All cause and cause specific mortality in 15-24-year-olds in Denmark 2010 to 2022: nationwide study of socioeconomic predictors
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SUBMITTER: Kruckow S
PROVIDER: S-EPMC11340248 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Summary Background Adolescents and young adults aged 15–24 years are disproportionately affected by unnatural deaths, including accidents, suicide and interpersonal violence for which alcohol is a leading risk factor. We aimed to explore the extent of and circumstances surrounding alcohol-related deaths in young people aged 15–24 years and whether socioeconomic background and ethnicity differ in those who died due to alcohol-related causes as compared to the background population. Methods All deaths of 15–24-year-olds occurring in Denmark from 2010 to 2019 were investigated. We manually reviewed death certificates containing information on circumstances, results from autopsies and blood tests, and statements from witnesses. Relevant information published in the media (most often newspaper articles) was included. Our main outcome measures were alcohol-related death and manner of death (accidents (transport accidents, drownings, falls, poisonings), suicide and violence). Further, we designed a population-based case–control study including 10 age- and sex-matched controls per case to test whether there was a socioeconomic gradient in alcohol-related deaths. We used parents’ educational level and employment status to define socioeconomic position. Immigration status was used to assess ethnicity. Findings Over the 10-year period, 1783 deaths occurred among 15–24-year-olds. Of those, 1067 (60%) were due to unnatural causes, corresponding to a mortality rate of 14.8 (95% confidence interval: 13.9–15.7) per 100,000. Twelve percent of unnatural deaths (n = 125) were alcohol related, corresponding to a rate of 1.7 (1.4–2.0) per 100,000, and were higher in males (2.9 [2.3–3.4]) than in females (0.6 [0.3–0.8]); thus, males accounted for 105 (84%) of alcohol-related deaths. The majority of alcohol-related deaths occurred on Fridays, Saturdays and Sundays (n = 77, 62%). Accidents accounted for 82% (n = 102) of alcohol-related deaths, followed by suicide (n = 19, 15%) and interpersonal violence (n = 4, 3%). Of all fatal accidents, 102 of 636 (16%) were alcohol related. Of all deaths caused by drownings and falls, 14 of 26 (54%) and 10 of 25 (40%), respectively, were alcohol related. Alcohol-related drownings most often occurred while the deceased was alone, whereas alcohol-related falls most often occurred in relation to parties, involving falls from a window or balcony. Those who died from alcohol-related causes more often had parents with a short education or who were unemployed, as compared to the general population. For example, odds ratios were 3.9 (2.2–7.0) and 1.8 (1.2–2.9) for having parents with short and medium as compared to long educations. The odds ratio for being of Danish origin was 4.0 (1.7–9.5) compared to being first- or second-generation immigrants. Interpretation In 15–24-year-olds, alcohol-related deaths accounted for a substantial proportion of all unnatural deaths. There was substantial socioeconomic inequality in alcohol-related deaths, as has repeatedly been shown for chronic alcohol-related mortality in older adults. Funding 10.13039/501100007437Trygfonden.
| S-EPMC10070885 | biostudies-literature
Project description:BACKGROUND: Not all patients have benefited equally from the advances in non-Hodgkin lymphoma (NHL) survival. This study investigates several individual-level markers of socioeconomic position (SEP) in relation to NHL survival, and explores whether any social differences could be attributed to comorbidity, disease and prognostic factors, or the treatment given. METHODS: This registry-based cohort study links clinical data on prognostic factors and treatment from the national Danish lymphoma database to individual socioeconomic information in Statistics Denmark including 6234 patients diagnosed with NHL in 2000-2008. RESULTS: All-cause mortality was 40% higher in NHL patients with short vs higher education diagnosed in the period 2000-2004 (hazard ratio (HR)=1.40 (1.27-1.54)), and 63% higher in the period 2005-2008 (HR=1.63 (1.40-1.90)). Further, mortality was increased in unemployed and disability pensioners, those with low income, and singles. Clinical prognostic factors attenuated, but did not eliminate the association between education and mortality. Radiotherapy was less frequently given to those with a short education (odds ratio (OR)= 0.84 (0.77-0.92)), low income (OR=0.80 (0.70-0.91)), and less frequent to singles (OR=0.79 (0.64-0.96)). Patients living alone were less likely to receive all treatment modalities. CONCLUSION: Patients with low SEP have an elevated mortality rate after a NHL diagnosis, and more advanced disease at the time of diagnosis explained a part of this disparity. Thus, socioeconomic disparities in NHL survival might be reduced by improving early detection among patients of low SEP.
