Significant cancer inequalities may exist across the United Kingdom (UK). Data are required to delineate and quantify these inequalities. This scoping review was undertaken to map the research evidence on UK cancer inequalities and determine the current data available, and the data gaps, that, if filled, could inform a strategy to reduce them. 444 studies were included. Their distribution across inequality domains, care pathways and cancer sites was uneven. The majority of studies were based on administrative datasets, notably cancer registry data, with a wide-range of methods used to define inequality groups. No UK-wide population-based evidence was identified. The landscape of data available in the UK to study cancer inequalities is uneven. Although there is a large volume of evidence available, there remain major gaps in both the data available and the knowledge base they are deployed to generate. This deficit needs to be addressed as a matter of urgency.

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Western Australian Department of Health. Background Chronic coronary heart disease (CCD) is associated with a high healthcare burden and expenditure in Western societies, yet population-level data on CCD are limited. Use of hospitalisation data to investigate CCD epidemiology has not been well explored. Our aim was to describe characteristics of patients hospitalised with CCD and to estimate the long-term risk of coronary outcomes in this cohort. Method We used Western Australian state-wide linked hospitalisation/mortality data to identify all hospitalisations for CCD, comprised stable angina (SA, ICD-10-AM I20.1-I20.9) and chronic ischaemic heart disease (IHD, I25) from 2002 – 2017. Index admissions were defined as the first SA or chronic IHD admission in the study period. 14-years of hospitalisation history data were used to identify prior medical history, including admissions for acute coronary syndromes (ACS) +/- angiography, PCI and CABG. Kaplan-Meier survival analyses were used to estimate risk of readmission for coronary outcomes and procedures using up to 15-years of follow-up from linked morbidity/mortality data. Results There were 32,557 index SA and 29,505 index chronic IHD admissions from 2002-2017. SA index case number declined by -3.9%/year while chronic IHD admissions increased steadily (+5.3%/year, age-adjusted). The mean age was 66 years for SA and chronic IHD index admissions, with women on average 3 years younger than men; median length of stay was 3 days. Women comprised a higher proportion of SA admissions (37.8%) than chronic IHD (26.9%, p<0.0001). SA admissions were more likely to be emergency admissions (45.6% vs 13.4%) and have comorbidities including diabetes, hypertension and stroke. Patients with a chronic IHD admission were more likely to undergo angiography only (65.3% vs 46.7%) or revascularisation (20.6% vs 12.9%) during the index admission. Around 1/3 of SA and chronic IHD patients had a prior ACS admission (n=9964 and 8291 respectively); around half of these prior ACS admissions occurred in the 1-year preceding the index SA and chronic IHD admissions (Figure), with the majority occurring in the 90 days immediately prior to the index admission. Following an index SA or chronic IHD admission, the risk of ACS within the initial year of follow-up was 9.4% in men and 8.6% in women with SA, and 5.6% in chronic IHD men and women. This risk increased to >20% in both groups with 15 years of follow-up. The 15-year risk of CVD mortality was 4.3% in men and 4.2% in women following a chronic IHD admission; similar long-term risks were seen following SA admissions. Conclusion The heterogeneity in clinical profile and outcomes between patients admitted for SA versus chronic IHD requires cautious interpretation of hospitalisation data to inform the epidemiology of CCD. However, while mortality risk is low, the risk of ACS readmission is high, indicating significant ongoing morbidity and healthcare burden of CCD.

AbstractBackgroundAlthough morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.Methods and resultsAnalyses used national administrative electronic hospital records in England, Scotland, and Wales for 2016–21. Admissions and procedures during the pandemic (2020–21) related to six major cardiovascular conditions [acute coronary syndrome (ACS), heart failure (HF), stroke/transient ischaemic attack (TIA), peripheral arterial disease (PAD), aortic aneurysm (AA), and venous thromboembolism(VTE)] were compared with the annual average in the pre-pandemic period (2016–19). Differences were assessed by time period and urgency of care.In 2020, there were 31 064 (−6%) fewer hospital admissions [14 506 (−4%) fewer emergencies, 16 560 (−23%) fewer elective admissions] compared with 2016–19 for the six major cardiovascular diseases (CVDs) combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries [−10 996 (−15%) fewer admissions]. However, these reductions were offset by higher than expected total emergency admissions [+25 878 (+6%) higher admissions], notably for HF and stroke in England, and for VTE in all three countries. Analyses for procedures showed similar temporal variations to admissions.ConclusionThe present study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

