Prenatal influenza exposure and cardiovascular events in adulthood

Viggo Andreasen, Noelle M. Cocoros, Timothy L. Lash, AI Ozonoff, M Nørgaard, Alfred DeMaria, Henrik Toft Sørensen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Objectives
This study examined the association between prenatal exposure to pandemic influenza and cardiovascular events in adulthood.
Design
Using Danish surveillance data to identify months when influenza activity was highest during three previous pandemics (1918, 1957, and 1968), persons were defined as exposed/unexposed based on whether they were in utero during peak months of one of the pandemics. Episodes of acute myocardial infarction (MI) and stroke were identified in the Danish National Registry of Patients covering all Danish hospitals since 1977.
Setting/Sample
Information from Danish national registries on all persons with a Civil Personal Registry number and birthdates in 1915 through 1922, 1954 through 1960, and 1966 through 1972 was collected.
Main outcome measures
Crude incidence rate ratios (IRRs) were calculated per pandemic. Generalized linear models were fit to estimate IRRs adjusted for sex.
Results
For acute MI, sex-adjusted IRRs for persons in utero during peaks of the 1918, 1957, and 1968 pandemics, compared with those born afterward, were 1·02 (95% confidence interval (CI): 0·99, 1·05), 0·96 (95% CI: 0·87, 1·05), and 1·18 (95% CI: 0·96, 1·45), respectively. For stroke, the corresponding IRRs were 0·99 (95% CI: 0·97, 1·02), 0·99 (95% CI: 0·92, 1·05), and 0·85 (95% CI: 0·77, 0·94), respectively.
Conclusions
There was generally no evidence of an association between prenatal influenza exposure and acute MI or stroke in adulthood. However, survivor bias and left truncation of outcomes for the 1918 pandemic are possible, and the current young ages of persons included in the analyses for the 1957 and 1968 pandemics may warrant later re-evaluation.
OriginalsprogEngelsk
TidsskriftInfluenza and Other Respiratory Viruses
Vol/bind8
Udgave nummer1
Sider (fra-til)83-90
Antal sider8
ISSN1750-2640
DOI
StatusUdgivet - 2014

Citer dette

Andreasen, V., Cocoros, N. M., Lash, T. L., Ozonoff, AI., Nørgaard, M., DeMaria, A., & Sørensen, H. T. (2014). Prenatal influenza exposure and cardiovascular events in adulthood. Influenza and Other Respiratory Viruses, 8(1), 83-90. https://doi.org/10.1111/irv.12202
Andreasen, Viggo ; Cocoros, Noelle M. ; Lash, Timothy L. ; Ozonoff, AI ; Nørgaard, M ; DeMaria, Alfred ; Sørensen, Henrik Toft. / Prenatal influenza exposure and cardiovascular events in adulthood. I: Influenza and Other Respiratory Viruses. 2014 ; Bind 8, Nr. 1. s. 83-90.
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abstract = "ObjectivesThis study examined the association between prenatal exposure to pandemic influenza and cardiovascular events in adulthood.DesignUsing Danish surveillance data to identify months when influenza activity was highest during three previous pandemics (1918, 1957, and 1968), persons were defined as exposed/unexposed based on whether they were in utero during peak months of one of the pandemics. Episodes of acute myocardial infarction (MI) and stroke were identified in the Danish National Registry of Patients covering all Danish hospitals since 1977.Setting/SampleInformation from Danish national registries on all persons with a Civil Personal Registry number and birthdates in 1915 through 1922, 1954 through 1960, and 1966 through 1972 was collected.Main outcome measuresCrude incidence rate ratios (IRRs) were calculated per pandemic. Generalized linear models were fit to estimate IRRs adjusted for sex.ResultsFor acute MI, sex-adjusted IRRs for persons in utero during peaks of the 1918, 1957, and 1968 pandemics, compared with those born afterward, were 1·02 (95{\%} confidence interval (CI): 0·99, 1·05), 0·96 (95{\%} CI: 0·87, 1·05), and 1·18 (95{\%} CI: 0·96, 1·45), respectively. For stroke, the corresponding IRRs were 0·99 (95{\%} CI: 0·97, 1·02), 0·99 (95{\%} CI: 0·92, 1·05), and 0·85 (95{\%} CI: 0·77, 0·94), respectively.ConclusionsThere was generally no evidence of an association between prenatal influenza exposure and acute MI or stroke in adulthood. However, survivor bias and left truncation of outcomes for the 1918 pandemic are possible, and the current young ages of persons included in the analyses for the 1957 and 1968 pandemics may warrant later re-evaluation.",
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Andreasen, V, Cocoros, NM, Lash, TL, Ozonoff, AI, Nørgaard, M, DeMaria, A & Sørensen, HT 2014, 'Prenatal influenza exposure and cardiovascular events in adulthood', Influenza and Other Respiratory Viruses, bind 8, nr. 1, s. 83-90. https://doi.org/10.1111/irv.12202

Prenatal influenza exposure and cardiovascular events in adulthood. / Andreasen, Viggo; Cocoros, Noelle M.; Lash, Timothy L. ; Ozonoff, AI; Nørgaard, M; DeMaria, Alfred; Sørensen, Henrik Toft.

