BACKGROUND AND AIMS:In women with IBD, there are few options to treat pain during pregnancy and prescribers sometimes rely on opioids. We investigated the prevalence of repeated opioid use during the pregnancy period as well as the impact on birth outcomes. METHODS:Using the Danish national registries, we identified pregnancies of women with IBD from January 1, 1997, to June 1, 2023. We defined repeated opioid use as at least two opioid prescriptions with a minimum 30-day interval between them. We examined the prevalence in three separate time periods: (1) nine months before conception; (2) throughout pregnancy; and (3) nine months postpartum, and we calculated adverse birth outcomes. RESULTS:Of 10 904 women with IBD, 237 (2.2%) had repeated use of opioids prior to pregnancy, 220 (2.0%) during pregnancy and 359 (3.3%) postpartum. Women with repeated opioid use prior to pregnancy were significantly more likely to have repeated use during pregnancy (adjusted odds ratio (aOR): 231.50 (95% CI, 159.80-335.36)). Women who had repeated use during pregnancy were significantly more likely to have repeated use during the postpartum period (aOR: 74.98 (95% CI, 53.76-104.57)). Women with repeated use of opioids during pregnancy had statistically significant risks of preterm birth (aOR: 1.87 (95% CI, 1.28-2.74)) and of delivering a small for gestational age infant (aOR: 2.46 (95% CI, 1.41-4.32)). DISCUSSION:The proportions of women who used repeated opioids prior to pregnancy, during pregnancy, and in the postpartum period were low but consequences for neonates can be severe. Providers should screen for opioid use in this population.

BACKGROUND:Despite the common use of opioids in patients with inflammatory bowel disease (IBD), there are limited studies on the prevalence of chronic opioid use in this population. METHODS:We conducted a nationwide Danish register-based study to examine the prevalence proportion of chronic opioid use in patients with IBD from 1996 to 2021. Analysis was performed for patients with Crohn's disease (CD) and ulcerative colitis (UC) and stratified by sex and age groups of young adults (18-39 years), adults (40-59 years), and elderly (+60 years). RESULTS:A total of 51 837 patients with IBD were identified. The prevalence proportion of chronic opioid use increased from 1996 and reached the highest point at 14.26% (95% confidence interval [CI], 13.67%-14.84%) for patients with CD in 2011 and 8.21% (95% CI, 7.88%-8.54%) in patients with UC in 2012. Subsequently, the prevalence proportion of chronic opioid use decreased to 8.88% (95% CI, 8.41%-9.35%) in patients with CD and 4.96% (95% CI, 4.70%-5.21%) in patients with UC by 2021. Throughout the 25-year period, female patients had higher prevalence proportion of chronic opioid use compared with that of male patients. Elderly patients had higher prevalence proportion of chronic opioid use compared with that of adult and young adult patients. DISCUSSIONS:Many patients with IBD rely on chronic opioid use as part of their pain management. Further investigations are needed to study the complications and sequelae of chronic opioid use in patients with IBD.

BACKGROUND:Only approximately 30% of conceptions result in live births. Historically, research has predominantly focused on maternal factors impacting pregnancy success, despite the cause remaining unidentified in most cases. The influence of paternal factors on a couple's likelihood of achieving a successful pregnancy is still not well understood and warrants further investigation. OBJECTIVES:This study aims to examine the chance of biochemical pregnancy, clinical pregnancy, and a live-born child in couples where the male partner has ischemic heart disease. MATERIALS AND METHODS:This nationwide cohort study based on Danish health registries included couples undergoing in vitro fertilization with or without intracytoplasmic sperm injection from 2006 to 2019. The cohort was divided into two groups: exposed and unexposed. The exposed cohort included embryo transfers in couples where the male partner had ischemic heart disease, while the unexposed group included those where the male partner did not have this condition. RESULTS:A total of 101,875 couples with a known male partner were included. Among these, 653 couples were included in the exposed cohort and 101,222 were included in the unexposed cohort. The adjusted odd ratios (ORs) for a biochemical pregnancy, clinical pregnancy, and live-born child were 0.99 (95% confidence interval [CI]: 0.79; 1.23), 0.79 (95% CI: 0.51, 1.23), and 0.94 (95% CI: 0.62, 1.44), respectively. CONCLUSIONS:These findings indicate that paternal ischemic heart disease prior to oocyte retrieval is not associated with a statistically significant decrease in the chances of biochemical pregnancy, clinical pregnancy, or live birth.