| S-EPMC3305955 | biostudies-other
Project description:BackgroundNo nationwide studies on social position and prevalence of comorbidity among cancer survivors exist.MethodsWe performed a nationwide prevalence study defining persons diagnosed with cancer 1943-2010 and alive on the census date 1 January 2011 as cancer survivors. Comorbidity was compared by social position with the non-cancer population.ResultsCancer survivors composed 4% of the Danish population. Somatic comorbidity was more likely among survivors (OR 1.59, 95% CI 1.57-1.60) and associated with higher age, male sex, short education, and living alone among survivors.ConclusionsAmong cancer survivors, comorbidity is common and highly associated with social position.
| S-EPMC4453680 | biostudies-literature
Project description:BackgroundWorldwide, an estimated 38.0 million people lived with the human immunodeficiency virus in 2019, and 3.4 million young people aged 15~24 years were living with HIV. Sub-Saharan Africa carries a significant HIV burden with West and Central Africa most affected with HIV. Among the young people living with HIV in West and Central Africa, an estimated 810,000 were aged 15~24 years. This study aimed to assess predictors that influence the uptake of HIV testing among youth aged 15~24 years in The Gambia.MethodsThe 2013 Gambia Demographic and Health Survey data for youth aged 15~24 years was used. The Andersen behavioral model of health service use guided this study. A cross-sectional study design was used on 6194 subjects, among which 4730 were female. The analysis employed Chi-squared tests and hierarchical logistic regression.ResultsLess than one-quarter of the youth 1404 (22.6%) had ever been tested for HIV. Young people aged 20~24 years (adjusted odds ratio (aOR): 1.98), who were females (aOR: 1.13), married youth (aOR: 3.89), with a primary (aOR: 1.23), secondary or higher education (aOR: 1.46), and who were from the Jola/Karoninka ethnic group (aOR: 1.81), had higher odds of having been tested for HIV. Those with adequate HIV knowledge and those who were sexually active and had aged at first sex ≥15 years (aOR: 3.99) and those <15 years (aOR: 3.96) were more likely to have been tested for HIV compared to those who never had sex.ConclusionThis study underscores the low level of model testing on HIV testing among youth (15~24 years) in The Gambia. Using Anderson's Model of Health Service Utilization, the predisposing factors (socio-demographic and HIV knowledge) and the need-for-care factors (sexual risk behaviors) predict healthcare utilization services (HIV testing) in our study; however, only socio-demographic model explained most of the variance in HIV testing. The low effect of model testing could be related to the limited number of major variables selected for HIV knowledge and sexual risk behavior models. Thus, consideration for more variables is required for future studies.
