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PubMed1993

Malignant melanoma of the vulva and vagina. Trends in incidence, age distribution, and long-term survival among 245 consecutive cases in Sweden 1960-1984.

BACKGROUND: Malignant melanomas of the vulva and vagina are rare tumors located in areas of the body not exposed to ultraviolet radiation. Investigations comprising large consecutive population-based series of patients with these diseases have not been published previously, to the knowledge of the authors. METHODS: Trends in incidence, age distribution, and prognosis were investigated among 219 consecutive cases of malignant melanoma of the vulva and 26 cases in the vagina, reported to the Swedish National Cancer Registry and representing virtually all primary tumors of that kind in Sweden during a 25-year period, 1960-1984. RESULTS: On average, 75% of the patients with vulvar melanoma and 73% with vaginal melanoma were older than 60 years of age. The mean age increased slightly but not significantly during the period. The age-standardized incidence of vulvar melanoma decreased from 0.27 to 0.14 per 100,000 Swedish women, or by 3% per year. The observed 5-year survival rate of patients with vulvar melanoma was 35%, and the relative survival rate was 47%. The observed and relative survival rates at 10 years were 23% and 44%, respectively. Observed and relative survival rates among patients with vaginal melanoma after 5 years were 13% and 18%, respectively. CONCLUSIONS: Accordingly, there was a decreasing incidence of vulvar and vaginal melanoma over the observed 25 years. This is in contrast to the trends in incidence for cutaneous melanomas in Sweden, which, during the same time period, increased almost 6% per year.

Adolescent↗
PubMed1994

Survival trend after invasive cervical cancer diagnosis in Sweden before and after cytologic screening. 1960-1984.

BACKGROUND: Cytologic screening can reduce mortality from cervical cancer by detection and removal of premalignant lesions. Conceivably, mortality is further reduced because more women with invasive disease are diagnosed at an earlier, curable stage. This hypothesis can be assessed in Sweden, where population-based screening programs were introduced successively over about a decade starting in 1964. METHODS: Record linkages permitted complete follow-up through 1986 of all 17,377 patients with invasive cervical cancer diagnosed in Sweden from 1960 through 1984. We analyzed relative survival rates that describe the survival of patients after elimination of the effects of causes of death other than cancer of the cervix. RESULTS: Prognosis improved substantially in patients younger than age 50 years at diagnosis; from 1960-1964 to 1980-1984, the 5-year relative survival rate increased from 69.8% to 88.8% at age 20-29 years, from 71.7% to 85.5% at age 30-39 years, and from 68.6% to 77.9% at age 40-49 years. The excess mortality was thus reduced by more than half in patients diagnosed when younger than 40 years. In contrast, only slight or no improvement was noted in those diagnosed at older ages when screening was less extensive. In all time periods, a strong association was found between older age at diagnosis and poorer prognosis. CONCLUSION: Although alternative explanations for our findings must be seriously considered, the most obvious interpretation is that cytologic screening reduces mortality from cervical cancer by earlier diagnosis of invasive disease.

Adult↗
PubMed1994

Cutaneous malignant melanoma in south Sweden 1965, 1975, and 1985. A histopathologic review.

