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Mariosa, D., Kamel, F., Bellocco, R., Ronnevi, L.-O., Almqvist, C., Larsson, H., . . . Fang, F. (2020). Antidiabetics, Statins, and the Risk of Amyotrophic Lateral Sclerosis. European Journal of Neurology
Open this publication in new window or tab >>Antidiabetics, Statins, and the Risk of Amyotrophic Lateral Sclerosis
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2020 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Medications that are used for treatment of metabolic disorders have been suggested to be associated with the development of amyotrophic lateral sclerosis (ALS).

METHODS: To examine the associations of antidiabetics and statins with the subsequent risk of ALS we conducted a population-based nested case-control study of 2,475 Swedish residents diagnosed with ALS during July 2006-December 2013, and 12,375 population controls (five for each ALS case). We extracted from the Swedish Prescribed Drug Register information on filled prescriptions of antidiabetics and statins for both cases and controls during the years before ALS diagnosis. Conditional logistic regression was used to calculate odds ratios (ORs) for the associations of these medications with ALS risk.

RESULTS: ALS patients were less likely to have been prescribed with antidiabetics, compared to controls (OR=0.76, 95%CI=0.65-0.90). Conversely, statins were not associated with ALS risk overall (OR=1.08, 95%CI=0.98-1.19), although a positive association was noted among women (OR=1.28, 95%CI=1.10-1.48). The latter association was mostly explained by ALS cases being more likely to have a first prescription of statins during the year before diagnosis, compared to controls (OR=2.54, 95%CI=1.84-3.49).

CONCLUSIONS: The inverse association of antidiabetics with ALS is consistent with the previously reported inverse association between type 2 diabetes and ALS risk. The increase in prescription of statins during the year before ALS diagnosis deserves attention because it might reflect an acceleration of the course of ALS due to statin use.

Place, publisher, year, edition, pages
Blackwell Publishing, 2020
Keywords
Amyotrophic lateral sclerosis, antidiabetics, diabetes, risk factors, statins
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-80311 (URN)10.1111/ene.14190 (DOI)32097525 (PubMedID)
Available from: 2020-03-03 Created: 2020-03-03 Last updated: 2020-03-03Bibliographically approved
Khemiri, L., Larsson, H., Kuja-Halkola, R., D'Onofrio, B. M., Lichtenstein, P., Jayaram-Lindström, N. & Latvala, A. (2020). Association of parental substance use disorder with offspring cognition: a population family-based study. Addiction, 115(2), 326-336
Open this publication in new window or tab >>Association of parental substance use disorder with offspring cognition: a population family-based study
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2020 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 115, no 2, p. 326-336Article in journal (Refereed) Published
Abstract [en]

AIMS: To assess whether parental substance use disorder (SUD) is associated with lower cognitive ability in offspring, and whether the association is independent of shared genetic factors.

DESIGN: A population family-based cohort study utilizing national Swedish registries. Linear regression with increased adjustment of covariates was performed in the full population. In addition, the mechanism of the association was investigated with children-of-sibling analyses using fixed-effects regression with three types of sibling parents with increasing genetic relatedness (half-siblings, full siblings and monozygotic twins).

SETTING AND PARTICIPANTS: A total of 3 004 401 people born in Sweden between 1951 and 1998.

MEASUREMENTS: The exposure variable was parental SUD, operationalized as having a parent with life-time SUD diagnosis or substance-related criminal conviction in the National Patient Register or Crime Register, respectively. Outcomes were cognitive test score at military conscription and final school grades when graduating from compulsory school. Covariates included in the analyses were sex, birth year, parental education, parental migration status and parental psychiatric comorbid diagnoses.

