NOFE

P1: Harmonizing a Monitoring System for Physical Activity, Sedentary Behavior, and Sleep in Working Age Adults Across Seven European Countries: A Pilot Study in the Joint Action Prevent NCD Project

Anders Husรธy1,2, Knut Eirik Dalene1, Ulf Ekelund1,2

  1. Department of Chronic Diseases, National Institute of Public Health, Oslo, Norway
  2. Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway

Introduction: The Joint Action Prevent NCD (JA PreventNCD) project is the EU’s largest health promotion and disease prevention project to date, with overall aims to reduce the burden of non-communicable diseases (NCD) in Europe through coordinated strategies on health determinants. JA PreventNCD is divided into a total of ten work packages, and this pilot study lies within Work Package 8 โ€“ aiming to enhance European monitoring systems for NCD risk factors.

Aims: To harmonize accelerometer-measured physical activity (PA), sedentary behavior (SB), and sleep in population-based samples of working aged adults in seven European countries using a standardized protocol.

Methods: The Norwegian part of this pilot study is coordinated by the Department of Chronic Diseases at the National Institute of Public Health in Oslo. A random sample of 20โ€“69-year-old men and women from the Oslo and Akershus counties will be invited, aiming to recruit 1000 participants. Two tri-axial accelerometers (Axivity AX3) will be used to measure PA, SB, and sleep, one placed at the right hip (waking hours) and one at the non-dominant wrist (24/7). The participants will be asked to wear the devices for seven consecutive days. For a wear day to be considered valid, we will test different minimum wear time criteria to get the best compromise between sample size and measurement reliability. A minimum of four valid wear days will be required โ€“ including at least one weekend day. The number of steps, and time spent sedentary and in light, moderate, and vigorous intensity PA, respectively, will be calculated using published cut-points validated in working aged adults, using the GGIR package in R. Demographic information, along with self-reported health, diet and supplementary information on PA and SB will be collected through a standardized questionnaire.

Results: The data collection will be completed before the 4th quarter of 2026, with a final report of the pilot to be delivered by March 31st, 2027. Success will be evaluated based on participation rate, percentage valid data, time consumption and manpower requirements.

Conclusions: If successful, this project has potential to be scaled up to a harmonized surveillance system for these key health determinants across Europe.

P2: Familial Cross-Recurrence Risks of Perinatal Outcomes and Neurodevelopmental Disorders

Anna S Hessevik1, Rolv T Lie1,2, Liv G Kvalvik1, Dag Moster1,3

  1. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  2. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
  3. Department of Pediatrics, Haukeland University Hospital, Bergen, Norway

Introduction: Neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD), epilepsy, autism spectrum disorder (ASD) and cerebral palsy (CP), are diagnosed in more than five per cent of Norwegian adolescents. However, the underlying causes of these disorders remain poorly understood. In this study, we explore potentially shared vulnerability factors for NDDs, psychiatric disorders, perinatal death and low Apgar score through sibling analyses.

Aim: Investigate shared underlying factors for NDDs, psychiatric disorders and adverse perinatal outcomes by assessing recurrence and cross-recurrence risks in siblings.

Methods: Norwegian national registries were linked and used to assemble a cohort of 1.3 million singleton sibling pairs born between 1967 and 2019. Stillbirths, neonatal deaths and newborns with five-minute Apgar scores below six were identified. Next, we identified sibling pairs in which the youngest sibling was diagnosed with CP, epilepsy, intellectual disability, ASD, ADHD, bipolar disorder or schizophrenia. Log-binomial regression models were used to estimate recurrence and cross-recurrence risks for the perinatal outcomes and NDDs or psychiatric disorders.

Results: Siblings of individuals who were stillborn, died neonatally or had low Apgar scores had increased risks of these perinatal outcomes and CP. In general, the recurrence risks were higher than cross-recurrence risks. Adjusted relative risks ranged from 1.6 (95% CI 1.1โ€“2.2) for the association between low Apgar score in the oldest sibling and stillbirth in the youngest sibling, to 5.5 (95% CI 4.5โ€“6.7) for recurrence of neonatal death. Additionally, siblings of stillborns had an increased risk of epilepsy (RR 1.2, 95% CI 1.0โ€“1.4), intellectual disability (RR 1.4, 95% CI 1.2โ€“1.7), ASD (RR 1.3, 95% CI 1.0โ€“1.6) and schizophrenia (RR 1.4, 95% CI 1.1โ€“1.8).

