Death anniversaries may trigger stress responses that negatively affect health in bereaved individuals. Little is known about such reactions after adult sibling loss. This study examined whether mortality risk increases around the anniversary of a sibling's death. Using Swedish national register data (1990-2016), we conducted a time-stratified case-crossover study including 12 789 adults who experienced sibling loss and later died. Conditional logistic regression estimated associations between mortality and death anniversaries (including pre-anniversary and post-anniversary periods), adjusting for time-invariant confounders. Analyses were stratified by the bereaved's sex and age, the sibling's sex, sibling order, and whether ≥1 parent was alive at the bereaved's death. Among women, mortality risk was lower on the anniversary date (OR, 0.44; 95% CI, 0.21-0.93), and in the period from 1 day before and up to the anniversary date for women who lost a younger or same-age sibling (OR, 0.45; 95% CI, 0.20-1.00). In contrast, men bereaved before age 50 years had a heightened risk in the period ranging from 12 days before and up to the anniversary (OR, 1.40; 95 % CI, 1.05-1.86). Overall, sibling-death anniversaries were not associated with elevated mortality, though observed sex- and age-specific patterns merits further investigation.

Background: We examined the association of peripubertal pregnancies with long-term health and developmental outcomes in adult offspring and strengthened causal inference using sibling-comparison methods.

Methods: Using linked Swedish register data from 1964 to 2018, we conducted a cohort study to estimate associations of pregnancies before age 16 years compared with pregnancies between ages 16 and 25 years, with body mass index (BMI), systolic blood pressure (SBP), cognitive function, and stress resilience among 943 444 male offspring aged 17–21 years in the Military Conscription Register. We further assessed associations with type 2 diabetes (T2D), depression, and anxiety among 2 461 510 male and female offspring aged 18–73 years using population-wide registers. Linear, multinomial, and survival models were used. Sibling fixed-effect models were used to account for unmeasured confounding shared among siblings.

Results: Offspring from pregnancies before age 16 years compared with pregnancies between ages 16 and 25 years had lower SBP (β − 1.12; 95% confidence interval [CI] − 1.97 to −0.26), poorer cognitive function (β  − 0.54; 95% CI −0.67 to −0.40), and poorer stress resilience (β −0.24; 95% CI −0.38, −0.10). There was no increased risk of being underweight or overweight compared with normal weight. There was a lower risk of anxiety (hazard ratio 0.87; 95% CI 0.80 to 0.95) and no increased risk of T2D or depression. Sibling-comparison analyses attenuated deleterious associations to null or reversed them and amplified associations with markers of better health.

Conclusion: Pregnancies before age 16 years may not be causally associated with adverse long-term health and developmental outcomes in adolescent and adult offspring. The adverse associations in conventional analyses appear attributable to shared familial characteristics.

Objective We aimed to examine the variability of chronic obstructive pulmonary disease (COPD) exacerbations and mortality, between primary healthcare centres, and their associations with comorbid diseases and body mass index, during an 8-year follow-up.

Design This was a cohort study using multilevel modelling with follow-up from 2014 to 2022. Data came from questionnaires in 2014 and 2022 and medical record reviews between 2004 and 2014. The main outcomes were exacerbations in 2022 and mortality by 2022. Exacerbations were defined as any emergency visit, and/or use of oral steroids or antibiotics due to worsening of COPD symptoms during the previous 6 months.

Setting The PRAXIS study included patients at 76 primary healthcare centres in central Sweden.

Participants Primary care patients aged ≤75 years and with a diagnosis of COPD in their medical records between 2007 and 2010 were included in 2014 (n=1163) and followed up in 2022 (n=906). There were no other exclusion criteria.

Results The 809 patients with complete data attended 70 primary care centres. Multilevel multinomial regression estimated risks of exacerbations and mortality, calculating relative risk ratios (RRRs) with 95% CIs. The intraclass correlation coefficient (ICC) quantified the proportion of variance attributed to variability between centres. The ICC was 0.024, indicating 2.4% of the variation was explained by differences between centres. Patients with a history of depression in 2014 had an increased risk of subsequent exacerbations (RRR 1.95, 95% CI 1.13 to 3.39). For mortality, there were associations with history of anxiety, RRR 3.71 (95% CI 2.06 to 6.87), or cardiovascular disease, especially chronic heart failure, RRR 2.69 (95% CI 1.36 to 5.33). Body mass index had a U-shaped association with mortality.