FINDINGS: In the full population, parental SUD was associated with decreased cognitive test stanine scores at conscription [4.56, 95% confidence interval (CI) = 4.55-4.57] and lower Z-standardized school grades (-0.43, 95% CI = -0.43 to -0.42) compared to people with no parental SUD (cognitive test: 5.17, 95% CI = 5.17-5.18; grades: 0.09, 95% CI = 0.08-0.09). There was evidence of a dose-response relationship, in that having two parents with SUD (cognitive test: 4.17, 95% CI = 4.15-4.20; grades: -0.83, 95% CI = -0.84 to -0.82) was associated with even lower cognitive ability than having one parent with SUD (cognitive test: 4.60, 95% CI = 4.59-4.60; grades: -0.38, 95% CI = -0.39 to -0.380). In the children-of-siblings analyses when accounting for genetic relatedness, these negative associations were attenuated, suggestive of shared underlying genetic factors.

CONCLUSIONS: There appear to be shared genetic factors between parental substance use disorder (SUD) and offspring cognitive function, suggesting that cognitive deficits may constitute a genetically transmitted risk factor in SUD.

Place, publisher, year, edition, pages
Blackwell Publishing, 2020
Keywords
Addiction, alcohol, cognition, cognitive ability, cognitive dysfunction, parental SUD, school performance, substance use disorder
National Category
Medical and Health Sciences Substance Abuse Psychiatry
Identifiers
urn:nbn:se:oru:diva-79528 (URN)10.1111/add.14813 (DOI)000491857300001 ()31503371 (PubMedID)2-s2.0-85074558514 (Scopus ID)
Available from: 2020-01-29 Created: 2020-01-29 Last updated: 2020-03-17Bibliographically approved
Song, H., Sieurin, J., Wirdefeldt, K., Pedersen, N. L., Almqvist, C., Larsson, H., . . . Fang, F. (2020). Association of Stress-Related Disorders With Subsequent Neurodegenerative Diseases. JAMA Neurology
Open this publication in new window or tab >>Association of Stress-Related Disorders With Subsequent Neurodegenerative Diseases
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2020 (English)In: JAMA Neurology, ISSN 2168-6149, E-ISSN 2168-6157Article in journal (Refereed) Epub ahead of print
Abstract [en]

Importance: Posttraumatic stress disorder (PTSD) has been associated with increased risk for dementia. Less is known, however, about other stress-related disorders and their associations with neurodegenerative diseases.

Objective: To examine the association between stress-related disorders and risk for neurodegenerative diseases.

Design, Setting, and Participants: This population-matched and sibling cohort study was conducted in Sweden using data from nationwide health registers, including the Swedish National Patient Register. Individuals who received their first diagnosis of stress-related disorders between January 1, 1987, and December 31, 2008, were identified. Individuals who had a history of neurodegenerative diseases, had conflicting or missing information, had no data on family links, or were aged 40 years or younger at the end of the study were excluded. Individuals with stress-related disorders were compared with the general population in a matched cohort design; they were also compared with their siblings in a sibling cohort. Follow-up commenced from the age of 40 years or 5 years after the diagnosis of stress-related disorders, whichever came later, until the first diagnosis of a neurodegenerative disease, death, emigration, or the end of follow-up (December 31, 2013), whichever occurred first. Data analyses were performed from November 2018 to April 2019.

Exposures: Diagnosis of stress-related disorders (PTSD, acute stress reaction, adjustment disorder, and other stress reactions).

Main Outcomes and Measurements: Neurodegenerative diseases were identified through the National Patient Register and classified as primary or vascular. Alzheimer disease, Parkinson disease, and amyotrophic lateral sclerosis were evaluated separately. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% CIs after controlling for multiple confounders.