In 2009. Cullen published ‘Crossroads or threshold? Sport and exercise medicine (SEM) as a specialty in the UK’. The editorial describes a ‘crossroads’ created by establishing SEM registrar posts but a lack of SEM National Health Service (NHS) consultant posts. The ‘threshold’ relates to the potential opportunities of establishing adequate SEM consultant posts to service the general population in the UK. In this editorial, the authors will examine ‘what lies beyond the crossroads’ and explore how the medical specialty of SEM in the UK has developed, the current challenges faced and discuss the recent vote (May 2023) in favour of dissolving the two largest SEM UK organisations to combine and reform as a college of SEM.

Purpose Cardiovascular disease (CVD) is the leading cause of morbidity and mortality, affecting over 523 million people globally. Atherosclerotic diseases, particularly ischemic heart disease (IHD) and stroke, are the primary mediators of CVD burden and trends, with half of CVD deaths attributed to IHD, and another quarter to ischemic stroke. The aim of this review was to provide an overview of world-wide trends in the burden of atherosclerotic CVD. Methods A literature review of published studies reporting regional or global trends or burden of CVD was undertaken, with a specific focus on atherosclerotic-mediated CVDs. Findings While long-term trends in age-standardized rates of CVD mortality and incidence indicate substantial declines in disease burden, the impact of population growth and ageing has contributed to a continued increase in the absolute number of people living with CVD. Additionally, when data are restricted to the most recent decade, there are indications that even declines in age-standardized CVD rates may have attenuated. Trends are also heterogeneous across countries and regions, with a relative increase in CVD burden in developing countries and differing trends within countries. The impact of the COVID-19 pandemic resulted in substantial short-term reductions in hospitalization rates for major atherosclerotic CVDs including acute coronary syndromes and heart failure in some countries. Implications Recent attenuation of declines in atherosclerotic CVDs with increasing absolute burden has significant implications for health systems and resource availability, with the impact of the COVID-19 pandemic on longer-term trends in CVD yet to be clearly established.

There is an increasing clinical focus on chronic coronary disease (CCD), yet population-level data on outcomes in CCD patients are limited. Our aim was to describe characteristics of people hospitalised with CCD and measure the short and long-term risk of cardiovascular outcomes by sex. We used state-wide linked hospitalisation/mortality data to identify CCD patients based on first (index) hospitalisation for stable angina (SA; ICD-10-AM I20.1–I20.9) or chronic ischaemic heart disease (IHD; I25) in 2002–2017. Kaplan-Meier survival analyses were used to estimate risk of acute coronary syndrome (ACS) and CVD death during 15-years follow-up from the linked dataset. There were 32,696 index SA (38% female) and 29,365 index chronic IHD (27% female) cases, with overall mean age of 66 years in men and 69 years in women in both groups. Men admitted with SA were more likely to receive angiography+/-revascularisation compared to women (66% vs 50% respectively, p<0.0001); but there was no difference between men and women for chronic IHD admissions (94% men, 91% women). One- and 15-year risk of ACS was greater in SA than chronic IHD patients, with minimal difference by sex (Table). Risk of CVD mortality was 1.4% at 1-year in SA and chronic IHD patients, increasing to 13.7% in men and 14.5% women at 15 years. There is a high short- and long-term risk of ACS or CVD death after index CCD hospitalisation irrespective of sex, indicating need for improved clinical management and secondary prevention of CCD in both sexes.Tabled 1Table. Risk of ACS following SA or chronic IHD index admission (%, 95% CI)Index admissionMenWomen1 year15 years1 year15 yearsSA (n=32,696)10.5 (10.1, 10.9)39.9 (38.8, 41.0)9.9 (9.3, 10.4)39.1 (37.3, 40.9)Chronic IHD (n=29,365)6.4 (6.1,6.8)31.1 (29.4, 32.9)6.4 (5.9, 7.0)34.6 (31.1, 38.2) Open table in a new tab