Conclusions The variability between centres was small and patient factors appear to be of more importance for COPD exacerbations and mortality than differences between these primary care settings. As expected, pre-existing cardiovascular disease is associated with future excess mortality risk, but, notably, anxiety may also be an important risk factor. Individualised care and management of comorbidity is thus essential among patients in primary care with COPD.

Background and Aims: Informal caregiving has increased over recent decades. Caregivers may face an increased risk of accidental falls because of care tasks or their consequences, such as fatigue. However, this association has not been investigated. Therefore, we aimed to examine whether giving personal care to someone at home increases fall risk.

Methods: Using longitudinal repeated measures for adults aged over 50 years in 17 European countries, with biennial data collection in 2004–2017 (N = 51,132), we compared periods of caregiving to non-caregiving for falls (outcome) using fixed-effects logistic models, estimating odds ratios (OR) with 95% confidence intervals (95% CI) while controlling for measured time-varying variables as well as unmeasured time-invariant confounders. To shed light on mechanisms, we tested effect modification by sociodemographic characteristics, and examined whether fatigue, sleep problems, lower concentration, and changes in behaviour mediate the association.

Results: Compared with the period of not giving care, the period of providing care was associated with higher fall risk (OR 1.19 [95% CI 1.05–1.35]). This association differed by baseline household income (below or above median). In higher-income households, there was no statistically significant difference in fall risk between the period giving and not giving care (OR 1.07 [95% CI 0.90, 1.26]). In contrast, in lower-income households, the caregiving period was associated with higher fall risk (OR 1.36 [95% CI 1.14–1.63]), which was equivalent to 29% (95% CI 12–46) increased probability of falls in caregiving periods. Fatigue, sleep problems, lower concentration, and behavioural changes jointly mediated 12% of the effect; thus, most of the effect of caregiving on falls is a direct effect.

Conclusion: There was an increased fall risk among caregivers who provide personal care at home in lower-income households. Fatigue and other consequences of caregiving mediated only small effects. Other factors, such as lack of equipment and living space, may relate to mechanisms.

Background  We aimed to examine if patients with COPD and comorbid type 2 diabetes, or COPD with comorbid depression or anxiety, had disproportionally raised excess risks of subsequent cardiovascular disease and mortality.

Methods  This general population-based cohort study used data from Swedish national registers, with follow-up during 2005–2018. Cox regression estimated risks of cardiovascular disease or mortality, producing hazard ratios (HR) with (95% confidence intervals). Interaction testing quantified disproportionally increased excess risks.

Results  Among 5,624,306 individuals, 332,549 had a COPD diagnosis. Compared with individuals who did not have COPD or type 2 diabetes, all-cause mortality risk was higher for individuals who had either COPD or type 2 diabetes, with HR 2.68 (2.66–2.69) and 1.70 (1.69–1.71), respectively. Having both conditions produced an HR of 3.72 (3.68–3.76). Among cardiovascular outcomes, the highest risks were found for chronic heart failure: COPD only, HR 2.87 (2.84–2.90); type 2 diabetes only, 1.86 (1.84–1.88); and both, 4.55 (4.46–4.64). Having both COPD and type 2 diabetes was associated with disproportionally higher excess risks than expected from the sum of the individual diseases, except for cerebrovascular disease or ischemic heart disease. For COPD and depression/anxiety, all-cause mortality risk was associated with COPD only, HR 2.74 (2.72–2.76); depression/anxiety only, 2.39 (2.38–2.40); and both 4.72 (4.68–4.75). Chronic heart failure was associated with COPD only, HR 2.74 (2.71–2.78); depression/anxiety only, 1.31 (1.30–1.32); and both, 3.45 (3.40–3.50). This disease combination was associated with disproportionally higher excess risks than expected, except for atrial fibrillation.

Conclusions  Type 2 diabetes or depression/anxiety in COPD patients were associated with disproportionally excess risks for cardiovascular disease and mortality. It is important for clinicians to be aware of these greater than expected risks, to prevent further cardiovascular morbidity and mortality.

