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  • 1.
    Allinson, James
    et al.
    Royal Brompton Hospital & National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Afzal, Shoaib
    Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
    Colak, Yunus
    Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of sustainable health/the OLIN unit, Umeå University.
    Van Den Berghe, Maarten
    Dept of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
    Boezen, Marike
    Dept of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
    Breyer, Marie
    Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
    Breyer-Kohansal, Robab
    Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
    Burghuber, Otto C.
    Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
    Faner, Rosa
    Centro de Investigación Biomedica en Red Enfermedades Respiratorias, IDIBAPS-Hospital Clinic de Barcelona, Barcelona, Spain.
    Hartl, Sylvia
    Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.
    Jarvis, Deborah
    Imperial College London, London, United Kingdom.
    Lahouse, Lies
    Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway.
    Lundback, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Nwaru, Bright
    Krefting Research Centre, Institute of Medicine, Gothenburg, Sweden.
    Ronmark, Eva
    Department of Public Health and Clinical Medicine, Section of sustainable health/the OLIN unit, Umeå University, Umeå, Sweden.
    Vikjord, Sigrid
    HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway.
    Vonk, Judith
    Dept of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
    Vijnant, Sara
    Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
    Szabo, Viktoria
    Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
    Agusti, Alvar
    Respiratory Institute, Hospital Clinic, IDIBAPS, CIBERES, Univ, Barcelona, Spain.
    Donaldson, Gavin
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Wedzicha, Jadwiga
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
    Vestbo, Jorgen
    Manchester University NHS Foundation Trust, Manchester, Manchester Academic Health Science Centre, and Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom.
    Vanfleteren, Lowie
    COPD center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Collating data from major European population studies – The CADSET (Chronic airway disease early stratification) clinical research collaboration2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 3757Article in journal (Other academic)
    Abstract [en]

    Background: European population cohorts continue to expand our understanding of chronic airways disease and inter-study collaboration may help address the inevitable limitations of study size, duration, era and geography. Towards this aim, CADSET has collated data from ten major general population European cohorts: Asklepios; Copenhagen City Heart Study; Copenhagen General Population Study; ECRHS; HUNT; LEAD; Lifelines, OLIN, Rotterdam Study and WSAS. We included males and females aged 20 to 95 years with baseline demographic and spirometry data.

    Results: Data from 262,829 individuals (44% male) from multiple European countries provided good coverage across all adult ages (Fig.1A). Recruitment occurred in every year from 1976 through 2020. 23% were current-smokers and 42% were never-smokers, a pattern varying with advancing age (Fig.1B). The prevalence of airflow limitation varied according to whether lower limit of normal (LLN) or <0.70 thresholds were applied, increasing with age if the latter was used (Fig.1C).

    Interpretation: These results fit with previous reports, however the size, geographical reach and span of recruitment provided by this collaboration provides a unique opportunity to explore chronic airways disease development. Together, we are now pursuing research questions previously beyond the scope of individual cohort studies.

  • 2.
    Almqvist, Linnéa
    et al.
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Dept of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenborg, Sweden.
    Hedman, Linnéa
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Remission of adult-onset asthma is rare: a 15-year follow-up study2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 4, article id 00620-2020Article in journal (Refereed)
    Abstract [en]

    Background There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up.

    Methods A cohort of 309 adults aged 20–60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months.

    Results Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma.

    Conclusion Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.

  • 3.
    Andersén, Heidi
    et al.
    Karolinska University Hospital, Thoracic Oncology Unit, Tema Cancer, Stockholm, Sweden. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Kankaanranta, Hannu
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Tuomisto, Leena E
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital. University of Helsinki, Helsinki, Finland.
    Sovijärvi, Anssi
    Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital. University of Helsinki, Helsinki, Finland.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway. Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
    Lehtimäki, Lauri
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Allergy Centre, Tampere University Hospital, Tampere, Finland.
    Ilmarinen, Pinja
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Multimorbidity in Finnish and Swedish speaking Finns; association with daily habits and socioeconomic status - Nordic EpiLung cross-sectional study2021In: Preventive Medicine Reports, E-ISSN 2211-3355, Vol. 22, article id 101338Article in journal (Refereed)
    Abstract [en]

    Multimorbidity is an emerging public health priority. This study aims to assess the role of lifestyle and socioeconomic status in the prevalence of multimorbidity and chronic diseases by using two language groups that are part of the same genetic subgroup but differ by daily habits. We conducted a cross-sectional survey in 2016 with randomly selected population sample with 4173 responders (52.3%) aged 20-69 years in Western Finland. We included 3864 Finnish participants with Swedish (28.1%) or Finnish (71.9%) as a native language. We used a questionnaire to assess participants' chronic diseases and lifestyle. We determined multimorbidity as a disease count ≥2.

    Finnish speakers were more likely to have a diagnosis of COPD, heart failure, diabetes, reflux disease, chronic kidney failure, and painful conditions than Swedish speakers. The prevalence of multimorbidity was higher for Finnish speakers in the age group of 60-69 years (41.0% vs. 32.0%, p=0.018) than Swedish speakers. A higher proportion of Finnish speakers smoked, were obese, inactive, and had lower socioeconomic status compared to Swedish speakers. All these factors, in addition to age and female sex, were significant risk factors for multimorbidity. Prevalence of multimorbidity was different in two language groups living in the same area and was associated with differences in lifestyle factors such as smoking, physical inactivity and obesity.

  • 4.
    Axelsson, Malin
    et al.
    Department of Care Science, Faculty of Health and Society, Malmö University, Malmö. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå .
    Vanfleteren, Lowie
    Centre for COPD Research, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Eriksson, Berne
    Research and Development, Region of Halland, Halmstad, Sweden.
    Nwaru, Bright
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Kankaanranta, Hannu
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Section of Medicine/the OLIN unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Underdiagnosis and misclassification of COPD in Sweden2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 1395Article in journal (Other academic)
    Abstract [en]

    Introduction: The prevalence of COPD seems to have leveled or decreased in some high income countries. Worldwide, population studies using spirometry have found substantial underdiagnosis of COPD.

