Carl Michael Baravelli

Background: Alcohol consumption is a risk factor to several non-communicable diseases, posing a threat to vulnerable populations. This study aims to analyse the association between alcohol consumption patterns and educational attainment across Europe. Methods: a cross-sectional study was conducted using pooled data from the European Social Survey 2023–2024 Round 11, which included individual data from 33,987 respondents aged between 25 and 74 years from 27 European countries. Alcohol consumption was assessed using self-reported frequency and quantity of consumption, using standardised questions to assess consumption patterns and alcohol quantities. Our main outcome was frequency of alcohol consumption. A mixed ordinal logistic regression model assessed associations between sex, age, educational attainment, and alcohol consumption. Results: The highest percentages of frequent drinkers were found in Western Europe (28.0%) and the lowest in Eastern Europe (14.5%), whereas moderate drinking was most common in Northern Europe (52.5%) and lowest in Eastern Europe (28.9%). The regression model indicated that female gender was positively associated with alcohol consumption (adjOR = 2.05, p < 0.001). Primary education was found to be a risk factor compared to tertiary education (adjOR = 1.31, p = 0.022). Early adulthood age groups (25–34 and 35–44) presented a positive association compared to the 65–74 group (adjOR = 1.44, p = 0.003 and adjOR = 1.33, p = 0.001, respectively). Conclusions: Being female and having lower educational attainment were associated with increased alcohol consumption. The differences in consumption patterns may, in part, reflect the heterogeneity of alcohol policy frameworks across European countries, including variations in taxation, availability restrictions, marketing regulations, and enforcement strategies. Together, these findings highlight that age-specific drinking patterns reflect a combination of socialisation, cultural normalisation, and health-related transitions across the life course.

Background and Aims: Acute intermittent porphyria (AIP) is a rare disorder with diverse clinical presentations, ranging from latent at‐risk individuals to recurrent acute attacks with severe complications. Differences between clinical states and risk factors for severe outcomes remain incompletely defined. Approach and Results: In this cross‐sectional study, personal, biochemical and clinical data were recorded for non‐givosiran treated AIP patients across all clinical states by European porphyria expert centres into the European Porphyria Registry during 2012–2018. Logistic regression models assessed associations between clinical factors and outcomes, with disease states defined according to clinical practice at study initiation. Urinary δ‐aminolevulinic acid (u‐ALA) and porphobilinogen (u‐PBG) were normalized to each centre's upper reference limits. Data from 239 participants were included and patients were classified as sporadic attack(s) ( n = 61), recurrent ( n = 49), in‐remission ( n = 58), asymptomatic high excreters ( n = 23) and latent at‐risk ( n = 48). Hospitalization for an acute attack was associated with ≥ 10‐fold u‐PBG increase (adjusted Odds Ratios [aOR] = 22.40, 95% CI = 5.34–94.03), 4–9‐fold (6.35 [2.87–14.02]) and ≥ 10‐fold (177.50 [8.03–3923]) u‐ALA increase, BMI < 18.5 (12.68 [2.86–56.23]) and age 20–39 (4.35 [1.82–10.42]). A 10‐fold u‐PBG increase (8.22 [2.31–29.28]) and a positive family history at diagnosis (0.30 [0.14–0.64]) were associated with recurrent classification. Recurrent AIP (7.28 [2.77–19.14]) and sporadic heme‐treated acute attacks (5.30 [1.89–14.91]) were associated with reduced work capacity and unemployment. Chronic hypertension, chronic kidney disease and primary liver cancer were observed across all clinical groups. Conclusions: In this multicentre European study, we describe disease burden across all clinical AIP states including non‐givosiran treated recurrent patients and identify risk factors associated with hospitalization and recurrent disease.

Reducing social inequalities in health is a priority in European policy and the UN’s Sustainable Development Goals. We aim to estimate the magnitude of health inequalities in Norway, a high-income country with a universal health care system but rising income inequality. Using survey and registry data, we estimated relative and absolute inequality in self-reported health, health behaviours and mortality by education and income, using the Relative and Slope Index of Inequality (RII/SII). Social disparities in health were evident across nearly all outcomes, for both income and education and for both sexes. Significant RIIs were found for self-reported health, long-standing health problems, global activity limitations, dental health and the behavioural risk factors of smoking, obesity, physical inactivity, low fruit (women only) and vegetable intake, and various causes of deaths. Inequality by income were particularly pronounced for mortality among men, with the RII for men’s all-cause mortality reaching 6.2 (CI 5.9–6.5) for income, compared to 3.6 (3.5–3.8) for education. SIIs were also significant for all outcomes, except for fruit intake for education among men. Thus, despite its extensive welfare system, income- and education-related health inequalities persist in Norway, highlighting the need for targeted policy interventions. Proportionate universalism may be a valuable strategy to address these disparities within European efforts to improve public health.