Results: The population-matched cohort included 61 748 exposed individuals and 595 335 matched unexposed individuals. A total of 44 839 exposed individuals and their 78 482 unaffected full siblings were included in the sibling cohort analysis. The median (interquartile range) age at the start of follow-up was 47 (41-56) years, and 24 323 (39.4%) of the exposed individuals were male. The median (interquartile range) follow-up was 4.7 (2.1-9.8) years. Compared with unexposed individuals, individuals with a stress-related disorder were at an increased risk of neurodegenerative diseases (HR, 1.57; 95% CI, 1.43-1.73). The risk increase was greater for vascular neurodegenerative diseases (HR, 1.80; 95% CI, 1.40-2.31) than for primary neurodegenerative diseases (HR, 1.31; 95% CI, 1.15-1.48). A statistically significant association was found for Alzheimer disease (HR, 1.36; 95% CI, 1.12-1.67) but not Parkinson disease (HR, 1.20; 95% CI, 0.98-1.47) or amyotrophic lateral sclerosis (HR, 1.20; 95% CI, 0.74-1.96). Results from the sibling cohort corroborated results from the population-matched cohort.

Conclusions and Relevance: This study showed an association between stress-related disorders and an increased risk of neurodegenerative diseases. The relative strength of this association for vascular neurodegenerative diseases suggests a potential cerebrovascular pathway.

Place, publisher, year, edition, pages
American Medical Association, 2020
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-80612 (URN)10.1001/jamaneurol.2020.0117 (DOI)32150226 (PubMedID)
Available from: 2020-03-13 Created: 2020-03-13 Last updated: 2020-03-13Bibliographically approved
Nordsletten, A. E., Brander, G., Larsson, H., Lichtenstein, P., Crowley, J. J., Sullivan, P. F., . . . Mataix-Cols, D. (2020). Evaluating the Impact of Nonrandom Mating: Psychiatric Outcomes Among the Offspring of Pairs Diagnosed With Schizophrenia and Bipolar Disorder.. Biological Psychiatry, 87(3), 253-262
Open this publication in new window or tab >>Evaluating the Impact of Nonrandom Mating: Psychiatric Outcomes Among the Offspring of Pairs Diagnosed With Schizophrenia and Bipolar Disorder.
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2020 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 87, no 3, p. 253-262Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Nonrandom mating has been shown for psychiatric diagnoses, with hypothesized-but not quantified-implications for offspring liability. This national cohort study enumerated the incidence of major psychiatric disorders among the offspring of parent pairs affected with schizophrenia (SCZ) and/or bipolar disorder (BIP) (i.e., dual-affected pairs).

METHODS: Participants were all Swedish residents alive or born between 1968 and 2013 (n = 4,255,196 unique pairs and 8,343,951 offspring). Offspring with dual-affected, single-affected, and unaffected parents were followed (1973-2013) for incidence of broad psychiatric disorders. Primary outcomes included hazard ratio (HR) and cumulative incidence for SCZ and BIP in the offspring. Additional outcomes included any neuropsychiatric, anxiety, depressive, personality, or substance use disorders. Cumulative incidences of SCZ and BIP were used to inform heritability models for these disorders.

RESULTS: Hazards were highest within disorder (e.g., offspring of dual-SCZ pairs had sharply raised hazards for SCZ [HR = 55.3]); however, they were significantly raised for all diagnoses (HR range = 2.89-11.84). Incidences were significantly higher for the majority of outcomes, with 43.4% to 48.5% diagnosed with "any" disorder over follow-up. Risks were retained, with modest attenuations, for the offspring of heterotypic pairs. The estimated heritability of liability for SCZ (h2 = 0.62, 95% confidence interval = 0.55-0.70) and BIP (h2 = 0.52, 95% confidence interval = 0.46-0.58) did not differ significantly from estimates derived from single-affected parents.

CONCLUSIONS: Risks for a broad spectrum of psychiatric diagnoses are significantly raised in the offspring of dual-affected parents, in line with expectations from a polygenic model of liability to disease risk. How these risks may contribute to population maintenance of these disorders is considered.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Bipolar disorder, Liability, Mating, Offspring, Risk, Schizophrenia
National Category
Medical and Health Sciences Psychiatry
Identifiers
urn:nbn:se:oru:diva-79531 (URN)10.1016/j.biopsych.2019.06.025 (DOI)000505773200010 ()31606138 (PubMedID)2-s2.0-85073004511 (Scopus ID)
Note

AEN has received support from the Brain and Behavior Research Foundation (formerly the National Alliance for Research on Schizophrenia and Depression) Young Investigator Grant No. 25202 and National Institutes of Health Grant No. 1R21MH112963-01.