    Aim: To investigate underdiagnosis and misclassification of COPD in Sweden.

    Methods: A randomly selected sample (n=1839; age 21-78 years; women 52.6%) was derived from two large scale population studies in Sweden, the West Sweden Asthma Study (WSAS) and the Obstructive Lung Disease in Northern Sweden (OLIN) Studies. Examinations including spirometry and structured interviews were conducted 2009-2012. COPD was defined following GOLD 2017: post-bronchodilator FEV1/FVC<0.70 and presence of respiratory symptoms. The subjects were asked if prior to the study they had been diagnosed with COPD, chronic bronchitis, emphysema, asthma, and if they used medicines for airway diseases.

    Results: Of those with COPD (GOLD) identified at the clinical examinations, 24% had, prior to the study, been diagnosed with COPD, emphysema, or chronic bronchitis (COPD-cluster), while 46% had been diagnosed with the COPD-cluster, asthma, or used medicines for airway disease (any OAD). The corresponding figures for those fulfilling the criteria of COPD GOLD grade ≥2 were 39% (COPD-cluster) and 62% (any OAD). Among the subjects who, prior to the study, had been diagnosed with COPD, 78% fulfilled the criteria of COPD, but among those who had been diagnosed as having any of the diseases in the COPD-cluster, 31% fulfilled the criteria of COPD.

    Conclusion: The proportion of underdiagnosis of COPD is still large in Sweden. Some misclassification of COPD was also found. The results reflect underuse of spirometry in primary care.

  • 5.
    Axelsson, Malin
    et al.
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Ilmarinen, Pinja
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Ekerljung, Linda
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Lindqvist, Ari
    Clinical Research Unit of Pulmonary Diseases, Helsinki University Hospital, Helsinki University and Clinical Research Institute HUCH Ltd, Helsinki, Finland.
    Nwaru, Bright I.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
    Pallasaho, Paula
    Espoo City Primary Health Care Services, Finland.
    Sovijärvi, Anssi
    Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, and University of Helsinki, Finland.
    Vähätalo, Iida
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
    Hisinger-Mölkänen, Hanna
    University of Helsinki, Helsinki, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, and University of Helsinki, Finland.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland: The Nordic EpiLung Study2021In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 58, no 9, p. 1196-1207Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method: In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results: The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7-8.2 % versus 6.3-6.7 %) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7-2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion: The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.

  • 6.
    Backman, Helena
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Umeå university.
    Bhatta, Laxmi
    Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Umeå university.
    Brumpton, Ben
    Department of Public Health and Nursing, NTNU, Norwegian University of Science. Technology and Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim, Norway.
    Vähätalo, Iida
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Lassman-Klee, Paul G
    Unit of Clinical Physiology, Helsinki University Central Hospital. University of Helsinki, Helsinki, Finland.
    Nwaru, Bright
    Krefting Research center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Mai, Xiao-Mei
    Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
    Vikjord, Sigrid Anna
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Umeå university, Umeå, Sweden.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway.
    Respiratory symptoms as risk factors for mortality – the Nordic EpiLung Study2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 1423Article in journal (Other academic)
    Abstract [en]

    Background: Little is known on associations between respiratory symptoms and mortality.

    Aim: To study whether respiratory symptoms are risk factors for all-cause, respiratory, cardiovascular (CV), and cancer mortality in Sweden and Norway.

    Methods: In 1995-1997, population samples (20-69y) were surveyed about respiratory symptoms, and n=7,104 (85.3% of invited, median age 45y) and n=54,240 (70.1%, 44y) participated within the OLIN Studies in Northern Sweden and the HUNT Study in Norway. Mortality was studied until December 31st 2015. Hazard ratios (HR) for associations between respiratory symptoms and mortality were estimated by Cox regression models adjusted for age, sex, educational level, and smoking habits.

    Results: The cumulative 20-year mortality was 14.5% in OLIN and 12.6% in HUNT. Dyspnea (mMRC grade≥2) (HR 1.9, 95%CI 1.6-2.2 in OLIN and 1.6, 1.5-1.7 in HUNT), chronic productive cough (1.5, 1.3-1.8 and 1.5, 1.3-1.6), and wheeze (1.3, 1.1-1.5 and 1.3, 1.2-1.4) were associated with increased risk of all-cause mortality. Women reported dyspnea and wheeze more frequently than men in both countries, but the association with mortality was similar in both sexes. Causes of death were studied in OLIN, where dyspnea associated with increased risk of respiratory (3.6, 2.1-6.1), CV (2.1, 1.6-2.7), and cancer (1.3, 1.0-1.8) mortality. Chronic productive cough was associated with increased risk of respiratory (2.4, 1.3-4.3) and cancer (1.6, 1.2-2.2) mortality, while wheeze was associated with increased risk of respiratory (3.5, 2.1-5.7) and CV (1.3, 1.0-1.6) mortality.

    Conclusions: Common respiratory symptoms were similarly associated with increased risk of mortality in adults in Sweden and Norway.

  • 7.
    Backman, Helena
    et al.
    Section for Sustainable Health, Umeå University, Umeå, Sweden.
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lundquist, Anders
    Department of Statistics, Umeå School of Business, Economics and Statistics (USBE), Umeå University, Umeå, Sweden.
    Strandkvist, Viktor
    Luleå University of Technology, Department of Health, Learning and Technology, Health, Medicine and Rehabilitation.
    Sawalha, Sami
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Nilsson, Ulf
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Eriksson-Ström, Jonas
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Section for Sustainable Health, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Section for Sustainable Health, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lung Function Trajectories and Associated Mortality Among Adults with and without Airway Obstruction2023In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 208, no 10, p. 1063-1074Article in journal (Refereed)
  • 8.
    Backman, Helena
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Jansson, Sven-Arne
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Sandström, Thomas
    Dept of Public Health and Clinical Medicine, Section of Medicine, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    FEV1 decline in relation to blood eosinophils and neutrophils in a population-based asthma cohort2020In: World Allergy Organization Journal, ISSN 1731-3317, E-ISSN 1939-4551, Vol. 13, no 3, article id 100110Article in journal (Refereed)
    Abstract [en]

    Background

    The relationship between lung function decline and eosinophils and neutrophils has important therapeutic implications among asthmatics, but it has rarely been studied in large cohort studies.

