Chronic obstructive pulmonary disease and cancer risk: A Danish nationwide cohort study

SummaryIntroductionLittle is known about the risk of cancer in patients with chronic obstructive pulmonary disease (COPD), including which cancer sites are most affected. We examined the short- and long-term risk of lung and extrapulmonary cancer in a nationwide cohort of COPD patients.MethodsWe linked the Danish National Registry of Patients and the nationwide cancer registry, and examined the incidence of various cancers in 236,494 individuals with a first incident hospital contact with COPD during 1980–2008. The observed cancer incidence in this cohort was compared with the expected incidence in the general population on the basis of national age-, sex-, and site-specific incidence rates.ResultsMedian follow-up was 3.5 years. During the first year of follow-up, 9434 cancers were diagnosed in COPD patients [standardized incidence ratio (SIR) = 3.1; 95% CI 3.0 to 3.2]. The 1-year SIR was 8.5 (8.2–8.9) for lung cancer, 5.1 (5.0–5.2) for all tobacco-related cancers, and 1.9 (1.9–2.0) for other cancers. In the following years, cancer incidence was increased 1.4-fold (1.4–1.5) in COPD patients. These patients had an increased risk of developing tobacco-related cancers (SIR = 2.1; 95% CI 2.0–2.1), including cancers of the lung, larynx, tongue, oral cavity, pharynx, esophagus, stomach, liver, pancreas, cervix uteri, and urinary tract (with SIRs ranging between 1.3 and 2.8).ConclusionsPatients with first-time hospital-diagnosed COPD are at considerably increased risk of developing both lung cancer and extrapulmonary cancers. Physicians should be aware of cancer in COPD patients

Use and quality of point-of-care microscopy, urine culture and susceptibility testing for urinalysis in general practice

Objective: To describe the use and quality of point-of-care (POC) microscopy, urine culture and susceptibility testing performed in general practice in Northern Denmark from 2013 to 2018. Design: Descriptive study Setting: General practices receiving a fee for examining urine samples. Subjects: Simulated urine samples containing uropathogenic bacteria distributed by the organisation for improvement of microbiological quality (MIKAP). Main outcome measures: Percentage of use and correct answers for microscopy, culture and susceptibility testing. Results: A total of 5361 samples were analysed by the use of microscopy (39.7%), culture (66.0%) and/or susceptibility testing (76.5%). For culture, Flexicult SSI urinary kit(tm) (87.6%) demonstrated the highest percentage of correct answers followed by chromogenic agar (85.1%) and 2-plate dipslide (85.2%). Mueller Hinton agar with tablets had the highest percentage of correct answers for susceptibility testing of most bacterial strains (84.6%), followed by Flexicult (77.2%). Furthermore, susceptibility testing with tablets (range: 76.1–84.6%) was found to be more accurate than discs (range: 72.9–75.5%). Overall, the highest percentage of correct answers was obtained when examining urine samples containing Escherichia coli: Microscopy (78.3%), culture (87.0%) and susceptibility testing (range: 84.3–90.7%). Conclusion: The quality of POC testing in general practice was high when examining urine samples containing the most common uropathogen E. coli. KEY POINTS: The quality of POC tests (microscopy, urine culture, susceptibility testing) performed in general practice was high when examining urine containing E. coli, whereas difficulties were observed for samples including S. saprophyticus or K. pneumoniae. Susceptibility testing was more often performed than urine culture, which indicates a problem as only urine cultures contribute with information about the flora composition and bacterial quantification

Positive predictive value of the ICD-10 hospital diagnosis of pleural empyema in the Danish National Registry of Patients

Mette Søgaard1,2, Jette Brommann Kornum2, Henrik Carl Schønheyder1, Reimar Wernich Thomsen21Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; 2Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, DenmarkObjective: Health care databases are a valuable source for epidemiological research in respiratory diseases if diagnoses are valid. We validated the International Classification of Diseases, 10th revision (ICD-10) diagnosis of pleural empyema in the Danish National Registry of Patients (DNRP).Methods: We randomly selected hospitalized patients registered in the DNRP with a discharge diagnosis of pleural empyema between 1995 and 2009 in the North Denmark Region. We retrieved and reviewed medical records and estimated the positive predictive value (PPV) of the empyema diagnosis. Analyses were stratified by study period, hospital type (referral versus district), department type (pulmonary medicine or thoracic surgery versus other), cause of empyema (medical, surgical, or traumatic), and age group. To assess changes over time, we included chi-square tests for linear trend.Results: We retrieved the medical records of 224/225 sampled patients with empyema (99.6%). Of those, 182 were classified as being definite cases, and 21 were probable cases, yielding a PPV of 90.6% (95% confidence interval [CI]: 86.0–94.1). The PPV decreased from 95.7% in patients aged 15–39 years to 87.5% in patients aged 80 years and over but was uniformly high regardless of study period, hospital or department type, or cause of empyema.Conclusion: Our finding of a high overall PPV indicated good agreement between ICD-10 codes for pleural empyema and medical records. Registry-based discharge codes may be a suitable source of data on pleural empyema for epidemiological research.Keywords: pneumonia, positive predictive value, validation, International Classification of Disease Codes, empyema&nbsp

