to show the variation in choice of diagnoses between physicians, all records from the two medical departments and 10% from the remaining departments were revised by two different physicians. In the medical “block” (medical departments B and F, and the departments of physical medicine, paediatrics, and neurology), there was agreement between the two physicians on at least one of the maximally 4 primary diagnoses which could be registered in 92% of the cases (2-digit code). For the surgical “block” (the departments of parenchymal surgery, orthopaedic surgery, gynaecology, and otology), the corresponding figure was 95%. If the two coders were in agreement on at least one primary diagnosis, this was identical with LPR’s primary diagnosis in 76% of the cases in the medical “block” and 85% of the cases in the surgical “block” (2-digit code). However, in the case of 15% of the medical and 7% of the surgical cases, the primary diagnosis, on which the two coders were in agreement, was not recorded at all by LPR (3-digit code).It is to be emphasized that a certain variation between different physicians in their choice of diagnoses cannot be eliminated. In conclusion, the level of agreement between LPR and the study material found in the present study is in general satisfactory if LPR’s function as a basis of information for policy making in the hospital sector is taken into consideration. On the other hand, agreement (especially on medical records) is presumably not good enough in LPR to be used for research purposes.

No abstract

SUMMARY The possible carcinogenic effects of antisecretory agents used in the treatment of gastric and duodenal ulcer were investigated in a population based cohort study of 16 739 patients who were prescribed the H2-antagonist cimetidine between 1977 and 1981. An excess risk for gastric cancer was observed, with a relative risk of about 10 in the first year after beginning use of the drug, which decreased thereafter. A similar pattern was seen for cancers of the colon, pancreas and gall bladder, and for non-Hodgkin's lymphoma. These increased risks probably represent cases in which a malignancy was misdiagnosed as a gastric ulcer. The excess risk for gastric cancer was unaffected by the method of diagnosis, the risk in those who had undergone an endoscopy being similar to those who had been diagnosed by an x-ray examination. A relative risk of 1.5-2.0 was observed for cancer of the respiratory organs, with no effect of latency, indicating that there are common risk factors for peptic ulcer and for lung cancer. Although the observed increases in cancer risk in persons receiving cimetidine is probably caused by factors other than a carcinogenic action of the drug itself, this possibility cannot be ruled out because of the short period of follow up.