Showing papers by "Timo Hakulinen published in 2014"

Non-cancer morbidity among Estonian Chernobyl cleanup workers: a register-based cohort study

Abstract: Objective: To examine non-cancer morbidity in the Estonian Chernobyl cleanup workers cohort compared with the population sample with special attention to radiation-related diseases and mental health disorders. Design: Register-based cohort study. Setting: Estonia. Participants: An exposed cohort of 3680 men (cleanup workers) and an unexposed cohort of 7631 men (population sample) were followed from 2004 to 2012 through the Population Registry and Health Insurance Fund database. Methods: Morbidity in the exposed cohort compared with the unexposed controls was estimated in terms of rate ratio (RR) with 95% CIs using Poisson regression models. Results: Elevated morbidity in the exposed cohort was found for diseases of the nervous system, digestive system, musculoskeletal system, ischaemic heart disease and for external causes. The most salient excess risk was observed for thyroid diseases (RR=1.69; 95% CI 1.38 to 2.07), intentional self-harm (RR=1.47; 95% CI 1.04 to 2.09) and selected alcohol-related diagnoses (RR=1.25; 95% CI 1.12 to 1.39). No increase in morbidity for stress reactions, depression, headaches or sleep disorders was detected. Conclusions: No obvious excess morbidity consistent with biological effects of radiation was seen in the exposed cohort, with the possible exception of benign thyroid diseases. Increased alcohol-induced morbidity may reflect alcohol abuse, and could underlie some of the higher morbidity rates. Mental disorders in the exposed cohort were probably under-reported. The future challenge will be to study mental and physical comorbidities in the Chernobyl cleanup workers cohort.

Economic evaluation of cancer registration in Europe

Abstract: Background: Little has been reported on costs of cancer registration, and standard indicators have not yet been identified This study investigated costs and outcomes of a sample of 18 European registries covering a population of 588 million inhabitants Methods: Through a questionnaire, we asked registries for real cost data including personnel, information technology (IT), and infrastructure Staff costs were grouped by professional position and by activity performed As outcomes, besides the production of current data, we considered publications in peer-reviewed journals (last 5 years’ impact factor [IF]) and characteristics of registry websites Results: In our sample, the average cost of cancer registration per inhabitant was €027 at purchasing power standard (PPS) (range €003–€097), while the mean cost per case registered was €5071 PPS (range €6–€213) Personnel costs accounted for an average of 79% of total resources Resources spent in routine activities (an average of 51%, range 28%–87%) were predominant with respect to those allocated to research, with a few exceptions Website quality seemed to be independent of total registry budget Conclusions: The variance in costs of cancer registration across Europe can be attributed mainly to the type of registry (whether national or regional), the size of the covered population, and the national economic profile, expressed as gross domestic product

Chernobyl fallout and cancer incidence in Finland.

Abstract: Twenty-five years have passed since the Chernobyl accident, but its health consequences remain to be well established. Finland was one of the most heavily affected countries by the radioactive fallout outside the former Soviet Union. We analyzed the relation of the estimated external radiation exposure from the fallout to cancer incidence in Finland in 1988-2007. The study cohort comprised all ∼ 3.8 million Finns who had lived in the same dwelling for 12 months following the accident (May 1986-April 1987). Radiation exposure was estimated using data from an extensive mobile dose rate survey. Cancer incidence data were obtained for the cohort divided into four exposure categories (the lowest with the first-year committed dose <0.1 mSv and the highest ≥ 0.5 mSv) allowing for a latency of 5 years for leukemia and thyroid cancer, and 10 years for other cancers. Of the eight predefined cancer sites regarded as radiation-related from earlier studies, only colon cancer among women showed an association with exposure from fallout [excess rate ratio per increment in exposure category 0.06, 95% confidence interval (CI) 0.02-0.11]. No such effect was observed for men, or other cancer sites. Our analysis of a large cohort over two decades did not reveal an increase in cancer incidence following the Chernobyl accident, with the possible exception of colon cancer among women. The largely null findings are consistent with extrapolation from previous studies suggesting that the effect is likely to remain too small to be empirically detectable and of little public health impact.

Regional variation in relative survival—quantifying the effects of the competing risks of death by using a cure fraction model with random effects

Abstract: Summary We extend a mixture cure fraction model with random effects to allow estimation of relative survival of cancer patients by region in a country with a parsimonious number of parameters. The heterogeneity in the expected survival was taken into account such that the expected mortality rate was considered as a random quantity varying across regions. Two sets of random effects were used to describe regional variation, both in the cure fraction and in the relative survival of the non-cured patients. This hierarchical model was fitted in a Bayesian framework to the follow-up data of Finnish colon cancer patients diagnosed in 1975–2004. The public health importance of the regional differences was described by the extra survival time and avoidable deaths that could be gained, if the regional variation were eliminated and all the hospital districts in Finland achieved the most favourable level of relative survival. The differences in relative survival between the districts were quite small during the three decades. If all the districts had achieved the most favourable level of relative survival, the mean survival times of the female patients diagnosed in 1975–1984, 1985–1994 and 1995–2004 would have increased by 5%, 4% and 2% respectively.