Does educational mobility in mid-life affect mortality? A cohort study covering 1.3 million individuals in Sweden.

•Studies on how increased formal educational level in mid-life affects mortality is lacking.•We found that women who increased their educational level in mid-life had a reduced risk of mortality.•In men, mortality was reduced only for those who increased their education from a low level.

Suicide attempt predicted by academic performance and childhood IQ: a cohort study of 26 000 children.

OBJECTIVE: Academic performance in youth, measured by grade point average (GPA), predicts suicide attempt, but the mechanisms are not known. It has been suggested that general intelligence might underlie the association. METHODS: We followed 26 315 Swedish girls and boys in population-representative cohorts, up to maximum 46 years of age, for the first suicide attempt in hospital records. Associations between GPA at age 16, IQ measured in school at age 13 and suicide attempt were investigated in Cox regressions and mediation analyses. RESULTS: There was a clear graded association between lower GPA and subsequent suicide attempt. With control for potential confounders, those in the lowest GPA quartile had a near five-fold risk (HR 4.9, 95% CI 3.7-6.7) compared to those in the highest quartile. In a mediation analysis, the association between GPA and suicide attempt was robust, while the association between IQ and suicide attempt was fully mediated by GPA. CONCLUSIONS: Poor academic performance in compulsory school, at age 16, was a robust predictor of suicide attempt past young adulthood and seemed to account for the association between lower childhood IQ and suicide attempt.

Cannabis Use as Risk or Protection for Type 2 Diabetes: A Longitudinal Study of 18 000 Swedish Men and Women.

Aims. Whether or not cannabis use may increase or decrease the risk of type 2 diabetes is not clear. We analyzed the association between cannabis and subsequent type 2 diabetes and if a potential positive or reverse association persisted after controlling for potential confounders. Methods. In this population-based cohort study, 17,967 Swedish men and women (aged 18-84 years), who answered an extensive questionnaire in 2002 (including questions on cannabis use), were followed up for new cases of type 2 diabetes (n = 608) by questionnaire (in 2010) and in health registers during 2003-2011. Odds ratios (ORs) with 95% CIs were estimated in a multiple logistic regression analysis. Potential confounders included age, sex, BMI, physical inactivity, smoking, alcohol use, and occupational position. Results. The crude association showed that cannabis users had a reduced risk of type 2 diabetes OR = 0.68 (95% CIs: 0.47-0.99). However, this inverse association attenuated to OR = 0.94 (95% CIs: 0.63-1.39) after adjusting for age. Conclusions. The present study suggests that there is no association between cannabis use and subsequent type 2 diabetes after controlling for age. To make more robust conclusions prospective studies, with longer periods of follow-up and more detailed information about cannabis use, are needed.

Testing Ødegaard's selective migration hypothesis: a longitudinal cohort study of risk factors for non-affective psychotic disorders among prospective emigrants.

BACKGROUND: The selection hypothesis posits that the increased rates of psychosis observed among migrants are due to selective migration of people who are predisposed to develop the disorder. To test this hypothesis, we examined whether risk factors for psychosis are more prevalent among future emigrants. METHOD: A cohort of 49,321 Swedish military conscripts was assessed at age 18 years on cannabis use, IQ, psychiatric diagnosis, social adjustment, history of trauma and urbanicity of place of upbringing. Through data linkage we examined whether these exposures predicted emigration out of Sweden. We also calculated the emigrants' hypothetical relative risk compared with non-emigrants for developing a non-affective psychotic disorder. RESULTS: Low IQ [odds ratio (OR) 0.5, 95% confidence interval (95% CI) 0.3-0.9] and 'poor social adjustment' (OR 0.4, 95% CI 0.2-0.8) were significantly less prevalent among prospective emigrants, whereas a history of urban upbringing (OR 2.3, 95% CI 1.4-3.7) was significantly more common. Apart from a non-significant increase in cannabis use among emigrants (OR 1.6, 95% CI 0.8-3.1), there were no major group differences in any other risk factors. Compared to non-emigrants, hypothetical relative risks for developing non-affective psychotic disorder were 0.7 (95% CI 0.4-1.2) and 0.8 (95% CI 0.7-1.0), respectively, for emigrants narrowly and broadly defined. CONCLUSIONS: This study adds to an increasing body of evidence opposing the selection hypothesis.

Prognosis of schizophrenia in persons with and without a history of cannabis use.