Increased demand of urine cultures from Danish general practice: a five-year register-based study

AbstractObjective: To characterise and explore the development in the number and content of urine samples sent from general practice in the North Denmark Region to the Department of Clinical Microbiology (DCM) at Aalborg University Hospital during a five-year period.Design: A register-based study.Setting: General practice.Subjects: Urine samples received at DCM, Aalborg University Hospital from general practice between 2017 and 2022.Main outcome measures: Number and content of urine samples.Results: A total of 255,271 urine samples from general practice were received at DCM, with 76.1% being from female patients. Uropathogens were identified in 43.0% of the samples. During the five-year period, a 23.0% increase in the number of urine samples per person (incidence rate ratio (IRR) 1.23, 95% CI 1.21–1.25) was observed. A slight increase in the proportion of positive cultures (risk ratio (RR) 1.03, 95% CI 1.01–1.05) was seen. No notable change in the patient population (age, gender) was observed. Overall, Escherichia coli was the most identified uropathogen (60.4%) followed by Klebsiella spp. (8.7%) and Enterococcus spp. (7.7%). Distribution of the various uropathogens differed slightly depending on patient gender and age, importantly E. coli was less frequently observed in males aged >65 years.Conclusion: During the past five years an increasing amount of urine cultures have been requested at DCM from general practice. Importantly, the cause(s) of this increasing demand needs to be explored further in future studies

Cancer risk and prognosis after a hospital contact for an elevated erythrocyte sedimentation rate

Background: An elevated erythrocyte sedimentation rate (ESR) may be a marker of occult cancer. Methods: We linked Danish medical databases to examine cancer incidence in patients with a first-time hospital contact for elevated ESR during 1980 to 2013. We calculated standardized incidence ratios (SIR) of cancer compared with the general population, and comorbidity-adjusted HRs (aHR) versus matched population comparisons without elevated ESR. We also compared survival among patients with cancer with elevated ESR with that among patients with cancer without elevated ESR. Results: During median follow-up of 4.9 years, we observed 3,926 cancers among 18,540 patients with a first-time hospital contact for elevated ESR. The risk for any cancer diagnosed during the first year following the contact for elevated ESR was 8.5% [95% confidence interval (CI) 8.1%–8.9%]. The overall 1-year cancer incidence was markedly elevated [SIR 5.3 (95% CI, 5.1–5.6); aHR 5.8 (95% CI, 5.4–6.3)] and was more than 3-fold elevated for most hematologic cancers and for cancers of the peritoneum and connective tissue in the abdominal wall, kidney, and adrenal glands. After the first year, patients were at increased risk of developing especially hematologic cancers. Patients diagnosed with cancer within 1 year after a contact for elevated ESR had poorer survival compared with matched cancer comparisons [adjusted mortality rate ratio 1.2 (95% CI, 1.1–1.3)]. Conclusions: Elevated ESR is a strong marker of undiagnosed cancer and is associated with poorer survival. Impact: Our findings may help clinicians in assessing absolute risk, common sites, and prognosis of cancers discovered after hospital contact with elevated ERS.</p

Gonorrhoea on the rise in Denmark since 2022: distinct clones drive increase in heterosexual individuals

A surge in gonorrhoea in Denmark has occurred since 2022, a 46% increase from 2021. National surveillance, leveraging mandatory reporting and epidemiological data, highlights three distinct clades linked to heterosexual transmission. Despite the rise, these exhibit high susceptibility, contrasting MSM-associated strains. Geographical hotspots and age-specific patterns further illuminate transmission dynamics. The combination of genomic and epidemiological data provides novel insights into the evolving landscape of gonorrhoea, indicating potential shifts in infection dynamics and transmissibility.</p