Geographical variation and clustering are found in atrial fibrillation beyond socioeconomic differences:a Danish cohort study, 1987–2015

Background: The prevalence and incidence rate of atrial fibrillation (AF) increase worldwide and AF is a risk factor for more adverse cardiovascular diseases including stroke. Approximately 44% of AF cases cannot be explained by common individual risk factors and risk might therefore also be related to the environment. By studying geographical variation and clustering in risk of incident AF adjusted for socioeconomic position at an individual level, potential neighbourhood risk factors could be revealed. Methods: Initially, yearly AF incidence rates 1987–2015 were estimated overall and stratified by income in a register-based cohort study. To examine geographical variation and clustering in AF, we used both spatial scan statistics and a hierarchical Bayesian Poisson regression analysis of AF incidence rates with random effect of municipalities (n = 98) in Denmark in 2011–2015. Results: The 1987–2015 cohort included 5,453,639 individuals whereof 369,800 were diagnosed with an incident AF. AF incidence rate increased from 174 to 576 per 100,000 person-years from 1987 to 2015. Inequality in AF incidence rate ratio between highest and lowest income groups increased from 23% in 1987 to 38% in 2015. We found clustering and geographical variation in AF incidence rates, with incidence rates at municipality level being up to 34% higher than the country mean after adjusting for socioeconomic position. Conclusions: Geographical variations and clustering in AF incidence rates exist. Compared to previous studies from Alberta, Canada and the United States, we show that geographical variations exist in a country with free access to healthcare and even when accounting for socioeconomic differences at an individual level. An increasing social inequality in AF was seen from 1987 to 2015. Therefore, when planning prevention strategies, attention to individuals with low income should be given. Further studies focusing on identification of neighbourhood risk factors for AF are needed.</p

Pulmonary pressure increases during acute exacerbation in COPD and clinical outcome

BACKGROUND: Elevated pulmonary pressures can lead to right ventricular dysfunction, worsen respiratory status and increase overall morbidity in COPD patients. Yet, little is known about the impact of right-sided pressure changes during acute exacerbation in COPD (AECOPD) on patient outcomes. Our aim was to determine whether pulmonary pressures are elevated during AECOPD compared with the stable phase and to investigate the association between tricuspid regurgitation (TR) gradient during AECOPD and days alive and out of hospital (DAOH).METHODS: This was a multicentre, prospective study of pulmonary pressures changes in patients with AECOPD and stable-phase COPD. Inclusion criteria were diagnosis of COPD and admission with AECOPD. Transthoracic echocardiography (TTE), including TR gradient, tricuspid annular plane systolic excursion (TAPSE), right ventricular diameter and right atrial parameters, was performed during AECOPD and the stable phase.RESULTS: Of 250 patients, 232 underwent TTE during AECOPD and 107 completed stable-phase follow-up. Reasons for incomplete follow-up included death (n=46), withdrawal (n=23), poor TTE quality (n=21) and unmeasurable TR gradients (n=35). TR gradient increased significantly during AECOPD, with a mean difference of 6.0 (95% CI 2.5-9.6) mmHg, while TAPSE, right ventricular diameter and right atrial size showed no significant changes. Higher TR gradients during AECOPD correlated with lower DAOH.CONCLUSION: TR gradients were significantly elevated during AECOPD, suggesting that transient right-sided pressure spikes are associated with COPD exacerbations. However, the direction of this association remains unclear and further research is needed to determine whether right-sided pressure changes contribute to exacerbations or whether exacerbations themselves drive these pressure spikes.</p

Stability of Major Geogenic Cations in Drinking Water—An Issue of Public Health Importance: A Danish Study, 1980–2017

Concentrations and spatial variations of the four cations Na, K, Mg and Ca are known to some extent for groundwater and to a lesser extent for drinking water. Using Denmark as case, the purpose of this study was to analyze the spatial and temporal variations in the major cations in drinking water. The results will contribute to a better exposure estimation in future studies of the association between cations and diseases. Spatial and temporal variations and the association with aquifer types, were analyzed with spatial scan statistics, linear regression and a multilevel mixed-effects linear regression model. About 65,000 water samples of each cation (1980&ndash;2017) were included in the study. Results of mean concentrations were 31.4 mg/L, 3.5 mg/L, 12.1 mg/L and 84.5 mg/L for 1980&ndash;2017 for Na, K, Mg and Ca, respectively. An expected west-east trend in concentrations were confirmed, mainly explained by variations in aquifer types. The trend in concentration was stable for about 31&ndash;45% of the public water supply areas. It is therefore recommended that the exposure estimate in future health related studies not only be based on a single mean value, but that temporal and spatial variations should also be included