Objective Cardiovascular multimorbidity (CVM) is the co-occurrence of multiple cardiovascular disease subtypes (CVDs) in one person. Because common patterns and incidence of CVM are not well-described, particularly in women, we conducted a descriptive study of CVM in the Million Women Study, a large population-based cohort of women.Methods UK women aged 50–64 years were followed up using hospital admissions and mortality records for an average of 19 years. CVM was defined as having ≥2 of 19 selected CVDs. The age-specific cumulative incidence of CVM between age 60 and 80 years was estimated. The numbers and proportions of individual, pairs and other combinations of CVDs that comprised incident CVM were calculated. For each individual CVD subtype, age-standardised proportions of the counts of other co-occurring CVDs were estimated.Results The age-specific likelihood of having CVM nearly doubled every 5 years between age 60 and 80 years. Among 1.2 million women without CVD at study baseline, 16% (n=196 651) had incident CVM by the end of follow-up. Around half of all women with CVM had a diagnosis of ischaemic heart disease (n=102 536) or atrial fibrillation (n=96 022), almost a third had heart failure (n=72 186) and a fifth had stroke (n=40 442). The pair of CVDs with the highest age-adjusted incidence was ischaemic heart disease and atrial fibrillation (18.95 per 10 000 person-years). Over 60% of individuals with any given CVD subtype also had other CVDs, after age standardisation.Conclusions CVM is common. The majority of women with any specific CVD subtype eventually develop at least one other. Clinical and public health guidelines for CVD management should acknowledge this high likelihood of CVM.

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council of AustraliaHealy Medical Research Foundation Background Case fatality is an important indicator of severity and quality of care for myocardial infarction (MI). Most studies focus on hospitalised case fatality, which does not capture the total burden of MI deaths. Additionally, changes in diagnostic criteria and acute clinical care, and evidence that identifying all coronary heart disease (CHD) events better captures this patient group,1 have led to suggestions that a different definition of case fatality is required. Purpose The aim of the study was to determine the impact of different definitions of case fatality on the composition of fatal cases, and to measure trends in case fatality across a range of case definitions. Methods A whole-state linked hospital/death dataset was used to identify all MI, acute coronary syndromes (ACS) and CHD events (fatal + nonfatal) from 1997-2015. The traditional MI case fatality definition included all MI deaths as the numerator, stratified as MI hospitalisation with death ≤28 days, non-MI hospitalisation with MI death ≤28 days, or pre-hospital MI deaths. The denominator was all MIs (fatal plus nonfatal MI). ACS and a broader CHD definition were trialled, with ACS or CHD deaths as the numerator respectively, stratified in a similar manner as MI. Case fatality was age-standardised by 5-year age group using the internal age distribution of each definition as the standard. Results From 1997 to 2015, there were 76,928 MI events, 126,470 ACS events, and 235,100 CHD events. Of the MI cohort, 64.1% were men, and 13.0% had a prior MI, with a similar pattern in the ACS and CHD cohorts. For the traditional definition of MI case fatality, 10,819 deaths (53.9%) occurred pre-hospital, 4990 deaths in those hospitalised for MI and dying ≤28 days (24.8%), and 4271 MI deaths (21.3%) ≤28 days of a non-MI hospitalisation (Figure). Using the broadest CHD definition of case fatality, there was a similar proportion of pre-hospital deaths, but a higher proportion of CHD deaths in those with a non-CHD hospitalisation. In men, age-standardised MI case fatality declined from 40.0% in 1997 to 17.3% by 2015; in women, the decline was from 41.9% to 18.2%. In contrast, using the ACS and broad CHD definitions, age-standardised case fatality was lower than for MI throughout the study period, with a smaller temporal decline (ACS: men 22.2% to 13.1%, women 20.5% to 13.0%; CHD: men 20.6% to 12.4%, women 19.3% to 12.3%). Conclusion Despite substantial falls in MI case fatality, the fatal burden remains high. Regardless of the case fatality definition, pre-hospital deaths from acute or all CHD have remained high over time, highlighting the need to target the pre-hospital setting. Caution is needed when using different definitions of case fatality to ensure relevant statistics are used, particularly for temporal trends. Figure Legend. Proportion of MI deaths occurring ≤28 days after MI hospitalisation (2), ≤28 days after non-MI hospitalisation (3), and pre-hospital (4).