    Objective

    The aim is to study the relationship between blood eosinophils and neutrophils and FEV1 decline in a long-term follow-up of a population-based adult asthma cohort.

    Methods

    In 2012–2014, an adult asthma cohort was invited to a follow-up including spirometry, blood sampling, and structured interviews, and n = 892 participated (55% women, mean age 59 y, 32–92 y). Blood eosinophils, neutrophils and FEV 1 decline were analyzed both as continuous variables and divided into categories with different cut-offs. Regression models adjusted for smoking, exposure to vapors, gas, dust, or fumes (VGDF), use of inhaled and oral corticosteroids, and other possible confounders were utilized to analyze the relationship between eosinophils and neutrophils at follow-up and FEV1 decline.

    Results

    The mean follow-up time was 18 years, and the mean FEV 1 decline was 27 ml/year. The annual FEV1 decline was related to higher levels of both blood eosinophils and neutrophils at follow-up, but only the association with eosinophils remained when adjusted for confounders. Further, the association between FEV1 decline and eosinophils was stronger among those using ICS. With EOS <0.3 × 109/L as reference, a more rapid decline in FEV1 was independently related to EOS ≥0.4 × 109/L in adjusted analyses.

    Conclusions and clinical relevance

    Besides emphasizing the importance of smoking cessation and reduction of other harmful exposures, our real-world results indicate that there is an independent relationship between blood eosinophils and FEV1 decline among adults with asthma.

  • 9.
    Backman, Helena
    et al.
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Umeå university, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit.
    Lindmark, Sofia Winsa
    Umeå University, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit, Luleå, Sweden.
    Hedman, Linnea
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Luleå, Sweden.
    Warm, Katja
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Kalmar, Sweden.
    Myrberg, Tomi
    Umeå University, Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå, Sweden.
    Stridsman, Caroline
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Luleå, Sweden.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Faculty of Medicine and Health Technology, University of Tampere; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Anne
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Luleå, Sweden.
    Obesity and inflammatory markers in adult-onset asthma2021In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 58, no 65, article id OA4215Article in journal (Other academic)
  • 10.
    Backman, Helena
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå university, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit.
    Stridsman, Caroline
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Luleå, Sweden.
    Jansson, Sven-Arne
    Umeå University, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit, Luleå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå university, Public Health and Clinical Medicine, section for Sustainable Health/the OLIN unit.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital. Faculty of Medicine and Health Technology, University of Tampere, Seinäjoki, Finland.
    Lindberg, Anne
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Umeå, Sweden.
    Lundback, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå University, Public Health and Clinical Medicine, section for Medicine/the OLIN unit, Luleå, Sweden.
    Risk factors for severe asthma among adults with asthma2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 4642Article in journal (Other academic)
    Abstract [en]

    Background: Severe asthma is a considerable challenge for patients, health care professionals and society, but there are few long-term studies on risk factors for severe asthma.

    Aim: To identify baseline risk factors of severe asthma in a longitudinal adult asthma cohort study.

    Methods: An adult asthma cohort was identified in 1986-2001 by clinical examinations of population samples within the OLIN studies in northern Sweden. The examinations included structured interviews, spirometry with reversibility testing, skin prick testing and metacholine challenge. The cohort was followed up in 2012-2014 when n=1006 participated (mean age 59y). Adjusted Risk Ratios (RR) for baseline factors as risk factors for GINA defined severe asthma (SA) at follow-up (n=51) were estimated by Poisson regression.

    Results: Older age, impaired lung function, increased reversibility and hyperreactivity, asthmatic wheeze, persistent wheeze, nighttime awakenings due to respiratory symptoms, and dyspnea were significant baseline risk factors for SA. Allergic sensitization, smoking, occupational groups or BMI did not predict SA. When adjusted for age, sex and smoking, post-bronchodilator FEV1/FVC<0.7, both present at baseline (RR 4.2, 95%CI 1.8-9.9) and developed during follow-up (2.9, 1.6-5.3), increased the risk. Also FEV1<80% at baseline associated with SA (2.9, 1.6-5.2). Triggers for respiratory symptoms at baseline such as tobacco smoke (2.1, 1.2-3.7) and physical activity (3.5, 1.5-81) associated with SA at follow-up, while pollen and furry animals did not.

    Conclusion: Among adults with asthma, impaired lung function, wheeze, dyspnea and nighttime awakenings due to respiratory symptoms are important long-term risk factors for severe asthma.

  • 11.
    Hedman, Linnea
    et al.
    Department of public health and clinical medicine, Division of sustainable health, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Backman, Helena
    Department of public health and clinical medicine, Division of sustainable health, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Lindberg, Anne
    Department of public health and clinical medicine, Division of medicine, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    Lundbäck, Bo
    Krefting research center, Institute of medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Department of public health and clinical medicine, Division of sustainable health, Umeå University; The OLIN studies, Norrbotten County Council, Luleå, Sweden.
    E-cigarette use is most common in persistent smokers in a Swedish prospective population study2019In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no 63, article id OA3313Article in journal (Other academic)
  • 12.
    Hedman, Linnea
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University Faculty of Medicine, Umeå, Sweden.
    Lundbäck, Magnus
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden.
    Predictors of electronic cigarette use among Swedish teenagers: a population-based cohort study2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 12, article id 040683Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aim was to identify predictors of electronic cigarette (e-cigarette) use among teenagers.