Conclusion: Adverse perinatal outcomes may share vulnerability factors with several NDDs, particularly CP, and schizophrenia as these conditions show increased cross-recurrence risks within families.

P3: Trends in Adolescent Overweight and Obesity in 30 European Countries 2002โ€“2022: Results from the Health Behaviour in School-Aged Children Study

Anne-Siri Fismen1, Otto Robert Frans Smith2

  1. Faculty of health and caring science, Western Norway University of Applied Science
  2. Department of Health Promotion, Norwegian Institute of Public Health

Introduction: Overweight and obesity in children and adolescents have become a global public health challenge, making it vital to examine prevalence, trends, and socioeconomic factors within Europe to inform targeted interventions and reduce health inequalities.

Aims: To examine trends in overweight and obesity in European adolescents.

Methods: Cross-sectional data from the WHO collaborative Health Behaviour in School-aged Children (HBSC) study were used to assess self-reported height and weight and socioeconomic status from nationally representative samples of adolescents aged 15 in 30 countries. Multilevel regression analysis was used to examine linear trends in overweight and obesity in six survey rounds from 2002 to 2022.

Results: In 2022, overweight and obesity prevalence ranged from 12.2% in the Netherlands to 24.7% in Canada and increased overall from 2002 to 2022 (RRโ€ฏ1.09, 95% CI 1.08โ€“1.10). The rise was steeper in lower SES groups (low: 1.13; medium: 1.10; high: 1.05; ฯ‡ยฒ(2)โ€ฏ=โ€ฏ39.02, pโ€ฏ<โ€ฏ.001) and was most pronounced in Eastern European countries (ฯ‡ยฒ(29)โ€ฏ=โ€ฏ279.39, pโ€ฏ<โ€ฏ.001), while SES-related trends did not differ significantly between countries (ฯ‡ยฒ(58)โ€ฏ=โ€ฏ63.97, pโ€ฏ=โ€ฏ.275).

Conclusion: The study highlights a significant rise in adolescent overweight and obesity across Europe (2002โ€“2022), with the sharpest increases in Eastern Europe and among lower SES groups, underscoring the need for targeted public health interventions.

P4: Validating Clinical Assumptions for Characterizing Prostate Cancer Aggressiveness Utilizing Historical Cancer Registry Data

Kaitlyn M Tsuruda1, Hilde Langseth1,2, Lauren M Hurwitz3, Stella Koutros3, Trude E Robsahm1, Rune Kvรฅle1,4

  1. Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
  2. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  4. Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway

Introduction: The prognosis of prostate cancer is highly dependent on disease characteristics at diagnosis. Etiologic risk factors may also differentially associate with such characteristics, but missing data on TNM and Gleason score to classify disease aggressiveness may obscure potentially causal relationships.

Aims: This study aimed to develop and validate a set of clinical assumptions to infer values for missing clinical TNM and Gleason scores for improved classification of aggressive and non-aggressive disease.

Methods: 17,542 males in the Norwegian Janus Serum Bank cohort diagnosed with incident prostate cancer from 1974โ€“2022 were included. Clinical assumptions for aggressivity based on published literature and treatment guidelines were validated using positive predictive values (PPVs) among men with non-missing data and long-term prostate cancer-specific mortality. Cases were classified as aggressive (cT4, N1, M1, or Gleason score โ‰ฅ8) or non-aggressive (complete information without aggressive features) both with and without the application of the clinical assumptions.

Results: 14 clinical assumptions for inferring cTNM or Gleason score were developed and validated, 8 of which had a PPV > 95%. Applying all clinical assumptions halved the proportion of cases with unclassifiable aggressivity from 60% to 28%. Cumulative mortality 15 years after diagnosis was similar for cancers previously known to be aggressive (42.6%, 95%CI: 40.5 to 44.8) and for cases assumed to be aggressive based on clinical assumptions (45.1%, 95%CI: 41.6 to 48.7).

Conclusions: Clinical assumptions based on available information can compensate for missing TNM and Gleason scores and substantially improve the classification of aggressive and non-aggressive prostate cancer. This major advancement in disease classification is crucial for identifying etiological risk factors associated with prostate cancer.

