Explore the vast range of titles available.

Understanding more about the risk of cardiovascular disease in the large population-group with mild Covid-19 is essential since the preventive need might be extensive. This study examined the risk of cardiovascular disease following Covid-19, considering risk periods and prognostic factors i.e., social factors, Covid-19-vaccination and comorbidities. The study cohort included the Swedish population aged 40-75 years ( n  = 4,095,414). Covid-19 was associated with elevated hazard ratios for all outcomes; ranging from 1.22 (95% confidence interval:1.14-1.31) for acute myocardial infarction to 4.31 (95% confidence interval:4.09-4.55) for pulmonary embolism. The increased risk was most evident among hospitalised individuals, however, also individuals with mild Covid-19 had an elevated risk. Finally, our findings demonstrated increased long-term cardiovascular risk and generally stronger effects of Covid-19 in more vulnerable social groups. In this work, we demonstrate an increased risk of cardiovascular disease after Covid-19, also among mild cases, findings relevant from both a public health and healthcare perspective. Covid-19 has been linked to cardiovascular complications, but the long-term impacts, particularly for mild infections, are not well understood. Here, the authors investigate the long-term impacts of Covid-19 on cardiovascular disease using data on the whole population of Sweden aged 40-75 years.

The impact of statins on COVID-19 remains unclear. This study aims to investigate whether statin exposure assessed both in the population and in well-defined cohorts of COVID-19 patients may affect the risk and severity of COVID-19 using nationwide Swedish population-based register data. A population ≥ 40 years was selected by age/sex-stratified random sampling from the Swedish population on 1 Jan 2020. COVID-19 outcomes were identified from the SmiNet database, the National Patient Register and/or Cause-of-Death Register and linked with the National Prescribed Drug Register and sociodemographic registers. Statin exposure was defined as any statin prescriptions in the year before index date. In Cox regressions, confounding was addressed using propensity score ATT (Average Treatment effect in the Treated) weighting. Of 572,695 individuals in the overall cohort, 22.3% had prior statin treatment. After ATT weighting, protective effects were observed among statin user for hospitalization and COVID-19 death in the overall cohort and onset cohort. In the hospitalized cohort, statin use was only associated with lower risk for death (HR = 0.86, 95% CI 0.79–0.95), but not ICU admission. Statin-treated individuals appear to have lower COVID-19 mortality than nonusers, whether assessed in the general population, from COVID-19 onset or from hospitalization.

The goal of this work is to investigate the sociodemographic characteristics and health status of women with breast cancer (BC) in association with COVID-19 by menopausal status. In a Swedish register-based cross-sectional study, we compared women with BC and with or without a positive COVID-19 test, stratified by menopausal status (age ≥ 51 years). Socioeconomic characteristics and health status (represented by diagnoses registered in 5 years- and prescription dispensed in 2 years preceding Jan 2020) were considered in association with COVID-19 diagnosis. The study population included 38,523 women with BC. Median age at BC diagnosis was 45 years (IQR = 40–48) for premenopausal- and 67 (IQR = 60–73) for postmenopausal BC. A logistic regression model was used and found the significant covariate effects (adjusted odds ratios, ORs) for a positive COVID-19 test among women with premenopausal BC to be being born outside of Europe: 1.29, (1.13–1.46), being married: 1.23, (1.12–1.36), being unemployed 1.92 (1.59–2.30), having upper secondary school education 1.25 (1.01–1.54), having > 15 outpatient visits: 1.31, (1.07–1.61), and a history of being admitted to hospital 1–5 times: 1.12 (1.01–1.25). Corresponding significant covariate effects among women with postmenopausal BC were being born outside of Europe: 1.61 (1.41–1.83), being married: 1.12 (1.04–1.21), and being unemployed 1.54 (1.40–1.69). Postmenopausal women furthermore had more outpatient visits or hospital admissions before the pandemic in COVID-19 positive patients compared to patients without a COVID-19 positive test, e.g. 1.47 (1.26–1.71) for > 15 outpatient visits compared with no visit and 6.35 (3.33–12.11) for > 15 hospital admissions compared with no admission. Varied socioeconomical and clinical conditions were more frequent among patients with a positive COVID-19 test compared to patients without a positive test among women with BC in pre- or post-menopausal status. We conclude that some characteristics of women such as unemployment, country of birth or health status measured by number of prescribed drugs were more prevalent among women who developed COVID-19 compared to women without COVID-19 diagnosis and either of menopausal status of breast cancer.