    Design and setting

    A prospective population-based cohort study of schoolchildren in northern Sweden.

    Participants

    In 2006, a cohort study about asthma and allergic diseases among schoolchildren started within the Obstructive Lung Disease in Northern Sweden studies. The study sample (n=2185) was recruited at age 7–8 years, and participated in questionnaire surveys at age 14–15 and 19 years. The questionnaire included questions about respiratory symptoms, living conditions, upper secondary education, physical activity, diet, health-related quality of life, parental smoking and parental occupation. Questions about tobacco use were included at age 14–15 and 19 years.

    Primary outcome

    E-cigarette use at age 19 years.

    Results

    At age 19 years, 21.4% had ever tried e-cigarettes and 4.2% were current users. Among those who were daily tobacco smokers at age 14–15 years, 60.9% had tried e-cigarettes at age 19 years compared with 19.1% of never-smokers and 34.0% of occasional smokers (p<0.001). Among those who had tried e-cigarettes, 28.1% were never smokers both at age 14–15 and 19 years, and 14.4% were never smokers among the current e-cigarette users. In unadjusted analyses, e-cigarette use was associated with daily smoking, use of snus and having a smoking father at age 14–15 years, as well as with attending vocational education, physical inactivity and unhealthy diet. In adjusted analyses, current e-cigarette use was associated with daily tobacco smoking at age 14–15 years (OR 6.27; 95% CI 3.12 to 12.58), attending a vocational art programme (OR 2.22; 95% CI 1.04 to 4.77) and inversely associated with eating a healthy diet (OR 0.74; 95% CI 0.59 to 0.92).

    Conclusions

    E-cigarette use was associated with personal and parental tobacco use, as well as with physical inactivity, unhealthy diet and attending vocational upper secondary education. Importantly, almost one-third of those who had tried e-cigarettes at age 19 years had never been tobacco smokers.

  • 13.
    Jalasto, Juuso
    et al.
    University of Helsinki, Faculty of Medicine, Helsinki, Finland; Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Kauppi, Paula
    Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
    Luukkonen, Ritva
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Lindqvist, Ari
    Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Kankaanranta, Hannu
    Krefting Research Centre, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Backman, Helena
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Sovijärvi, Anssi
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki Finland.
    Piirilä, Päivi
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki Finland.
    Mortality in association with occupational exposure and respiratory diagnosis in Helsinki, Finland: a 24-year follow-up2022In: NLC Abstracts / [ed] Vibeke Backer, Ole Hilberg, Charlotte Ulrik, Taylor & Francis, 2022, Vol. 9, article id 2058255Conference paper (Refereed)
  • 14.
    Jalasto, Juuso
    et al.
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Kauppi, Paula
    Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
    Luukkonen, Ritva
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Lindqvist, Ari
    Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Kankaanranta, Hannu
    Krefting Research Centre, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Backman, Helena
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden.
    Sovijärvi, Anssi
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Piirilä, Päivi
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Self-Reported Physician Diagnosed Asthma with COPD is Associated with Higher Mortality than Self-Reported Asthma or COPD Alone – A Prospective 24-Year Study in the Population of Helsinki, Finland2022In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 19, no 1, p. 226-235Article in journal (Refereed)
    Abstract [en]

    Asthma and COPD are common chronic obstructive respiratory diseases. COPD is associated with increased mortality, but for asthma the results are varying. Their combination has been less investigated, and the results are contradictory. The aim of this prospective study was to observe the overall mortality in obstructive pulmonary diseases and how mortality was related to specific causes using postal questionnaire data. This study included data from 6,062 participants in the FinEsS Helsinki Study (1996) linked to mortality data during a 24-year follow-up. According to self-reported physician diagnosed asthma, COPD, or smoking status, the population was divided into five categories: combined asthma and COPD, COPD alone and asthma alone, ever-smokers without asthma or COPD and never-smokers without asthma or COPD (reference group). For the specific causes of death both the underlying and contributing causes of death were used. Participants with asthma and COPD had the highest hazard of mortality 2.4 (95% CI 1.7–3.5). Ever-smokers without asthma or COPD had a 9.5 (3.7–24.2) subhazard ratio (sHR) related to lower respiratory tract disease specific causes. For asthma, COPD and combined, the corresponding figures were 10.8 (3.4–34.1), 25.0 (8.1–77.4), and 56.1 (19.6–160), respectively. Ever-smokers without asthma or COPD sHR 1.7 (95% CI 1.3–2.5), and participants with combined asthma and COPD 3.5 (1.9–6.3) also featured mortality in association with coronary artery disease. Subjects with combined diseases had the highest hazard of overall mortality and combined diseases also showed the highest hazard of mortality associated with lower respiratory tract causes or coronary artery causes.

  • 15.
    Jalasto, Juuso
    et al.
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Lassmann-Klee, Paul
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Schyllert, Christian
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Luukkonen, Ritva
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Meren, Mari
    National Institute for Health Development, Tallinn, Estonia and North Estonia Medical Centre Foundation, Tallinn, Estonia.
    Larsson, Matz
    Clinical Health Promotion Centre, University of Lund, and Örebro University Hospital, Örebro, Sweden.
    Polluste, Jaak
    National Institute for Health Development, Tallinn, Estonia and North Estonia Medical Centre Foundation, Tallinn, Estonia.
    Sundblad, Britt-Marie
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Lindqvist, Ari
    Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
    Krokstad, Steinar
    HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway.
    Kankaanranta, Hannu
    Krefting Research Centre, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Kauppi, Paula
    Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
    Sovijärv, Anssi
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Haahtela, Tari
    Skin and Allergy Hospital, Helsinki, Finland.
    Backman, Helena
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden.
    Piirilä, Päivi
    Department of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Occupation, socioeconomic status and chronic obstructive respiratory diseases – the EpiLung Study in Finland, Estonia and Sweden2022In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 191, article id 106403Article in journal (Refereed)
    Abstract [en]

    Objective: To study occupational groups and occupational exposure in association with chronic obstructive respiratory diseases.

