title: National cohort study of absolute risk and age-specific incidence of multiple adverse outcomes between adolescence and early middle age.
abstract: BACKGROUND
  Psychiatric illness, substance misuse, suicidality, criminality and premature death represent major public health challenges that afflict a sizeable proportion of young people. However, studies of multiple adverse outcomes in the same cohort at risk are rare. In a national Danish cohort we estimated sex- and age-specific incidence rates and absolute risks of these outcomes between adolescence and early middle age.
  
  
  METHODS
  Using interlinked registers, persons born in Denmark 1966-1996 were followed from their 15(th) until 40(th) birthday or December 2011 (N = 2,070,904). We estimated sex- and age-specific incidence rates of nine adverse outcomes, in three main categories: Premature mortality (all-causes, suicide, accident); Psychiatric morbidity (any mental illness diagnosis, suicide attempt, alcohol or drug misuse disorder); Criminality (violent offending, receiving custodial sentence, driving under influence of alcohol or drugs). Cumulative incidences were also calculated using competing risk survival analyses.
  
  
  RESULTS
  For cohort members alive on their 15(th) birthday, the absolute risks of dying by age 40 were 1.99 % for males [95 % confidence interval (CI) 1.95-2.03 %] and 0.85 % for females (95 % CI 0.83-0.88 %). The risks of substance misuse and criminality were also much higher for males, especially younger males, than for females. Specifically, the risk of a first conviction for a violent offence was highest amongst males aged below 20. Females, however, were more likely than males to have a hospital-treated psychiatric disorder. By age 40, 13.25 % of females (95 % CI 13.16-13.33 %) and 9.98 % of males (95 % CI 9.91-10.06 %) had been treated. Women aged below 25 were also more likely than men to first attempt suicide, but this pattern was reversed beyond this age. The greatest gender differentials in incidence rates were in criminality outcomes.
  
  
  CONCLUSIONS
  This is the first comprehensive assessment of the incidence rates and absolute risks of these multiple adverse outcomes. Approximately 1 in 50 males and 1 in 120 females who are alive on their 15th birthday will die by age 40. By examining the same cohort at risk, we compared risks for multiple outcomes without differential inter-cohort biases. These epidemiological profiles will inform further research into the pathways leading to these adverse events and future preventive strategies.
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. pearl.mok@manchester.ac.uk.
authors.forename: Pearl L H
authors.initials: PL
authors.lastname: Mok
authors.affiliation: Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark. sa@econ.au.dk.|National Centre for Register-Based Research, Aarhus University, Business and Social Sciences, Aarhus, Fuglesangs Alle 4, 8210, Aarhus V, Denmark. sa@econ.au.dk.
authors.forename: Sussie
authors.initials: S
authors.lastname: Antonsen
authors.affiliation: Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark. cbp@econ.au.dk.|National Centre for Register-Based Research, Aarhus University, Business and Social Sciences, Aarhus, Fuglesangs Alle 4, 8210, Aarhus V, Denmark. cbp@econ.au.dk.
authors.forename: Carsten Bøcker
authors.initials: CB
authors.lastname: Pedersen
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. louis.appleby@manchester.ac.uk.
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. jennifer.j.shaw@manchester.ac.uk.
authors.forename: Jenny
authors.initials: J
authors.lastname: Shaw
authors.affiliation: Centre for Mental Health and Safety, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. roger.webb@manchester.ac.uk.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Webb
mesh_terms: D000059:Accidents; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D057237:Criminals / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data