BACKGROUND: There is an increase in the incidence of cutaneous malignant melanoma (CMM) among white people throughout the world. In Sweden, a fivefold increase has been recorded since 1960, but the mortality is rising at a much lower rate. Tumor thickness is the single most important prognostic factor for primary melanoma. This study aimed to clarify whether the thickness of the tumor in invasive CMM decreased during the period 1965-1985. METHODS: This population-based study identified 574 cases of CMM, both invasive and noninvasive, in the South Swedish Health Care Region in 1965, 1975, and 1985. Twenty-six cases were excluded because the collection or evaluation of the material was not possible. The remaining 548 cases were reviewed histopathologically, and a diagnosis of invasive CMM was rejected in 71 cases. Eventually, 467 cases of invasive melanoma remained in our study (70 in 1965, 124 in 1975, and 273 in 1985). The level of invasion, tumor thickness, regression, ulceration, presence of inflammatory cells, benign naevus cells, and the site of presentation were studied. RESULTS: The study found neither a significant decrease of tumor thickness of invasive CMM nor changes in the level of invasion or proportion of ulcerated melanoma. A significantly higher proportion of melanoma tumors containing benign naevus cells was seen throughout the years (P < 0.05). Women had significantly fewer inflammatory cells in their tumors than did men (P < 0.01). As expected, the anatomical site of presentation showed a significant sex-related difference, with more tumors on the legs of female patients and more on the trunk of male patients (P < 0.001). CONCLUSIONS: There is a divergence between the rapidly increasing incidence and the slower increase in mortality of CMM. This cannot be explained by a removal of the melanoma at a thinner thickness. Differences between the sexes according to the tumor site and the increasing rate of CMM containing benign naevus cells could implicate changes in the tumor biology. Public education in Sweden concerning ultraviolet radiation and the connection with melanoma is fairly new and might not have any influence on this time period. Additional investigation is needed to clarify this matter.

Adolescent↗
PubMed2001

Incidence of ovarian cancer among alcoholic women: a cohort study in Sweden.

Linkage of nationwide databases in Sweden allowed us to evaluate the incidence of ovarian cancer among 36,856 women diagnosed with alcoholism between 1965 and 1994. Mean duration of follow-up was 9.6 years, for a total of 317,518 person-years at risk. The expected number of cases of ovarian cancer was calculated by multiplying the number of person-years by 5-year age group and calendar year-specific incidence rates of ovarian cancer in Sweden. The effect measure was the standardized incidence ratio (SIR), with 95% confidence intervals (CIs). Our results indicate an overall deficit of cases of ovarian cancer of about 14% among women with a diagnosis of alcoholism. This deficit is particularly strong and statistically significant among alcoholic women younger than 60 years (SIR = 0.76, 95% CI 0.58-1.00). This deficit is compatible with the reported reduction of gonadotrophin levels among alcoholic women younger than 60 years and with the hypothesis invoking these gonadotrophins in the etiology of ovarian cancer.

Adult↗
PubMed2004

Working conditions and health among female and male employees at a call center in Sweden.

BACKGROUND: The call center industry is one of the most expansive labor market sectors in Sweden today. The purpose of this study was to investigate the working conditions and symptoms among employees at a call center in Sweden. METHODS: This study represents the cross-sectional baseline survey, which was part of a prospective cohort study. Fifty-seven call center workers were compared with a reference group of 1,459 professional computer users from other occupations. A questionnaire covered physical and psychosocial working conditions and symptoms during the last month. Structured observations in accordance with an ergonomic checklist were used to assess workstation design during the subject's ordinary work. RESULTS: The call center group had worked for a shorter time in their present tasks and spent longer continuous time in front of the computer than the reference group. There were deficiencies in workspace, keyboard- and input device placement. The subjects reported poor support from their immediate supervisor, low control and limited opportunities to influence their work. A higher proportion of the call center group reported musculoskeletal symptoms. CONCLUSION: The call center operators were exposed to working conditions that in other studies have indicated an increased risk of developing musculoskeletal disorders. The study also shows that young computer operators in the call center group with a short working career had a higher prevalence of neck- and upper extremity symptoms than older computer workers in other labor market sectors.

Adult↗
PubMed2006

Increased incidence of malignancies in Sweden after the Chernobyl accident--a promoting effect?

BACKGROUND: After the Chernobyl accident in 1986, as much as 5% of the released caesium-137 was deposited in Sweden due to a heavy rainfall 2 days after the event. A study of increased incidence of malignancies was initiated after the accident. METHODS: The cohort included 1,137,106 inhabitants who were 0-60 years old in 1986 and lived in 8 counties of Sweden with the highest fallout of caesium-137. With the dwelling coordinate, GIS-technique and a digital map on caesium-137, each individual was matched for the exposure. Adjustments were made for several potential confounding factors. During the follow-up 33,851 malignancies was recorded 1988-1999. RESULTS: Exposure categories were: 0-8 (reference), 9-23, 24-43, 44-66, 67-84, and > or =85 nGy/hr. The corresponding adjusted Mantel-Haenszel incidence rate ratios for total malignancies during follow-up amounted to 1.000, 0.997, 1.072, 1.114, 1.068, 1.125, respectively. The excess relative risk per 100 nGy/hr with the same adjustments and time period was 0.042 95% confidence limit 0.001;0.084. An excess for thyroid cancer or leukemia could not be ruled out. CONCLUSION: Increased incidence of total malignancies possibly related to the fallout from the Chernobyl accident is seen.