Osteogenesis imperfecta (OI) is a group of rare, hereditary diseases caused by mutations to the genes involved in the biosynthesis of collagen type 1. A cardinal feature of OI is the frequent occurrence of fractures. Individuals with OI often experience pain that is not related to fracture episodes. However, little is known about the use of analgesics among people with OI. We aim to examine the use of analgesics in Danes with OI as a measure of pain, using register-based data. This study is a Danish nationwide, population-based, and register-based cohort study. It includes all individuals registered with an OI diagnosis from January 1977 to December 2018, and a reference population matched by birth month, year, and sex. We examined the number of prevalent analgesic users over time and by age, the amount of analgesic use in Defined Daily Doses (DDDs), and the risk of initiating analgesics as well as treatment at a specialised pain centre during the observation period. We present the Sub Hazard Ratio (SHR) [95% confidence interval] for the endpoints comparing the OI cohort to the reference population. Lastly, we evaluated the changes in analgesic use related to fractures in the OI cohort and the proportion of long-term opioid users in both cohorts. A total of 905 individuals with OI and 4542 in the reference population were identified. There were more prevalent analgesic users (71.8% vs. 46.8%) in the OI cohort, with the number of users increasing over time and with age. Individuals in the OI cohort were more likely to initiate analgesics (SHR 1.86 [1.68-2.05]) and specialised pain care (SHR 5.8 [3.1-11.0]) than in the reference cohort. The use of analgesics, as measured in total DDDs, increased shortly after a fracture in the OI cohort but normalised to pre-fracture levels within 6 months. A higher proportion of the OI cohort had repeated dispensed prescriptions of opioids compared to the reference population. Individuals with OI are more likely to use analgesics and to use more analgesics-as measured by DDDs-than non-OI individuals.

This study investigated the annual incidence rates of spine-related hospital diagnoses in Danish children aged 0–17 years from 2009 to 2021. It aimed to assess trends stratified by diagnostic groups, hospital departments, and residential regions. A nationwide register-based cohort study was conducted using data from the Danish National Patient Register and census data. Spine-related diagnoses were identified through International Classification of Disease (ICD-10) codes and categorized into five groups: critical, whiplash, radiating, structural, and regional. Incidence rates (IR) per 100,000 children were calculated and stratified by diagnostic group, hospital department, and region. Temporal trends were visualized using descriptive statistics. The study identified 43,073 children with 78,304 spine-related diagnoses. The median age was 13 years with interquartile range of 5.3, and 55% were female. IRs remained stable over the 13-year period. Whiplash and structural diagnoses decreased after 2015, while regional diagnoses increased until stabilizing in 2019. Regional disparities were noted, with the capital region having higher IRs than other regions. Most diagnoses were managed within orthopedic departments. Conclusion : This study highlights stable IRs of pediatric spine–related diagnoses despite significant changes in diagnostic practices, reflecting a potential shift toward a biopsychosocial approach in hospital care. Regional disparities and variability in diagnostic coding practices emphasize the need for standardized protocols and equitable care pathways. Further research could validate coding practices, investigate care trajectories, and explore long-term outcomes to optimize pediatric spine care. What is Known:• Pediatric spinal pain is increasingly reported in epidemiological surveys, with substantial health burden.• Hospital-based diagnostic patterns in children remain largely unexplored. What is New:• This is the first national registry-based study of spine-related hospital diagnoses in Danish children.• Marked regional variation and changing departmental patterns suggest a need for standardization.