P5: The Problem Areas In Diabetes (PAID) scale: A registry-based study applying IRT analyses to compare information provided on diabetes distress when using PAID-20 or the short forms PAID-11 and PAID-5

Anne Haugstvedt1, Roy M Nilsen1, Kyrre Breivik2,3, Marjolein M Iversen1,3, Ragnhild B Strandberg1, Karianne F Lรธvaas4, Tone V Madsen4, Grethe ร… Ueland4,5, Timothy C Skinner6, Ingvild Hernar1,5

  1. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
  2. Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
  3. Centre on Patient-Reported Outcomes Data, Haukeland University Hospital, Bergen, Norway
  4. Norwegian Diabetes Register for Adults, Noklus, Haraldsplass Deaconess Hospital, Bergen, Norway
  5. Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
  6. The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia

Introduction: The emotional impact of living with type 1 diabetes (diabetes distress) is well acknowledged but often unrecognized and/or underreported in diabetes care. Therefore, it is recommended to systematically assess diabetes distress in clinical diabetes practice. The Problem Areas In Diabetes (PAID) scale is one of the most commonly used Patient-Reported Outcome measures to assess diabetes distress. Also, shorter versions of the original 20-item PAID (PAID-20) have been suggested and tested. Both PAID-11 and PAID-5 with respectively 11 and 5 items from the original PAID-20, have shown satisfactory psychometric properties in traditional validation studies. However, no studies have explored the possible information lost about diabetes distress when using one of the short forms and no studies have evaluated the performance of each PAID item.

Aims: To 1) evaluate information provided on the latent diabetes distress trait when using the PAID-20, PAID-11 or PAID-5, and 2) evaluate the information provided by each scale item.

Methods: Using nationwide registry data from 10,190 individuals with type 1 diabetes in Norway, we applied Item Response Theory (IRT) analyses to compare test information curves for PAID-20, PAID-11, PAID-5 and their scale items.

Results: The test information curve for PAID-20 captured an overall broader range of the latent distress trait compared to the other versions. At test information level โ‰ฅ10, the ranges (SD under/above mean) were: PAID-20: -1.30 to 3.32; PAID-11: -1.17 to 2.76; and PAID-5: -0.59 to 2.27. Six PAID-20 items had flat information curves with limited contribution to the latent trait, whereas the PAID-11 included 11 of the 12 items most frequently reported as serious problem areas.

Conclusions: The PAID-20 captures most information on the latent diabetes distress trait, but includes items with limited contribution. PAID-11 also provides satisfactory information and includes items that gave satisfactory information and captures the most serious problem areas. The PAID-5 covers limited aspects of distress. Overall, the PAID-11 appears to be a good choice for assessing diabetes distress in both research and clinical practice.

P6: AI-driven handwriting recognition for digitalization of health data from paper questionnaires

Rafael Nozal Caรฑadas1, Marit Waaseth2, Bjรธrn-Richard Pedersen3, Marko Lukic3, Karina Standahl Olsen1

  1. Department of Community Medicine, UiT The Arctic University of Norway, Tromsรธ, Norway
  2. Department of Pharmacy, UiT The Arctic University of Norway, Tromsรธ, Norway
  3. HistLab, Department of Archaeology, History and Religious Studies, UiT The Arctic University of Norway, Tromsรธ, Norway
  4. Center for faculty development (HelPed), UiT The Arctic University of Norway, Tromsรธ, Norway

Introduction: Health data from questionnaires is a backbone of epidemiological research using data from cohorts and other study designs. Today, data collections are done digitally, but excessive amounts of data are still available only in paper format. Currently, the price of processing 50,000 2-page questionnaires using market solutions, including scanning and translation of medication names to ATC codes, would be at least 1.5 MNOK.

Aims: This project aims to provide a cost-effective solution for digitalizing health- and medication data from hand-written questionnaires frequently used in cohort studies, within the framework of Norwegian data protection regulations.

