Jonas Ludvigsson

Research problem and specific questions The significant advances in treating childhood cancers over the past decades resulted in an increasing population of childhood cancer survivors. However, the survivors have an increased risk of developing secondary cancers, other chronic illnesses and psychological disorders, thus a poorer quality of life compared to individuals without a history of cancer. Studies have reported adverse socioeconomic outcomes for survivors of childhood cancer with respect to educational attainment, unemployment, and income compared to the general population or their siblings. Also, there is evidence that childhood cancer substantially impacts parental socioeconomic situation by disruptions in parents´ employment which subsequently exacerbates parental psychological distress and can affect siblings well-being. Given the increasing population of childhood cancer survivors and lack of knowledge on the role of psychological distress in income, sickness absence, and disability pension among survivors and their first-degree relatives, especially in the Swedish population, this topic merits further investigation.Data and methodsWe will conduct several registry-linkage studies by integrating various Swedish population-based registers including the Childhood Cancer Registry, Patient Register, Multi-generation Register, Longitudinal Integration Database for Health Insurance and Labor Market Studies, and Social Insurance Register. Information from childhood cancer survivors and their first degree relatives will be obtained and several statistical analyses including mediation analysis will be performed.Societal relevance and utilizationThis research project may significantly contribute to filling knowledge gaps concerning the role of mental health in the sickness absence and financial burden of childhood cancer survivors and their first degree relatives. By identifying detailed sociodemographic characteristics, our studies provide knowledge that may be informative for prevention strategies and would facilitate policy interventions and thus could lead to reduce work disability in these vulnerable groups and reduce social inequity.Plan for project realizationA large proportion of the cleaned data is available to the group. Data from the Social Insurance Agency and the Childhood Cancer Registry will be requested. The main applicant with the assistance of a statistician will perform the statistical analysis and write several manuscripts.

RESEARCH PROBLEMAbout 1-2% of the Swedish population suffer from celiac disease. My earlier research has mainly focused on severe complications of celiac disease (e.g. death and cancer). In this project I will use laboratory data and primary care data to study early comorbidity in celiac disease, especially kidney-liver disease and neuro-cognitive/psychiatric disorders, such as stress-related illness, depression and dementia. DATA AND METHODProject 1: Through Swedish pathology departments, we have identified some 50,000 individuals with celiac disease. We expect that approx. 12-13,000 of these live in the Stockholm area and can therefore be linked to the laboratory database “SCREAM”. For these patients, we will identify all kidney and liver blood samples to follow kidney and liver function longitudinally.Project 2: Via a primary care dataset (covering 20 of 21 Swedish regions), we will examine celiac disease and the risk of neuro-cognitive disorders. WORK PLANProject 1: Using the personal identity number, data on celiac disease are linked to laboratory data in the SCREAM study. Using linear regression, we will study the development of early kidney and liver disease using laboratory data.Project 2: Data have already been linked. We will use Cox regression to calculate hazard ratios for our outcomes. RELEVANCEAn increased understanding of early comorbidity in celiac disease can improve the care of patients. In the long term, our goal is to prevent comorbidity in celiac disease.

Every year, one in three Swedes seeks care for gastrointestinal problems. A significant number have cancer, others have gastrointestinal diseases where there may be an increased risk of cancer. In our study, we will study: (1) gastrointestinal/liver disease and risk of cancer, (2) risk factors for gastrointestinal cancer, and (3) the prognosis of such cancer. Unlike the majority of previous international studies, by linking data from tissue samples from intestine/liver to Sweden's national health register, we will be able to study the entire population. It makes it possible to calculate precise cancer risks for average patients. We have established a brand new register of more than 2 million Swedes (Espresso), and will study the RISK OF CANCER in irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) such as e.g. Crohn's disease and ulcerative colitis, but also in liver diseases, the esophageal disease eosinophilic esophagitis

RISK FACTORS FOR GASTROINTESTINAL CANCER such as colon cancer, and whether mucosal healing and medication can protect against IBD and liver cancer

and finally PROGNOSIS in two less common forms of cancer (cholangiocarcinoma and small bowel cancer). Our goal is to be able to tailor individual patients' follow-up for gastrointestinal disease as well as their drug treatment to influence cancer development and mortality in gastrointestinal cancer. Our hope is that our project will lead to savings and make care more efficient. Furthermore, we want to conduct research that is relevant to the patient. Jonas Eriksson from the patient association Magtarmförbundet has participated in the planning of the studies (http://www.magotarm.se).