Available from: 2020-01-29 Created: 2020-01-29 Last updated: 2020-03-17Bibliographically approved
Sevilla-Cermeño, L., Isomura, K., Larsson, H., Åkerstedt, T., Vilaplana-Pérez, A., Lahera, G., . . . Fernández de la Cruz, L. (2020). Insomnia in obsessive-compulsive disorder: A Swedish population-based cohort study. Journal of Affective Disorders, 266, 413-416
Open this publication in new window or tab >>Insomnia in obsessive-compulsive disorder: A Swedish population-based cohort study
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2020 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 266, p. 413-416Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The association between specific psychiatric disorders and insomnia is well established, but the prevalence of insomnia in obsessive-compulsive disorder (OCD) is unknown. This population-based study examined the prevalence of insomnia in patients with OCD compared to unaffected individuals from the general population and to their unaffected full siblings, and evaluated the contribution of psychiatric comorbidities to this association.

METHODS: Individuals diagnosed with OCD (31,856) were identified from a cohort of 13,017,902 individuals living in Sweden anytime during 1973 and 2013. Logistic regression analyses were used to investigate the odds of insomnia in individuals with OCD, compared to the general population and their unaffected full siblings. Sensitivity analyses were performed in subgroups from which all individuals with comorbid psychiatric conditions were excluded, one at a time.

RESULTS: Individuals with OCD had almost 7-fold increased odds of receiving an insomnia diagnosis or being dispensed a drug with specific indication for insomnia, compared to unaffected individuals from the general population (42.2% vs. 11.0%, respectively; OR=6.92 [95% CI, 6.76-7.08]). Familiar factors shared with siblings and comorbid conditions did not fully explain this association, but when individuals with comorbid depression and anxiety disorders were excluded, the odds of insomnia were significantly reduced (OR=4.97 [95% CI, 4.81-5.14] and OR=4.51 [95% CI, 4.33-4.69], respectively).

LIMITATIONS: Due to the intrinsic coverage issues of the registers, results may not be generalizable to milder forms of the disorder and to individuals who do not seek help.

CONCLUSIONS: Insomnia should be systematically evaluated and managed in individuals with OCD, particularly in those with comorbid anxiety and depression.

Place, publisher, year, edition, pages
Elsevier, 2020
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-80942 (URN)10.1016/j.jad.2020.01.122 (DOI)32056907 (PubMedID)2-s2.0-85078875496 (Scopus ID)
Available from: 2020-04-01 Created: 2020-04-01 Last updated: 2020-04-01Bibliographically approved
Vilaplana-Pérez, A., Pérez-Vigil, A., Sidorchuk, A., Brander, G., Isomura, K., Hesselmark, E., . . . Fernández de la Cruz, L. (2020). Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan. Psychological Medicine
Open this publication in new window or tab >>Much more than just shyness: the impact of social anxiety disorder on educational performance across the lifespan
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2020 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Social anxiety disorder (SAD) has been linked to academic underachievement, but previous studies had methodological limitations. We investigated the association between SAD and objective indicators of educational performance, controlling for a number of covariates and unmeasured confounders shared between siblings.

METHODS: This population-based birth cohort study included 2 238 837 individuals born in Sweden between 1973 and 1997, followed-up until 2013. Within the cohort, 15 755 individuals had a recorded ICD-10 diagnosis of SAD in the Swedish National Patient Register. Logistic regression models tested the association between SAD and educational performance. We also identified 6488 families with full siblings discordant for SAD.

