Michael Davidsen

Background. Ambient air pollution has been associated with exacerbations of chronic obstructive pulmonary disease (COPD) and asthma; however, little is known about indoor environmental factors. Our aim was to study the association between perceived indoor environment and the long-term risk of exacerbations of COPD or asthma. Methods. We followed 2,317 individuals aged ≥16 years with COPD or asthma from the Danish Health and Morbidity Survey from 2000 to 2018. Individuals developing COPD or asthma during the study period were included at the time of incident diagnosis. Individuals were grouped according to their patterns of perceived indoor environment and followed up for exacerbations defined based on information from the Danish National Health Registers. The association between perceived indoor environment and exacerbations was examined using a generalized mixed model with the Poisson distribution of the number of exacerbations and logarithmic transformation of follow-up time as offset. Analyses were adjusted for age, sex, education, household income, smoking, calendar year, construction year, urbanization, home ownership, and resident density. Results. A total of 5,352 exacerbations were recorded in 2,317 individuals during a median of 13.9 years (interquartile range, 7.9–18.2 years). The adjusted incidence rate ratio (IRR) of exacerbations were 1.40 (95% CI 0.85–2.29 and 0.82 (95% CI 0.49–1.38) among individuals with medium and high levels om annoyances, respectively. For annoyances related to temperature and traffic the IRR was 0.88 (95% CI 0.61–1.27) and 1.39 (95% CI 0.88–2.19), respectively. Conclusion. We found no association between indoor environment assessed as annoyances at a single time-point and exacerbations of COPD and asthma.

The increasing prevalence of reported annoyances in the indoor environment threatens public health. This study aimed to investigate the association between perceived annoyances from the home environment and respiratory infections among individuals with and without asthma or chronic obstructive pulmonary disease (COPD). A total of 16,688 individuals from the Danish Health and Morbidity Survey initiated in 2000 were grouped according to their patterns of perceived annoyances. Information on respiratory infections (all causes, bacterial, viral, and those leading to hospital admissions) was obtained from Danish registers up to 19 years after the survey. Poisson regression of incidence rates (IRs) was applied to estimate incidence rate ratios (IRRs). Annoyances significantly increased the IR for respiratory infections of all causes and bacterial respiratory infections in individuals without asthma or COPD, adjusted IRR 1.16 (95% CI: 1.01, 1.34) and 1.15 (95% CI: 1.02, 1.31), respectively. However, no difference was observed for viral respiratory infections nor hospital admissions. Individuals with asthma or COPD and a high level of annoyances had a non-significantly increased IR in all four analyses of respiratory infections. These findings provide support for perceived annoyances as an important risk factor for respiratory infections.

The indoor environment is composed of several exposures existing simultaneously. Therefore, it might be useful to combine exposures into common combined measures when used to assess the association with health. The aim of our study was to identify patterns of the perceived indoor environment. Data from the Danish Health and Morbidity Survey in the year 2000 were used. The perceived indoor environment was assessed using a questionnaire (e.g., annoyances from noise, draught, and stuffy air; 13 items in total). Factor analysis was used to explore the structure of relationships between these 13 items. Furthermore, groups of individuals with similar perceived indoor environment were identified using latent class analysis. A total of 16,688 individuals ≥16 years participated. Their median age was 46 years. Four factors were extracted from the factor analysis. The factors were characterized by: (1) a mixture of items, (2) temperature, (3) traffic, and (4) neighbor noise. Moreover, three groups of individuals sharing the same perception of their indoor environment were identified. They were characterized by: a low (n = 14,829), moderate (n = 980), and large number of annoyances (n = 879). Observational studies need to take this correlation and clustering of perceived annoyances into account when studying associations between the indoor environment and health.