BACKGROUND: The aim of the study was to determinate whether schizophrenia patients with a history of cannabis use have a different prognosis, with regards to readmission and hospital duration, compared with those without a history of cannabis use. METHOD: The present investigation was a cohort study of 50,087 Swedish men with data on cannabis use at the ages of 18-20 years. A total of 357 cases of schizophrenia were identified from in-patient care and followed up from 1973 to 2007. RESULTS: Schizophrenia patients with a history of cannabis use had a higher median duration of first hospital episode (59 days v. 30 days). Patients with a history of cannabis use had a higher median rate of readmission (10 times v. four times). Also, total number of hospital days was higher in patients with a history of cannabis use compared with those without (547 days v. 184 days). Patients with a history of cannabis use had an increased odds of having more than 20 hospital readmissions compared with non-users [3.1, 95% confidence interval (CI) 1.3-7.3] as well as an increased odds of hospital admission lasting more than 2 years (2.4, 95% CI 1.1-7.4) after controlling for diagnosis of personality disorders, family socio-economic position, IQ score, civil status, place of residence, risky use of alcohol and use of other drugs. Patients with a history of cannabis use were less likely to have paranoid schizophrenia compared with never users (8% v. 17%) in the first admission. CONCLUSIONS: Schizophrenia patients with a history of cannabis use had a significantly higher burden of lifetime in-patient care than non-cannabis users. Not only does cannabis increase the risk of schizophrenia, but also our findings indicate that the course and prognosis of schizophrenia may be more severe than schizophrenia cases in general.

Individual- and area-level influence on suicide risk: a multilevel longitudinal study of Swedish schoolchildren.

BACKGROUND: Characteristics related to the areas where people live have been associated with suicide risk, although these might reflect aggregation into these communities of individuals with mental health or social problems. No studies have examined whether area characteristics during childhood are associated with subsequent suicide, or whether risk associated with individual characteristics varies according to childhood neighbourhood context. METHOD: We conducted a longitudinal study of 204,323 individuals born in Sweden in 1972 and 1977 with childhood data linked to suicide (n = 314; 0.15%) up to age 26-31 years. Multilevel modelling was used to examine: (i) whether school-, municipality- or county-level characteristics during childhood are associated with later suicide, independently of individual effects, and (ii) whether associations between individual characteristics and suicide vary according to school context (reflecting both peer group and neighbourhood effects). RESULTS: Associations between suicide and most contextual measures, except for school-level gender composition, were explained by individual characteristics. There was some evidence of cross-level effects of individual- and school-level markers of ethnicity and deprivation on suicide risk, with qualitative interaction patterns. For example, having foreign-born parents increased the risk for individuals raised in areas where they were in a relative minority, but protected against suicide in areas where larger proportions of the population had foreign-born parents. CONCLUSIONS: Characteristics that define individuals as being different from most people in their local environment as they grow up may increase suicide risk. If robustly replicated, these findings have potentially important implications for understanding the aetiology of suicide and informing social policy.

Predictors of a favourable socio-economic situation in middle age for Swedish conscripts with self-reported drug use.

BACKGROUND: Risk and protective factors for adverse outcomes among drug users in the general population have been identified. This study considers whether some of these factors predict favourable socio-economic situations in middle age. METHODS: A 37-year follow-up of 49,411 Swedish male conscripts 1969/70, born 1949-1951. Based on self-reports at conscription, 36,191 living subjects in 2006 were divided into users of certain dominant drugs (n=3946) and non-users (n=32,245). Individual data from conscription and national registers were linked. Using logistic bivariate and multivariate regression, odds ratios (ORs) for the categories of dominant-drug users, compared with non-users, were computed for outcomes in 1990 and in 2006: education ≥12 years, being in work, and having a disposable income above the median. The ORs were calculated after considering familial, social and individual risk and protective factors, with separate analyses being performed for drug-use categories. RESULTS: Small changes were observed in the ORs for the outcomes in 1990 and 2006. After adjustment for protective and risk factors, users of the various dominant drugs had increased ORs with an education ≥12 years but lower or non-significantly different from non-users for the other outcomes. The ORs decreased with severity of drug use. Among drug users, high intellectual ability, having a father from highest SES group, and communication with parents were among the factors that increased the probability of favourable socio-economic outcomes, especially when several protective factors were involved. CONCLUSIONS: Protective factors increase the probability of favourable outcomes, but least among individuals with severe drug use.

Cognitive ability in early adulthood is associated with later suicide and suicide attempt: the role of risk factors over the life course.