BACKGROUND:High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported. METHODS:We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011-2013, 2014-2016, 2017-2019, and 2020-2022. RESULTS:We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%). CONCLUSIONS:In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin). SIGNIFICANCE STATEMENT:This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

Background: About 15% of all pregnancies end in pregnancy loss. As most studies have focused on maternal factors little is known regarding the influence of paternal factors on the chance of successful pregnancy. Objectives: This cohort study aims to assess the chance of biochemical pregnancy, clinical pregnancy, and live-born children in couples where the male partner has diabetes mellitus (DM). Materials and methods: We performed a nationwide cohort study. Couples undergoing assisted reproductive technology treatment from 2006 to 2019 were included. The exposed cohorts comprised embryo transfers in couples with paternal type 1 DM (T1DM), type 2 DM (T2DM), or mixed type DM (TMDM). The unexposed cohort included embryo transfers in couples without paternal DM. Results: A total of 101,875 embryo transfers were included. Of these, 503 males had T1DM, 225 males had T2DM, 263 males had TMDM, and 100,884 did not have DM. For paternal T1DM, the adjusted OR for achieving a biochemical pregnancy, clinical pregnancy, and live-born child were 0.97 (95% CI 0.77-1.23), 1.08 (95% CI 0.65-1.79), and 0.75 (95% CI 0.49-1.14), respectively. For paternal T2DM, the adjusted OR for achieving a biochemical pregnancy, clinical pregnancy, and live-born child were 0.80 (95% CI 0.56;1.16), 0.67 (95% CI 0.32-1.41), and 1.03 (95% CI 0.48-2.20), respectively. For the paternal TMDM, the adjusted OR for achieving a biochemical pregnancy, clinical pregnancy and livebirth were 0.95 (95% CI 0.67-1.33), 1.31 (95% CI 0.56-2.92), and 1.19 (95% CI 0.59-2.38), respectively. Conclusion: Paternal DM was not associated with a statistically significant decreased chance of biochemical pregnancy, clinical pregnancy, or live birth

Background The development of diseases with a possible autoimmune pathogenesis is common in adults with inflammatory bowel disease (IBD). In early onset IBD, it may differ but the evidence is sparse. We aimed to investigate the risk and time span from IBD diagnosis to outcomes with different associated disorders with possible autoimmune pathogenesis.Methods A register-based study included all Danish patients with early onset of IBD (<= 18 years) between 1980 and 2021 and 50 matched references without IBD for each case. We examined the risk of type 1 and type 2 diabetes, celiac disease, thyroid disease, rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis in Cox regression models.Results In total, 6822 patients with IBD were identified, and 337 728 matched references. The median age at the time of IBD diagnosis or index date for the matched references was 16 years (25-75 percentile: 13-18 years), and the median age at the time of an outcome or at the end of follow-up was 28.1 years (25-75 percentile: 21.5-37.0 years). According to the cumulative incidence plots psoriatic arthritis, and spondyloarthritis was diagnosed approximately 10 years after the IBD onset, and the remaining outcomes later. The adjusted hazard ratio after full follow-up was 4.72 (95% CI, 3.85-5.80) for psoriatic arthritis, 5.21 (95% CI, 4.17-6.50) for spondyloarthritis, 2.77 (95% CI, 1.92-4.00) for celiac disease, 2.15 (95% CI, 1.54-3.01) for rheumatoid arthritis, 1.69 (95% CI, 1.23-2.32) and 1.64 (95% CI, 1.21-2.21) for type 1 and type 2 diabetes, respectively. For thyroid disease, it was 1.16 (95% CI, 0.97-1.40).Conclusions The risk estimates were significantly increased for all outcomes at the end of follow-up, except for thyroid disease, but according to the cumulative incidence plots, only psoriatic arthritis and spondyloarthritis occurred earlier in the IBD cohort than in the matched references. Children and adolescents diagnosed with inflammatory bowel disease are at increased risk of developing several diseases with possible autoimmune pathogenesis compared with a matched reference group. Cumulative incidence curves showed that psoriatic arthritis and spondyloarthritis debut in young adulthood when compared with a matched reference group without IBD. Graphical Abstract

In this nationwide cohort study, we found no association between the use of Glucagon-like peptide 1 receptor agonists and the risk of ileus or intestinal obstruction in patients with IBD.