Introduction: Despite increasing numbers of working-age cancer survivors, evidence on their future work-related circumstances is limited. This study examined their future sick leave, disability pension, and unemployment benefits compared to matched cancer-free individuals. Methods: A matched cohort study was conducted using nationwide Swedish registers. In total, 94,411 individuals aged 25 to 59 years when diagnosed with incident cancer in 2001–2012 and who returned to work after cancer were compared with their matched cancer-free individuals (N = 354,814). Follow-up started from the year before cancer diagnosis and continued up to 14 years. Generalized estimating equations were used to calculate incidence rate ratios (IRR) and odds ratios for the difference between cancer survivors and matched cancer-free individuals. Results: Compared with cancer-free individuals, cancer survivors had six times higher sick-leave days per year after cancer (IRR 6.25 [95% CI, 5.97–6.54] for men; IRR, 5.51 [5.39–5.64] for women). This higher number of sick-leave days declined over time but a two-fold difference persisted. An approximate 1.5 times higher risk of receiving disability pension remained during follow-up. The unemployment days tended to be lower for cancer survivors (IRR, 0.84 [0.75–0.94] for men; IRR, 0.91 [0.86–0.96] for women). Risk of sick leave and disability pension was higher among those with leukemia, colorectal, and breast cancer than skin and genitourinary cancers. Conclusions: Cancer survivors who returned to work experienced a high and persisting sick leave and disability pension for over a decade. Prolonged receipt of a high amount of benefits may have long-term adverse impacts on financial circumstances; more knowledge to promote the environment that encourages returning to and remaining in work is needed.

Purpose: Patients with a diagnosis of chronic obstructive pulmonary disease (COPD) often have other chronic disorders. This study aims to describe the life-course pattern of morbidity in patients with COPD.

Patients and Methods: Among all residents aged 50– 90 years in Sweden in 1997, people with a hospital COPD diagnosis were identified using Swedish national registers (1997– 2018). Each patient with COPD was matched by sex, birthyear and county of residency with up to five COPD-free controls. Other chronic disease diagnoses were identified during 1987– 2018. Conditional logistic regression calculated risk of diseases diagnosed prior to first COPD diagnosis, producing odds ratios (OR) and 95% confidence intervals (95% CI). Cox regression estimated risk of diagnoses after first COPD diagnosis, producing hazard ratios (HR) and 95% CI.

Results: Among 2,706,814 individuals, 225,159 (8.3%) had COPD. The nested case–control sample included 223,945 COPD-cases with 1,062,731 controls. Prior to first COPD diagnosis, future COPD patients had higher risks than controls for most examined conditions. Highest risks were seen for chronic heart failure (OR = 3.25, 3.20– 3.30), peripheral arterial disease (OR = 3.12, 3.06– 3.18) and lung cancer (OR = 12.73, 12.12– 13.37). Following the COPD diagnosis, individuals with COPD had higher risks of most conditions than individuals without COPD. Chronic heart failure (HR = 3.50, 3.46– 3.53), osteoporosis (HR = 3.35, 3.30– 3.42), depression (HR = 2.58, 2.53– 2.64) and lung cancer (HR = 6.04, 5.90– 6.18) predominated. The risk of vascular dementia was increased after COPD diagnosis (HR = 1.53, 1.48– 1.58) but not Alzheimer’s disease.

Conclusion: Accumulation of chronic morbidity may precede COPD. Following the diagnosis, an increased burden of cardiovascular disease and cancer is to be expected, but subsequent depression, osteoporosis, and vascular dementia should also be noted. Management strategies for patients with COPD should consider the higher-than-average risk of multimorbidity.

Background Loneliness at older ages has been associated with higher morbidity and mortality. One of the risk factors for loneliness may be age-related decline in skeletal muscle strength, which may limit the possibilities for engagement in usual social activities and maintaining relationships. We aimed to identify if decrease in grip strength is an independent determinant of subsequent change in loneliness.

Methods Prospective cohort study of participants aged 50 years or older living in private households and provided data in the English Longitudinal Study of Ageing waves 2 (2004/2005), 4 (2008/2009) and 6 (2012/2013) (n=6118). We used fixed effects linear models to estimate β coefficients and 95% confidence intervals.