Methods: In the Norwegian Women and Health (NOWAC) study, 42,000 out of 50,000 2-page paper questionnaires remain unprocessed. For digitalization we used Visual Language Models (VLM) to process checkboxes, and Computer Vision libraries (CV) to process handwritten numbers and text, such as medication names. In the pilot phase, the method was designed and tested using mock questionnaires on three different computers, and all the code was run locally without an internet connection. Results were compared to those of 8,000 manually processed questionnaires.

Results: Preliminary results from the pilot are promising, and include metrics of the methods, data quality, and the cost of AI-driven handwriting recognition compared to manual processing of questionnaires. However, running the model on all 50,000 questionnaires in the Norwegian Service for Sensitive Data (TSD) has so far been hindered by lack of access to Graphics Processing Units (GPU) within TSD.

Conclusions: The pilot phase has yielded promising results. However, when processing the full collection of 50,000 questionnaires, all data will have to be kept within TSD. For the time being, the Norwegian framework for approved handling of sensitive data remains a considerable bottleneck for cost-effective digitalization of health data, as the appropriate computerization resources are currently not available for researchers.

P7: Risk of Acute Somatic Hospital Admissions among Seafarers: A Registry-Based Study in Norway

Sahil Gulati1,2, Stein Hรฅkon Lรฅstad Lygre1, Marit Grรธnning1, Jon Magnus Haga1,2

  1. Norwegian Centre for Maritime and Diving Medicine, Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
  2. Department of Global Public Health and Primary Care, University of Bergen, Norway

Introduction: Medical certification is used to assess the fitness of seafarers for work at sea, yet little is known about the prognostic value of these assessments for future health outcomes. Given the unique occupational risks and barriers to timely healthcare access in maritime settings, understanding predictors of acute somatic illness is important.

Aims: To examine whether seafarers who received a time-limited health certificate or a declaration of unfitness had a higher risk of acute somatic hospital admissions compared to those who received a full health certificate.

Methods: This registry-based nationwide cohort study included all seafarers aged 18โ€“70 years who underwent medical examinations in Norway between 2018 and 2019 (n=43,758). Health outcomes were linked to acute somatic hospital admissions over a 24-month follow-up using data from the Norwegian Patient Registry. Hazard ratios (HRs) for hospital admissions were estimated using Cox proportional hazards models in two follow-up intervals: 0โ€“3 months and 3โ€“24 months. Models were adjusted for age, gender, education, and centrality of residence.

Results: Compared to seafarers who received full health certificates, those declared unfit had substantially elevated risk of acute hospital admission in both time periods: 0โ€“3 months (HR 5.13, 95% CI 3.27โ€“8.04) and 3โ€“24 months (HR 2.63, 95% CI 2.07โ€“3.34). Seafarers who received time-limited certificates also had increased risk: 0โ€“3 months (HR 2.02, 95% CI 1.39โ€“2.93) and 3โ€“24 months (HR 2.45, 95% CI 2.15โ€“2.79). Adjustment for sociodemographic factors did not substantially alter the effect estimates.

Conclusions: Seafarers who receive a declaration of unfitness, as well as those who receive time-limited health certificates, face a significantly higher risk of acute hospital admissions compared to seafarers who receive full health certificates. These findings highlight the importance of medical certification to identify individuals at risk of future somatic illness and to ensure safety at sea.

P8: Post-Deployment Mortality from Violent Causes among 41,170 Norwegian Male Veterans from International Peacekeeping Missions

Leif Aage Strand1, Inger Rudvin1, Kristine Vejrup1, Elin Anita Fadum1,2

  1. Norwegian Armed Forces Joint Medical Services, Institute of Military Epidemiology, Sessvollmoen, Norway
  2. Norwegian Medical Association, Institute for Studies of the Medical Profession, Oslo, Norway

Introduction: Despite the fact that military personnel are selected for service on the basis of good physical and mental health and typically show lower all-cause mortality than the general population, studies show increased mortality from violent causes among soldiers after completing service in conflict areas.

Aims: To assess post-discharge mortality from violent causes, inclusive of accidents, in a cohort of 41,170 Norwegian male military peacekeepers.

Methods: The cohort was established by the Norwegian Armed Forces Health Registry and comprises virtually all Norwegian military men who participated in international peacekeeping missions between 1978 and 2023. The cohort members were followed-up for violent-cause deaths after discharge from peacekeeping service through 2023. We calculated standardized mortality ratios (SMRs) by dividing the observed numbers of deaths with the expected numbers calculated from national population rates in Norway, for the whole follow-up and for the first 5 years, and 5+ years post-discharge separately.