Background: Mental health represents an important public health issue, and mental health problems have been linked to school dropout. This study aimed to identify mental health groups of high school students using both positive and negative aspects of mental health and to examine whether these mental health groups longitudinally predict school dropout. Methods: We conducted latent class analysis using the Danish National Youth Study 2014 (n = 60,526; mean 17.9 years) to identify clustering of mental health (11 items covering positive and negative aspects of emotional wellbeing and functioning in daily life), separately by sex. The relationship with subsequent school dropout was examined using logistic regression models, adjusted for age, ethnicity and socioeconomic status. Information on dropout status was obtained through educational registers. Results: School dropout rates was highest among first-year students. Four mental health groups were identified: Flourishing (females: 38%, males: 55%), moderate mental health (females: 15%, males: 20%), emotionally challenged (females: 28%, males: 15%) and languishing (females: 19%, males: 10%). Compared to the flourishing group, adjusted odds ratio (AOR) for dropout were 3.43 (95% CI: 2.98, 3.95), 1.73 (95% CI: 1.45, 2.06) and 1.76 (95% CI: 1.52, 2.04) in the languishing, moderate mentally healthy and emotional challenged females. Results in males were comparable. Conclusions: Mental health in high school students cluster together in four categories among both males and females. Students who are languishing, emotionally challenged or moderate mentally healthy have about 1.5-fold to threefold higher risk of dropping out of high school compared with flourishing students. Universal mental health interventions may be a promising strategy, particularly in the first year of high school where most students drop out of school.

This study analyzed the trend in self‐reported dentate status over 30 years (1987–2017) among Danish adults, the self‐reported frequencies of preventive dental visits undertaken annually during the period 1987–2013, and the self‐reported use of the 2016 recall scheme for preventive dental check‐ups. The impact of social determinants (education, employment, civil status, and ethnic background) on these dental outcome variables in 2017 was explored. Questionnaire data were obtained from the Danish Health and Morbidity Surveys conducted from 1987–2017, and they were analyzed by tri‐variate frequency distributions and multivariate analyses. The prevalence of complete tooth loss was 17.7% in 1987 but 3.4% in 2017. The frequency of adults having 20 or more teeth grew markedly from 1987 (65.9%) to 2017 (85.1%). Educational inequality in dentate status persisted over the period. The frequency of preventive dental visits at least annually increased from 1987 to 2013, although visits were less frequent for young people. In 2017, preventive dental check‐ups were reported in intervals: less than 12 months (56.4%), 12–18 months (18.9%), 19–24 months (4.8%), and more than 24 months (5.2%). In 2017, dentate status and preventive dental check‐ups varied profoundly by social determinants. In conclusion, social policies should be implemented to tackle the persistent inequities in dentate status and public health policies should target Universal Health Coverage.

Studies have indicated that people with disabilities die earlier and may experience a poorer health than the general population. This study investigated 31 factors related to health and well-being, health behaviour and social relations among Danish adults with activity limitation (AL). This study was based on data from the Danish Health and Morbidity Survey (DHMS) 2013 where 25,000 men and women aged 16 years or older were selected randomly from the adult Danish population. A total of 14,265 individuals answered the self-administered questionnaire including 100 questions on health-related quality of life, health behaviour, morbidity, consequences of illness and social relations. Based on an international standard question on AL, 888 individuals (6%) were defined as having profound AL and 4180 (29%) as having some AL. Multiple logistic regression analyses were used to analyse the associations between activity limitation and 31 indicators of health. The results were presented as relative risks 95% confidence intervals. Twenty-eight of 31 indicators showed consistently poorer health and well-being, health behaviour and social relations among individuals with AL as compared to individuals without AL. The increased relative risks were in a range of 7-661% the risk among individuals without AL. An example is obesity where RR (95% CI) was 2.07 (1.82–2.37). Only contact with internet friends was significantly higher among individuals with AL as compared to individuals with no AL. There was no association between alcohol and AL and no association between fast food and some AL. Danish adults with AL experience a poorer health and well-being, and have an unhealthier lifestyle and poorer social relations than adults without AL. People with activity limitation should be prioritized in public health and efforts done to secure availability and flexibility of health care services and primary prevention programs. Policies should address accessibility, availability and affordability of health care and health behaviour among people with activity limitation.