ObjectivesAntihypertensives reduce the risk of myocardial infarction and stroke. Restrictions during the COVID-19 pandemic limited access to healthcare, which may have had a negative impact on drug prescribing. This study aimed to assess the effect of the COVID-19 pandemic on the initiation of antihypertensive drugs.DesignInterrupted time series study using a segmented linear regression model.SettingSwedish population assessed through linked national healthcare registers.Participants720 300 new users of antihypertensives.InterventionMarch 2020, COVID-19 pandemic onset.Main outcomes measuresThe change in the initiation of antihypertensives expressed as monthly cumulative incidence, stratified by age and sex. Data on dispensed prescriptions of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors (ACEi) and angiotensin receptor blockers were extracted from the Swedish Prescribed Drug Register, from March 2018 to November 2021. Initiation (new use) was defined as having no previous dispensations before March 2019. Monthly cumulative incidence in March 2019–November 2021 was calculated as the number of patients initiating each drug class in each month divided by the population.ResultsThe start of the pandemic was associated with an immediate drop in the initiation of any antihypertensive, but no sustained effects were observed, as the incidence continued to increase in the postinterruption period by +0.02% each month in both sexes. The immediate drop was statistically significant for ACEi in both sexes and all antihypertensive classes except diuretics in patients >65 years. А significant postintervention trend change was observed for initiation of diuretics (+0.013% overall), driven mainly by a significant increase in patients >65 years. Similar findings were also observed for diuretics in females (+0.02%) and ACEi (+0.03%) in patients >65 years.ConclusionsThe pandemic had an immediate negative short-term effect, but we found no major long-term negative influence of the COVID-19 pandemic on initiation of any type of antihypertensive drugs.

ObjectiveType 2 diabetes mellitus (T2DM) and osteoarthritis (OA) are globally prevalent chronic diseases that affect millions of individuals in ageing populations. Hip and knee replacements are well established and effective treatments in patients suffering from end-stage OA. Understanding how T2DM influences the outcomes of these surgeries is important for optimising patient care and improving surgical results. This study aimed to explore the association of T2DM with reoperation (regardless of the reason), adverse events (AEs) and mortality after primary hip and knee replacement surgery.DesignObservational study based on prospectively collected registry data analysed retrospectively.Setting and participantsData from several Swedish national quality registers and health data registers were used to create a study database. 109 938 and 80 897 primary hip and knee replacements due to OA, performed between 2008 and 2019 (hip) and 2009 and 2018 (knee), were included in the study.Outcome measuresThe risk of complications, such as reoperation, AEs and mortality, was investigated by estimating HRs using Cox regression, and OR using logistic regression, unadjusted and adjusted for confounding factors, such as patient characteristics, socioeconomic status and comorbidities, and mediators, such as surgical factors.ResultsAdjusted multivariable Cox-regression analysis showed no T2DM-associated risk of reoperation after hip or knee replacement, adjusted HR 1.10 (95% CI 0.99 to 1.23) and 1.09 (95% CI 0.96 to 1.24), respectively, while T2DM was associated with increased risk of death after hip and knee replacement, adjusted HR 1.40 (95% CI 1.34 to 1.47) and 1.38 (95% CI 1.31 to 1.45). Adjusted logistic regression analysis showed T2DM-associated increase of reoperation within 90 days (OR 1.23 (95% CI 1.05 to 1.43)) and increased mortality within 90 days (OR 1.42 (95% CI 1.01 to 1.95)) following hip replacement; however, this was not the case after knee replacement, OR 1.08 (95% CI 0.85 to 1.36) for reoperation and OR 1.29 (95% CI 0.84 to 1.94) for mortality. Several factors closely linked with T2DM, such as body-mass index and comorbidities, were identified as important when assessing risk of reoperation and mortality. Regarding AEs within 30 and 90 days, very slight but not statistically significant T2DM-associated increases were seen after either hip replacement, OR 1.01 (95% CI 0.91 to 1.11) and 1.07 (95% CI 0.98 to 1.16) or after knee replacement, OR 1.05 (95% CI 0.93 to 1.17) and 1.08 (95% CI 0.98 to 1.19).ConclusionThe observed risk of reoperation suggests that T2DM alone was not a strong justification to advise against hip or knee replacement in individuals with T2DM deemed eligible for joint replacement. The T2DM-associated increased mortality after hip and knee replacement is challenging to interpret, as T2DM itself without undergoing hip or knee replacement surgery is associated with increased mortality.