Results: We observed a total of 577 violent deaths during the overall study period, which was close to the expected number (SMR 0.98). The SMR was elevated during the first 5 years (SMR 1.19) and slightly lowered during the rest of the follow-up (SMR 0.93), a pattern also seen for accident-related mortality, inclusive of accidental falls. Mortality from transport accidents was elevated throughout the full follow-up but the risk was particularly high during the first 5 years (SMR 1.54). The risk of death by accidental poisoning was half that of expected during our study period (SMR 0.53), and was particularly low in the first 5 years (1 observed vs. 16 expected).

Conclusions: Our study found an elevated risk of mortality from violent causes during the first 5 years after discharge from service in international peacekeeping operations, due to high risk of death by transport accidents. Previous studies among war veterans observed that risky driving was associated with increasing exposure to traumatic events during deployment. Such exposure is probably more important than military selections before deployment, but self-selection of risk takers into peacekeeping service might also have contributed to our results.

P9: Childhood Socioeconomic Position and Later-Life Mortality: A Linked Study from The Historical Population Register of Norway and The Tromsรธ Study

Petja L Langholz1, Hilde L Sommerseth1, Doris T Kristoffersen1, Laila A Hopstock2

  1. Department of Archaeology, History, Religious Studies and Theology, UiT The Arctic University of Norway, Tromsรธ, Norway
  2. Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsรธ, Norway

Introduction: Low socio-economic position in child- and adulthood (CSEP) is associated with increased risk of illness and early death. In Norway, most research on CSEP and health is based on data from 1960 onwards, by using the modern Population Register. The Historical Population Register of Norway (HPR) is a national database under construction compiling data from historical censuses and church books covering the period 1801โ€“1964. By linking historical censuses, it is possible to study individuals across and between generations. Thus, HPR yields unique possibilities for in-depth studies of trends in SEP including familial transmission.

Aims: In this study, we aimed to examine whether there is an association between parental socioeconomic status and their children’s health in later adulthood, that is, at age 50 and above.

Methods: We investigated the relationship between HPR-registered parental occupation and later-life health by linking HPR to a longitudinal population-based health survey, the Tromsรธ Study 1974โ€“2016, Northern Norway. Cox proportional hazards models and (ordinal) logistic regression were used to investigate the associations between fathersโ€™ occupation in 1950 and all-cause mortality (n=7,056), as well as chronic disease prevalence and self-rated health (n=4,576) at age 50 and older among the Tromsรธ Study participants born between 1930 and 1955.

Results: Prospectively measured CSEP was associated with later-life health, although to a varying degree depending on the health indicator under study. Self-rated health showed the strongest association with CSEP and a clear social gradient that was more pronounced among women. We found only minor differences in all-cause mortality and varying patterns for prevalence of chronic diseases by CSEP. High CSEP was associated with lower prevalence of chronic respiratory diseases for both women and men, and higher odds for cancer among women.

Conclusions: This study contributes to the health inequality literature which aims to exploit new opportunities for record linkage across the life-course. Self-rated health is a subjective measure that captures physical, mental, and social aspects of health. Social inequalities in self-rated health can be explained by differences in both childhood conditions and socioeconomic circumstances in adulthood, which in turn influence lifestyle, working conditions, mental health, and other factors.

P10: Sexual Dysfunction in Men with Obstructive Sleep Apnoea: The Role of Daytime Sleepiness in a Population-Based Study

Elin Helga Thorarinsdottir1,2, Anders Flataker Viken3, Silver Peeter Siiak4, Vivi Schlunssen5,6, Marianne Lรธnnebotn7, Randi Jacobsen Bertelsen3, Francisco Gรณmez Real3, Thorarinn Gislason2,8

  1. Primary Health Care of the Capital Area, Reykjavik, Iceland
  2. Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  3. Department of Clinical Science, University of Bergen, Bergen, Norway
  4. Tartu University Andrology Centre, Tartu, Estonia
  5. Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
  6. Department of Public Health, Aarhus University, Aarhus, Denmark
  7. Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
  8. Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland

Introduction: Sexual dysfunction is common in middle-aged and older men and may be underrecognized in those with obstructive sleep apnoea (OSA), particularly when accompanied by excessive daytime sleepiness (EDS), which is increasingly associated with adverse health outcomes in OSA.