BACKGROUND: Cognitive ability/intelligence quotient (IQ) in youth has previously been associated with subsequent completed and attempted suicide, but little is known about the mechanisms underlying the associations. This study aims to assess the roles of various risk factors over the life course in explaining the observed relationships. METHOD: The present investigation is a cohort study based on data on IQ test performance and covariates, recorded on 49 321 Swedish men conscripted in 1969-1970, at ages 18-20 years. Information on suicides and hospital admissions for suicide attempt up to the age of 57 years, childhood and adult socio-economic position, and adult family formation, was obtained from linkage to national registers. RESULTS: Lower IQ was associated with increased risks of both suicide and suicide attempt during the 36 years of follow-up. The associations followed a dose-response pattern. They were attenuated by approximately 45% in models controlling for social background, mental ill-health, aspects of personality and behavior, adult socio-economic position and family formation. Based on one-unit decreases in IQ test performance on a nine-point scale, the hazard ratios between ages 35 and 57 years were: for suicide 1.19 [95% confidence interval (CI) 1.13-1.25], fully adjusted 1.10 (95% CI 1.04-1.18); and for suicide attempt 1.25 (95% CI 1.20-1.31), fully adjusted 1.14 (95% CI 1.09-1.20). CONCLUSIONS: Cognitive ability was found to be associated with subsequent completed and attempted suicide. The associations were attenuated by 45% after controlling for risk factors measured over the life course. Psychiatric diagnosis, maladjustment and aspects of personality in young adulthood, and social circumstances in later adulthood, contributed in attenuating the associations.

Unemployment and suicide in the Stockholm population: a register-based study on 771,068 men and women.

OBJECTIVES: Several studies have reported a higher risk of suicide among the unemployed. Some individuals may be more prone to both unemployment and suicide due to an underlying health-related factor. In that case, suicide among the unemployed might be a consequence of health-related selection. This study aimed to investigate the relationship between unemployment and suicide, and the importance of previous sickness absence to this relationship. STUDY DESIGN: The study was based on 771,068 adults aged 25-58 years in Stockholm County in 1990-1991. Data on sickness absence in 1990-1991 and unemployment in 1991-1993 were collected from registers for each individual. Time and cause of death in 1994-1995 were obtained from Sweden's Cause of Death Register. METHODS: The association between sickness absence in 1990-1991 and unemployment in 1992-1993, and the association between unemployment in 1992-1993 and suicide in 1994-1995 was investigated using logistic regression. RESULTS: Unemployment lasting for >90 days in 1992-1993 was associated with suicide in men in 1994-1995 [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.38-3.38], while unemployment lasting for ≤ 90 days in 1992-1993 was associated with suicide in women in 1994-1995 (OR 2.68, 95% CI 1.23-5.85). Higher levels of sickness absence were related to an increased risk of subsequent unemployment in both sexes. The higher prevalence of sickness absence among the unemployed attenuated the association between unemployment and suicide in both men and women. CONCLUSIONS: Unemployment is related to suicide. Individuals in poor health are at increased risk of unemployment and also suicide. The higher relative risk of suicide among the unemployed seems to be, in part, a consequence of exclusion of less healthy individuals from the labour market.

Alcohol, mortality and cardiovascular events in a 35 year follow-up of a nationwide representative cohort of 50,000 Swedish conscripts up to age 55.

AIMS: To assess the association between drinking patterns and mortality, and cardiovascular disease in a large cohort of young- and middle-aged men and to assess whether the net balance of harm and protective effect implies protective effect or not. METHODS: Information from health examinations, psychological assessments and alcohol use background in a nationally representative birth cohort of 49,411 male military conscripts aged 18-20 years in 1969/1970, were linked to mortality and hospitalization data through 2004. Cox regression analyses were conducted and attributable proportions (APs) calculated. Confounders (baseline social status, intelligence, personality and smoking) were taken into account. RESULTS: Increasing alcohol use was associated with increasing mortality (2614 deceased) and with decreasing risk for myocardial infarction (MI). The hazard ratio (HR) for mortality was 1.42 [95% confidence interval (CI) 1.10-1.82] with a consumption corresponding to 30 g 100% ethanol/day or more in multivariate analysis. The risk for non-fatal MI was significantly reduced at 60 g 100% ethanol/day (HR 0.37, 95% CI 0.15-0.90), not reduced for fatal MI, and non-significantly reduced for total MI. There was a marked association between alcohol use at conscription and mortality and hospitalization with alcohol-related diagnosis. APs indicate that alcohol caused 420 deaths, 61 cases of non-fatal stroke and protected from 154 cases on non-fatal MI. CONCLUSION: Many more deaths were caused by alcohol than cases of non-fatal MI prevented. From a strict health perspective, we find no support for alcohol use in men below 55 years.