Research on how the COVID-19 pandemic, societal restrictions, and healthcare services barriers have impacted patients with hypertension is limited. This study aimed to evaluate trends in alcohol-related disorders, other alcohol-associated conditions, and deaths among patients with hypertension during the pandemic (March 2020–Feb 2022) compared to the pre-pandemic period (March 2018–Feb 2020) in Region Stockholm, Sweden. This exploratory descriptive time series analysis was conducted among adults diagnosed with hypertension between 2015 and 2018. Data were obtained from the Swedish National Patient Register (specialist care) and the Stockholm Region’s primary care database. The quarterly period prevalence of diagnoses or cumulative incidence of acute diagnoses and deaths was presented. The study included 168,963 patients with hypertension (57% females). Overall, no profound shifts in alcohol-related disorders or mortality were observed during the pandemic. However, noteworthy trends were: alcohol-related disorder diagnoses in primary care increased among females (3.2/1000 compared to 2.8–3.1/1000 pre-pandemic), while rates of alcohol dependency decreased in specialist care, particularly among males (3.5–4.1/1000 compared to 4.1–5.1/1000 pre-pandemic). Alcohol-related disorders and deaths remained higher in males than in females during both periods. Among other alcohol-associated conditions, cardiovascular disease prevalence increased in both sexes in primary care and in male patients in specialist care, whereas mental illness decreased in both sexes. This study highlights the need for continued prevention of hazardous alcohol use among patients with hypertension and monitoring of cardiovascular risk factors. Further research on hypertensive patients is needed, as the pandemic-related health impacts may not become apparent until many years later.

The role of COVID-19 vaccination on the mental health of the general population remains poorly understood. This study aims to assess the short-term change in depressive and anxiety symptoms in relation to COVID-19 vaccination among Swedish adults. A prospective study of 7,925 individuals recruited from ongoing cohort studies at the Karolinska Institutet, Stockholm, Sweden, or through social media campaigns, with monthly data collections on self-reported depressive and anxiety symptoms from December 2020 to October 2021 and COVID-19 vaccination from July to October 2021. Prevalence of depressive and anxiety symptoms (defined as a self-reported total score of [greater than or equal to]10 in PHQ-9 and GAD-7, respectively) was calculated one month before, one month after the first dose, and, if applicable, one month after the second dose. For individuals not vaccinated or choosing not to report vaccination status (unvaccinated individuals), we selected three monthly measures of PHQ-9 and GAD-7 with 2-month intervals in-between based on data availability. 5,079 (64.1%) individuals received two doses of COVID-19 vaccine, 1,977 (24.9%) received one dose, 305 (3.9%) were not vaccinated, and 564 (7.1%) chose not to report vaccination status. There was a lower prevalence of depressive and anxiety symptoms among vaccinated, compared to unvaccinated individuals, especially after the second dose. Among individuals receiving two doses of vaccine, the prevalence of depressive and anxiety symptoms was lower after both first (aRR = 0.82, 95%CI 0.76-0.88 for depression; aRR = 0.81, 95%CI 0.73-0.89 for anxiety) and second (aRR = 0.79, 95%CI 0.73-0.85 for depression; aRR = 0.73, 95%CI 0.66-0.81 for anxiety) dose, compared to before vaccination. Similar results were observed among individuals receiving only one dose (aRR = 0.76, 95%CI 0.68-0.84 for depression; aRR = 0.82, 95%CI 0.72-0.94 for anxiety), comparing after first dose to before vaccination. We observed a short-term improvement in depressive and anxiety symptoms among adults receiving COVID-19 vaccines in the current pandemic. Our findings provide new evidence to support outreach campaigns targeting hesitant groups.

Background Air pollution is a large environmental health hazard whose exposure and health effects are unequally distributed among individuals. This is, at least in part, due to gene-environment interactions, but few studies exist. Thus, the current study aimed to explore genetic susceptibility to airway inflammation from short-term air pollution exposure through mechanisms of gene-environment interaction involving the SFTPA , GST and NOS genes. Methods Five thousand seven hundred two adults were included. The outcome measure was fraction of exhaled nitric oxide (FeNO), at 50 and 270 ml/s. Exposures were ozone (O 3 ), particulate matter < 10 µm (PM 10 ), and nitrogen dioxide (NO 2 ) 3, 24, or 120-h prior to FeNO measurement. In the SFTPA , GST and NOS genes, 24 single nucleotide polymorphisms (SNPs) were analyzed for interaction effects. The data were analyzed using quantile regression in both single-and multipollutant models. Results Significant interactions between SNPs and air pollution were found for six SNPs ( p  < 0.05): rs4253527 ( SFTPA1 ) with O 3 and NO x , rs2266637 ( GSTT1 ) with NO 2 , rs4795051 ( NOS2 ) with PM 10 , NO 2 and NO x , rs4796017 ( NOS2 ) with PM 10 , rs2248814 ( NOS2 ) with PM 10 and rs7830 ( NOS3 ) with NO 2 . The marginal effects on FeNO for three of these SNPs were significant (per increase of 10 µg/m 3 ):rs4253527 ( SFTPA1 ) with O 3 (β: 0.155, 95%CI: 0.013–0.297), rs4795051 ( NOS2 ) with PM 10 (β: 0.073, 95%CI: 0.00–0.147 (single pollutant), β: 0.081, 95%CI: 0.004–0.159 (multipollutant)) and NO 2 (β: -0.084, 95%CI: -0.147; -0.020 (3 h), β: -0.188, 95%CI: -0.359; -0.018 (120 h)) and rs4796017 ( NOS2 ) with PM 10 (β: 0.396, 95%CI: 0.003–0.790). Conclusions Increased inflammatory response from air pollution exposure was observed among subjects with polymorphisms in SFTPA1, GSTT1, and NOS genes, where O 3 interacted with SFTPA1 and PM10 and NO 2 /NO x with the GSTT1 and NOS genes. This provides a basis for the further exploration of biological mechanisms as well as the identification of individuals susceptible to the effects of outdoor air pollution.