Results The adjusted estimates for a 5-kilogramme decrease in grip strength and loneliness score (ranging from 3 to 9) are β 0.04 and 95% CI −0.003 to 0.08 among men and β 0.03 and 95% CI −0.02 to 0.09 among women. In age-stratified analysis, a statistically significant association was observed among men below the age of 80 years (0.04, 0.0001 to 0.08) but not among older men (0.04, –0.28 to 0.35), and among women below the age of 80 years (0.03, –0.002 to 0.09) or above (−0.02, –0.32 to 0.28).

Conclusion Muscle strength declines with age and may help explain the greater social isolation that occurs at older ages. Decline in strength was only independently associated with modestly increased loneliness among men younger than 80 years of age, indicating its limitation as a potential marker of loneliness risk.

Objective This study aims to investigate the association of ulcerative colitis (UC) with all-cause dementia and assess differences in those with and without a total colectomy.

Design, setting and participants This Swedish prospective register-based study comprised 4.8 million individuals aged at least 59 years between 1964 and 2018 with the linkage of several Swedish national registers.

Primary and secondary outcome measures Individuals with dementia were defined according to International Classification of Diseases diagnostic codes and Anatomical Therapeutic Classification codes for medication prescriptions. Fitting Cox hazards models, the risk of developing all-cause dementia in individuals with and without UC was estimated. Further, we compared the risk of all-cause dementia among those with and without a colectomy.

Results Among 4 821 488 individuals (52.6% females) followed for 84.1 million person-years between 1964 and 2018, the incidence rate of all-cause dementia was 63.90 (63.73–64.07) events per 10 000 person-years in individuals without UC, 94.80 (92.04–97.64) among those with UC, 95.01 (92.25–97.86) in those with UC but without colectomy and 63.42 (40.92–98.31) in those with UC and a colectomy. Adjusted Cox models showed an increased all-cause dementia risk in individuals with UC (HR 1.07, 95% CI 1.04 to 1.10). We found no differences between unexposed individuals and those with UC and a colectomy (HR 0.89, 95% CI 0.57 to 1.38).

Conclusion The findings are consistent with previous evidence suggesting a slightly increased dementia risk among individuals with UC. This study provided no evidence of further risk increase of dementia among those who had a colectomy.

Background: Atopic dermatitis is a chronic inflammatory skin disease and inflammation has been implicated in development of other chronic diseases, but few studies have examined the relationship with dementia.

Objectives: This study examines associations of atopic dermatitis (AD) and systemic inflammation in adolescence measured using erythrocyte sedimentation rate (ESR), as well as AD diagnosed in adulthood, with dementia risk.

Methods: We used three Swedish register-based cohorts. Cohort I (N = 795,680) comprised men, born in 1951–1968, who participated in the military conscription examinations with physician-assessed AD and ESR; Cohort II (N = 1,757,600) included men and women, born in 1951–1968; and Cohort III (N = 3,988,783) included all individuals in Sweden, born in 1930–1968. We used Cox regression, estimating hazard ratios (HR), with the follow-up from 50 years of age to dementia diagnosis, date of emigration, death, or 31 December 2018, whichever occurred first. Further, we used a sibling comparison design to adjust for unmeasured confounders shared among siblings.

Results: Cohort I: 1466 dementia events were accrued during follow-up of 7.8 years, with a crude rate of 21.6 [95% confidence interval (CI): 20.6, 22.8] per 100,000 person-years. Cohort II: 3549 dementia events were accrued during follow-up of 7.4 years, with a crude rate of 23.7 (95% CI: 22.9, 24.5) per 100,000 person-years. Cohort III: 120,303 dementia events were accrued during follow-up of 23.7 years, with a crude rate of 180.3 (95% CI: 179.3, 181.3) per 100,000 person-years. In multivariable analysis using Cohort I, there was no association between AD and dementia [HR 0.68 (95% CI 0.32, 1.43)], nor with moderate [HR 0.71 (95% CI: 0.46, 1.10)] or high [HR 1.23 (95% CI: 0.87, 1.75)] ESR. AD was not associated with dementia risk in Cohort II [HR 1.28 (0.97, 1.71)] or Cohort III [HR 1.01 (0.92, 1.11)].

Conclusions: AD was not associated with dementia risk, neither was systemic inflammation measured by ESR in adolescence.