    Methods: In early 2000s, structured interviews on chronic respiratory diseases and measurements of lung function as well as fractional expiratory nitric oxide (FENO) were performed in adult random population samples of Finland, Sweden and Estonia. Occupations were categorized according to three classification systems. Occupational exposure to vapours, gases, dusts and fumes (VGDF) was assessed by a Job-Exposure Matrix (JEM). The data from the countries were combined.

    Results: COPD, smoking and occupational exposure were most common in Estonia, while asthma and occupations requiring higher educational levels in Sweden and Finland. In an adjusted regression model, non-manual workers had a three-fold risk for physician-diagnosed asthma (OR 3.18, 95%CI 1.07-9.47) compared to professionals and executives, and the risk was two-fold for healthcare & social workers (OR 2.28, 95%CI 1.14-4.59) compared to administration and sales. An increased risk for physician-diagnosed COPD was seen in manual workers, regardless of classification system, but in contrast to asthma, the risk was mostly explained by smoking and less by occupational exposure to VGDF. For FENO, no associations with occupation were observed.

    Conclusions: In this multicenter study from Finland, Sweden and Estonia, COPD was consistently associated with manual occupations with high smoking prevalence, highlighting the need to control for tobacco smoking in studies on occupational associations. In contrast, asthma tended to associate with non-manual occupations requiring higher educational levels. The occupational associations with asthma were not driven by eosinophilic inflammation presented by increased FENO.

  • 16.
    Lassmann-Klee, Paul G.
    et al.
    Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Finland.
    Piirilä, Päivi L.
    Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Finland.
    Brumpton, Ben
    Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Larsson, Matz
    Clinical Health Promotion Centre, University of Lund, And Örebro University Hospital, Örebro, Sweden.
    Sundblad, Britt-Marie
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Põlluste, Jaak
    National Institute for Health Development, Tallinn, Estonia.
    Juusela, Maria
    The Finnish Institute of Lung Health, FILHA, Helsinki, Finland.
    Rouhos, Annamari
    Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Central Hospital and University of Helsinki, Finland.
    Meren, Mari
    National Institute for Health Development, Tallinn, Estonia. The North Estonia Medical Centre, Tallinn, Estonia.
    Lindqvist, Ari
    Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Finland.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Division of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Langhammer, Arnulf
    HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway and Central Norway Regional Health Authority, Trondheim, Norway.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Sovijärvi, Anssi R.A.
    Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki, Finland.
    Parallel gradients in FENO and in the prevalences of asthma and atopy in adult general populations of Sweden, Finland and Estonia — A Nordic EpiLung study2020In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 173, article id 106160Article in journal (Refereed)
    Abstract [en]

    The prevalence of asthma is higher in Sweden and Finland than in neighbouring eastern countries including Estonia. Corresponding difference in bronchial eosinophilic inflammation could be studied by FENO measurements. We aimed to compare FENO in adult general populations of Sweden, Finland, and Estonia, to test the plausibility of the west-east disparity hypothesis of allergic diseases.

    We conducted clinical interviews (N = 2658) with participants randomly selected from the general populations in Sweden (Stockholm and Örebro), Finland (Helsinki), and Estonia (Narva and Saaremaa), and performed FENO (n = 1498) and skin prick tests (SPT) in 1997–2003.

    The median (interquartile range) of FENO (ppb) was 15.5 (9.3) in Sweden, 15.4 (13.6) in Finland and 12.5 (9.6) in Estonia. We found the lowest median FENO values in the Estonian centres Saaremaa 13.1 (9.5) and Narva 11.8 (8.6). In the pooled population, asthma was associated with FENO ≥25 ppb, odds ratio (OR) 3.91 (95% confidence intervals: 2.29–6.32) after adjusting for SPT result, smoking, gender and study centre. A positive SPT test increased the likelihood of asthma OR 3.19 (2.02–5.11). Compared to Saaremaa, the likelihood of having asthma was higher in Helsinki OR 2.40 (1.04–6.02), Narva OR 2.45 (1.05–6.19), Örebro OR 3.38 (1.59–8.09), and Stockholm OR 5.54 (2.18–14.79).

    There was a higher prevalence of asthma and allergic airway inflammation in adult general populations of Sweden and Finland compared to those of Estonia. Atopy and elevated FENO level were independently associated with an increased risk of asthma. In conclusion, the findings support the earlier west-east disparity hypothesis of allergic diseases.

  • 17.
    Lindberg, Anne
    et al.
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå.
    Linder, Robert
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå.
    Eriksson Ström, Jonas
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå.
    Frølich, Andreas
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå.
    Nilsson, Ulf
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, Umeå University, Umeå.
    Johansson Strandkvist, Viktor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Behndig, Annelie F
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå.
    Blomberg, Anders
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå.
    From COPD epidemiology to studies of pathophysiological disease mechanisms: challenges with regard to study design and recruitment process2017In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 4, no 1, article id 1415095Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is a largely underdiagnosed disease including several phenotypes. In this report, the design of a study intending to evaluate the pathophysiological mechanism in COPD in relation to the specific phenotypes non-rapid and rapid decline in lung function is described together with the recruitment process of the study population derived from a population based study. Method: The OLIN COPD study includes a population-based COPD cohort and referents without COPD identified in 2002-04 (n = 1986), and thereafter followed annually since 2005. Lung function decline was estimated from baseline in 2002-2004 to 2010 (first recruitment phase) or to 2012/2013 (second recruitment phase). Individuals who met the predefined criteria for the following four groups were identified; group A) COPD grade 2-3 with rapid decline in FEV1 and group B) COPD grade 2-3 without rapid decline in FEV1 (≥60 and ≤30 ml/year, respectively), group C) ever-smokers, and group D) non-smokers with normal lung function. Groups A-C included ever-smokers with >10 pack years. The intention was to recruit 15 subjects in each of the groups A-D. Results: From the database groups A-D were identified; group A n = 37, group B n = 29, group C n = 41, and group D n = 55. Fifteen subjects were recruited from groups C and D, while this goal was not reached in the groups A (n = 12) and B (n = 10). The most common reasons for excluding individuals identified as A or B were comorbidities contraindicating bronchoscopy, or inflammatory diseases/immune suppressive medication expected to affect the outcome. Conclusion: The study is expected to generate important results regarding pathophysiological mechanisms associated with rate of decline in lung function among subjects with COPD and the in-detail described recruitment process, including reasons for non-participation, is a strength when interpreting the results in forthcoming studies.