AimTo analyse the timing and scale of temporal changes in rates of hospitalised myocardial infarction (MI) in England by age and sex from 1968 to 2016.MethodsMI admissions for adults aged 15–84 years were identified from electronic hospital data. We calculated age-standardised and age-specific rates, and examined trends using joinpoint.ResultsFrom 1968 to 2016, there were 3.5 million admissions for MI in England (68% men). Rates increased in the early years of the study in both men and women, peaked in the mid-1980s (355 per 100 000 population in men; 127 in women) and declined by 38.8% in men and 37.4% in women from 1990 to 2011. From 2012, however, modest increases were observed in both sexes. Long-term trends in rates over the study period varied by age and sex, with those aged 70 years and older having the greatest and most sustained increases in the early years (1968–1985). During subsequent years, rates decreased in most age groups until 2010–2011. The exception was younger women (35–49 years) and men (15–34 years) who experienced significant increases from the mid-1990s to 2007 (range +2.1%/year to 4.7%/year). From 2012 onwards, rates increased in all age groups except the oldest, with the most marked increases in men aged 15–34 years (7.2%/year) and women aged 40–49 (6.9%–7.3%/year) .ConclusionDespite substantial declines in hospital admission rates for MI in England since 1990, the burden of annual admissions remains high. Continued surveillance of trends and coronary disease preventive strategies are warranted.