PURPOSE:Today about 12.5% of all children are conceived using assisted reproductive technology. Intracytoplasmic sperm injection (ICSI) was introduced without knowledge of the possible long-term adverse consequences on the offspring health. We aimed to examine risk of neurodevelopmental disorders, asthma, epilepsy, inflammatory bowel disease, rheumatoid arthritis, thyroid disease, and diabetes in the offspring conceived with ICSI, compared with offspring conceived with in vitro fertilization (IVF) and natural conception. PATIENTS AND METHODS:All offspring conceived using ICSI, IVF, and natural conception in Denmark from July 9th, 1994 until December 31st, 2019 were included in this nationwide cohort study using Danish national health registries. RESULTS:Median follow-up time was 10 years (6-16 years, interquartile range (IQR)) for offspring conceived with ICSI (n = 22,906), 13 years (7-20 years, IQR) for offspring conceived with IVF (n = 32,458), and 13 years (8-20, IQR) for offspring born after natural conception (n = 1,397,791). Several of the outcomes occurred rarely. The most frequent outcome in offspring conceived with ICSI was neurodevelopmental disorder which did not show an increased risk when comparing offspring conceived with ICSI with offspring conceived with IVF (hazard ratio 1.02 (95 % CI: 0.92;1.12)) and natural conception (hazard ratio 0.96 (95 % CI: 0.88;1.40)). CONCLUSION:Reassuringly, there were no statistically significantly increased risks of the examined outcomes in offspring conceived with ICSI. Before any firm conclusions are made, this study should be replicated in large populations with longer follow-up time.

Background Only about 30% of conceptions end in live births, yet there are little data on paternal causes of pregnancy loss. Men with inflammatory bowel disease may have multiple disease-related issues that may affect fertility. We aimed to examine pregnancy outcomes in women undergoing assisted reproduction whose male partners had Crohn's disease or ulcerative colitis.Methods This nationwide study included all embryo transfers registered in the Danish Assisted Reproduction Registry from January 2, 2006, to September 3, 2019. The exposed cohort included embryo transfers from couples in which the male partners had Crohn's disease or ulcerative colitis. The unexposed cohort included embryo transfers in which male partners did not have inflammatory bowel disease.Results For fathers with ulcerative colitis, the adjusted odds ratio for a positive biochemical pregnancy (positive human chorionic gonadotropin) was 1.14 (95% confidence interval [CI], 0.92-1.42), for a clinical pregnancy (positive vaginal ultrasonography at 7-8 weeks) was 0.91 (95% CI, 0.59-1.40), and for a live birth was 0.99 (95% CI, 0.71-1.60). For fathers with Crohn's disease, the adjusted odds ratio for a biochemical pregnancy was 0.83 (95% CI, 0.63-1.09), for a clinical pregnancy was 0.58 (95% CI, 0.34-0.97), and for a live birth was 0.88 (95% CI, 0.51-1.55).Conclusions These findings may indicate that partners of men with Crohn's disease may have an increased risk of early pregnancy loss. Future studies should confirm these results and examine the impact of paternal medications, paternal disease activity, and other factors associated with chronic inflammatory bowel disease. Using the Danish IVF registry, we examined embryo transfers from couples in which the male partners had Crohn's disease or ulcerative colitis. We found that partners of men with Crohn's disease may have an increased risk of early pregnancy loss.

Purpose This study based exclusively on register-data provides a scientific basis for further research on the use of opioids in patients with degenerative back disorder. The main objective of this study is to investigate whether surgically treated back pain patients have the same risk of being long-term opioid users as back pain patients who did not have surgery. Methods We performed a retrospective register-based cohort study based on all patients diagnosed with a degenerative back disorder at the Spine Center of Southern Denmark from 2011 to 2017. The primary outcome of the study was the use of opioids two years after the patient's first hospital contact with a degenerative back condition. Fisher exact tests were used for descriptive analyses. The effect of the surgery was estimated using adjusted logistic regression analyses. Results For patients who used opioids before the first hospital contact, the ratio for long-term opioid use for surgically treated patients is significantly lower than for non-surgically treated patients (OR = 0.75, 95%CI (0.66; 0.86)). For patients who did not use opioids before, the ratio for long-term opioid use for surgically treated patients does not differ from that of non-surgically treated patients (OR = 1.01, 95%CI (0.84; 1.22)). Conclusions Patients with a degenerative back disorder who used opioids before their first visit to a specialized spine center have a lower risk of becoming long-term opioid users if they were surgically treated. Whereas for patients who did not use opioids before the first visit, surgical treatment does not influence the risk of becoming long-term opioid users.