  • 18.
    Räisänen, P.
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Andersson, M.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, C.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, A.
    Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN Unit, Umeå University, Umeå, Sweden.
    Lundbäck, B.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden. Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, E.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden.
    Non-response did not affect prevalence estimates of asthma and respiratory symptoms - results from a postal questionnaire survey of the general population2020In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 173, article id 106017Article in journal (Refereed)
    Abstract [en]

    Background

    A high participation rate is warranted in order to ensure validity in surveys of the general population. However, participation rates in such studies have declined during the last decades.

    Objective

    To evaluate the reasons for and potential effects of non-response in a large population-based survey about asthma and respiratory symptoms in Northern Sweden.

    Methods

    Within the Obstructive Lung Disease In Norrbotten (OLIN) studies, a random sample of 12,000 adults aged 20–79 was invited to a postal questionnaire survey about asthma, allergic rhino-conjunctivitis and respiratory symptoms in 2016. Three reminders were sent. A random sample of 500 non-responders was invited to a telephone interview.

    Results

    The participation rate in the initial mailing was 41.4%, and 9.2%, 5.0%, and 2.6% in the subsequent three reminders and totally 58.3% (n = 6854) responded. Of 500 non-responders selected for telephone interviews, 320 were possible to reach and 272 participated. Male sex, younger age, and current smoking were associated with both late and non-response. The prevalence of asthma and most respiratory symptoms did not differ significantly between responders and non-responders while allergic rhino-conjunctivitis and smoking was more common among non-responders. Reminders increased the participation rate but did not alter risk ratios for smoking and occupational exposures. Reasons for non-response were mainly lack of time and having forgotten to answer.

    Conclusions

    With a response rate of 58.3%, neither the prevalence estimates of asthma, respiratory symptoms nor the associations to risk factors were affected by non-response, while allergic rhino-conjunctivitis and smoking was underestimated in this Swedish population.

  • 19.
    Räisänen, Petri
    et al.
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Andersson, Martin
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Dept of Public Health and Clinical Medicine, Section of Medicine, the OLIN unit, Umeå University, Umeå, Sweden.
    Kankaanranta, Hannu
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Ilmarinen, Pinja
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Andersen, Heidi
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Section of Medicine, the OLIN unit, Umeå University, Umeå, Sweden.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
    High but stable incidence of adult-onset asthma in northern Sweden over the last decades2021In: ERJ Open Research, E-ISSN 2312-0541, Vol. 7, no 3, article id 00262-2021Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of asthma has increased both among children and adults during the latter half of the 20th century. The prevalence among adults is affected by the incidence of asthma not only in childhood but also in adulthood. Time trends in asthma incidence have been poorly studied.

    Aims: The aim of this study was to review the incidence of adult-onset asthma from 1996 to 2006 and 2006 to 2016 and compare the risk factor patterns.

    Methods: In the Obstructive Lung Disease in Northern Sweden (OLIN) studies, two randomly selected population-based samples in the 20-69-year age group participated in postal questionnaire surveys about asthma in 1996 (n=7104, 85%) and 2006 (n=6165, 77%). A 10-year follow-up of the two cohorts with the same validated questionnaire was performed, and 5709 and 4552 responded, respectively. Different definitions of population at risk were used in the calculations of asthma incidence. The protocol followed a study performed between 1986 and 1996 in the same area.

    Results: The crude incidence rate of physician-diagnosed asthma was 4.4 per 1000 person-years (men 3.8, women 5.5) from 1996 to 2006, and 4.8 per 1000 person-years (men 3.7, women 6.2) from 2006 to 2016. When correcting for possible under-diagnosis at study entry, the incidence rate was 2.4 per 1000 person-years from 1996 to 2006 and 2.6 per 1000 person-years from 2006 to 2016. The incidence rates were similar across age groups. Allergic rhino-conjunctivitis was the main risk factor for incident asthma in both observation periods (risk ratio 2.4-2.6).

    Conclusions: The incidence of adult-onset asthma has been stable over the last two decades and has remained at a similar level since the 1980s. The high incidence contributes to the increase in asthma prevalence.

  • 20.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
    Childhood onset asthma is associated with lower educational level in young adults – A prospective cohort study2021In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 186, article id 106514Article in journal (Refereed)
    Abstract [en]

    Background

    Asthma is associated with low socioeconomic status among both children and adults, and adolescents with asthma report more school absenteeism than those without. However, it is unclear whether asthma in childhood and adolescence affects socioeconomic status in adulthood.

    Methods

    Within the Obstructive Lung disease In Northern Sweden Studies, all children in grade 1 and 2 in three municipalities were invited to a questionnaire survey, 97% participated (n=3430). They were followed annually until age 19, and thereafter at age 28 years. In this study, participants at ages 8y, 12y, 19y and 28y (n=2017) were included. Asthma was categorized into childhood onset (up to age 12y) and adolescent onset (from 12 to 19y). Data for assessment of socioeconomic status was collected at 28y and included educational level, occupation, and occupational exposure to gas, dust and/or fumes (GDF).