Background Myocardial infarction mortality has declined since the 1970s, but contemporary drivers of this trend remain unexplained. The aim of this study was to compare the contribution of trends in event rates and case fatality to declines in myocardial infarction mortality in four high-income jurisdictions from 2002-15. Methods Linked hospitalisation and mortality data were obtained from New South Wales (NSW), Australia; Ontario, Canada; New Zealand; and England, UK. People aged between 30 years and 105 years were included in the study. Age-adjusted trends in myocardial infarction event rates and case fatality were estimated from Poisson and binomial regression models, and their relative contribution to trends in myocardial infarction mortality calculated. Findings 1 947 895 myocardial infarction events from a population of 80.4 million people were identified in people aged 30 years or older. There were significant declines in myocardial infarction mortality, event rates, and case fatality in all jurisdictions. Age-standardised myocardial infarction event rates were highest in New Zealand (men 893/100 000 person-years in 2002, 536/100 000 person-years in 2015; women 482/100 000 person-years in 2002, 271/100 000 person-years in 2015) and lowest in England (men 513/100 000 person-years in 2002, 382/100 000 person-years in 2015; women 238/100 000 person-years in 2002, 173/100 000 person-years in 2015). Annual age-adjusted reductions in event rates ranged from -2.6% (95% CI -3.0 to -2.3) in men in England to -4.3% (-4.4 to -4.1) in women in Ontario. Age-standardised case fatality was highest in England in 2002 (48%), but declined at a greater rate than in the other jurisdictions (men -4.1%/year, 95% CI -4.2 to -4.0%; women -4.4%/year, -4.5 to -4.3%). Declines in myocardial infarction mortality rates ranged from -6.1%/year to -7.6%/year. Event rate declines were the greater contributor to myocardial infarction mortality reductions in Ontario (69.4% for men and women), New Zealand (men 68.4%; women 67.5%), and NSW women (60.1%), whereas reductions in case fatality were the greater contributor in England (60% in men and women) and for NSW men (54%). There were greater contributions from case fatality than event rate reductions in people younger than 55 years in all jurisdictions, with contributions to mortality declines varying by country in those aged 55-74 years. Event rate declines had a greater impact than changes in case fatality in those aged 75 years and older. Interpretation While the mortality burden of myocardial infarction has continued to fall across these four populations, the relative contribution of trends in myocardial infarction event rates and case fatality to declining mortality varied between jurisdictions, including by age and sex. Understanding the causes of this variation will enable optimisation of prevention and treatment efforts. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Objectives: Elderly patients requiring emergency general surgery (EGS) are at high risk for complications due to preexisting malnutrition. Thus, correcting nutritional deficits perioperatively is essential to improve outcomes. However, even in patients unable to tolerate enteral nutrition, initiation of parenteral nutrition (PN) is often delayed due to concerns of associated complications. In this study, we hypothesized that in elderly EGS patients with relative short-term contraindications to enteral nutrition, early administration of PN is as safe as delayed administration. Furthermore, early PN may improve outcomes by enhancing caloric intake and combatting malnutrition in the immediate perioperative period. Design and Setting: A single-institution, retrospective review was performed at a quaternary academic medical center. Participants: Participants consisted of 58 elderly patients >65 years of age admitted to the EGS service who required PN between July 2017 and July 2020. Measurements: Postoperative outcomes of patients started on PN on hospital day 0-3 (early initiation) were compared to patients started on PN on hospital day 4 or later (late initiation). Bivariate analysis was conducted using the Chi-square or Fisher’s exact test for categorical variables and the Wilcoxon-Mann-Whitney test and F-test for continuous variables. Results: Fifty-eight patients met inclusion criteria, with 27 (46.6%) patients receiving early PN and 31 (53.4%) receiving late PN. Both groups shared similar baseline characteristics, including degree of frailty, body mass index, and nutritional status at time of admission. Complications associated with PN administration were negligible, with no instances of central venous catheter insertion-related complications, catheter-associated bloodstream infection, or factors leading to early termination of PN therapy. A significantly higher proportion of patients in the early administration group met 60% of their caloric goal within 72 hours of admission (62.9% versus 19.5%, p=0.0007). Patients receiving late PN demonstrated a significantly higher rate of unplanned admission to the intensive care unit (38.7% versus 14.8%, p=0.04). Moreover, there was a 21.5% reduction in mortality among patients in the early initiation group compared to patients in the late initiation group (33.3% versus 54.8%, p=0.10). Conclusions: Early initiation of PN in hospitalized elderly EGS patients was not associated with increased adverse events compared to patients undergoing delayed PN administration. Furthermore, patients receiving early PN demonstrated a 2.6-fold decrease in the rate of unplanned admission to the intensive care unit and trended toward improved mortality. Based on these results, further prospective studies are warranted to further explore the safety and potential benefits of early PN administration in elderly surgical patients unable to receive enteral nutrition.

This Review presents data describing the health burden of cardiovascular disease (CVD) within and across the WHO European Region. CVD remains the most common cause of death in the region. Deaths from CVD in those aged <70 years, commonly referred to as premature, are a particular concern, with >60 million potential years of life lost to CVD in Europe annually. Although more women than men die from CVD, age-standardized rates of both morbidity and death are higher in men, and these differences in rates are greatest in individuals aged <70 years. Large inequalities in all measures of morbidity, treatment and mortality can be found between countries across the continent and must be a focus for improving health. Large differences also exist in the data available between countries. The development and implementation of evidence-based preventive and treatment approaches must be supported in all countries by consistent surveillance and monitoring, such that we can quantify the health burden of CVD as well as target interventions and provide impetus for action across Europe.

AIMS:The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. METHODS AND RESULTS:In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5-23.1%] vs. 15.7% (IQR 14.5-21.1%)}, diabetes [7.7% (IQR 7.1-10.1%) vs. 5.6% (IQR 4.8-7.0%)], and among males smoking [43.8% (IQR 37.4-48.0%) vs. 26.0% (IQR 20.9-31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0-10.8) vs. 16.7% (IQR 13.9-19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655-8115)] compared with high-income [2235 (IQR 1896-3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. CONCLUSION:A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest.