Adolescent↗
PubMed1987

Delivery outcome among women employed in the plastics industry in Sweden and Norway.

In Sweden and Norway separate case-control studies of pregnancy outcome for the period 1973-1981 among female workers in the plastics industry were carried out with similar design. Employment records were obtained from companies producing and/or processing plastics and these were matched with the national medical birth and malformation registers. Within the cohorts of pregnancies during which the mother held employment in a plastics industry (1.397 in the Swedish and 288 in the Norwegian study), cases of stillbirths or infant deaths, selected malformations, or low birthweight (less than 2,000 g) were identified. For each case two controls from the same source were individually matched with regard to date of birth, age of mother, and parity. Exposure data concerning the 44 Swedish and ten Norwegian triplets were obtained from the employers. An increased odds ratio was found for processing of polyvinylchloride (PVC) plastics (95% CI Sweden 1.0-5.1; total material 1.1-4.5). However, processing of cold plastics yielded a higher odds ratio than processing of heated plastics. No increased odds ratio was found for processing of styrene or polyurethane plastics. Since not all of the plastics industries in the two countries participated in the studies and the number of cases was small, the result must be interpreted with caution.

Abnormalities, Drug-Induced↗
PubMed2005

In vitro fertilization (IVF) in Sweden: risk for congenital malformations after different IVF methods.

BACKGROUND: The possible excess of congenital malformations in infants born after in vitro fertilization (IVF) has been much discussed in the literature, with controversial conclusions. This population based study is aimed at analyzing the presence of congenital malformations in a large group of infants born after IVF and to compare malformation risk both with that of all infants born and according to IVF method used. METHODS: Infants born after IVF during the period 1982-2001 were ascertained from all IVF clinics in Sweden. The presence of congenital malformations was identified from three national health registers: the Swedish Medical Birth Register, the Swedish Registry of Congenital Malformations, and the Swedish Hospital Discharge Register. The IVF children were compared with all children born in Sweden during the same period and recorded in the Swedish Medical Birth Register. RESULTS: Among 16,280 IVF children (30% conceived after intracytoplasmatic sperm injection [ICSI]) a 42% excess of any congenital malformation was found, explainable by parental characteristics and in some cases by the high rate of multiple births. Among these children, 8% had a congenital malformation, and 5% had a relatively severe condition. For neural tube defects, choanal atresia, and alimentary tract atresia, an additional risk increase was seen. There was no difference in malformation rate according to IVF method except for an excess of hypospadias after ICSI. CONCLUSIONS: An increased risk for congenital malformations occurs after IVF, similar for the different IVF techniques used, and mainly a consequence of parental characteristics. A few specific conditions show an extra increase in risk.

Congenital Abnormalities↗
PubMed1993

Increasing incidence of carcinoma of the gastric cardia in Sweden from 1970 to 1985.

Several American, Japanese and European centres have reported an increase in carcinoma of the gastric cardia, contrary to the general trend in the incidence of gastric cancer. The aim of this nationwide population-based study was to describe trends in the incidence of tumours of the gastric cardia in Sweden over the 16-year period from 1970 to 1985. The Swedish cancer register, which is more than 95 per cent complete, was used to identify cases. There were 1514 men and 481 women with cancer of the gastric cardia. The age-standardized rates increased in men from 1.9 per 10(5) population in 1970-1973 to 3.0 per 10(5) in 1982-1985, corresponding to a mean annual increase of 2.5 per cent (95 per cent confidence interval (c.i.) 1.6-3.4 per cent). In women, the age-standardized rates increased from 0.5 per 10(5) in 1970-1973 to 0.8 per 10(5) in 1982-1985, the mean annual increase being 0.9 per cent (95 per cent c.i. 0.0-1.8 per cent). The highest incidences were found in southern Sweden, contrary to the geographical distribution of gastric cancer in general, which shows a south-to-north gradient. The disparate epidemiological features of cancer of the cardia and gastric cancer at other sites suggest that the aetiologies may also be different. Since little is known about the aetiology of cancer of the cardia, and the incidence seems to be rising rapidly, analytical studies are urgently needed.

