Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries
Abstract Background External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and ex...
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2024-11-01
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| Online Access: | https://doi.org/10.1186/s12916-024-03731-2 |
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| author | Josephine Funck Bilsteen Signe Opdahl Anna Pulakka Per Ivar Finseth Weiyao Yin Kristine Pape Jorun Schei Johanna Metsälä Anne-Marie Nybo Andersen Sven Sandin Eero Kajantie Kari Risnes |
| author_facet | Josephine Funck Bilsteen Signe Opdahl Anna Pulakka Per Ivar Finseth Weiyao Yin Kristine Pape Jorun Schei Johanna Metsälä Anne-Marie Nybo Andersen Sven Sandin Eero Kajantie Kari Risnes |
| author_sort | Josephine Funck Bilsteen |
| collection | DOAJ |
| description | Abstract Background External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood. Methods Individual level data from national health registries in Denmark (1978–2001), Finland (1987–2003), Norway (1967–2002), and Sweden (1974–2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016–2018. Gestational age was categorized as “very/moderately preterm” (23–33 weeks), “late preterm” (34–36 weeks), “early term” (37–38 weeks), “full term” (39–41 weeks), and “post term” (42–44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country’s estimates in meta-analyses. Results Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99–1.24) for males and 1.55 (95% CI 1.28–1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04–1.18) and 1.15 (95% CI 1.02–1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34–2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99–1.53] and 1.29 [95% CI 1.16–1.45], respectively) and females (HRs 1.53 [95% CI 0.97–2.41] and 1.35 [95% CI 1.07–1.71], respectively, with some heterogeneity across countries). Conclusions Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males. |
| format | Article |
| id | doaj-art-c214f3fc06b04e8b9d9720adde5915a0 |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| spelling | doaj-art-c214f3fc06b04e8b9d9720adde5915a02024-11-10T12:29:05ZengBMCBMC Medicine1741-70152024-11-0122111310.1186/s12916-024-03731-2Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countriesJosephine Funck Bilsteen0Signe Opdahl1Anna Pulakka2Per Ivar Finseth3Weiyao Yin4Kristine Pape5Jorun Schei6Johanna Metsälä7Anne-Marie Nybo Andersen8Sven Sandin9Eero Kajantie10Kari Risnes11Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyPopulation Health Unit, Finnish Institute for Health and WelfareDepartment of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDepartment of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyDepartment of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and TechnologyPopulation Health Unit, Finnish Institute for Health and WelfareSection of Epidemiology, Department of Public Heath, University of CopenhagenDepartment of Medical Epidemiology and Biostatistics, Karolinska InstitutetDepartment of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyDepartment of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and TechnologyAbstract Background External causes of death, such as accidents, substance use, and suicide, contribute substantially to mortality during adolescence and early adulthood and show marked sex differences. Individuals born preterm are at increased risk of mental disorders, and impaired cognitive and executive functions, potentially increasing their vulnerability to death from external causes. We investigated sex-specific associations between gestational age at birth and mortality from external causes during late adolescence and early adulthood. Methods Individual level data from national health registries in Denmark (1978–2001), Finland (1987–2003), Norway (1967–2002), and Sweden (1974–2001) were linked to form nationwide cohorts. In total, 6,924,697 participants were followed from age 15 years to a maximum of 50 years in 2016–2018. Gestational age was categorized as “very/moderately preterm” (23–33 weeks), “late preterm” (34–36 weeks), “early term” (37–38 weeks), “full term” (39–41 weeks), and “post term” (42–44 weeks). Outcomes were mortality from external causes overall and from the largest subgroups transport accidents, suicide, and drugs or alcohol. We estimated sex-specific hazard ratios (HRs), with full term as the reference, and pooled each country’s estimates in meta-analyses. Results Across gestational ages mortality was higher for males than females. Individuals born very/moderately preterm had higher mortality from external causes, with HRs 1.11 (95% confidence interval [CI] 0.99–1.24) for males and 1.55 (95% CI 1.28–1.88) for females. Corresponding estimates for late preterm born were 1.11 (95% CI 1.04–1.18) and 1.15 (95% CI 1.02–1.29), respectively. Those born very/moderately preterm had higher mortality from transport accidents, but precision was low. For females, suicide mortality was higher following very/moderately preterm birth (HR 1.76, 95% CI 1.34–2.32), but not for males. Mortality from drugs or alcohol was higher in very/moderately and late preterm born males (HRs 1.23 [95% CI 0.99–1.53] and 1.29 [95% CI 1.16–1.45], respectively) and females (HRs 1.53 [95% CI 0.97–2.41] and 1.35 [95% CI 1.07–1.71], respectively, with some heterogeneity across countries). Conclusions Mortality from external causes overall was higher in preterm than full term born among both males and females. A clear sex difference was seen for suicide, where preterm birth was a risk factor in females, but not in males.https://doi.org/10.1186/s12916-024-03731-2MortalityExternal causes of deathSuicideTransport AccidentsDrugsAlcohol |
| spellingShingle | Josephine Funck Bilsteen Signe Opdahl Anna Pulakka Per Ivar Finseth Weiyao Yin Kristine Pape Jorun Schei Johanna Metsälä Anne-Marie Nybo Andersen Sven Sandin Eero Kajantie Kari Risnes Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries BMC Medicine Mortality External causes of death Suicide Transport Accidents Drugs Alcohol |
| title | Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries |
| title_full | Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries |
| title_fullStr | Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries |
| title_full_unstemmed | Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries |
| title_short | Mortality from external causes in late adolescence and early adulthood by gestational age and sex: a population-based cohort study in four Nordic countries |
| title_sort | mortality from external causes in late adolescence and early adulthood by gestational age and sex a population based cohort study in four nordic countries |
| topic | Mortality External causes of death Suicide Transport Accidents Drugs Alcohol |
| url | https://doi.org/10.1186/s12916-024-03731-2 |
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