Aims In observational studies, type-2 diabetes is associated with increased risk of dementia; however, the causal nature of this association remains unanswered. In an unselected nationwide study of all Danes, we wanted to test whether type-2 diabetes is associated with dementia subtypes, and to test whether potential associations are of a causal nature. Methods In the current study of nationwide observational registry data in all Danes above the age of 65 years (n = 784 434) combined with genetic consortia data on 213 370 individuals, we investigated the associations between type-2 diabetes and Alzheimer's disease, vascular dementia, unspecified dementia and all-cause dementia, and whether observational associations were of a causal nature by applying a two-sample Mendelian randomisation strategy. We addressed key biases inherent in Mendelian randomisation approaches. Results Important confounders (age, ethnicity, size of community, region, civil status and education level) were captured on all 784 434 individuals and adjusted for in the models. Multifactorial adjusted hazard ratios were 1.13 (1.06–1.21) for Alzheimer's disease, 1.98 (1.83–2.14) for vascular dementia, 1.53 (1.48–1.59) for unspecified dementia and 1.48 (1.44–1.53) for all-cause dementia in persons with type-2 diabetes v. without. Results were similar for men and women. The two-sample Mendelian randomisation estimate for the association between the genetic instrument and Alzheimer's disease was 1.04 (0.98–1.10), consistent with sensitivity estimates, addressing pleiotropy, measurement bias and weak instrument bias. Conclusions In a nationwide study of all Danes above the age of 65 years, we show that type-2 diabetes is associated with major subtypes of dementia – with particularly strong associations for vascular dementia and unspecified dementia – the two types of dementia with the most obvious vascular pathologies. Although the present two-sample Mendelian randomisation approach using genetic consortia data suggests that type-2 diabetes is not a direct cause of Alzheimer's disease, we were unable to test the causal nature of type-2 diabetes for vascular dementia and unspecified dementia, because no publicly available genetic consortia data yet exist for these dementia endpoints. The causal nature of type-2 diabetes for dementia with vascular pathologies is pivotal questions to solve for future public health recommendations and therapeutic advice.
Aims To examine the temporal trends and factors associated with national CR referral and compare the risk of hospital readmission and mortality in those referred for CR versus no referral. Methods and Results This cohort study includes all adult patients alive 120 days from incident HF identified by the Danish Heart Failure Register (n = 33,257) between 2010 and 2018. Multivariable logistic regression models were used to assess the association between CR referral and patient factors and acute all-cause hospital readmission and mortality at 1-year following HF admission. Overall, 46.7% of HF patients were referred to CR, increasing from 31.7% in 2010 to 52.2% in 2018. Several factors were associated with lower odds of CR referral: male sex (odds ratio (OR): 0.85; 95% CI, 0.80-0.89), older age, unemployment, retirement, living alone, non-Danish ethnic origin, low educational level, New York Heart Association (NYHA) class IV vs I. (OR: 0.75; 0.60-0.95), left ventricular ejection fraction (LVEF) >40% and comorbidity (stroke, chronic kidney disease, atrial fibrillation/flutter, and diabetes). Myocardial infarction, arthritis, coronary artery bypass grafting, percutaneous coronary intervention, valvular surgery, NYHA class II, and use of angiotensin-converting enzyme inhibitors were associated with higher odds of CR referral. CR referral was associated with lower risk of acute all-cause readmission (OR: 0.92; 0.87-0.97) and all-cause mortality (OR: 0.65; 0.58-0.72). Conclusion Although increased over time, only one in two HF patients in Denmark were referred to CR in 2018. Strategies are needed to reduce referral disparities, focusing on subgroups of patients to be at highest risk of non-referral.
BackgroundThe effectiveness of health checks aimed at the general population is disputable. However, it is not clear whether health checks aimed at certain groups at high risk may reduce adverse health behaviour and identify persons with metabolic risk factors and non-communicable diseases (NCDs).ObjectivesTo assess the effect of general practice-based health checks on health behaviour and incidence on NCDs in individuals with low socioeconomic position.MethodsIndividuals with no formal education beyond lower secondary school and aged 45–64 years were randomly assigned to the intervention group of a preventive health check or to control group of usual care in a 1:1 allocation. Randomisation was stratified by gender and 5-year age group. Due to the real-life setting, blinding of participants was only possible in the control group. Effects were analysed as intention to treat (ITT) and per protocol. The trial was undertaken in 32 general practice units in Copenhagen, Denmark.InterventionInvitation to a prescheduled preventive health check from the general practitioner (GP) followed by a health consultation and an offer of follow-up with health risk behaviour change or preventive medical treatment, if necessary.Primary outcome measuresSmoking status at 12-month follow-up. Secondary outcomes included status in other health behaviours such as alcohol consumption, physical activity and body mass index (measured by self-administered questionnaire), as well as incidence of metabolic risk factors and NCDs such as hypertension, hypercholesterolaemia, chronic obstructive pulmonary disease, diabetes mellitus, hypothyroidism, hyperthyroidism and depression (drawn from national healthcare registries).Results1104 participants were included in the study. For the primary outcome, 710 participants were included in the per protocol analysis, excluding individuals who did not attend the health check, and 1104 participants were included in the ITT analysis. At 12-month follow-up, 37% were daily smokers in the intervention group and 37% in the control group (ORs=0.99, 95% CI: 0.76 to 1.30). No difference in health behaviour nor in the incidence of metabolic risk factors and NCDs between the intervention and control group were found. Side effects were comparable across the two groups.ConclusionThe lack of effectiveness may be due to low intensity of intervention, a high prevalence of metabolic risk factors and NCDs among the participants at baseline as well as a high number of contacts with the GPs in general or to the fact that general practices are not an effective setting for prevention.Trial registration numberNCT01979107.