Adult↗
PubMed2002

Incidence of cancer among patients with knee implants in Sweden, 1980-1994.

BACKGROUND: As knee implants become more common, it is important to study their potential health risks. We investigated cancer occurrence in a nationwide population-based cohort of 30,011 patients who underwent knee replacement surgery in Sweden from 1980 to 1994. METHODS: Patients were followed from 1 year after the date of their surgery through December 31, 1995, accruing 122,616 person-years of observation. The average follow-up time was 4.3 years, with 2365 patients followed for 10 years or more. RESULTS: Overall cancer incidence was not elevated compared with the general population of Sweden (standardized incidence ratio [SIR] = 1.03; 95% confidence interval [CI] = 0.98-1.08). A reduced rate for all respiratory cancers (SIR = 0.73; 95% CI = 0.59-0.91) and for lung cancer (SIR = 0.73; 95% CI = 0.58-0.91) was found among both men and women. Elevated rates were found for prostate (SIR = 1.20; 95% CI = 1.06-1.34) and bone cancer (SIR = 6.00; 95% CI = 1.24-17.52) in men. The bone cancer excess was based on three observed cases, two of which occurred at a site unrelated to the implant and the site of the third tumor is unknown. Rates of connective tissue cancer and leukemia-lymphoma were not elevated significantly among knee implant recipients. Long-term follow-up (>or= 10 years) did not show a significant excess risk for all cancer (SIR = 1.10; 95% CI = 0.86-1.38) or for any site-specific cancer, including bone cancer, lymphoma, or leukemia. Subgroup analyses for patients with rheumatoid arthritis produced results similar to the overall results. CONCLUSIONS: This epidemiologic study of cancer risk among patients with knee implants is the largest to date. It provides evidence that the incidence of cancer among patients with knee implants is similar to that of the general population. Continued follow-up of this cohort is warranted to evaluate further potential long-term effects of these implants.

Aged↗
PubMed1976

Sources of information on drug usage in Sweden.

Based on sales statistics, prescription habits and figures, interviews, and, in certain instances, on determinations of drug plasma levels, various aspects of drug usage in Sweden are examined. The working of the drug regulatory agency in Sweden is elucidated against the background of the above sources from which drug usage information is obtained.

Adolescent↗
PubMed2002

Older criminals: a descriptive study of psychiatrically examined offenders in Sweden.

OBJECTIVE: We retrospectively examined psychiatric diagnoses of older offenders referred by court for psychiatric assessment in Sweden, and compared them with younger offenders. METHOD: In Sweden, structured court-ordered forensic psychiatric evaluations are undertaken by a forensic psychiatric team. Data on age, sex, citizenship, psychiatric diagnoses, offences, and legal insanity declarations were obtained for the years 1988-2000 (n = 7297). RESULTS: There were 210 forensic psychiatric evaluations in those aged 60 and over. 7% had a diagnosis of dementia, 32% psychotic illness, 8% depressive or anxiety disorder, 15% substance abuse or dependence, and 20% personality disorder. Older offenders were significantly less likely to be diagnosed with schizophrenia or a personality disorder, and more likely to have dementia or an affective psychosis compared to younger ones. Logistic regression analyses suggested that of the studied factors, the ones most typical of older offenders were a diagnosis of dementia and being charged with a sexual offence. CONCLUSION: There appear to be important differences in psychiatric morbidity between older offenders and younger ones who come into contact with forensic psychiatric services. This research may assist in the planning of forensic and therapeutic services for the increasing number of older adults passing through the criminal justice system.

