Educational attainment and work disability in cancer survivors: Do diagnosis and comorbidity affect this association?

OBJECTIVES: To study whether educational attainment had less impact on work disability in cancer survivors than in individuals without cancer. To study whether comorbidity had a higher impact on work disability in low-educated cancer survivors than in high-educated and whether this impact differed when compared with individuals without cancer. METHODS: Linkage of population-based public health survey data and the Danish Cancer Registry formed two groups: cancer survivors (n = 3,514) and cancer-free individuals (n = 171,262). In logistic regression models, the risk of experiencing an 8-week sick leave spell and the granting of disability pension within a 3-year follow-up period was studied in three educational levels and whether these associations were modified by history of cancer and comorbidity. Odds ratios (OR) with 95% confidence intervals (CI) are reported. RESULTS: Non-stratified adjusted risk of experiencing an 8-week sick leave spell (OR: 1.41, 95% CI (1.33-1.49)) or being granted a disability pension (OR: 1.61, 95% CI (1.31-1.97)) was significantly higher in low-educated than in high-educated respondents. Cancer or comorbidity did not significantly interact with education on the risk of work disability. CONCLUSIONS: A moderate impact of low education on future work disability was found for all respondents, neither history of cancer nor comorbidity modified this association.

The effect of multiple reminders on response patterns in a Danish health survey.

BACKGROUND: Reminders are routinely applied in surveys to increase response rates and reduce the possibility of bias. This study examines the effect of multiple reminders on the response rate, non-response bias, prevalence estimates and exposure-outcome relations in a national self-administered health survey. METHODS: Data derive from the Danish National Health Survey 2010, in which 298,550 individuals (16 years of age or older) were invited to participate in a cross-sectional survey using a mixed-mode approach (paper and web questionnaires). At least two reminders were sent to non-respondents, and 177,639 individuals completed the questionnaire (59.5%). Response patterns were compared between four groups of individuals (first mailing respondents, second mailing respondents, third mailing respondents and non-respondents). RESULTS: Multiple reminders led to an increase in response rate from 36.7 to 59.5%; however, the inclusion of second and third mailing respondents did not change the overall characteristics of respondents compared with non-respondents. Furthermore, only small changes in prevalence estimates and exposure-outcome relationships were observed when including second and third mailing respondents compared with only first mailing respondents. CONCLUSIONS: Multiple reminders were an effective way to increase the response rate in a national Danish health survey. However, when differences do exist between respondents and non-respondents, the results suggest that second and third mailings are unlikely to eliminate these differences. Overall, multiple reminders seemed to have only minor effect on response patterns and study conclusions in the present study.

Lifestyle factors associated with type 2 diabetes and use of different glucose-lowering drugs: cross-sectional study.

AIMS: To examine the lifestyle profile among persons with and without Type 2 diabetes mellitus (DM) and among users of different glucose-lowering drugs. METHODS: We used questionnaire data from a Danish health survey and identified presence of Type 2 DM and use of medications through medical databases. We calculated age- and gender-standardized prevalence ratios (PRs) of lifestyle factors according to Type 2 DM and different glucose-lowering drugs. RESULTS: Of 21,637 survey participants aged 25-79 years, 680 (3%) had Type 2 DM (median age 63 years) with a median diabetes duration of 5 years. Participants with Type 2 DM had a substantially higher prevalence of obesity (36% vs. 13%, PR: 3.1, 95% confidence interval (CI): 2.8-3.6), yet more reported to eat a very healthy diet (25% vs. 21%, PR: 1.2, 95% CI: 1.0-1.4) and to exercise regularly (67% vs. 53%, PR: 1.3, 95% CI: 1.2-1.4). Also, fewer were current smokers or had high alcohol intake. When compared with metformin users, obesity was substantially less prevalent in users of sulfonylurea (PR: 0.5, 95% CI: 0.4-0-8), and insulin and analogues (PR: 0.4, 95% CI: 0.3-0.7). Tobacco smoking was more prevalent in sulfonylurea users (PR: 1.4, 95% CI: 0.9-2.1) compared with metformin users. We found no material differences in physical exercise, diet or alcohol intake according to type of glucose-lowering drug. CONCLUSIONS: Type 2 DM patients are substantially more obese than other individuals, but otherwise report to have a healthier lifestyle. Metformin use is strongly associated with obesity, whereas sulfonylurea use tends to be associated with tobacco smoking.

Energy drink consumption and the relation to socio-demographic factors and health behaviour among young adults in Denmark. A population-based study.