Aim: To present the study design, study population and questionnaire content of the Danish National Youth Study 2019, and to describe the differences between participants and non-participants regarding demographic and socioeconomic characteristics. Method: The Danish National Youth Study 2019 is a nationwide web-survey among high school students in Denmark. Data was collected from January to April 2019 through a self-administered questionnaire in the classroom. The questionnaire included 120 questions on, for example, physical and mental health, health behaviour and well-being. Data collection took place at 50 general high schools, 32 preparatory high schools, 15 commercial high school and 19 technical high schools. Results: A total of 29,086 students participated (20,287 general high school students, 2,113 preparatory higher school students, 4027 commercial high school students and 2659 technical high school students) corresponding to 66% of the students in the 88 participating schools (31% of invited schools). Among students, 55% were female and the mean age was 17.8 years. Participants were more likely to be female, to be younger, to be of Danish origin, and have family disposable income in the highest quartile compared to non-participants. Conclusions: The Danish National Youth Study 2019 contributes to knowledge on high school students’ health, health behaviour and well-being that can support health planning and prioritizing, through identification of specific risk groups at both local and national level. The study also offers great opportunities for future research as it provides possibility of linkage to various Danish national registers.
Meta-analyses and Mendelian randomization (MR) may clarify the associations of smoking, blood cells and myeloproliferative neoplasms (MPN). We investigated the association of smoking with blood cells in the Danish General Suburban Population Study (GESUS, n = 11 083), by meta-analyses (including GESUS) of 92 studies (n = 531 741) and MR of smoking variant CHRNA3 (rs1051730[A]) in UK Biobank, and with MPN in a meta-analysis of six studies (n (total/cases):1 425 529/2187), totalling 2 307 745 participants. In the meta-analysis the random-effects standardized mean difference (SMD) in current smokers versus non-smokers was 0Á82 (0Á75-0Á89, P = 2Á0 * 10 À108 ) for leukocytes, 0Á09 (À0Á02 to 0Á21, P = 0Á12) for erythrocytes, 0Á53 (0Á42-0Á64, P = 8Á0 * 10 À22 ) for haematocrit, 0Á42 (0Á34-0Á51, P = 7Á1 * 10 À21 ) for haemoglobin, 0Á19 (0Á08-0Á31, P = 1Á2 * 10 À3 ) for mean corpuscular haemoglobin (MCH), 0Á29 (0Á19-0Á39, P = 1Á6 * 10 À8 ) for mean corpuscular volume (MCV), and 0Á04 (À0Á04 to 0Á13, P = 0Á34) for platelets with trends for ever/ex-/current smokers, light/heavy smokers and female/male smokers. Analyses presented high heterogeneity but low publication bias. Per allele in CHRNA3, cigarettes per day in current smokers was associated with increased blood cell counts (leukocytes, neutrophils), MCH, red cell distribution width (RDW) and MCV. The pooled fixed-effects odds ratio for MPN was 1Á44 [95% confidence interval (CI): 1Á33-1Á56; P = 1Á8 * 10 À19 ; I 2 = 0%] in current smokers, 1Á29 (1Á15-1Á44; P = 8Á0 * 10 À6 ; I 2 = 0%) in ex-smokers, 1Á49 (1Á26-1Á77; P = 4Á4 * 10 À6 ; I 2 = 0%) in light smokers and 2Á04 (1Á74-2Á39, P = 2Á3 * 10 À18 ; I 2 = 51%) in heavy smokers compared with non-smokers.Smoking is observationally and genetically associated with increased leukocyte counts and red blood cell indices (MCH, MCV, RDW) and observationally with risk of MPN in current and ex-smokers versus non/neversmokers.
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