Adult↗
PubMed2005

Increasing socio-economic inequalities in life expectancy and QALYs in Sweden 1980-1997.

The aim of this study was to estimate the change in socio-economic differences in life expectancy and in quality-adjusted life years (QALYs), for men and women at different ages, in Sweden 1980 to 1997. We used data from the Swedish Survey of Living Conditions (the ULF survey), which is linked to mortality data, to estimate the life expectancy in different socio-economic groups in 1980 and 1997 (n=100 868). Health state scores were obtained by mapping responses to selected ULF survey interview questions into the generic health-related quality of life measure EQ-5D, using the UK EQ-5D index tariff (n=34 447). For 20-year-old men the difference in life expectancy between the highest (higher non-manual) and the lowest socio-economic group (unskilled manual) was 2.11 years in 1980 and 3.79 years in 1997. The corresponding figures for 20-year-old women were 1.56 in 1980 and 2.15 in 1997. The difference in QALYs between the highest and the lowest socio-economic group increased from 5.76 QALYs in 1980 to 7.06 QALYs in 1997 for 20-year-old men, and from 4.14 QALYs in 1980 to 5.66 QALYs in 1997 for 20-year-old women. The widening socio-economic inequalities over time were more stable for men than for women. We conclude that our results suggest that the socio-economic inequality in health has increased between 1980 and 1997 in Sweden.

Adolescent↗
PubMedDate not supplied

Equity in health care; experiences from Sweden.

Mortality figures for Sweden, and for expectation of life, match and in many cases better those of other developed countries of the world. At the same time, there is no doubt that there are many inequalities existing in Sweden which such figures disguise. The ideals of achieving good health, and care on equal terms, for the whole population are fine, but the realities are some distance from their achievement. Care on equal terms must be a urgent political goal: but, the contents of that goal must be specified more clearly. Despite all the good already achieved, the article suggests some of the key areas in which political action and rethinking are now necessary.

Democracy↗
PubMedDate not supplied

New ways of financing and organizing health care in Sweden.

The health care system in Sweden has been undergoing radical change since 1991. The mainly public financed (90%) system with 26 autonomous counties spent 8.5% of its gross domestic product on health care in 1991. The main features of the 'paradigm shift' are: separation of production and financing; resource allocation to health districts in relation to the needs of the population; and introduction of public competition between health districts (purchasers) and hospitals (providers). The health district boards are responsible for the health care of the population in their district hospitals financed by their activities (e.g. through diagnosis-related groups (DRGs)) and quality aspects monitored by central authorities. A parliamentary committee (HSU 2000) is investigating how Sweden's health care system can be organized and financed in the future. Three models are analyzed: a reformed county council court model, a primary care-managed model, and a compulsory insurance model. Each model must be consistent with equity and public financing. From 1992 in the Stockholm county, five surgical specialties were paid for their activities according to DRGs for inpatient care and another system for outpatient care. The number of treated patients during 1992 increased by 8% in inpatient care, 50% in day surgery and by 15% in outpatient care. Taken together, the activities increased by 11%, which is slightly more than the expected 10% increase in productivity. (There was a 10% decrease in DRG prices from 1 January 1992.) The total costs decreased by 1% due to fewer personnel. Nothing has been reported concerning the quality of care, neither before nor after the model was introduced. From 1993, all somatic acute specialties are paid by DRGs and the equivalent outpatient classification systems. The results from 1993 will be presented in the autumn of 1994.

Cost-Benefit Analysis↗
PubMed2002

Cancer risks in first-generation immigrants to Sweden.