The role of COVID-19 vaccination on the mental health of the general population remains poorly understood. This study aims to assess the short-term change in depressive and anxiety symptoms in relation to COVID-19 vaccination among Swedish adults. A prospective study of 7,925 individuals recruited from ongoing cohort studies at the Karolinska Institutet, Stockholm, Sweden, or through social media campaigns, with monthly data collections on self-reported depressive and anxiety symptoms from December 2020 to October 2021 and COVID-19 vaccination from July to October 2021. Prevalence of depressive and anxiety symptoms (defined as a self-reported total score of ≥10 in PHQ-9 and GAD-7, respectively) was calculated one month before, one month after the first dose, and, if applicable, one month after the second dose. For individuals not vaccinated or choosing not to report vaccination status (unvaccinated individuals), we selected three monthly measures of PHQ-9 and GAD-7 with 2-month intervals in-between based on data availability. 5,079 (64.1%) individuals received two doses of COVID-19 vaccine, 1,977 (24.9%) received one dose, 305 (3.9%) were not vaccinated, and 564 (7.1%) chose not to report vaccination status. There was a lower prevalence of depressive and anxiety symptoms among vaccinated, compared to unvaccinated individuals, especially after the second dose. Among individuals receiving two doses of vaccine, the prevalence of depressive and anxiety symptoms was lower after both first (aRR = 0.82, 95%CI 0.76-0.88 for depression; aRR = 0.81, 95%CI 0.73-0.89 for anxiety) and second (aRR = 0.79, 95%CI 0.73-0.85 for depression; aRR = 0.73, 95%CI 0.66-0.81 for anxiety) dose, compared to before vaccination. Similar results were observed among individuals receiving only one dose (aRR = 0.76, 95%CI 0.68-0.84 for depression; aRR = 0.82, 95%CI 0.72-0.94 for anxiety), comparing after first dose to before vaccination. We observed a short-term improvement in depressive and anxiety symptoms among adults receiving COVID-19 vaccines in the current pandemic. Our findings provide new evidence to support outreach campaigns targeting hesitant groups.

IntroductionWe investigated whether living in immigrant-dominated neighbourhoods constituted a risk factor for COVID-19 infection and hospitalisation among healthcare workers (HCWs) in Sweden, and if so, whether such exposure exacerbated the risk of COVID-19 among immigrant HCWs.MethodsWe used population-based register data from HCWs aged 20–62 years (N=86 187) resident in 14 Swedish municipalities (3 of which are Sweden’s largest metropolitan cities) on 1 January 2020. Residential neighbourhoods of the HCWs were categorised into three groups: Swedish-dominated, mixed and immigrant-dominated. Multilevel mixed-effects survival regression was used for the association analyses, with control for relevant confounding variables. The results are reported as HRs, with 95% CIs.ResultsFrom 1 January 2020 to 30 September 2022, we recorded 39 746 COVID-19 infections and 860 COVID-19-related hospitalisations. Except during the first wave of the pandemic, living in immigrant-dominated (adjusted HR 0.98; 95% CI 0.94 to 1.01) or mixed (adjusted HR 1.02; 95% CI 0.99 to 1.05) neighbourhoods was not associated with COVID-19 infection, but living in these areas was associated with an increased risk of having COVID-19-related hospitalisation throughout the study period. Immigrant HCWs, regardless of their neighbourhood of residence, had approximately 2-fold higher risk of being hospitalised for COVID-19 than non-immigrant HCWs living in Swedish-dominated neighbourhoods.ConclusionsAmong HCWs in Sweden, neighbourhood immigrant density constituted a risk factor for COVID-19-related hospitalisation. However, immigrant HCWs had an elevated risk of COVID-19-related hospitalisation regardless of where they lived.