| S-EPMC8856544 | biostudies-literature
Project description:ObjectiveThe objective of this study is to estimate the proportion of alcohol-related ambulance contacts and to describe characteristics of these contacts in young people.DesignA descriptive population-based study with alcohol-related ambulance contacts identified from free texts in prehospital medical records by a two-stepped approach; an automatic search for specific keywords followed by manual verification.SettingCopenhagen, Denmark.ParticipantsA random sample (n=26 600) of all ambulance contacts in 15-24-year-olds between 10 March 2015 and 1 November 2022.Main outcomes measureProportion and relative proportion (RP) of alcohol-related ambulance contacts.ResultsOf all ambulance contacts, 16% (n=4145) were alcohol related. Most alcohol-related contacts had acute alcohol intoxication (46%) as the primary cause followed by accident (23%). Alcohol-related contacts followed a clear circadian pattern with most contacts during night-time, peaking on Saturday and Sunday mornings between 03:00 and 04:00 hours with 59% and 55% of ambulance contacts being alcohol related. Compared with Mondays, the number of all ambulance contacts was 46% and 38% higher on Fridays and Saturdays, which was attributable to the large number of alcohol-related contacts. Alcohol-related contacts were more frequent in males compared with females (RP 1.46 (95% CI 1.37 to 1.55)) and equally frequent in 15-17- and 18-24-year-olds (RP 1.04, 95% CI 0.97 to 1.13).ConclusionA large proportion of ambulance dispatches in young people is attributable to excessive alcohol drinking, even among minors. This emphasises a need for preventive measures to reduce the harmful effects of binge drinking in youth and the impact on the healthcare system.
| S-EPMC11812728 | biostudies-literature
Project description:BackgroundEvidence shows that similar levels of alcohol consumption lead to greater harm in adults with low socioeconomic position (SEP) compared to high SEP. We investigated if SEP is associated with alcohol-related hospital contacts in adolescents, and whether differences in risk can be explained by differences in levels of alcohol consumption, drinking pattern, and substance use.MethodsThis is a prospective cohort study of 68,299 participants aged 15-19 years old from the Danish National Youth Cohort 2014. SEP was operationalised as parent educational level, family income and perceived financial strain in the family. Data were linked to national registers and participants were followed up for five years from 2014 to 2019. Outcomes were hospital contacts due to alcohol. Multilevel Poisson regression was used to estimate incidence rates (IR) and incidence rate ratios (IRR).FindingsDuring 280,010 person years of follow-up, 872 participants had an alcohol-attributable hospital contact; intoxications (n = 778, 89%) were the most common diagnosis. Low as compared to high SEP was associated with higher IRR of alcohol-attributable hospital contacts for all three SEP measures. The adjusted IRR of harm was 1.73 (95% CI: 1.29-2.33) for elementary school as the highest parent education compared to longer parent education and 1.57 (95% CI: 1.30-1.89) for family financial strain compared to those without financial strain. Adjustment for weekly alcohol intake, drinking pattern and substance use did not substantially change results. Cubic spline analysis of the association between family income and alcohol-attributable hospital contacts revealed a dose-response relationship with decreasing risk of alcohol-related harm with higher income.InterpretationOur findings suggested that alcohol-related harm is more common in socioeconomically disadvantaged adolescents despite similar levels of alcohol consumption, regardless of differences in drinking pattern or substance use. Future preventive strategies should prioritise young adolescents, including those who are most disadvantaged.FundingTryg Foundation (ID: 153539).
| S-EPMC10415833 | biostudies-literature
Project description:BackgroundDue to the lack of a national mortality inequality monitoring framework, the overall picture in Japan remains unclear. Here, we investigated educational inequalities in mortality and their cause-specific contribution in Japan.MethodData were obtained by linking the 2010 Japanese population census and death records between 1 October 2010 and 30 September 2015. We included 7 984 451 Japanese people aged 30-79 years who had a unique 'matching key' generated by sex, birth year/month, address (municipality), marital status and age of spouse (9.9% of the total census population). We computed population-weighted all-cause and cause-specific age-standardized mortality rates (ASMRs) by education level. In addition, we calculated the slope index of inequality (SII), relative index inequality (RII) by education level, and population attributable fraction (PAF) referenced with the highest education (e.g. university graduation).ResultsIndividuals with less education had higher all-cause and cause-specific ASMRs than highly educated individuals. All-cause SII (per 100 000 person-years) values were 433 (95% CI: 410-457) for men and 235 (95% CI: 217-252) for women. RII values were 1.48 (95% CI: 1.45-1.51) for men and 1.47 (95% CI: 1.43-1.51) for women. Estimated PAFs, excess premature deaths caused by educational inequalities, were 11.6% for men and 16.3% for women, respectively. Cerebrovascular diseases, ischaemic heart diseases and lung cancer were the major contributors to mortality inequalities for both sexes.ConclusionsThis first census-based comprehensive report on cause-specific educational mortality inequalities suggested that differences in unfavourable health risk factors by educational background might be associated with these inequalities in Japan.