The goal of this analysis was to describe socioeconomic inequalities in dental health among Spanish middle-aged adults, and the role of behavioral and psychosocial factors in explaining these inequalities. This cross-sectional study used survey data from the 2006 Spanish National Health Survey and focused on adults ages 30 – 64. The outcome was dental health status based on the presence of self-reported dental problems. We used education, income, and occupational class as indicators of socioeconomic position and applied logistic regression analysis to estimate associations. We included behavioral and psychosocial variables in the models and compared non-adjusted to adjusted estimates to assess their potential role in explaining socioeconomic gradients. Results showed clear socioeconomic gradients in dental health among middle-aged adults. The percentage of people who reported more dental problems increased among those with lower levels of education, income, and occupation. These gradients were statistically significant (p < .001). Logistic regression showed that groups with lower education, income, and occupation had higher odds of reporting the outcome (p < .001). Associations were stronger when considering education as the indicator of socioeconomic position. Substantial unexplained associations remained significant after adjusting the model by behavioral and psychosocial variables. This study shows significant socioeconomic gradients in dental health among middle-aged adults in Spain. Behavioral and psychosocial variables were insufficient to explain the inequalities described, suggesting the intervention of other factors. Further research should incorporate additional explanations to better understand and comprehensively address socioeconomic inequalities in dental health.

Background Osteoarthritis is an age-related debilitating disease of the joints. The disease is the leading cause of disability in the elderly and frequently interferes in both activity and social participation. However, osteoarthritis has difficulties in competing with highly mortal and visible diseases in a political context. Therefore, the Danish Rheumatism Association progressively makes use of social costs as a selling point to politicians. Historically, the calculation of social costs has partly been based on professional judgements caused by lack of credible data. However, the present opportunities in data collection in Denmark give unique prospects of detailed calculations of social costs. Objectives The aim of this analysis was to determine the economic consequences of osteoarthritis. This was done by estimating the social costs of osteoarthritis in Denmark. The perspective was partly macro economical and partly public cost-related. Methods Data was used from the National Health Interview Survey from 2010 (NHIS-2010), which was a national representative survey based on responses from 15,165 Danish citizens aged 16 years or above. NHIS-2010 was linked with a wide range of register data within healthcare and welfare providing a unique opportunity of determining the respondents' use of health services etc. at an individual level. In this economic “cost-of-illness” analysis (COI) both direct costs, which are costs for treatment in primary and secondary care, as well as indirect costs due to production losses was included. The production losses were estimated by the Human Capital Method, where the production loss was considered permanent from the time of early retirement until the normal retirement age (65 years). The value of the production losses in the future was set to the expected income in the given period. In the public cost-related part of the analysis, the perspective was limited to the cost of public funds and thus includes treatment costs (excluding any co-payment) and transfers. The results of this part of the analysis are therefore not social costs per se. Results A total of 3,008 NHIS respondents responded that they have osteoarthritis now or suffer from effects of past osteoarthritis. This corresponds to 18.6%, or almost one-fifth of the Danish population aged 16 years or above having osteoarthritis-related complications in 2010. The total social costs associated with osteoarthritis were estimated to €0.9 billion (6.8 billion DKK) in 2010. Additional treatment costs for citizens with osteoarthritis constituted the largest part. In the public cost-related analysis, osteoarthritis was estimated to cause additional public expenditures in Denmark of €1.5 billion (11.5 billion DKK) in 2010. Conclusions Due to new data, this report provides a unique insight into osteoarthritis' consequences for the economy. These new published estimates provide substantial economic arguments underlining the importance of better prevention and treatment of osteoarthritis. The results will be an important factor in the Danish Rheumatism Association's political campaigning. References Johnsen NF, Koch MB, Davidsen M and Juel K (2013) De samfundsmæssige omkostninger ved artrose. The National Institute of Public Health, University of Southern Denmark. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1876