Cannabis, schizophrenia and other non-affective psychoses: 35 years of follow-up of a population-based cohort.

BACKGROUND: There is now strong evidence that cannabis use increases the risk of psychoses including schizophrenia, but the relationship between cannabis and different psychotic disorders, as well as the mechanisms, are poorly known. We aimed to assess types of psychotic outcomes after use of cannabis in adolescence and variation in risk over time. METHOD: A cohort of 50 087 military conscripts with data on cannabis use in late adolescence was followed up during 35 years with regard to in-patient care for psychotic diagnoses. RESULTS: Odds ratios for psychotic outcomes among frequent cannabis users compared with non-users were 3.7 [95% confidence interval (CI) 2.3-5.8] for schizophrenia, 2.2 (95% CI 1.0-4.7) for brief psychosis and 2.0 (95% CI 0.8-4.7) for other non-affective psychoses. Risk of schizophrenia declined over the decades in moderate users but much less so in frequent users. The presence of a brief psychosis did not increase risk of later schizophrenia more in cannabis users compared with non-users. CONCLUSIONS: Our results confirm an increased risk of schizophrenia in a long-term perspective, although the risk declined over time in moderate users.

Psychiatric diagnosis in late adolescence and long-term risk of suicide and suicide attempt.

OBJECTIVE: To investigate the associations between psychiatric diagnosis in late adolescence in an unselected population and subsequent suicide attempt and suicide during 36-year follow-up. METHOD: A total of 49,321 Swedish men conscripted for compulsory military training in 1969/1970, born 1949-1951, were screened for psychiatric disorder and, if detected, diagnosed by a psychiatrist according to ICD-8. Data on suicides and suicide attempts 1971-2006 were collected in national registers. RESULTS: At conscription examination, 11.7% of the cohort received a psychiatric diagnosis. Among those, increased risks of suicide 1971-2006 [HR = 2.7 (2.2-3.2), 624 cases] and suicide attempt 1973-2006 [HR = 3.5 (3.1-4.0), 1170 cases] were found. The increased relative risks persisted during the follow-up period 19-36 years after examination [1989-2006 suicide HR = 2.1 (1.6-2.7), 308 cases, and 1989-2006 suicide attempt HR = 2.6 (2.1-3.1), 484 cases]. The dominant diagnostic groups, neurosis and personality disorder, were significantly associated with suicide and suicide attempt in the early as well as the late follow-up period. CONCLUSION: Psychiatric diagnoses made in late adolescence predicted subsequent suicide and suicide attempt over a 36-year follow-up period. The increased relative risks were not limited to young adulthood but were also evident 18-36 years after conscription examination.

School performance and risk of suicide in early adulthood: follow-up of two national cohorts of Swedish schoolchildren.

BACKGROUND: Poor school performance and low IQ are associated with an increased risk of suicide in males; it is uncertain whether cognitive performance is a risk factor for suicide in females and whether severe mental illness influences these associations. METHOD: Record linkage study of Swedish education, population and census data with mortality and inpatient registers. Data were available for 95,497 males and 91,311 females born in 1972 and 1977 and followed up until 31 December 2005. RESULTS: 230 males and 90 females died from suicide over the follow-up period. There were strong inverse associations between school performance at age 16 and subsequent suicide risk in males (fully adjusted hazard ratio (HR) per SD increase in school performance score: 0.6 (95% CI 0.6 to 0.7; p < 0.001)) but not females: adjusted HR. 1.1 (CI 0.9 to 1.4 p = 0.50). In males there were almost four fold differences in suicide risk between children in the top and bottom fifths of the range of school grade scores. Similar associations were seen with upper secondary school performance (age 18/19 years). There was no strong evidence that deterioration in school performance between ages 16 and 18 was associated with increased suicide risk. Amongst men who developed severe psychiatric illness school performance was not associated with suicide risk. LIMITATIONS: We had limited information on the prevalence of minor psychiatric disorder in cohort members and no data on IQ for the cohort as a whole. CONCLUSIONS: Good performance in secondary (age 16) and upper secondary (age 18) school is associated with a reduced risk of suicide in men but not women. This protective effect is not seen amongst those who develop severe psychiatric illness. These differences indicate that the aetiology of suicide differs in males and females and in those with and without severe mental illness.