RESULTS: Compared to unexposed individuals, individuals diagnosed with SAD were less likely to pass all subjects in the last year of compulsory education [adjusted odds ratios (aOR) ranging from 0.19 to 0.44] and less likely to be eligible for a vocational or academic programme in upper secondary education [aOR = 0.31 (95% confidence interval [CI] 0.30-0.33) and aOR = 0.52 (95% CI 0.50-0.55), respectively], finish upper secondary education [aOR = 0.19 (95% CI 0.19-0.20)], start a university degree [aOR = 0.47 (95% CI 0.45-0.49)], obtain a university degree [aOR = 0.35 (95% CI 0.33-0.37)], and finish postgraduate education [aOR = 0.58 (95% CI 0.43-0.80)]. Results were attenuated but remained statistically significant in adjusted sibling comparison models. When psychiatric comorbidities were taken into account, the results were largely unchanged.

CONCLUSIONS: Treatment-seeking individuals with SAD have substantially impaired academic performance throughout the formative years. Early detection and intervention are warranted to minimise the long-term socioeconomic impact of the disorder.

Place, publisher, year, edition, pages
Cambridge University Press, 2020
Keywords
Educational attainment, epidemiology, social anxiety disorder
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-78970 (URN)10.1017/S0033291719003908 (DOI)31907098 (PubMedID)
Available from: 2020-01-14 Created: 2020-01-14 Last updated: 2020-01-14Bibliographically approved
Andersson, A., Tuvblad, C., Chen, Q., Du Rietz, E., Cortese, S., Kuja-Halkola, R. & Larsson, H. (2020). Research Review: The strength of the genetic overlap between ADHD and other psychiatric symptoms - a systematic review and meta-analysis. Journal of Child Psychology and Psychiatry and Allied Disciplines
Open this publication in new window or tab >>Research Review: The strength of the genetic overlap between ADHD and other psychiatric symptoms - a systematic review and meta-analysis
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2020 (English)In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with other psychiatric disorders. Twin studies have established that these co-occurrences are in part due to shared genetic risks. However, the strength of these genetic overlaps and the potential heterogeneity accounted for by type of psychiatric symptoms, age, and methods of assessment remain unclear. We conducted a systematic review to fill this gap.

METHODS: ) were used as effect size measures.

RESULTS:  = .50 (0.33-0.65).

CONCLUSIONS: These findings indicate that the co-occurrence of externalizing, internalizing, and neurodevelopmental disorder symptoms in individuals with ADHD symptoms in part is due to a shared genetic risk.

Place, publisher, year, edition, pages
Blackwell Publishing, 2020
Keywords
ADHD, externalizing, genetic, internalizing, neurodevelopmental, overlap, twins
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-80610 (URN)10.1111/jcpp.13233 (DOI)32157695 (PubMedID)
Available from: 2020-03-13 Created: 2020-03-13 Last updated: 2020-03-13Bibliographically approved
Sariaslan, A., Arseneault, L., Larsson, H., Lichtenstein, P. & Fazel, S. (2020). Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden. JAMA psychiatry
Open this publication in new window or tab >>Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden
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2020 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Importance: Key outcomes for persons with psychiatric disorders include subjection to violence and perpetration of violence. The occurrence of these outcomes and their associations with psychiatric disorders need to be clarified.

Objective: To estimate the associations of a wide range of psychiatric disorders with the risks of subjection to violence and perpetration of violence.

Design, Setting, and Participants: A total of 250 419 individuals born between January 1, 1973, and December 31, 1993, were identified to have psychiatric disorders using Swedish nationwide registers. Premorbid subjection to violence was measured since birth. The patients were matched by age and sex to individuals in the general population (n = 2 504 190) and to their full biological siblings without psychiatric disorders (n = 194 788). The start date for the patients and control groups was defined as the discharge date of the first psychiatric episode. The participants were censored either when they migrated, died, experienced the outcome of interest, or reached the end of the study period on December 31, 2013. Data were analyzed from January 15 to September 14, 2019.