Background Patients with back pain are often in contact with 2–4 hospital departments when receiving a back pain diagnosis and treatment. This complicates the entire clinical course description. There is, currently, no model that describes the course across departments for patients with back pain. This study aims to construct an interdisciplinary clinical course using the central register’s information. Methods All patients with back pain referred for diagnosis and treatment at the Spine Center of Southern Denmark from 1 January 2011 until 31 December 2017 were included. By means of information available in central registers, we described the interdisciplinary clinical course for the individual patient, including information on all contacts at different departments, and proposed three different models to define the index and final date. The index date was defined as the first visit without a previous contact to the Spine Center for 6 months for model I, 1 year for model II, and 2 years for model III. The final date was defined as the last visit without following contacts for 6 months, 1 year, and 2 years, respectively, for models I, II, and III. Results A total of 69,564 patients (male: n = 30,976) with back pain diagnosis were identified. The three models all leave the information on the entire course at the hospital. In model I (64,757 clinical back pain courses), the time span to a possible previous clinical course is too short to secure the start of a new course (14% had two or more). With at least 1 year between a possible previous contact, model II (60,914 courses) fits the everyday clinical practice (9% had two or more clinical back pain courses). In model III (60,173 courses) it seems that two independent courses might be connected in the same course as only 5% had two or more clinical back pain courses. Conclusions Despite contact with different departments, the clinical course for back pain patients can be described by information from the central registers. A one-year time interval fits best the clinicians’ everyday observations.

Despite the relevance of semantic fluency measures to risk for dementia and psychiatric disorders, little is known about their genetic and environmental architecture in mid-to-late life. Participants represent 21,684 middle-aged and older adult twins (M = 60.84 years, SD = 11.21; Range 40-89) from six studies from three countries participating in the Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium. All completed the same measure of semantic fluency (naming animals in 60 seconds). Results revealed small-to-moderate phenotypic associations with age and education, with education more strongly and positively associated with fluency performance in females than males. Heritability and environmental influences did not vary by age. Environmental variance was smaller with higher levels of education, but this effect was observed only in males. This is the largest study to examine the genetic and environmental architecture of semantic fluency, and the first to demonstrate that environmental influences vary based on levels of education.

BACKGROUNDTransient cognitive impairment is common in adult patients of all ages following anaesthesia and surgery. Apolipoprotein E (APOE) ε4 carriers may have a larger deterioration in short-term cognitive function after major surgery compared with APOE ε4 noncarriers.OBJECTIVESThe aim was to examine the effect of APOE ε4 on the association between exposure to surgery and anaesthesia, and subsequent cognitive functioning. A more pronounced deterioration in cognitive function in APOE ε4 carriers was hypothesised.DESIGNAn observational cross-sectional and a 6 to 10 years longitudinal twin cohort design.SETTINGSurvey and register study of 2936 Danish twins aged 45 to 92 years.MAIN OUTCOME MEASURESCognitive function was assessed using five age-sensitive cognitive tests. In the cross-sectional study, we compared twins exposed to surgery with a reference group (unexposed). Linear regression models were used adjusting for sex and age and stratified by APOE ε4 carrier status. In the longitudinal cognitive follow-up study 1671 twins participated. Intrapair analyses were also performed using 70 same-sexed twin pairs concordant for APOE ε4 carrier status, but discordant for major surgery.RESULTSAPOE ε4 carriers had lower cognitive scores compared with noncarriers, and this was statistically significant in elderly twins 70+ years of age (mean difference, −0.67; 95% CI, −1.14 to −0.17). There was no significant impact on cognitive function after surgery according to APOE ε4 carrier status in the cross-sectional study. Similarly, there was no APOE ε4 modification in the longitudinal study. Also, in the intrapair analyses no evidence was found of lower cognitive score after major surgery compared with the nonexposed cotwins among APOE ε4 carriers.CONCLUSIONNo evidence was found of more pronounced long-term deterioration in cognitive function after surgery among APOE ε4 carriers, but elderly APOE ε4 carriers in general performed worse on the cognitive tests than noncarriers.