Aims: To assess the association between sexual dysfunction and OSA, focusing on subjective sleepiness and risk of dozing, in a population-based sample of middle-aged and older men.

Methods: Cross-sectional analysis of data from the Respiratory Health in Northern Europe (RHINE) cohort. Population-based, multicentre study conducted in Tartu (Estonia), Reykjavik (Iceland), Bergen (Norway), and Aarhus (Denmark). A total of 1,700 men (mean age 61.0 years; SD 6.7) who completed the Aging Males’ Symptoms (AMS) questionnaire and provided data on OSA symptoms and relevant covariates were included. Moderate to severe symptoms of sexual dysfunction was defined by the AMS scale: decreased morning erections, reduced sexual performance, and decreased libido. Participants were categorized by OSA diagnosis and by the Multivariable Apnoea Prediction (MAP) index (>0.5 = high risk). Sleepiness was defined by the Epworth Sleepiness Scale (ESS score >10 = โ€œrisk of dozingโ€) and subjective report of โ€œfeeling sleepyโ€ โ‰ฅ3 days/week. Four sleepiness phenotypes were identified: non-sleepy, risk of dozing only, feeling sleepy only and both. Associations were examined using multivariable logistic regression adjusted for age, BMI, smoking, diabetes, hypertension, cardiovascular disease, and study centre.

Results: Sexual dysfunction was significantly more prevalent among men with diagnosed or suspected OSA. Subjects with suspected OSA based on MAP and reporting โ€œboth risk of dozing and feeling sleepyโ€ had the highest odds of sexual dysfunction (ORs up to 4.10; 95% CI 2.27โ€“7.38). Weaker or no significant associations were observed for snoring, snorting/gasping, or reporting โ€œrisk of dozing onlyโ€ without subjective sleepiness.

Conclusions: Subjective sleepiness is strongly associated with sexual dysfunction in men with OSA, independent of traditional cardiometabolic risk factors. Assessing sleepiness phenotypes may improve recognition of clinically significant OSA in men presenting with sexual health concerns.

P11: Potentially Modifiable Risk Factors for Dementia in Norway: The HUNT4 70+ Study

Merete Ellingjord-Dale1, Bjรธrn Heine Strand1,2,3, Vegard Skirbekk1,4, Bernt Bratsberg4,5, Teferi Mekonnen Yitayew1, Ekaterina Zotcheva2,3, Geir Selbรฆk2,3,6, Yaakov Stern7, Asta Kristine Hรฅberg8,9, Bo Engdahl1

  1. Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
  2. Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tรธnsberg, Norway
  3. Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
  4. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
  5. Frisch Centre for Economic Research, Oslo, Norway
  6. Department of Geriatric Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  7. Cognitive Neuroscience Division, Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
  8. Department of Neuromedicine and Movement Science, NTNU, Norway
  9. MiDT National Research Center, Center for Innovation, Medical Equipment, and Technology, St Olavs Hospital, Trondheim, Norway

Background: The 2024 Lancet Commission report on dementia identified 14 modifiable dementia risk factors. Since the Norwegian HUNT Study uniquely includes all 14 risk factors in the same individuals throughout adulthood and a study-specific dementia diagnosis, we evaluated the potential for dementia prevention of the 14 risk factors, plus three additional sociodemographic risk factors in this prospective cohort.

Methods: Data from 9,745 participants aged 70+ years from the HUNT4 70+ Study (2017โ€“2019), with study-specific dementia diagnosis were included. The study sample was linked with national administrative registries (1960โ€“2018) and earlier HUNT surveys (1984โ€“2008) with data on risk factors at ages 35โ€“92 years. Inverse probability weighting was applied to account for non-response, and regression was used to assess dementia risk following exposure in early adult-life (<45 years) to low education, in midlife (45โ€“65 years) to hearing loss, elevated LDL-cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use, and in late-life (โ‰ฅ65 years) to social isolation, air pollution, and vision loss. Midlife occupational physical activity, marital- and employment status were added to the Lancet model. The potential for dementia prevention was assessed using population attributable fraction (PAF).