Environmental noise is the second largest environmental risk factor in disease burden estimates for Europe. While socioeconomic inequalities in noise exposure have been reported, the impact of socioeconomic status (SES) on the disease burden attributable to noise exposure has to our knowledge not been reported previously. The aim of this study is to assess the impact of SES on traffic noise exposure and the associated disease burden in selected Nordic populations. We employed nationwide data on road traffic noise exposure and SES from Danish and Norwegian Nationwide Models. The impact of household income and education on traffic noise exposure was assessed using linear regression analyses. Burden of disease estimates were calculated for populations stratified according to their level of income and education in terms of Disability-Adjusted Life Years (DALY) for high degree of noise annoyance, high degree of sleep disturbance and ischaemic heart disease. The most consistent finding observed for the Danish population was that, compared to medium and low household income, high household income was associated with lower noise exposure. Moreover, the burden of disease estimates for high noise annoyance were up to 20% lower in the high compared to the lower household income groups.

Objective To assess the impact of COVID-19 on pregnancy-related healthcare utilisation and differences across social groups. Design Nationwide longitudinal prospective registry-based study. Setting Norway. Participants Female residents aged 15–50 years (n=1 244 560). Main outcome measures Pregnancy-related inpatient, outpatient and primary care healthcare utilisation before the COVID-19 pandemic (prepandemic: 1 January to 11 March 2020), during the initial lockdown (first wave: 12 March to 3 April 2020), during the summer months of low restrictions (summer period: 4 April to 31 August 2020) and during the second wave to the end of the year (second wave: 1 September to 31 December 2020). Rates were compared with the same time periods in 2019. Results There were 130 924 inpatient specialist care admissions, 266 015 outpatient specialist care consultations and 2 309 047 primary care consultations with pregnancy-related diagnostic codes during 2019 and 2020. After adjusting for time trends and cofactors, inpatient admissions were reduced by 9% (adjusted incidence rate ratio (aIRR)=0.91, 95% CI 0.87 to 0.95), outpatient consultations by 17% (aIRR=0.83, 95% CI 0.71 to 0.86) and primary care consultations by 10% (aIRR=0.90, 95% CI 0.89 to 0.91) during the first wave. Inpatient care remained 3%–4% below prepandemic levels throughout 2020. Reductions according to education, income and immigrant background were also observed. Notably, women born in Asia, Africa or Latin America had a greater reduction in inpatient (aIRR=0.87, 95% CI 0.77 to 0.97) and outpatient (aIRR 0.90, 95% CI 0.86 to 0.95) care during the first wave, compared with Norwegian-born women. We also observed that women with low education had a greater reduction in inpatient care during summer period (aIRR=0.88, 95% CI 0.83 to 0.92), compared with women with high educational attainment. Conclusion Following the introduction of COVID-19 mitigation measures in Norway in March 2020, there were substantial reductions in pregnancy-related healthcare utilisation, especially during the initial lockdown and among women with an immigrant background.