BACKGROUND:β-adrenoceptors are widely expressed in different human organs, mediate important body functions and are targeted by medications for various diseases (such as coronary heart disease and heart attack) and many β-adrenoceptor acting drugs are listed on the WHO Model List of Essential Medicines. β-adrenoceptor antagonists are used by billions of patients with neurological disorders, primarily for the treatment of migraine and action tremor (mainly essential tremor), worldwide.RECENT DEVELOPMENTS:An observational study reported a link between the chronic use of the β-adrenoceptor antagonist propranolol and an increased risk of Parkinson's disease, while the chronic use of the β-adrenoceptor agonists was associated with a decreased risk. Further support of this association was provided by a dose-dependent decrease in the risk of Parkinson's disease with chronic β-adrenoceptor agonist (eg, salbutamol) use, and by functional data indicating a possible underlying molecular mechanism. Five additional epidemiological studies have examined the modulation of the risk of Parkinson's disease as a result of the use of β-adrenoceptor-acting drugs in different populations. Overall, similar estimates but different interpretations of the associations were provided. Several findings suggest that the increase in risk of Parkinson's disease associated with β-adrenoceptor antagonists use can be explained by reverse causation because prodromal Parkinson's disease is often associated with non-specific action tremor, which is usually treated with propranolol. The lower risk of Parkinson's disease seen in patients receiving β-adrenoceptor agonists is likely to be indirectly mediated by smoking because smoking has a strong inverse association with Parkinson's disease (people that smoke have a reduced risk of developing Parkinson's disease). Smoking also causes chronic obstructive pulmonary disease, which is treated with β-adrenoceptor-agonist medications. Even if causal, the effect of β-adrenoceptor antagonists on the risk of Parkinson's disease would be small compared with other Parkinson's disease risk factors and would be similar to the risk evoked by pesticide exposure. The estimated risk of Parkinson's disease because of β-adrenoceptor antagonists use corresponds to one case in 10 000 patients after 5 years of propranolol use, and would be considered a very rare adverse effect. Thus, not using β-adrenoceptor antagonists would severely harm patients with recommended indications, such as heart disease or migraine. Similarly, 50 000 people would have to be treated for 5 years with salbutamol to prevent Parkinson's disease in one patient, suggesting that primary preventive therapy studies on disease modification are not warranted. WHERE NEXT?: Epidemiological evidence for a causal relationship between use of β2-adrenoceptor antagonists and the increased risk of Parkinson's disease is weak, with other explanations for the association being more probable. Future observational studies are warranted to clarify this association. However, given the very low risk associated with propranolol, most clinicians are unlikely to change their treatment approach.

We appreciate the comments from Drs. Scherzer, Riise, and Locascio on our article1 on the effects of β2-adrenoceptor (β2AR) antagonists and agonists and risk of Parkinson disease (PD). Since the initial publication,2 this hypothesis has been scrutinized by multiple groups, yielding conflicting results.2–5

The number of very old individuals in the population is rapidly increasing. Previous studies have indicated that many factors known to be strongly associated with survival among middle-aged and elderly show no association among the oldest old. Resting heart rate (RHR) is associated with increased risk of death in the general population as well as in patients with various types of heart disease. The association between RHR and mortality in the very old is the subject of this report. The study population was identified in The Nationwide Danish 1905 Cohort Study (n?=?1086) and comprised 854 subjects with a median age of 95.2?years (range 94.7?95.9), in whom RHR was measured by radial pulse palpation. Participants were followed until death through the civil registration system, and remaining lifespan after RHR measure was used as outcome. Participants were divided into six groups according to RHR (?50, 51?60, 61?70, 71?80, 81?90 and ?91) with the largest group used as the reference group (61?70 beats per minute (bpm)). Survival analyses using Cox? proportional hazards models were performed to study the association between RHR and mortality. Median RHR was 68?bpm in males (IQR 62?76) and 70?bpm (IQR 64?78) in females. After stratifying both sexes into six groups according to RHR, we found no significant difference in remaining lifespan between groups in either males or females. No significantly increased risk was demonstrated in groups with higher RHR. In very old people, elevated RHR is not associated with increased mortality.