    Results

    Childhood onset asthma was associated with having compulsory school as the highest educational level at age 28y, also after adjustment for sex, smoking and BMI at age 19y and socioeconomic factors in childhood (OR 4.84 95%CI 2.01-11.65), and the pattern was the same among men and women. However, we found no significant associations between asthma in childhood or adolescence and socioeconomic groups, occupational groups or occupational exposure to GDF at age 28y.

    Conclusions

    Even though asthma in high-income countries, such as Sweden, is well recognised and treated, this study highlight that childhood onset asthma may have a negative long-term effect with regard to educational level in young adulthood.

  • 21.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN unit, Umea University, Sweden.
    Ekström, Magnus
    Department of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Sweden.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN unit, Umeå University, Sweden.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN unit, Umeå University, Sweden.
    Job titles classified into socioeconomic and occupational groups identify subjects with increased risk for respiratory symptoms independent of occupational exposure to vapour, gas, dust, or fumes2018In: European Clinical Respiratory Journal, ISSN 2001-8525, Vol. 5, no 1, article id 1468715Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the ability of three different job title classification systems to identify subjects at risk for respiratory symptoms and asthma by also taking the effect of exposure to vapours, gas, dust, and fumes (VGDF) into account. Background: Respiratory symptoms and asthma may be caused by occupational factors. There are different ways to classify occupational exposure. In this study, self-reported occupational exposure to vapours, gas, dust and fumes was used as well as job titles classifed into occupational and socioeconomic Groups according to three different systems. Design: This was a large population-based study of adults aged 30-69 years in Northern Sweden (n = 9,992, 50% women). Information on job titles, VGDF-exposure, smoking habits, asthma and respiratory symptoms was collected by a postal survey. Job titles were used for classification into socioeconomic and occupational groups based on three classification systems; Socioeconomic classification (SEI), the Nordic Occupations Classification 1983 (NYK), and the Swedish Standard Classification of Occupations 2012 (SSYK). Associations were analysed by multivariable logistic regression. Results: Occupational exposure to VGDF was a risk factor for all respiratory symptoms and asthma (odds ratios (ORs) 1.3-2.4). Productive cough was associated with the socioeconomic groups of manual workers (ORs 1.5-2.1) and non-manual employees (ORs 1.6-1.9). These groups include occupations such as construction and transportation workers, service workers, nurses, teachers and administration clerks which by the SSYK classification were associated with productive cough (ORs 2.4-3.7). Recurrent wheeze was significantly associated with the SEI group manual workers (ORs 1.5-1.7). After adjustment for also VGDF, productive cough remained significantly associated with the SEI groups manual workers in service and non-manual employees, and the SSYK-occupational groups administration, service, and elementary occupations. Conclusions: In this cross-sectional study, two of the three different classification systems, SSYK and SEI gave similar results and identified groups with increased risk for respiratory symptoms while NYK did not give conclusive results. Furthermore, several associations were independent of exposure to VGDF indicating that also other job-related factors than VGDF are of importance.

  • 22.
    Schyllert, Christian
    et al.
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health, Learning and Technology, Nursing and Medical Technology. Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Andersson, Martin
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Andersén, Heidi
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, HUS-Medical Diagnostic Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
    Nwaru, Bright I.
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Krokstad, Steinar
    HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway.
    Rönmark, Eva
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden.
    Socioeconomic inequalities in asthma and respiratory symptoms in a high-income country: changes from 1996 to 20162023In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 60, no 1, p. 185-194Article in journal (Refereed)
    Abstract [en]

    Objective: Low socioeconomic status based both on educational level and income has been associated with asthma and respiratory symptoms, but changes over time in these associations have rarely been studied. The aim was to study the associations between educational or income inequality and asthma and respiratory symptoms among women and men over a 20-year period in northern Sweden. Methods: The study was performed within the Obstructive Lung disease in Northern Sweden (OLIN) research program. Mailed questionnaire surveys were administered to a random sample of adults (20-69 years of age) living in Sweden, in 1996, 2006 and 2016. Data on educational level and income were collected from the national integrated database for labor market research. Results: The educational inequality associated with asthma and asthmatic wheeze tended to decrease from 1996 to 2016, while it increased for productive cough, the latter among men not among women. The income inequality decreased for productive cough, especially for women, while no clear overall trends were found for asthmatic wheeze and asthma, apart from a decrease in income inequality regarding asthma among men. Conclusion: The patterns for socioeconomic inequality differed for asthma and wheeze compared to productive cough, and the results emphasize that education and income do not mirror the same aspects of socioeconomic inequality in a high-income country. Our findings are important for decision makers, not the least on a political level, as reduced inequality, e.g. through education, could lead to reduced morbidity.

  • 23.
    Schyllert, Christian
    et al.
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Lindberg, Anne
    Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Stridsman, Caroline
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology.
    Andersson, Martin
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Ilmarinen, Pinja
    Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
    Piirilä, Päivi
    Unit of Clinical Physiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
    Krokstad, Steinar
    HUNT Research Centre, Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway.
    Lundbäck, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Dept of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Umeå University, Umeå, Sweden.
    Low socioeconomic status relates to asthma and wheeze, especially in women2020In: ERJ Open Research, E-ISSN 2312-0541, Vol. 6, no 3, article id 00258-2019Article in journal (Refereed)
    Abstract [en]

    Low socioeconomic status (SES) has been associated with asthma and wheezing. Occupational group, educational level and income are commonly used indicators for SES, but no single indicator can illustrate the entire complexity of SES. The aim was to investigate how different indicators of SES associate with current asthma, allergic and nonallergic, and asthmatic wheeze. In 2016, a random sample of the population aged 20-79 years in Northern Sweden were invited to a postal questionnaire survey, with 58% participating (n=6854). The survey data were linked to the national Integrated Database for Labour Market Research by Statistics Sweden for the previous calendar year, 2015. Included SES indicators were occupation, educational level and income. Manual workers had increased risk for asthmatic wheeze, and manual workers in service for current asthma, especially allergic asthma. Primary school education associated with nonallergic asthma, whereas it tended to be inversely associated with allergic asthma. Low income was associated with asthmatic wheeze. Overall, the findings were more prominent among women, and interaction analyses between sex and income revealed that women, but not men, with low income had an increased risk both for asthmatic wheeze and current asthma, especially allergic asthma. To summarise, the different indicators of socioeconomic status illustrated various aspects of associations between low SES and asthma and wheeze, and the most prominent associations were found among women.

