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Introduction: Breathlessness is common in the general population and associated with poorer health. Prevalence, frequencies and overlap of underlying contributing conditions among individuals reporting breathlessness in the general population is unclear. The aim was to evaluate which conditions that were prevalent, overlapping and associated with breathlessness in a middle-aged general population., Method: Cross-sectional analysis of individuals aged 50-65 years in the Swedish CArdioPulmonary bioImage Study pilot. Data from questionnaire, spirometry testing and fitness testing were used to identify underlying contributing conditions among participants reporting breathlessness (a modified Medical Research Scale (mMRC) score ≥ 1). Multivariate logistic regression was used to identify independent associations with breathlessness., Results: 1097 participants were included; mean age 57.5 years, 50% women and 9.8% (n=108) reported breathlessness (mMRC ≥ 1). Main underlying contributing conditions were respiratory disease (57%), anxiety or depression (52%), obesity (43%) and heart disease or chest pain (35%). At least one contributing condition was found in 99.6% of all participants reporting breathlessness, while two or more conditions were present in 66%., Conclusion: In a middle-aged general population, the main underlying contributing conditions to breathlessness were respiratory disease, anxiety or depression, obesity and heart disease or chest pain with a high level of overlap., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV 1 :FVC) after bronchodilation, and FEV 1 :FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV 1 :FVC were associated with any respiratory symptom (cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers., Methods: In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV 1 and FVC after bronchodilation. We calculated their z -scores for FEV 1 :FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI 5 and increasing percentiles up to GLI 25 . We analysed the associations between different strata of percentiles and prevalence of any respiratory symptom using multivariable logistic regression for estimation of OR., Results: Among all subjects, regardless of smoking habits, the odds of any respiratory symptom were elevated up to the GLI 15-20 strata. Among never-smokers, the odds of any respiratory symptom were elevated at GLI <5 (OR 3.57, 95% CI 2.43 to 5.23) and at GLI 5-10 (OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds of any respiratory symptom were elevated from GLI <5 (OR 4.64, 95% CI 3.79 to 5.68) up to GLI ≥25 (OR 1.33, 95% CI 1.00 to 1.75)., Conclusions: The association between percentages of FEV 1 :FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV 1 :FVC for never-smokers and, in particular, for ever-smokers., Competing Interests: Competing interests: AA reports personal fees from Novartis and AstraZeneca, outside this work. AL reports personal fees from Boehringer Ingelheim, AstraZeneca, Novartis and Active Care, outside the submitted work. JV reports personal fees from Boehringer Ingelheim, outside the submitted work. PW reports personal fees from AstraZeneca and Chiesi Pharmaceuticals, outside the submitted work. CMS reports personal fees from Boehringer Ingelheim, GlaxoSmithKline, Novartis, AstraZeneca, Roche and Genzyme, outside the submitted work. PW has a patent device and method for pulmonary capacity measurements issued. MS reports personal fees from AstraZeneca, outside the submitted work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Risk factors operating independently of hyperuricemia could be of importance in determining why only a minority of people with hyperuricemia develop gout. Exposure to inorganic dust has been linked to other inflammatory diseases and could influence the development of gout., Objectives: To evaluate if occupational exposure to inorganic dust increases the risk of gout., Methods: Individuals aged 30-65 years with a first gout diagnosis in 2006-2012 in the population-based healthcare database of the Western Swedish Healthcare Region (VEGA) and population controls matched by age and sex were included. Data on occupation was collected from the Swedish occupational register. Exposure status was assigned by means of a job exposure matrix. Data on gout-related comorbidities was collected from VEGA. Alcohol use disorder and obesity were related both to gout and exposure to inorganic dust and were adjusted for in multivariate analyses. ORs were calculated using conditional logistic regression., Results: 5042 gout cases and 20 682 controls were included. Exposure to inorganic dust was associated with gout in both unadjusted (OR 1.12, 95% CI 1.04 to 1.20) and multivariate (OR 1.08, 95% CI 1.00 to 1.16) analyses of the whole population. In sex-stratified multivariate analyses, dust exposure was significantly associated with gout in women (adjusted OR 1.26, 95% CI 1.05 to 1.51), but not in men (adjusted OR 1.05, 95% CI 0.97 to 1.13)., Conclusions: We describe for the first time an association between exposure to inorganic dust and gout. After adjusting for confounders, the findings were statistically significant for women but not for men., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The aim of the study was to monitor trends in socioeconomic inequalities in body mass index (BMI), cardiorespiratory fitness (CRF), and muscular strength over several decades in a population of Swedish males aged 18-19 years., Methods: The cohort consists of 1.5 million young men attending military conscript examinations from late 1968 to 2005. Parental education was used as a marker for socioeconomic conditions in the conscripts' families of origin. Changing gradient in BMI, CRF, and muscular strength in sons of parents with higher and lower educational attainment was evaluated during four periods covering 36 years., Results: Over the course of the obesity epidemic, BMI remained higher in conscripts with lesser (vs. higher) parental education. Moreover, the absolute difference in obesity prevalence between groups showed a continuous increase, from .6% to 3.9%, indicating growing inequalities. Regarding fitness, lower CRF was consistently associated with less parental education, but with no clear secular trend in the magnitude of the difference. Finally, social differences in muscular strength changed in direction, from lower strength among conscripts with higher parental education in the initial observation period to lower strength associated with lower parental education in the final decade studied., Conclusions: Among Swedish conscripts entering adulthood, social gradients in BMI and obesity widened continuously between 1968 and 2005. An apparent reversal of the earlier gradient in muscular strength in young men may be related to societal trends in occupational and leisure-time physical activity over the observation period. This cohort is being continually monitored through national registries for obesity-related comorbidities in later life., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started., (© 2015 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Objectives: To investigate the association between living near dense traffic and lung function in a cohort of adults from a single urban region., Design: Cross-sectional results from a cohort study., Setting: The adult-onset asthma and exhaled nitric oxide (ADONIX) cohort, sampled during 2001-2008 in Gothenburg, Sweden. Exposure was expressed as the distance from participants' residential address to the nearest road with dense traffic (>10,000 vehicles per day) or very dense traffic (>30,000 vehicles per day). The exposure categories were: low (>500 m; reference), medium (75-500 m) or high (<75 m)., Participants: The source population was a population-based cohort of adults (n=6153). The study population included 5441 participants of European descent with good quality spirometry and information about all outcomes and covariates., Outcome Measures: Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured at a clinical examination. The association with exposure was examined using linear regression adjusting for age, gender, body mass index, smoking status and education in all participants and stratified by sex, smoking status and respiratory health status., Results: We identified a significant dose-response trend between exposure category and FEV1 (p=0.03) and borderline significant trend for FVC (p=0.06) after adjusting for covariates. High exposure was associated with lower FEV1 (-1.0%, 95% CI -2.5% to 0.5%) and lower FVC (-0.9%, 95% CI -2.2% to 0.4%). The effect appeared to be stronger in women. In highly exposed individuals with current asthma or chronic obstructive pulmonary disease, FVC was lower (-4.5%, 95% CI -8.8% to -0.1%)., Conclusions: High traffic exposure at the residential address was associated with lower than predicted FEV1 and FVC lung function compared with living further away in a large general population cohort. There were particular effects on women and individuals with obstructive disease., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)