The Stockholm non-affective psychoses study (snaps): the importance of including out-patient data in incidence studies.

OBJECTIVE: To estimate the incidence rate of schizophrenia and non-affective psychoses from registers, to highlight the importance of including data from out-patient care, and to assess the proportion of persons treated in out-patient care only. METHOD: Data from out-patient and in-patient psychiatric care in Stockholm and information from several national registers constitute 'The Stockholm Non-Affective Psychoses Study' (SNAPS). Incidence rates based on SNAPS data were calculated and compared to in-patient care incidence rates. RESULTS: The incidence rate was 72/100 000 for non-affective psychoses (age group 18-44) and 28/100 000 for schizophrenia (age group 18-34) in the SNAPS. This was higher compared to in-patient based incidence rates (42 and 13/100 000 respectively). The proportion of individuals with psychosis treated in out-patient care only was 25%. CONCLUSION: There are substantial differences in the incidence rates of non-affective psychoses and schizophrenia depending on the availability of data. Not including out-patient care will underestimate the incidence rates.

The use of population based registers in psychiatric research.

OBJECTIVE: Much of the knowledge we now take for granted regarding major mental disorders such as schizophrenia, suicide and other disorders, would not exist without the use of population based registers. The use of population based registers in psychiatric epidemiology have enabled analyses of associations that otherwise would not have been possible to address. METHOD: The use of registers in psychiatric research is described, exemplified, and discussed. RESULTS: Methodological and validity aspects depend to a large part on the type of register being considered. A classification is proposed of different types of registers, each one implying specific methodological issues. These can be addressed according to the dimensions coverage, attrition, representativity and validity. Specific methodological consideration has still to be taken in relation to each specific research question. Thus, special validity studies usually need to be performed when embarking on studies using population based registers. CONCLUSION: With increasing burden of disease due to mental disorders worldwide, knowledge of the epidemiology of these disorders are of increasing interest. The Nordic countries have a strong history in this field of research, of great interest to the rest of the world. Universities and research funding agencies should recognize this valuable source of research capacity, and support fruitful continuation of a strong tradition.

Cognitive ability in adolescence and mortality in middle age: a prospective life course study.

BACKGROUND: An association between childhood cognitive ability measured by IQ tests and mortality has been reported recently. It is not clear from those studies to what extent the increased relative risk associated with lower IQ scores may be attenuated by adjustment for other risk factors. This study aims to investigate the association between cognitive ability measured at age 18-20 years and mortality among middle-aged men adjusting for risk factors for mortality over the life course. METHODS: Data on cognitive ability, and other risk factors for premature mortality (indicators of mental health and social adjustment and behavioural factors), were collected among 49 321 men, born in 1949-51, at conscription for compulsory military training in 1969-70. Information on socioeconomic factors in childhood and adulthood, as well as information on mortality, was collected through national registers. RESULTS: Cognitive ability showed an inverse and graded association with mortality between 40 and 53 years of age (1297 cases, crude hazard ratio (HR) 1.15, 95% CI 1.12 to 1.18, for one-point decrease on the nine-point IQ scale). Adjustment for indicators of social misbehaviour, mental health problems and behavioural risk factors, measured in late adolescence, and adult social circumstances strongly attenuated the increased risks of mortality, and it was no longer significantly increased (adjusted HR 1.02, 95% CI 0.99 to 1.06, for one-point decrease on the nine-point IQ scale). CONCLUSION: The association between IQ and mortality among men below 54 years of age was almost completely attenuated by adjustment for risk factors captured by our measures of achieved social positions.

A preliminary examination of the construct validity of the KABC-II in Ugandan children with a history of cerebral malaria.