Magnesium in drinking water and atrial fibrillation:Geographical variations and association

Sammenhængen mellem højere magnesium koncentrationer i drikkevand og en lavere risiko for hjertekarsygdomme er blevet undersøgt i årtier. Trods dette, er resultaterne ikke entydige og der er derfor brug for yderligere forskning på området. Atrieflimren (AF) tilhører gruppen af hjertekarsygdomme og AF er en almindelig hjerterytmeforstyrrelse samt en risikofaktor for mere kritiske hjertekarsygdomme. Både forekomsten af AF og nye tilfælde af AF per år per 100.000 personer stiger på verdensplan. Trods mange individuelle risikofaktorer for AF er kendte, eks. alder, mangler der fortsat viden omkring risikofaktor relateret til for eksempel omgivelserne. Formål- At undersøge variationen i koncentrationen af magnesium i drikkevandet i Danmark for perioden 1980-2017.- At undersøge udviklingen i og den geografiske variation i nye tilfælde af AF.- At analysere sammenhængen mellem magnesium i drikkevandet og risikoen for nye tilfælde af AF. Studiet er baseret på data fra nationale registre og mere end 5 mio. personer i perioden 1987-2015 indgår i studiet samt mere end 60.000 drikkevandsanalyser af magnesium fra den danske boringsdatabase (Jupiter).Generelt er magnesiumkoncentrationen i drikkevandet stabil (1980-2017). Signifikant højere magnesiumkoncentrationer blev fundet i det østlige Danmark (18,2 mg/L) og lavere i det vestlige Danmark (7,0 mg/L). Eksponering til magnesium i drikkevandet var fra 0,1 til 62 mg/L. Det årlige antal af nye tilfælde af AF steg fra 174 til 576 per 100.000 personer. En stigende social ulighed i nye tilfælde af AF er observeret i 1987-2015 og selv efter justering af socio-økonomiske forskelle ses der geografiske variationer i risikoen for nye tilfælde af AF. Der blev ikke fundet nogen entydig sammenhæng mellem magnesium i drikkevandet og risiko for AF.<br/

Magnesium in drinking water and atrial fibrillation:Geographical variations and association

Sammenhængen mellem højere magnesium koncentrationer i drikkevand og en lavere risiko for hjertekarsygdomme er blevet undersøgt i årtier. Trods dette, er resultaterne ikke entydige og der er derfor brug for yderligere forskning på området. Atrieflimren (AF) tilhører gruppen af hjertekarsygdomme og AF er en almindelig hjerterytmeforstyrrelse samt en risikofaktor for mere kritiske hjertekarsygdomme. Både forekomsten af AF og nye tilfælde af AF per år per 100.000 personer stiger på verdensplan. Trods mange individuelle risikofaktorer for AF er kendte, eks. alder, mangler der fortsat viden omkring risikofaktor relateret til for eksempel omgivelserne. Formål- At undersøge variationen i koncentrationen af magnesium i drikkevandet i Danmark for perioden 1980-2017.- At undersøge udviklingen i og den geografiske variation i nye tilfælde af AF.- At analysere sammenhængen mellem magnesium i drikkevandet og risikoen for nye tilfælde af AF. Studiet er baseret på data fra nationale registre og mere end 5 mio. personer i perioden 1987-2015 indgår i studiet samt mere end 60.000 drikkevandsanalyser af magnesium fra den danske boringsdatabase (Jupiter).Generelt er magnesiumkoncentrationen i drikkevandet stabil (1980-2017). Signifikant højere magnesiumkoncentrationer blev fundet i det østlige Danmark (18,2 mg/L) og lavere i det vestlige Danmark (7,0 mg/L). Eksponering til magnesium i drikkevandet var fra 0,1 til 62 mg/L. Det årlige antal af nye tilfælde af AF steg fra 174 til 576 per 100.000 personer. En stigende social ulighed i nye tilfælde af AF er observeret i 1987-2015 og selv efter justering af socio-økonomiske forskelle ses der geografiske variationer i risikoen for nye tilfælde af AF. Der blev ikke fundet nogen entydig sammenhæng mellem magnesium i drikkevandet og risiko for AF.<br/