  • 24.
    Schyllert, Christian
    et al.
    Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Luleå, Sweden.
    Lindberg, Anne
    Umeå University, Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN unit, Luleå, Sweden.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit.
    Stridsman, Caroline
    Umeå University, Department of Public Health and Clinical Medicine, Section of Medicine/the OLIN unit, Luleå, Sweden.
    Bhatta, Laxmi
    Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway.
    Kankaanranta, Hannu
    Department of Respiratory Medicine, Seinäjoki Central Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Seinäjoki, Finland.
    Piirila, Päivi
    Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.
    Lundback, Bo
    Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Ronmark, Eva
    Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit, Luleå, Sweden.
    Backman, Helena
    Luleå University of Technology, Department of Health Sciences, Nursing and Medical technology. Umeå University, Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN unit.
    Risk factor pattern for asthma in 1996, 2006 and 2016 in Sweden – the OLIN and Nordic EpiLung studies2020In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 56, no Suppl 64, article id 425Article in journal (Other academic)
    Abstract [en]

    Background: During the second half of the 20th century the prevalence of asthma has increased and smoking habits and socioeconomy has changed in Sweden.

    Aim: To analyze risk factor patterns for current asthma in 1996, 2006 and 2016.

    Methods: Three cross-sectional random samples from the same area of Sweden, 20-69 years, participated in population surveys with the same validated questionnaire in 1996 (n=7104 participants, 85% response rate), 2006 (n=6165, 77%) and 2016 (n=5466, 53%). Current asthma was defined as physician-diagnosed asthma with symptoms common in asthma and/or asthma medication use during the last 12 months. Socioeconomic classification was based on occupation. Risk factors for current asthma were analyzed by multivariable logistic regression.

    Results: A family history of asthma yielded the highest odds ratios (OR) all three years with ORs 3.19-3.66. Data on occupational exposure to gas, dust or fumes (GDF) was not available in 1996, but associated with current asthma in both 2006 (1.86, 1.51-2.30) and 2016 (1.70, 1.37-2.10). Ex-smoking was a risk factor in 1996 (1.39, 1-12-1.73) and 2006 (1.38, 1.11-1.71) but not in 2016 (1.15, 0.92-1.44). Manual workers in service and industry, non-manual employees and self-employed had increased risk for current asthma in 2016, but not in 1996 or 2006, compared to professionals and executives.

    Conclusion: The risk factor pattern for asthma among adults has changed in Sweden from 1996 to 2016. While occupational exposure to GDF was a prominent and constant risk factor for asthma, ex-smoking lost significance in 2016, and socioeconomic differences with regard to occupation emerged.

  • 25.
    Stridsman, Caroline
    et al.
    Luleå University of Technology, Department of Health Sciences, Nursing Care. The OLIN Studies.
    Svensson, My
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Medicine, Umeå University.
    Johansson Strandkvist, Viktor
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Hedman, Linnea
    Luleå University of Technology, Department of Health Sciences, Nursing Care. Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Occupational and Environmental Medicine, Umeå University.
    Backman, Helena
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Occupational and Environmental Medicine, Umeå University.
    Lindberg, Anne
    Department of Public Health and Clinical Medicine, The OLIN Unit/Division of Medicine, Umeå University.
    The COPD Assessment Test (CAT) can screen for fatigue among patients with COPD2018In: Therapeutic Advances in Respiratory Disease, ISSN 1753-4658, E-ISSN 1753-4666, Vol. 12, article id 1753466618787380Article in journal (Refereed)
    Abstract [en]

    Background:

    Fatigue is one of the most common symptoms among subjects with chronic obstructive pulmonary disease (COPD), but is rarely identified in clinical practice. The aim of this study was to evaluate the association between fatigue and health-related quality of life (HRQoL) assessed with clinically useful instruments, both among subjects with and without COPD. Further, to investigate the association between fatigue and the COPD Assessment Test (CAT)-energy question.

    Methods:

    Data were collected in 2014 within the population-based OLIN COPD study. Subjects with (n = 367) and without (n = 428) COPD participated in clinical examinations including spirometry and completed questionnaires about fatigue (FACIT-Fatigue, clinically relevant fatigue ⩽43), and HRQoL (EQ-5D-VAS, lower score = worse health; CAT, lower score = fewer symptoms/better health).

    Results:

    Subjects with clinically relevant fatigue had worse HRQoL measured with EQ-5D-VAS, regardless of having COPD or not. Decreasing EQ-5D-VAS scores, any respiratory symptoms and anxiety/depression were associated with clinically relevant fatigue also when adjusted for confounders. Among subjects with COPD, clinically relevant fatigue was associated with increasing total CAT score, and CAT score ⩾10. The proportion of subjects with clinically relevant fatigue increased significantly, with a higher score on the CAT-energy question, and nearly 50% of those with a score of 2, and 70% of those with a score of ⩾3, had clinically relevant fatigue.

    Conclusions:

    Fatigue was associated with respiratory symptoms, anxiety/depression and worse HRQoL when using the clinically useful instruments EQ-5D-VAS and CAT. The CAT-energy question can be used to screen for fatigue in clinical practice, using a cut-off of ⩾2.

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