Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations

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dc.contributor.author Risnes, Kari
dc.contributor.author Bilsteen, Josephine Funck
dc.contributor.author Brown, Paul
dc.contributor.author Pulakka, Anna
dc.contributor.author Andersen, Anne-Marie Nybo
dc.contributor.author Opdahl, Signe
dc.contributor.author Kajantie, Eero
dc.contributor.author Sandin, Sven
dc.date.accessioned 2021-03-02T15:10:01Z
dc.date.available 2021-03-02T15:10:01Z
dc.date.issued 2021-01-08
dc.identifier.citation Risnes , K , Bilsteen , J F , Brown , P , Pulakka , A , Andersen , A-M N , Opdahl , S , Kajantie , E & Sandin , S 2021 , ' Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations ' , JAMA Network Open , vol. 4 , no. 1 , 2032779 . https://doi.org/10.1001/jamanetworkopen.2020.32779
dc.identifier.other PURE: 160833738
dc.identifier.other PURE UUID: 031a19d9-101f-455b-82f3-f2c2896ae9d4
dc.identifier.other WOS: 000610371600004
dc.identifier.uri http://hdl.handle.net/10138/327368
dc.description.abstract IMPORTANCE Adverse long-term outcomes in individuals born before full gestation are not confined to individuals born at extreme gestational ages. Little is known regarding mortality patterns among individuals born in the weeks close to ideal gestation, and the exact causes are not well understood; both of these are crucial for public health, with the potential for modification of risk. OBJECTIVE To examine the risk of all-cause and noncommunicable diseases (NCD) deaths among young adults born preterm and early term. DESIGN, SETTING, AND PARTICIPANTS This multinational population-based cohort study used nationwide birth cohorts from Norway, Sweden, Denmark, and Finland for individuals born between 1967 and 2002. Individuals identified at birth who had not died or emigrated were followed up for mortality from age 15 years to 2017. Analyses were performed from June 2019 to May 2020. EXPOSURES Categories of gestational age (ie, moderate preterm birth and earlier [23-33 weeks], late preterm [34-36 weeks], early term [37-38 weeks], full term [39-41 weeks] and post term [42-44 weeks]). MAIN OUTCOMES AND MEASURES All-cause mortality and cause-specific mortality from NCD, defined as cancer, diabetes, chronic lung disease, and cardiovascular disease (CVD). RESULTS A total of 6 263 286 individuals were followed up for mortality from age 15 years. Overall, 339 403 (5.4%) were born preterm, and 3 049 100 (48.7%) were women. Compared with full-term birth, the adjusted hazard ratios (aHRs) for all-cause mortality were 1.44 (95% CI, 1.34-1.55) for moderate preterm birth and earlier; 1.23 (95% CI, 1.18-1.29) for late preterm birth; and 1.12 (95% CI, 1.09-1.15) for early-term birth. The association between gestational age and all-cause mortality were stronger in women than in men (P for interaction = .03). Preterm birth was associated with 2-fold increased risks of death from CVD (aHR, 1.89; 95% CI, 1.45-2.47), diabetes (aHR, 1.98; 95% CI, 1.44-2.73), and chronic lung disease (aHR, 2.28; 95% CI, 1.36-3.82). The main associations were replicated across countries and could not be explained by familial or individual confounding factors. CONCLUSIONS AND RELEVANCE The findings of this study strengthen the evidence of increased risk of death from NCDs in young adults born preterm. Importantly, the increased death risk was found across gestational ages up to the ideal term date and includes the much larger group with early-term birth. Excess mortality associated with shorter gestational age was most pronounced for CVDs, chronic lung disease, and diabetes. en
dc.format.extent 12
dc.language.iso eng
dc.relation.ispartof JAMA Network Open
dc.rights cc_by
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject CORONARY-HEART-DISEASE
dc.subject BIRTH-WEIGHT
dc.subject GESTATIONAL-AGE
dc.subject RISK-FACTORS
dc.subject METAANALYSIS
dc.subject VALIDATION
dc.subject MORBIDITY
dc.subject CHILDREN
dc.subject STROKE
dc.subject 3121 General medicine, internal medicine and other clinical medicine
dc.title Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations en
dc.type Article
dc.contributor.organization HUS Children and Adolescents
dc.contributor.organization Lastentautien yksikkö
dc.contributor.organization Clinicum
dc.contributor.organization Children's Hospital
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1001/jamanetworkopen.2020.32779
dc.relation.issn 2574-3805
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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