More than 60,000 people in Sweden suffer from Crohn's disease or ulcerative colitis. Together, these diseases are referred to as "Inflammatory Bowel Disease" (IBD). Several previous studies have shown an increased risk of colon cancer in colon cancer, but the differences in results have been great, ranging from multiply increased risks to very small risk increases for cancer.   The incidence of IBD is increasing among children, but it is unclear whether IBD among children leads to an increased risk of cancer. Several IBD drugs appear to have a protective effect against colon cancer, but it is unclear whether the protective effect is due to mucosal healing and decreased inflammation. We will link diagnostic data for IBD from the National Patient Register with data from the Cancer Registry to calculate the risk of colon cancer (and for children also for lymphoma) at IBD. The new thing about our research is that we currently collect data from biopsy reports on IBD from Sweden's all 28 pathology departments. These biopsy reports contain unique information that will enable us to better calculate the risk of cancer, but also to study whether the medications given against IBD themselves protect against cancer development, and whether it is due to decreased inflammation of the intestinal mucosa. Many people with IBD are very concerned about the risk of cancer (especially colon cancer), the same applies to parents of children with IBD. With our study design we will be better able to answer whether IBD is a risk factor for cancer (for adults and children), and whether certain medications currently used against IBD not only relieve the IBD disease but also reduce the risk of cancer in the patients.   As part of the research, we also investigate how good / bad IBD is registered in the Patient Register. This will facilitate later cancer research within IBD.

More than 60,000 people in Sweden suffer from Crohn's disease or ulcerative colitis. Together, these diseases are referred to as "Inflammatory Bowel Disease" (IBD). Several previous studies have shown an increased risk of colon cancer in colon cancer, but the differences in results have been great, ranging from multiply increased risks to very small risk increases for cancer.   The incidence of IBD is increasing among children, but it is unclear whether IBD among children leads to an increased risk of cancer. Several IBD drugs appear to have a protective effect against colon cancer, but it is unclear whether the protective effect is due to mucosal healing and decreased inflammation. We will link diagnostic data for IBD from the National Patient Register with data from the Cancer Registry to calculate the risk of colon cancer (and for children also for lymphoma) at IBD. The new thing about our research is that we currently collect data from biopsy reports on IBD from Sweden's all 28 pathology departments. These biopsy reports contain unique information that will enable us to better calculate the risk of cancer, but also to study whether the medications given against IBD themselves protect against cancer development, and whether it is due to decreased inflammation of the intestinal mucosa. Many people with IBD are very concerned about the risk of cancer (especially colon cancer), the same applies to parents of children with IBD. With our study design we will be better able to answer whether IBD is a risk factor for cancer (for adults and children), and whether certain medications currently used against IBD not only relieve the IBD disease but also reduce the risk of cancer in the patients.   As part of the research, we also investigate how good / bad IBD is registered in the Patient Register. This will facilitate later cancer research within IBD.

More than 60,000 people in Sweden suffer from Crohn's disease or ulcerative colitis. Together, these diseases are referred to as "Inflammatory Bowel Disease" (IBD). Several previous studies have shown an increased risk of colon cancer in colon cancer, but the differences in results have been great, ranging from multiply increased risks to very small risk increases for cancer.   The incidence of IBD is increasing among children, but it is unclear whether IBD among children leads to an increased risk of cancer. Several IBD drugs appear to have a protective effect against colon cancer, but it is unclear whether the protective effect is due to mucosal healing and decreased inflammation. We will link diagnostic data for IBD from the National Patient Register with data from the Cancer Registry to calculate the risk of colon cancer (and for children also for lymphoma) at IBD. The new thing about our research is that we currently collect data from biopsy reports on IBD from Sweden's all 28 pathology departments. These biopsy reports contain unique information that will enable us to better calculate the risk of cancer, but also to study whether the medications given against IBD themselves protect against cancer development, and whether it is due to decreased inflammation of the intestinal mucosa. Many people with IBD are very concerned about the risk of cancer (especially colon cancer), the same applies to parents of children with IBD. With our study design we will be better able to answer whether IBD is a risk factor for cancer (for adults and children), and whether certain medications currently used against IBD not only relieve the IBD disease but also reduce the risk of cancer in the patients.   As part of the research, we also investigate how good / bad IBD is registered in the Patient Register. This will facilitate later cancer research within IBD.