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Long-term follow-up of patients with elevated serum calcium concentrations in Swedish primary care.

Dalemo S, Eggertsen R, Hjerpe P, Jansson S, Almqvist EG, Bengtsson Boström K - Scand J Prim Health Care (2013)

Bottom Line: Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3-3.8).Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations.This study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients--88% in our study--will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period.

View Article: PubMed Central - PubMed

Affiliation: Institute of Medicine, Department of Public Health and Community, Primary Health Care, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.

ABSTRACT

Objective: To follow up patients with elevated calcium concentrations after 10 years.

Design: Longitudinal, using medical records, questionnaires, and clinical investigation.

Setting: Primary care in Tibro, Sweden, 2008-2010.

Subjects: 127 patents with elevated calcium concentrations and 254 patients with normal calcium concentrations from the local community, attending the health care centre.

Main outcome measures: Diagnoses and mortality in patients with elevated calcium concentrations in 1995-2000, compared with patients with normal calcium concentrations and the background population.

Results: The proportion of patients for whom no underlying cause was detected decreased from 55% at baseline to 12% at follow-up. Primary hyperparathyroidism was most common in women, 23% at baseline and 36% at follow-up, and the cancer prevalence increased from 5% to 12% in patients with elevated calcium concentration. Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3-3.8). Cancer mortality was significantly increased in men (p = 0.039). Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations.

Conclusion: This study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients--88% in our study--will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period. Elevated calcium concentrations had a different disease pattern in men and women, with men showing increased cancer mortality in this study.

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Related in: MedlinePlus

Mortality of patients with elevated (≥ 2.56 mmol/L) and normal (≤ 2.46 mmol/L) calcium concentrations, Panel A: men, Panel B: women, at Tibro Health Care Centre in 1995–2000. Mortality in both men and women, Panel C: with different calcium concentrations (≥ 2.56, 2.31–2.46, ≤ 2.30 mmol/L). Note: Censored = follow-up period interrupted.
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Figure 2: Mortality of patients with elevated (≥ 2.56 mmol/L) and normal (≤ 2.46 mmol/L) calcium concentrations, Panel A: men, Panel B: women, at Tibro Health Care Centre in 1995–2000. Mortality in both men and women, Panel C: with different calcium concentrations (≥ 2.56, 2.31–2.46, ≤ 2.30 mmol/L). Note: Censored = follow-up period interrupted.

Mentions: Total mortality was not significantly different between patients with elevated and normal calcium concentrations (see Table III). Men with elevated calcium concentrations had a tendency towards higher mortality compared with normocalcaemic male patients. This was most pronounced between seven and 14 years of follow-up (see Figure 2, panel A, and Table III). There was an increase in cancer mortality (p = 0.039) in men. A comparison with the background population revealed a 2.3 times increased mortality rate (SMR 2.3, 95% CI 1.3–3.8) in men, but not in women with elevated calcium concentrations.


Long-term follow-up of patients with elevated serum calcium concentrations in Swedish primary care.

Dalemo S, Eggertsen R, Hjerpe P, Jansson S, Almqvist EG, Bengtsson Boström K - Scand J Prim Health Care (2013)

Mortality of patients with elevated (≥ 2.56 mmol/L) and normal (≤ 2.46 mmol/L) calcium concentrations, Panel A: men, Panel B: women, at Tibro Health Care Centre in 1995–2000. Mortality in both men and women, Panel C: with different calcium concentrations (≥ 2.56, 2.31–2.46, ≤ 2.30 mmol/L). Note: Censored = follow-up period interrupted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860302&req=5

Figure 2: Mortality of patients with elevated (≥ 2.56 mmol/L) and normal (≤ 2.46 mmol/L) calcium concentrations, Panel A: men, Panel B: women, at Tibro Health Care Centre in 1995–2000. Mortality in both men and women, Panel C: with different calcium concentrations (≥ 2.56, 2.31–2.46, ≤ 2.30 mmol/L). Note: Censored = follow-up period interrupted.
Mentions: Total mortality was not significantly different between patients with elevated and normal calcium concentrations (see Table III). Men with elevated calcium concentrations had a tendency towards higher mortality compared with normocalcaemic male patients. This was most pronounced between seven and 14 years of follow-up (see Figure 2, panel A, and Table III). There was an increase in cancer mortality (p = 0.039) in men. A comparison with the background population revealed a 2.3 times increased mortality rate (SMR 2.3, 95% CI 1.3–3.8) in men, but not in women with elevated calcium concentrations.

Bottom Line: Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3-3.8).Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations.This study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients--88% in our study--will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period.

View Article: PubMed Central - PubMed

Affiliation: Institute of Medicine, Department of Public Health and Community, Primary Health Care, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.

ABSTRACT

Objective: To follow up patients with elevated calcium concentrations after 10 years.

Design: Longitudinal, using medical records, questionnaires, and clinical investigation.

Setting: Primary care in Tibro, Sweden, 2008-2010.

Subjects: 127 patents with elevated calcium concentrations and 254 patients with normal calcium concentrations from the local community, attending the health care centre.

Main outcome measures: Diagnoses and mortality in patients with elevated calcium concentrations in 1995-2000, compared with patients with normal calcium concentrations and the background population.

Results: The proportion of patients for whom no underlying cause was detected decreased from 55% at baseline to 12% at follow-up. Primary hyperparathyroidism was most common in women, 23% at baseline and 36% at follow-up, and the cancer prevalence increased from 5% to 12% in patients with elevated calcium concentration. Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3-3.8). Cancer mortality was significantly increased in men (p = 0.039). Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations.

Conclusion: This study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients--88% in our study--will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period. Elevated calcium concentrations had a different disease pattern in men and women, with men showing increased cancer mortality in this study.

Show MeSH
Related in: MedlinePlus