BACKGROUND: The objective of this study is to estimate the prevalence of energy drink consumption and examine the associations of socio-demographic factors and health behaviour with energy drink consumption among young adults in Denmark. METHODS: The study is based on a public health survey from 2010 (n = 3923). Multiple logistic regression analyses were used to analyse the association between weekly consumption of energy drink and the potential explanatory factors of interest. RESULTS: In total, 15.8 % of the young adults drink energy drinks on a weekly basis. Men have higher odds of weekly energy drink consumption than women. The study also shows that young age, being employed and having a low educational level are associated with weekly energy drink consumption. According to health behaviour, daily smoking, high amounts of alcohol consumption, alcoholic binge drinking and being overweight are associated with weekly energy drink consumption. CONCLUSION: Compared with other European countries the prevalence of energy drink consumption is relatively low in Denmark. In Denmark energy drink consumption is typically a male phenomenon and there is a clear social gradient in the prevalence of energy drink consumption where the intake is far more common among people with low levels of education than among people with higher levels of education. This study also shows that there is some kind of 'add on' effect of energy drinks, meaning that people who also use other stimulants-such as alcohol and cigarettes-are more inclined to consume energy drinks.

Lifestyle factors among proton pump inhibitor users and nonusers: a cross-sectional study in a population-based setting.

PURPOSE: Lifestyle factors may influence observed associations between proton pump inhibitor (PPI) usage and health outcomes. The aim of the study reported here was to examine characteristics and differences in lifestyle among PPI users and nonusers. METHODS: This cross-sectional study utilized data from a 2006 population-based health survey of 21,637 persons in the Central Danish Region. All persons using prescribed PPIs were identified through linkage to a population-based prescription database. Biometric measures and prevalence of smoking, excessive alcohol consumption, diet, and physical exercise were analyzed, comparing PPI users with nonusers. RESULTS: Among 10,129 (46.8%) male and 11,508 (53.2%) female survey respondents, 1,356 (13.4%) males and 1,691 (14.7%) females reported ever use of PPIs. PPI users were more obese (16.7%) than nonusers (13.1%), with an age- and sex-standardized prevalence ratio (PR) of 1.3 (95% confidence interval [CI]: 1.2-1.4). The prevalence of smokers was also higher in the PPI group (26.2% vs 22.3% [PR =1.2, 95% CI: 1.1-1.3]), as was the prevalence of ex-smokers (41.0% vs 32.0% [PR =1.2, 95% CI: 1.1-1.2]). Unhealthy diet was slightly more common among PPI users than among nonusers (15.4% vs 13.0%), with a PR of 1.2 (95% CI: 1.1-1.3). Physical exercise level and alcohol consumption were similar in the two groups. Hospital-diagnosed comorbidity was observed in 35% of PPI users (a Charlson Comorbidity Index score of 1 or more) compared with only 15% among nonusers. CONCLUSION: PPI users are more obese, smoke more, and have significantly more comorbidities than PPI nonusers. These data are important when evaluating unmeasured confounding in observational studies of PPI effects.

A registry-based follow-up study, comparing the incidence of cardiovascular disease in native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia: do social inequalities play a role?

BACKGROUND: This study compared the incidence of cardiovascular disease (CVD) and acute myocardial infarction (AMI) between native Danes and immigrants born in Turkey, Pakistan and the former Yugoslavia. Furthermore, we examined whether different indicators of socioeconomic status (SES), such as employment, income and housing conditions influenced potential differences. METHODS: In this registry-based follow-up study individuals were identified in a large database that included individuals from two major regions in Denmark, corresponding to about 60% of the Danish population. Incident cases of CVD and AMI included fatal and non-fatal events and were taken from registries. Using Cox regression models, we estimated incidence rates at 5-year follow-up. RESULTS: Immigrant men and women from Turkey and Pakistan had an increased incidence of CVD, compared with native Danish men. In the case of AMI, a similar pattern was observed; however, differences were more pronounced. Pakistanis and Turks with a shorter duration of residence had a lower incidence, compared with those of a longer residence. Generally, no notable differences were observed between former Yugoslavians and native Danes. In men, differences in CVD and AMI were reduced after adjustment for SES, in particular, among Turks regarding CVD. In women, effects were particularly reduced among Yugoslavians in the case of CVD and in Turks in the case of CVD and AMI after adjustment for SES. CONCLUSIONS: In conclusion, country of birth-related differences in the incidence of CVD and AMI were observed. At least some of the differences that we uncovered were results of a socioeconomic effect. Duration of residence also played a certain role. Future studies should collect and test different indicators of SES in studies of CVD among immigrants.

Violence, sexual abuse and health in Greenland.

The purposes of the study were to analyse the lifetime prevalence of violence and sexual abuse among the Inuit in Greenland and to study the associations between health and having been the victim of violence or sexual abuse. Associations were studied with specific attention to possible differences between women and men. Further, response rates were analysed specifically in order to understand consequences of including questions on violence and sexual abuse in the questionnaire survey. The analyses were based on material from a cross-sectional health interview survey conducted during 1993-94 with participation from a random sample of the Inuit population in Greenland (N = 1393). The prevalence of ever having been a victim of violence was 47% among women and 48% among men. Women had more often than men been sexually abused (25% and 6%) (p < 0,001) and had more often been sexually abused in childhood (8% and 3%) (p = 0.001). Having been the victim of violence or sexual abuse was significantly associated with a number of health problems: chronic disease, recent illness, poor self-rated health, and mental health problems. The associations between having been the victim of violence or sexual abuse and health was stronger for women than for men. It is possible to secure a reasonably high response rate in a general health survey that includes questions on violence and sexual abuse.