We used the nationwide Swedish Family-Cancer Database to analyse cancer risks in 613,000 adult immigrants to Sweden. All the immigrants had become parents in Sweden and their median age at immigration was 24 years for men and 22 years for women. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for 18 cancer sites using native Swedes as a reference. Data were also available from compatriot marriages. All cancer was decreased by 5% and 8% for immigrant men and women, respectively. However, most of the male increase was due to lung cancer for which male immigrants showed a 41% excess. Among individual cancer sites and immigrant countries, 110 comparisons were significant, 62 showing protection and 48 an increased risk. Most of the differences between the rates in immigrants and Swedes could be ascribed to the variation of cancer incidence in the indigenous populations. Some high immigrant SIRs were 5.05 (n = 6, 95% CI 1.82-11.06) for stomach cancer in Rumanian women and 2.41 (41, 1.73-3.27) for lung cancer in Dutch men. At some sites, such as testis, prostate, skin (melanoma), kidney, cervix and nervous system, the SIRs for immigrants were decreased; in some groups of immigrants SIRs were about 0.20. The highest rates for testicular cancer were noted for Danes and Chileans. Women from Yugoslavia and Turkey had an excess of thyroid tumours. All immigrant groups showed breast, endometrial and ovarian cancers at or below the Swedish level but the differences were no more than 2-fold.

Adult↗
PubMed2005

Profound changes in breast cancer incidence may reflect changes into a Westernized lifestyle: a comparative population-based study in Singapore and Sweden.

Breast cancer incidence in Sweden has always been approximately twice as high as in Singapore. In recent years, this difference is limited to postmenopausal women. The aim of this study was to explore the reasons behind these differences through the use of age-period-cohort modeling. This population-based study included all breast cancer cases reported to the Swedish and the Singapore cancer registries from 1968 to 1997, with a total of 135,581 Swedish and 10,716 Singaporean women. Poisson regression using age-period and age-cohort models was used to determine the effects of age at diagnosis, calendar period and birth cohort. Incidence rate ratios were used to summarize these effects. An age-cohort model provided the best fit to the data in both countries, indicating that changes over lifetime, rather than recent differences in medical surveillance, might account for the observed differences in these 2 populations. The changes over birth cohort were much greater among Singaporean women. The relative effect of age was very similar in the 2 countries. Analyses show that age and cohort effects may explain the differences in trends of female breast cancer incidence between Sweden and Singapore. The larger cohort effect seen in Singaporean women may be attributed to more rapid changes in reproduction and lifestyle patterns than that of Swedish women during the period studied. The incidence of breast cancer in postmenopausal women in Singapore will probably continue to rise in the coming decades to match the current Swedish rates.

Adult↗
PubMed2006

Body mass index and cancer: results from the Northern Sweden Health and Disease Cohort.

Excess weight has been associated with increased risk of cancer. The effect of body mass index (BMI, kg/m(2)) on overall cancer risk and on risk of developing several common cancer types was examined in a population-based cohort study. Height and weight measurements were available for 35,362 women and 33,424 men recruited in the Northern Sweden Health and Disease Cohort between 1985 and 2003. Among cohort members, 2,691 incident cancer cases were identified. The association of BMI with cancer risk was examined using Poisson regression. Women with BMI > 27.1 (top quartile) had a 29% higher risk of developing any malignancy compared to women with BMI of 18.5-22.2 (lowest quartile), which increased to 47% in analysis limited to nonsmokers. Analyses according to WHO cut-off points showed that obese women (BMI > or = 30) had a 36% higher risk of cancer than women with BMI in the normal range (18.5-25). Individual cancer sites most strongly related to obesity were endometrium (risk for top quartile = 3.53, 95% confidence interval 1.86-7.43), ovary (2.09, 1.13-4.13) and colon (2.05, 1.04-4.41). BMI was inversely related to breast cancer occurring before age 49 (0.58, 0.29-1.11, p(trend) < 0.04). In men, there was no association of BMI with overall cancer risk. Obese men (BMI > or = 30), however, were at increased risk of developing kidney cancer (3.63, 1.23-10.7) and, after exclusion of cases diagnosed within 1 year of recruitment, colon cancer (1.77, 1.04-2.95). Our study provides further evidence that BMI is positively associated with cancer risk. In women from northern Sweden, up to 7% of all cancers were attributable to overweight and obesity and could be avoided by keeping BMI within the recommended range.

Adult↗