Findings: The total PAF for the 14 Lancet risk factors was 50.9% (95% confidence interval [CI] 37.7โ€“61.4). Including sociodemographic factors increased the PAF to 54.9% (95% CI 42.3โ€“64.7, p<0.0001). In women the total PAF increased from 48.0% (95% CI 29.4โ€“61.7) to 52.2% (95% CI 34.2โ€“65.3, p=0.009) comparing the 14- to the 17-risk factors model. There was no significant difference in men (p=0.71).

Interpretation: Theoretically, addressing all 14 Lancet risk factors could prevent over half of all dementia cases. Adding aspects related to marital- and occupational status have additional risk reduction potential, both overall and in women.

P12: Health capacity to work among older adults in different occupational groups

Kristin Holvik1, Ellen Melbye Langballe2, Asta Hรฅberg3, Vegard Skirbekk1,2, Astri Syse2, Bjรธrn Heine Strand1,2

  1. Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
  2. Norwegian National Centre for Ageing and Health, Tรธnsberg, Norway
  3. Dept of Neuromedicine and Movement Science, Norwegian University of Science & Technology, Trondheim, Norway

Introduction: As life expectancy rises and research shows improved health and function in old age, there is growing political interest in increasing labor force participation among older adults. Yet, it is unclear whether most people maintain the health and functional ability needed to work at older ages.

Aims: To examine how health capacity to work involving physical, mental, and cognitive health and functional capacity in older age varies across occupational groups.

Methods: We examined 55โ€“69-year-olds who participated in the Trรธndelag Health Study (HUNT4, 2017โ€“2019). Health variables covered self-rated health, self-reported memory problems, chronic diseases, pain, functional status, BMI (measured), blood pressure and mental distress (HADS). The data was linked with current employment status and occupation in most recent job (ISCO-08) from Statistics Norway. First, the association between health and employment was assessed among 55โ€“59-year-olds by occupational group and gender, using a linear probability model. Next, coefficients from this model predicted potential health capacity to work in age groups 60โ€“64 and 65โ€“69 years, assuming a uniform effect on employment by health across age. Inverse probability weighting by gender, age, education (three levels), and self-rated health (dichotomous) was used to correct for healthy selection.

Results: Among 12,736 participants aged 55โ€“69 years included in the analysis, 49% were employed. In elementary occupations (ISCO 9, women), 51% of those aged 60โ€“64 were employed with a predicted negative additional health capacity to work (โ€“4 percentage points). At age 65โ€“69, 15% were employed with a predicted 35 percentage points of additional health capacity to work. In manual occupations (ISCO 6โ€“8, men), 74% of those aged 60โ€“64 were employed with a predicted additional capacity of 1 percentage point. At age 65โ€“69, 35% were employed with 31 percentage points of additional capacity. For managers and professionals (ISCO 1โ€“2), a predicted health capacity to work of approximately 90% persisted in older age and both genders.

Conclusions: We found differences in potential health capacity to work across gender, age and occupational groups. Our findings suggest that many older adults, whether currently employed or not, possess untapped health capacity to work, provided they are matched with suitable job opportunities.

P13: Low and inequitable influenza and COVID-19 vaccination coverage among pregnant women in Norway: Nationwide population-based cohort study

Bo T Hansen1, Jesper Dahl1, Margrethe Greve-Isdahl1, Brita A Winje2, Kjersti Margrethe Rydland1, Suzanne Campbell3, Aase SD Pay4,5, Trond M Michelsen6,7, Hinta Meijerink1

  1. Department of Infection control and vaccines, Norwegian Institute of Public Health, Oslo, Norway
  2. Faculty of Health Sciences, Oslo Metropolitan University, 0170 Oslo, Norway
  3. Department of Infection Control Registries, Norwegian Institute of Public Health, Oslo, Norway
  4. Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
  5. Department of Gynecology and Obstetrics, Vestre Viken Hospital Trust, Bรฆrum, Norway
  6. Department of Obstetrics, Division of Obstetrics and Gynecology, Oslo University Hospital, 0424 Oslo, Norway
  7. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway

Introduction: Many countries recommend vaccination against influenza and COVID-19 during pregnancy, but surveillance of coverage is often lacking.