Exposures: Patients with common psychiatric disorders (eg, schizophrenia, bipolar disorder, depression, and anxiety) were differentiated using a hierarchical approach. Patients with personality disorders and substance use disorders were also included.

Main Outcomes and Measures: Subjection to violence was defined as an outpatient visit (excluding a primary care visit), inpatient episode, or death associated with any diagnosis of an injury that was purposefully inflicted by other persons. Perpetration of violence was defined as a violent crime conviction. Stratified Cox regression models were fitted to account for the time at risk, a range of sociodemographic factors, a history of violence, and unmeasured familial confounders (via sibling comparisons).

Results: Among 250 419 patients (55.4% women), the median (interquartile range) age at first diagnosis ranged from 20.0 (17.4-24.0) years for alcohol use disorder to 23.7 (19.9-28.8) years for anxiety disorder. Compared with 2 504 190 matched individuals without psychiatric disorders from the general population, patients with psychiatric disorders were more likely to be subjected to violence (7.1 [95% CI, 6.9-7.2] vs 7.5 [95% CI, 7.4-7.6] per 1000 person-years) and to perpetrate violence (1.0 [95% CI, 0.9-1.0] vs 0.7 [95% CI, 0.7-0.7] per 1000 person-years). In the fully adjusted models, patients with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence (adjusted hazard ratio [aHR], 3.4 [95% CI, 3.2-3.6]) or to perpetrate violence (aHR, 4.2 [95% CI, 3.9-4.4]). Diagnosis with any of the specific disorders was associated with higher rates of violent outcomes, with the sole exception of schizophrenia, which was not associated with the risk of subjection to violence.

Conclusions and Relevance: In this study, persons with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to have been subjected to violence or to have perpetrated violence after the onset of their conditions. The risks of both outcomes varied by specific psychiatric diagnosis, history of violence, and familial risks. Clinical interventions may benefit from targeted approaches for the assessment and management of risk of violence in people with psychiatric disorders.

Place, publisher, year, edition, pages
American Medical Association, 2020
National Category
Medical and Health Sciences Psychiatry
Identifiers
urn:nbn:se:oru:diva-79548 (URN)10.1001/jamapsychiatry.2019.4275 (DOI)31940015 (PubMedID)2-s2.0-85078292498 (Scopus ID)
Funder
Swedish Research Council, 2016-01989Swedish Research Council, 2018-02599
Note

The study was supported by grant 202836/Z/16/Z from the Wellcome Trust and grants 2016-01989 and 2018-02599 from the Swedish Research Council.

Available from: 2020-01-29 Created: 2020-01-29 Last updated: 2020-02-03Bibliographically approved
Lundholm, C., Gunnerbeck, A., D'Onofrio, B. M., Larsson, H., Pershagen, G. & Almqvist, C. (2020). Smoking and snuff use in pregnancy and the risk of asthma and wheeze in pre-school children: a population-based register study. Clinical and Experimental Allergy
Open this publication in new window or tab >>Smoking and snuff use in pregnancy and the risk of asthma and wheeze in pre-school children: a population-based register study
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2020 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Associations between tobacco smoking during pregnancy and offspring asthma have been observed, but the role of nicotine and familial factors remains unclear.

OBJECTIVE: To estimate the association between tobacco use in pregnancy, both smoking and Swedish oral moist snuff, and asthma/wheeze in the offspring, how it varies by the child's age and explore the influence of measured and unmeasured familial confounding.

METHODS: Register-based cohort study with sibling comparisons. The cohort included 788 508 children, born in Sweden 2005-2012 with information on maternal tobacco use in pregnancy, followed until December 2015. Asthma was based on a validated algorithm using asthma diagnoses from hospital visits and prescribed asthma drugs from nationwide registers, both as incident asthma/wheeze in age 0-8 years and current asthma at ages 2, 3, 4, 5 and 6 years.