| S-EPMC10972615 | biostudies-literature
Project description:BackgroundWhile underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark.MethodsWe identified all children diagnosed with a cancer at ages 0-15 years in 1998-2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage.ResultsWe found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease.ConclusionFamilies with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.
| S-EPMC8518314 | biostudies-literature
Project description:Adolescent pregnancy is a major health concern which has lifelong consequences. The aim of this study is to examine the regional trends and socioeconomic predictors of adolescent pregnancy in Nigeria. This study used pooled data from the 2008, 2013 and 2018 Nigeria Demographic and Health Survey (NDHS). A total of 22,761 women aged 15-19 years were selected across the three surveys. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify predictors of adolescent pregnancy in Nigeria, across the six geopolitical zones of Nigeria. Adolescent pregnancy remained constant between 2008 (22.9%; 95% CI = 22.14, 24.66), and 2013 (22.5%; 95% CI = 20.58, 24.50), but a significant decline was reported in 2018 (18.7%; 95% CI = 17.12, 20.46). Trends show a decrease in adolescent pregnancy across all six geopolitical zones, except for the South-East zone which reported a slight increase (0.6%). Multivariable analysis revealed that the main socioeconomic predictors across all six geopolitical zones were: poor households, increasing age, and low education. Exposure to media (watching television and reading newspapers) was reported as predictor in all regions except the North-East geopolitical zone, while all northern zones reported high levels of adolescent pregnancy in male-led households. To address adolescent pregnancy in Nigeria, there is need to promote girls' education especially among poor households, and for the dissemination of reproductive health messages to adolescents through various forms of mass media campaign, as well as the adoption of social marketing interventions to improve sexual and reproductive health literacy.
| S-EPMC9266692 | biostudies-literature
Project description:BackgroundThe treatment of heart failure (HF) is complex and the prognosis remains serious. A range of strategies is used across health care systems to improve the quality of care for HF patients. We present results from a nationwide multidisciplinary initiative to monitor and improve the quality of care and clinical outcome of HF patients using indicator monitoring combined with systematic auditing.MethodsWe conducted a nationwide, population-based prospective study using data from the Danish Heart Failure Registry. The registry systematically monitors and audits the use of guideline recommended processes of care at Danish hospital departments treating incident HF patients. We identified patients registered between 2003 and 2010 (n?=?24,504) and examined changes in use of recommended processes of care and 1-year mortality.ResultsThe use of the majority of the recommended processes of care increased substantially from 2003 to 2010: echocardiography (from 62.7% to 90.5%; Relative Risk (RR) 1.45 (95% CI, 1.39-1.50)), New York Heart Association classification (from 29.4% to 85.5%; RR 2.91 (95% CI, 2.69-3.14)), betablockers (from 72.6% to 88.3%; RR 1.23 (95% CI, 1.15-1.29)), physical training (from 5.6% to 22.8%; RR 4.04 (95% CI, 2.96-4.52)), and patient education (from 49.3% to 81.4%; RR 1.65 (95% CI, 1.52-1.80)). Use of ACE/ATII inhibitors remained stable (from 92.0% to 93.2%; RR 1.01 (95% CI, 0.99-1.04)). During the same period, 1-year mortality dropped from 20.5% to 12.8% (adjusted Hazard Ratio 0.79 (95% CI, 0.65-0.96).ConclusionsUse of guideline recommended processes of care has improved among patients with incident HF included in the Danish Heart Failure Registry between 2003 and 2010. During the same period, a decrease in mortality was observed.
| S-EPMC3851278 | biostudies-literature