Aims: To estimate the coverage of influenza and COVID-19 vaccination during the second or third trimester of pregnancy in Norway and to investigate its associations with sociodemographic characteristics.

Methods: We combined nationwide individual-level registry data on childbirth, vaccinations and sociodemographic factors for all pregnancies in Norway between 1 September 2021 and 31 December 2022. We estimated maternal influenza and COVID-19 vaccination coverage and its correlates among women whose only indication for influenza vaccination was pregnancy, i.e., during the second and third trimester.

Results: Among 52,833 women eligible for influenza vaccination during pregnancy in the 2021/2022 influenza season, 27.7% (n=14,646) received the influenza vaccine. Similarly, among 50,108 women eligible for COVID-19 vaccination during pregnancy in the study period, 31.8% (n=15,951) received the COVID-19 vaccine. Coverage estimates were lower among mothers with immigrant background, low education, low income, low maternal age, multiple children, those living rurally and those outside the workforce. The lowest coverage was observed among immigrant women (14.5% for influenza, 16.0% for COVID-19 vaccination), with corresponding relative risks (RR) compared to native Norwegian women of 0.44 (95% CI: 0.42, 0.46) and 0.41 (95% CI: 0.39, 0.43). The highest coverage was observed among women with the highest education (38.2% for influenza, 43.6% for COVID-19), with corresponding RRs compared to women with the lowest education of 2.47 (95% CI: 2.33, 2.62) and 2.36 (95% CI: 2.24, 2.49).

Conclusions: The coverage of maternal vaccination against influenza and COVID-19 is insufficient. Additionally, there is high and consistent inequity in uptake. Timely and comprehensive surveillance of maternal vaccination programs should be prioritized to ensure that program performance can be adequately assessed and improved.

P14: Causal inference in evaluating benzene exposure and risk of lymphohematopoetic cancers: a study protocol

Sara Nafisi1,2*, Leon AM Berge1,3, Niki Marjerrison1,3, Nita K Shala1, Ronnie Babigumira1,3, Tom K Grimsrud1, Marit B Veierรธd3, Jo S Stenehjem1,3

  1. Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
  2. Norwegian Research Centre for Womenโ€™s Health, Oslo University Hospital, Oslo, Norway
  3. Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

Introduction: Benzene has been recognised as a cause of acute myeloid leukaemia by the International Agency for Research on Cancer (IARC) since 1979. In their 2017 evaluation of benzene, IARC concluded that positive associations were also observed for other histological subtypes of lymphohematopoietic (LH) cancers: chronic myeloid leukaemia, non-Hodgkin lymphoma, chronic lymphoid leukaemia, and multiple myeloma. There is a need to further clarify benzeneโ€™s association with these LH cancer subtypes, using causal inference methodology to assess the role of exposure time-windows.

Aims: We aim to investigate the time-dependent effect of benzene exposure on the incidence of LH cancer subtypes in offshore petroleum workers using a target trial emulation framework.

Methods: We will use the Norwegian Offshore Petroleum Workers (NOPW) cohort and the Heliport cohort, encompassing 100,000 workers employed offshore 1965โ€“2023. Inclusion criteria will be specified according to the causal roadmap framework. NOPW participants were invited to complete a questionnaire on work history and lifestyle data by the Cancer Registry of Norway (CRN) in 1998 and were followed up since then. Heliport cohort participants were followed up since the start of employment. The two cohorts will be harmonized to create a comprehensive exposure dataset and prospectively analyse risk of LH cancers from 1999 onwards. Between 1999โ€“2023, 823 LH cancer cases were identified by linkage to the CRN. Start of follow-up (time zero) will be 1999 or at employment start and continues until cancer diagnosis, death, or end of follow-up. Benzene exposure will be assessed using an expert-developed job-exposure matrix. Data on potential confounding factors (e.g. smoking and non-offshore benzene exposure) will be retrieved from questionnaire and national registries.

Results: Results will be presented as cumulative incidence (absolute and relative risks) calculated using multi-state models with death as a competing event, using inverse probability of treatment weights to handle potential confounders.

Conclusions: These cohorts, with time-dependent benzene exposure, enable application of a target trial emulation framework, which may contribute to important clarifications regarding benzene exposure and risk of the major histological subtypes of LH cancers, and hence follow up on the latest IARC evaluation of benzene.