RESULTS: For smoking during pregnancy (SDP), we saw a pattern with higher hazard ratios for asthma/wheeze around ages 5 and 18 months. Snuff did not show the same pattern. For current asthma, we saw the strongest association at age 2 years (adjOR=1.22, 95% CI: 1.17-1.28), for snuff it was weaker (adjOR=1.06, 95% CI: 0.96-1.18). When using sibling controls the estimates for SDP were clearly attenuated, albeit with wide confidence intervals.

CONCLUSION AND CLINICAL RELEVANCE: We saw an association between SDP and asthma at early age. The association with snuff was clearly weaker. The associations with SDP were attenuated when adjusting for measured and unmeasured familial factors shared by siblings. Based on those results, nicotine seems to have a limited role in the association between SDP and asthma; rather environmental tobacco smoke and other familial factors seems to explain observed associations.

Place, publisher, year, edition, pages
Blackwell Science Ltd., 2020
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-80613 (URN)10.1111/cea.13593 (DOI)32149429 (PubMedID)
Available from: 2020-03-13 Created: 2020-03-13 Last updated: 2020-03-13Bibliographically approved
Du Rietz, E., Jangmo, A., Kuja-Halkola, R., Chang, Z., D'Onofrio, B. M., Ahnemark, E., . . . Larsson, H. (2020). Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register-based study. Journal of Child Psychology and Psychiatry and Allied Disciplines
Open this publication in new window or tab >>Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register-based study
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2020 (English)In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: A better understanding of the trajectories and economic burden of psychiatric and somatic disorders (multimorbidity) in ADHD from childhood to adulthood is important for guiding more targeted areas for treatment of ADHD and prevention of multimorbidity, and for forecasting demands on the medical infrastructure. This study aimed to investigate patterns of healthcare utilization and costs of multimorbidity across young adulthood in individuals with a childhood ADHD diagnosis, and additionally in individuals who continue to have ADHD-related contact with health services (persisters) and those who do not (remitters).

Methods: We prospectively followed a cohort (N = 445,790) born 1987-1990 from the ages of 18 to 26 years. Data on healthcare utilization were obtained from the Swedish National Patient Register (inpatient and outpatient care) and the Prescribed Drug Register (medication prescriptions).

Results: Mean annual costs per capita from multimorbidity was euro890 ($1,223) in individuals with a childhood ADHD diagnosis (persisters/remitters: euro1,060[$1,456]/euro609[$837]) and euro304 ($418) in individuals without. Costs were largely driven by inpatient hospital admissions, mainly from drug abuse and injuries. Healthcare utilization and costs of psychiatric and somatic disorders at 18 years was significantly higher in individuals with childhood ADHD compared to those without. These group differences remained stable or increased across young adulthood for most outcomes and were generally larger in women than in men. ADHD remitters continued to show significantly greater healthcare utilization and costs compared to individuals without childhood ADHD, although their profiles were not as severe as ADHD persisters.

Conclusions: Childhood ADHD has long-term associations with both psychiatric and somatic disorders. Findings demonstrate the individual and societal burden of ADHD in adulthood and highlight the importance of continued support from childhood-adolescent to adult health services and early prevention of multimorbidity. Findings also point to specific targets for intervention that may be effective, such as drug abuse and injuries.

Place, publisher, year, edition, pages
Blackwell Publishing, 2020
Keywords
ADHD, comorbidity, healthcare, epidemiology, cost
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-80651 (URN)10.1111/jcpp.13206 (DOI)000517103100001 ()32115717 (PubMedID)
Funder
Swedish Research Council, 2018-02599The Swedish Brain Foundation, FO2018-0273Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01172
Note

Funding Agency:

Shire International GmbH, a member of Takeda group of companies, Zug, Switzerland

Available from: 2020-03-16 Created: 2020-03-16 Last updated: 2020-03-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6851-3297

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