BACKGROUND: Several diseases and adverse conditions affect the cognitive development of children in Sub-Saharan African. There is need to assess these children to determine which abilities are affected and the severity of the damage so as to plan interventions accordingly. However most psychological tests developed in the West have not been validated in this region making it impossible to know whether they measure what they were intended to in African children. OBJECTIVE: To examine the construct validity of the Kaufman Assessment Battery for Children, Second Edition (KABC-II) in Ugandan children. METHODS: Sixty five Ugandan children aged 7 to 16 years (Mean=9.90, SD=2.46) were tested using the KABC-II 44.59 months (SD=2.82) after an episode of cerebral malaria. The KABC-II scales of Sequential Processing, Simultaneous Processing, Planning and Learning were administered. In order to identify which factors result from administering the KABC-II in these children, factor analysis using principal component analysis with Varimax rotation was applied to the subtests making up the above scales. RESULTS: Five factors emerged after factor analysis comprising of subtests measuring Sequential Processing, Simultaneous Processing, Planning and Learning. The fifth scale comprised of subtests measuring immediate and delayed recall. CONCLUSION: This preliminary study in Ugandan children shows the KABC-II to have good construct validity with subtests measuring similar abilities loading on the same factor. The KABC-II can be used in assessing Ugandan children after a few modifications. Further analysis of its psychometric properties in Ugandan children is required.

Association of IQ scores and school achievement with suicide in a 40-year follow-up of a Swedish cohort.

OBJECTIVE: Few studies have investigated the association of childhood IQ and school achievement with suicide. The aim of this study was to investigate the association of childhood IQ with suicide in a cohort of Swedish women and men. METHOD: 21 809 subjects born in 1948 and 1953 who completed IQ and school tests at age 13 years have been followed until 2003. Information on paternal education and in-patient care for psychosis was linked using the Swedish personal identification number. RESULTS: There were 180 suicides amongst subjects with measured IQ. High IQ was associated with reduced suicide risk among men (OR per unit increase in age-adjusted model 0.90, 95% CI 0.83-0.99), while there was no statistical evidence of an association in women (OR 1.04, 95% CI 0.90-1.20). Among men with a history of psychosis, high IQ was associated with an increased risk of suicide. CONCLUSION: Low childhood IQ at age 13 years is associated with an increased risk of suicide in men but not in women; however, amongst those with psychosis, low IQ appears to be protective.

Risk factors for anal sphincter tears: the importance of maternal position at birth.

OBJECTIVE: To assess the role of birth position in the occurrence of anal sphincter tears (AST). DESIGN: Observational cohort study. SETTING: South Hospital in Stockholm, a teaching hospital with around 5700 births per year. POPULATION: Among all 19,151 women who gave birth at the South Hospital during the study period 2002-05, 12,782 women met the inclusion criteria of noninstrumental, vaginal deliveries. METHODS: Data on birth position and other obstetric factors were analysed in relation to occurrence of AST. MAIN OUTCOME MEASURE: Third- and fourth-degree AST. RESULTS: AST occurred in 449 women (3.5%). The trauma was more frequent in primiparous (5.8%) than in multiparous women (1.7%). The highest proportion of AST was found among women who gave birth in lithotomy position (6.9%), followed by squatting position (6.4%). Logistic regression analyses showed that lithotomy (adjusted OR 2.02, 95% CI 1.58-2.59) and squatting positions (adjusted OR 2.05, 95% CI 1.09-3.82) were associated with a significantly increased risk for AST. Other major risk factors for anal sphincter trauma were primiparity (adjusted OR 3.29, 95% CI 2.55-4.25), prolonged second stage of labour >1 hour (adjusted OR 1.52, 95% CI 1.11-2.10), infant birthweight more than 4 kg (adjusted OR 2.12, 95% CI 1.64-2.72) and large infant head circumference (adjusted OR 1.57, 95% CI 1.23-1.99). CONCLUSION: Lithotomy and squatting position at birth were associated with an increased risk for AST also after control for other risk factors.

Do women with tuberculosis have a lower likelihood of getting diagnosed? Prevalence and case detection of sputum smear positive pulmonary TB, a population-based study from Vietnam.

OBJECTIVE: The aim was to estimate the gender-specific prevalence of tuberculosis (TB) through screening. A further aim was to calculate case detection within the Vietnamese National TB program. STUDY DESIGN AND SETTING: A population-based survey of 35,832 adults was performed within an existing sociodemographic longitudinal study in Bavi district, northern Vietnam. Cases were identified by a screening question about prolonged cough and further diagnosed with sputum examination and a chest X-ray. RESULTS: The estimated prevalence of pulmonary TB among men was 90/100,000 (95% CI 45-135/100,000) and among women 110/100,000 (95% CI 63-157/100,000). Case detection in the district was estimated to 39% (95% CI 20-76%) among men and 12% (95% CI 6-26%) among women. CONCLUSION: TB prevalence was similar among men and women. Case detection among men and women was significantly lower than the reported national case detection of 80%, and there was a significant underdetection of female cases. These findings warrant actions, and emphasize the need to perform similar studies in different contexts.