Fluoxetine is commonly prescribed in adolescent depression, but the neural mechanisms underlying its action remain poorly understood. Here, we used resting-state functional magnetic resonance imaging to investigate the effects of a single dose of fluoxetine vs. placebo in adolescents with major depressive disorder. In contrast with previous studies in adults that have demonstrated an acute effect of antidepressants on activity within the default mode network, a single dose of fluoxetine did not alter activity in this network in adolescent depression. There were unexpected group activity differences in the motor network, which should be clarified in future research.

OBJECTIVES To study trends in stroke mortality rates, event rates, and case fatality, and to explain the extent to which the reduction in stroke mortality rates was influenced by changes in stroke event rates or case fatality. DESIGN Population based study. SETTING Person linked routine hospital and mortality data, England. PARTICIPANTS 795 869 adults aged 20 and older who were admitted to hospital with acute stroke or died from stroke. MAIN OUTCOME MEASURES Stroke mortality rates, stroke event rates (stroke admission or stroke death without admission), and case fatality within 30 days after stroke. RESULTS Between 2001 and 2010 stroke mortality rates decreased by 55%, stroke event rates by 20%, and case fatality by 40%. The study population included 358 599 (45%) men and 437 270 (55%) women. Average annual change in mortality rate was -6.0% (95% confidence interval -6.2% to -5.8%) in men and -6.1% (-6.3% to -6.0%) in women, in stroke event rate was -1.3% (-1.4% to -1.2%) in men and -2.1% (-2.2 to -2.0) in women, and in case fatality was -4.7% (-4.9% to -4.5%) in men and -4.4% (-4.5% to -4.2%) in women. Mortality and case fatality but not event rate declined in all age groups: the stroke event rate decreased in older people but increased by 2% each year in adults aged 35 to 54 years. Of the total decline in mortality rates, 71% was attributed to the decline in case fatality (78% in men and 66% in women) and the remainder to the reduction in stroke event rates. The contribution of the two factors varied between age groups. Whereas the reduction in mortality rates in people younger than 55 years was due to the reduction in case fatality, in the oldest age group (>= 85 years) reductions in case fatality and event rates contributed nearly equally. CONCLUSIONS Declines in case fatality, probably driven by improvements in stroke care, contributed more than declines in event rates to the overall reduction in stroke mortality. Mortality reduction in men and women younger than 55 was solely a result of a decrease in case fatality, whereas stroke event rates increased in the age group 35 to 54 years. The increase in stroke event rates in young adults is a concern. This suggests that stroke prevention needs to be strengthened to reduce the occurrence of stroke in people younger than 55 years.

Reported associations between coffee consumption and an increased risk of pancreatic cancer could be due to residual confounding by smoking and/or biased recall of coffee consumption in retrospective studies. Studying associations prospectively in never smokers should minimize these problems, but thus far such studies have included relatively small numbers of cases. In our study, 309,797 never‐smoking women self‐reported typical daily coffee consumption at a mean age of 59.5 years (SD 5.0 years) and were followed up for a median of 13.7 years (IQR: 12.2–14.9) through record linkage to national health cancer and death registries. During this period, 962 incident cases of pancreatic cancers were registered. Cox regression was used to calculate adjusted relative risks [RRs] of incident pancreatic cancer with 95% confidence intervals [CIs] in relation to coffee consumption at baseline. After adjustment for potential confounding factors, including body mass index and alcohol consumption, RRs of pancreatic cancer in never‐smokers who reported usually consuming 1–2, 3–4, and ≥ 5 cups of coffee daily, compared to nondrinkers of coffee, were 1.02 (CI 0.83–1.26), 0.96 (0.76–1.22), and 0.87 (0.64–1.18), respectively (trend p = 0.2). A meta‐analysis of results from this cohort and 3 smaller prospective studies found little or no statistically significant association between coffee consumption and pancreatic cancer risk in never smokers (summary RR = 1.00, CI 0.86–1.17 for ≥2 vs. zero cups of coffee per day).