I: Influenza and Other Respiratory Viruses, Bind 8, Nr. 1, 2014, s. 83-90.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Prenatal influenza exposure and cardiovascular events in adulthood

AU - Andreasen, Viggo

AU - Cocoros, Noelle M.

AU - Lash, Timothy L.

AU - Ozonoff, AI

AU - Nørgaard, M

AU - DeMaria, Alfred

AU - Sørensen, Henrik Toft

PY - 2014

Y1 - 2014

N2 - ObjectivesThis study examined the association between prenatal exposure to pandemic influenza and cardiovascular events in adulthood.DesignUsing Danish surveillance data to identify months when influenza activity was highest during three previous pandemics (1918, 1957, and 1968), persons were defined as exposed/unexposed based on whether they were in utero during peak months of one of the pandemics. Episodes of acute myocardial infarction (MI) and stroke were identified in the Danish National Registry of Patients covering all Danish hospitals since 1977.Setting/SampleInformation from Danish national registries on all persons with a Civil Personal Registry number and birthdates in 1915 through 1922, 1954 through 1960, and 1966 through 1972 was collected.Main outcome measuresCrude incidence rate ratios (IRRs) were calculated per pandemic. Generalized linear models were fit to estimate IRRs adjusted for sex.ResultsFor acute MI, sex-adjusted IRRs for persons in utero during peaks of the 1918, 1957, and 1968 pandemics, compared with those born afterward, were 1·02 (95% confidence interval (CI): 0·99, 1·05), 0·96 (95% CI: 0·87, 1·05), and 1·18 (95% CI: 0·96, 1·45), respectively. For stroke, the corresponding IRRs were 0·99 (95% CI: 0·97, 1·02), 0·99 (95% CI: 0·92, 1·05), and 0·85 (95% CI: 0·77, 0·94), respectively.ConclusionsThere was generally no evidence of an association between prenatal influenza exposure and acute MI or stroke in adulthood. However, survivor bias and left truncation of outcomes for the 1918 pandemic are possible, and the current young ages of persons included in the analyses for the 1957 and 1968 pandemics may warrant later re-evaluation.

AB - ObjectivesThis study examined the association between prenatal exposure to pandemic influenza and cardiovascular events in adulthood.DesignUsing Danish surveillance data to identify months when influenza activity was highest during three previous pandemics (1918, 1957, and 1968), persons were defined as exposed/unexposed based on whether they were in utero during peak months of one of the pandemics. Episodes of acute myocardial infarction (MI) and stroke were identified in the Danish National Registry of Patients covering all Danish hospitals since 1977.Setting/SampleInformation from Danish national registries on all persons with a Civil Personal Registry number and birthdates in 1915 through 1922, 1954 through 1960, and 1966 through 1972 was collected.Main outcome measuresCrude incidence rate ratios (IRRs) were calculated per pandemic. Generalized linear models were fit to estimate IRRs adjusted for sex.ResultsFor acute MI, sex-adjusted IRRs for persons in utero during peaks of the 1918, 1957, and 1968 pandemics, compared with those born afterward, were 1·02 (95% confidence interval (CI): 0·99, 1·05), 0·96 (95% CI: 0·87, 1·05), and 1·18 (95% CI: 0·96, 1·45), respectively. For stroke, the corresponding IRRs were 0·99 (95% CI: 0·97, 1·02), 0·99 (95% CI: 0·92, 1·05), and 0·85 (95% CI: 0·77, 0·94), respectively.ConclusionsThere was generally no evidence of an association between prenatal influenza exposure and acute MI or stroke in adulthood. However, survivor bias and left truncation of outcomes for the 1918 pandemic are possible, and the current young ages of persons included in the analyses for the 1957 and 1968 pandemics may warrant later re-evaluation.

KW - Acute myocardial infarction

KW - influenza

KW - pandemic

KW - stroke

U2 - 10.1111/irv.12202

DO - 10.1111/irv.12202

M3 - Journal article

VL - 8

SP - 83

EP - 90

JO - Influenza and Other Respiratory Viruses

JF - Influenza and Other Respiratory Viruses

SN - 1750-2640

IS - 1

ER -