Background: Porphyria cutanea tarda (PCT) is a skin disorder caused by a defect in the liver enzyme uroporphyrinogen decarboxylase and is associated with hepatitis C virus infection, high alcohol intake, smoking and iron overload. Data on the long-term morbidity of PCT is lacking.Methods: We conducted a nationwide matched cohort study over a 24-year period. The study sample included 534 persons aged 18–67 years with a biochemically confirmed PCT diagnosis and a sample of 21,360 persons randomly selected from the working age population, matched on age, sex and educational attainment. We investigated if persons with sporadic and familial PCT had an increased risk of long-term sick leave (LTSL) or disability pension. We further assessed risk before (pre-PCT), during (during-PCT) and after (post-PCT) the typical period of first onset to diagnosis, treatment and remission.Results: Overall, persons with PCT had a 40% increased risk (hazard ratio [HR] = 1.4, 95% confidence interval [CI] = 1.3, 1.5) of LTSL and a 50% increased risk (HR = 1.5, CI = 1.3, 1.7) of disability pension. Risk of disability pension was increased pre-PCT (HR = 1.3, CI 1.3 (1.0, 1.6), during-PCT (HR 1.5, CI 1.0, 2.2) and post-PCT (HR = 2.0, CI 1.5, 2.6). For LTSL, risk was increased pre-PCT (HR = 1.3, CI 1.1, 1.4) and during-PCT (HR = 1.5, CI 1.1, 2.1), but not post-PCT. Risk was greatest in persons with sporadic than familial PCT. Diagnostic reasons for disability pension that were increased compared to matched controls were PCT or skin disease in 11 of 199 cases (PCT: n = 7, incident rate ratios [IRR] = 49.2, CI = 38.8, 62.4; diseases of the skin and subcutaneous tissue, n = 4, IRR = 4.2, CI = 1.6, 11.0). The vast majority of diagnostic reasons for accessing disability pension were related to comorbidities, PCT susceptibility factors and more general health issues such as: malignant neoplasms (n = 12, IRR = 2.4, CI = 1.4, 4.2), substance and alcohol dependence (n = 7, IRR = 5.0, CI = 2.5, 10.1), neurotic and mood—disorders (n = 21, IRR = 1.7, CI = 1.1, 2.6), and diseases of the musculoskeletal system and connective tissue (n = 71, IRR = 2.5, CI = 1.9, 3.2).Conclusions: Persons with PCT have an increased risk of LTSL and disability pension indicating significant morbidity in this patient group. Appropriate long-term follow-up and monitoring for relapses and co-morbid diseases are recommended.

Background: Porphyria cutanea tarda (PCT) is a skin disorder caused by a defect in the liver enzyme uroporphyrinogen decarboxylase and is associated with hepatitis C virus infection, high alcohol intake, smoking and iron overload. Data on the long-term morbidity of PCT is lacking. Methods: We conducted a nationwide matched cohort study over a 24-year period. The study sample included 534 persons aged 18-67 years with a biochemically confirmed PCT diagnosis and a sample of 21,360 persons randomly selected from the working age population, matched on age, sex and educational attainment. We investigated if persons with sporadic and familial PCT had an increased risk of long-term sick leave (LTSL) or disability pension. We further assessed risk before (pre-PCT), during (during-PCT) and after (post-PCT) the typical period of first onset to diagnosis, treatment and remission. Results: Overall, persons with PCT had a 40% increased risk (hazard ratio [HR]=1.4, 95% confidence interval [CI]=1.3, 1.5) of LTSL and a 50% increased risk (HR=1.5, CI=1.3, 1.7) of disability pension. Risk of disability pension was increased pre-PCT (HR=1.3, CI: 1.3 (1.0, 1.6), during-PCT (HR: 1.5, CI: 1.0, 2.2) and post-PCT (HR=2.0, CI: 1.5, 2.6). For LTSL, risk was increased pre-PCT (HR=1.3, CI: 1.1, 1.4) and during-PCT (HR=1.5, CI: 1.1, 2.1), but not post-PCT. Risk was greatest in persons with sporadic than familial PCT. Diagnostic reasons for disability pension that were increased compared to matched controls were PCT or skin disease in 11 of 199 cases (PCT: n=7, incident rate ratios [IRR]=49.2, CI=38.8, 62.4; diseases of the skin & subcutaneous tissue, n=4, IRR=4.2, CI=1.6, 11.0). The vast majority of diagnostic reasons for accessing disability pension were related to comorbidities, PCT susceptibility factors and more general health issues such as: malignant neoplasms (n=12, IRR=2.4, CI=1.4, 4.2), substance and alcohol dependence (n=7, IRR=5.0, CI=2.5, 10.1), neurotic and mood – disorders (n=21, IRR=1.7, CI=1.1, 2.6), and diseases of the musculoskeletal system & connective tissue (n=71, IRR=2.5, CI=1.9, 3.2).Conclusions: Persons with PCT have an increased risk of LTSL and disability pension indicating significant morbidity in this patient group. Appropriate long-term follow-up and monitoring for relapses and co-morbid diseases are recommended.